Detection of genes TEM, OXA, SHV and CTX-M in 73 clinical isolates of Escherichia coli producers of extended spectrum Betalactamases and determination of their susceptibility to antibiotics.

A total of 73 clinical isolates of extended spectrum β- lactamase producingEscherichia coli were sampled in North Lebanon

Ecr, une protéine potentiellement impliquée dans la résistance hétérogène à la colistine des clusters I et IV du complexe Enterobacter cloacae

International audienceObjectif - Introduction : La colistine (COS), antibiotique longtemps délaissé, est devenue une alternative de dernier recours pour le traitement des infections à entérobactéries multirésistantes, notamment productrices de carbapénémases. Le complexe Enterobacter cloacae (CEC) comprend plusieurs clusters étroitement liés et non différenciables phénotypiquement, dont certains présentent un phénotype d’hétérorésistance (HR) à la COS. Même si plusieurs gènes ont été identifiés (ex. tolC, phoP et soxS-soxR) dans cette HR, les mécanismes restent en grande partie inconnus. En 2019, Huang et al. ont décrit le gène ecr qui serait également impliqué dans l’HR en régulant positivement l’expression de phoP et de l’opéron arnBCADTEF. Le but de ce travail a été de rechercher la présence du gène ecr par PCR en temps réel dans une collection de souches de CEC déjà caractérisées et par une approche in silico à partir des séquences génomiques disponibles.Matériels et méthodes : Une collection de 100 souches cliniques uniques représentatives des différents clusters du CEC (C-I à C-XIV) a été étudiée. Les souches identifiées par séquençage partiel du gène hsp60 ont été caractérisées pour l’HR à la COS par CMI par microdilution et analyse de population. Après le design d’amorces spécifiques, une technique de PCR en temps réel a été développée. Parallèlement, le gène ecr a été recherché par une analyse in silico sur 1560 souches du CEC.Résultats : Sur les 100 souches, 48 présentaient une HR à la COS et appartenaient aux clusters hsp60suivants : C-I (7/8), C-II (16/16), C-III (1/14), C-IV (8/9), CVII (2/4), C-IX (3/3), C-X (1/2), C-XI (8/9), C-XII (2/2). Le gène ecr a été retrouvé uniquement pour les clusters C-I (7/7, 100%), C-IV (7/8, 87,5%), C-VII (1/2) et C-X (1/1) par PCR. L’analyse in silico des 1560 génomes a montré la présence du gène ecr uniquement pour les clusters C-I (87/87, 100%) et C-IV (86/92, 93,5%). Conclusion : Dans cette étude, nous avons pu montrer que le gène ecr semble particulièrement présent chez les clusters C-I et C-IV. Ces résultats montrent l’importance de la détermination précise du cluster en matière d’interprétation de la sensibilité à la COS. L’analyse génomique doit être étendue aux 100 souches cliniques de ce panel pour confirmer cette association exclusive à certains clusters et redéfinir ainsi précisément le cluster des 2 souches ecr positif non C-I ou C-IV

Global transmission of extended-spectrum cephalosporin resistance in Escherichia coli driven by epidemic plasmids

Background Extended-spectrum cephalosporins (ESCs) are third and fourth generation cephalosporin antimicrobials used in humans and animals to treat infections due to multidrug-resistant (MDR) bacteria. Resistance to ESCs (ESC-R) in Enterobacterales is predominantly due to the production of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated AmpC β-lactamases (AmpCs). The dynamics of ESBLs and AmpCs are changing across countries and host species, the result of global transmission of ESC-R genes. Plasmids are known to play a key role in this dissemination, but the relative importance of different types of plasmids is not fully understood. Methods In this study, Escherichia coli with the major ESC-R genes blaCTX-M-1, blaCTX-M-15, blaCTX-M-14 (ESBLs) and blaCMY-2 (AmpC), were selected from diverse host species and other sources across Canada, France and Germany, collected between 2003 and 2017. To examine in detail the vehicles of transmission of the ESC-R genes, long- and short-read sequences were generated to obtain complete contiguous chromosome and plasmid sequences (n = 192 ESC-R E. coli). The types, gene composition and genetic relatedness of these plasmids were investigated, along with association with isolate year, source and geographical origin, and put in context with publicly available plasmid sequences. Findings We identified five epidemic resistance plasmid subtypes with distinct genetic properties that are associated with the global dissemination of ESC-R genes across multiple E. coli lineages and host species. The IncI1 pST3 blaCTX-M-1 plasmid subtype was found in more diverse sources than the other main plasmid subtypes, whereas IncI1 pST12 blaCMY-2 was more frequent in Canadian and German human and chicken isolates. Clonal expansion also contributed to the dissemination of the IncI1 pST12 blaCMY-2 plasmid in ST131 and ST117 E. coli harbouring this plasmid. The IncI1 pST2 blaCMY-2 subtype was predominant in isolates from humans in France, while the IncF F31:A4:B1 blaCTX-M-15 and F2:A-:B- blaCTX-M-14 plasmid subtypes were frequent in human and cattle isolates across multiple countries. Beyond their epidemic nature with respect to ESC-R genes, in our collection almost all IncI1 pST3 blaCTX-M-1 and IncF F31:A4:B1 blaCTX-M-15 epidemic plasmids also carried multiple antimicrobial resistance (AMR) genes conferring resistance to other antimicrobial classes. Finally, we found genetic signatures in the regions surrounding specific ESC-R genes, identifying the predominant mechanisms of ESC-R gene movement, and using publicly available databases, we identified these epidemic plasmids from widespread bacterial species, host species, countries and continents. Interpretation We provide evidence that epidemic resistance plasmid subtypes contribute to the global dissemination of ESC-R genes, and in addition, some of these epidemic plasmids confer resistance to multiple other antimicrobial classes. The success of these plasmids suggests that they may have a fitness advantage over other plasmid types and subtypes. Identification and understanding of the vehicles of AMR transmission are crucial to develop and target strategies and interventions to reduce the spread of AMR

Dynamics of extended-spectrum cephalosporin resistance genes in Escherichia coli from Europe and North America

Extended-spectrum cephalosporins (ESCs) are critically important antimicrobial agents for human and veterinary medicine. ESC resistance (ESC-R) genes have spread worldwide through plasmids and clonal expansion, yet the distribution and dynamics of ESC-R genes in different ecological compartments are poorly understood. Here we use whole genome sequence data of Enterobacterales isolates of human and animal origin from Europe and North America and identify contrasting temporal dynamics. AmpC β-lactamases were initially more dominant in North America in humans and farm animals, only later emerging in Europe. In contrast, specific extended-spectrum β-lactamases (ESBLs) were initially common in animals from Europe and later emerged in North America. This study identifies differences in the relative importance of plasmids and clonal expansion across different compartments for the spread of different ESC-R genes. Understanding the mechanisms of transmission will be critical in the design of interventions to reduce the spread of antimicrobial resistance

Global transmission of extended-spectrum cephalosporin resistance in Escherichia coli driven by epidemic plasmids

Background: Extended-spectrum cephalosporins (ESCs) are third and fourth generation cephalosporin antimicrobials used in humans and animals to treat infections due to multidrug-resistant (MDR) bacteria. Resistance to ESCs (ESC-R) in Enterobacterales is predominantly due to the production of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated AmpC β-lactamases (AmpCs). The dynamics of ESBLs and AmpCs are changing across countries and host species, the result of global transmission of ESC-R genes. Plasmids are known to play a key role in this dissemination, but the relative importance of different types of plasmids is not fully understood. Methods: In this study, Escherichia coli with the major ESC-R genes bla CTX-M-1, bla CTX-M-15, bla CTX-M-14 (ESBLs) and bla CMY-2 (AmpC), were selected from diverse host species and other sources across Canada, France and Germany, collected between 2003 and 2017. To examine in detail the vehicles of transmission of the ESC-R genes, long- and short-read sequences were generated to obtain complete contiguous chromosome and plasmid sequences (n = 192 ESC-R E. coli). The types, gene composition and genetic relatedness of these plasmids were investigated, along with association with isolate year, source and geographical origin, and put in context with publicly available plasmid sequences. Findings: We identified five epidemic resistance plasmid subtypes with distinct genetic properties that are associated with the global dissemination of ESC-R genes across multiple E. coli lineages and host species. The IncI1 pST3 bla CTX-M-1 plasmid subtype was found in more diverse sources than the other main plasmid subtypes, whereas IncI1 pST12 bla CMY-2 was more frequent in Canadian and German human and chicken isolates. Clonal expansion also contributed to the dissemination of the IncI1 pST12 bla CMY-2 plasmid in ST131 and ST117 E. coli harbouring this plasmid. The IncI1 pST2 bla CMY-2 subtype was predominant in isolates from humans in France, while the IncF F31:A4:B1 bla CTX-M-15 and F2:A-:B- bla CTX-M-14 plasmid subtypes were frequent in human and cattle isolates across multiple countries. Beyond their epidemic nature with respect to ESC-R genes, in our collection almost all IncI1 pST3 bla CTX-M-1 and IncF F31:A4:B1 bla CTX-M-15 epidemic plasmids also carried multiple antimicrobial resistance (AMR) genes conferring resistance to other antimicrobial classes. Finally, we found genetic signatures in the regions surrounding specific ESC-R genes, identifying the predominant mechanisms of ESC-R gene movement, and using publicly available databases, we identified these epidemic plasmids from widespread bacterial species, host species, countries and continents. Interpretation: We provide evidence that epidemic resistance plasmid subtypes contribute to the global dissemination of ESC-R genes, and in addition, some of these epidemic plasmids confer resistance to multiple other antimicrobial classes. The success of these plasmids suggests that they may have a fitness advantage over other plasmid types and subtypes. Identification and understanding of the vehicles of AMR transmission are crucial to develop and target strategies and interventions to reduce the spread of AMR. Funding: This project was supported by the (Theme 1, Epidemiology and Evolution of Pathogens in the Food Chain)

Enterobacteriaceae resistant to carbapenems isolated in North Lebanon : mechanisms, genetic support and pathogenicity

Les carbapénèmes sont des antibiotiques de la famille des β-lactamines utilisées en dernier recours à cause de leur stabilité vis-à-vis de la plupart des mécanismes de résistance. Cependant, on assiste chez les entérobactéries à l’émergence de carbapénèmases capables d’inactiver ces molécules. Les objectives de ce travail étaient d’explorer l’émergence de ces mécanismes de résistance dans des entérobactéries isolées au Nord Liban entre 2008 et 2012, d’analyser leur support génétique, ainsi que le fond génétique et la pathogénicité des souches porteuses. Nous avons observé une augmentation d’un facteur quatre de la prévalence des entérobactéries de sensibilité diminuée ou résistantes aux carbapénèmes dans les prélèvements cliniques hospitaliers entre 2008 et 2012. Un portage intestinal a été également observé chez 1,5% des individus dans une population d’enfants issus de la communauté. Le phénotype de résistance observé était lié à la production de la carbapénèmase OXA-48. Bien que sept espèces productrices ont été identifiées, la plupart des isolats étaient des souches non-redondantes appartenant aux espèces K. pneumoniae et surtout E. coli. Le vecteur de la diffusion de OXA-48 dans ces bactéries était trois plasmides du groupe d’incompatibilité IncL/M de 49 kb, 63 kb et 84 kb. Cependant, 67% des souches E. coli portaient le gène codant OXA-48 (blaOXA-48) sur le chromosome. La caractérisation des supports génétiques par des approches de séquençage à haut débit a montré qu’ils étaient apparentés et le produit de remaniements génétiques impliquant le transposon Tn21-like, la séquence d'insertion IS1R ou un nouveau transposon composite appelé Tn6237. L’insertion chromosomique de blaOXA-48 résultait de la transposition de Tn6237 qui est capable de transférer un fragment plasmidique de 20 kb dans différents sites du chromosome de E. coli. Les souches K. pneumoniae produisant OXA-48 n’appartenaient pas aux génotypes capsulaires hautement virulents K1 et K2, mais portaient des facteurs identifiées pour favoriser la virulence ou la colonisation de l’hôte. OXA-48 a été observée dans tous les phylogroupes de E. coli, y compris les phylogroupes B2 et D connus pour contenir les souches pathogènes extra-intestinales. Une souche se distinguait par une accumulation sans précédent de huit îlots de pathogénicité. Cette souche induisait une létalité inhabituellement élevée dans un modèle murin de sepsis. En conclusion, l’acquisition du gène blaOXA-48 est donc liée à la diffusion de plasmides apparentés, qui sont marqués par une plasticité conduisant à une localisation chromosomique du gène pouvant favoriser sa persistance. Elle conduit à une diffusion multi-clonale de souches K. pneumoniae et surtout E. coli potentiellement hautement virulentes. Cette association entre de l’espèce E. coli et la carbapénèmase OXA-48 est inquiétante, car E. coli constitue à la fois un réservoir dont la taille peut être considérable et un pathogène responsable d’infections fréquentes pouvant parfois mettre en jeu le pronostic vital.In the β-lactam family, carbapenems are the most effective antimicrobial agents used as a last resort due to their stability toward most resistance mechanisms. However, we recently observed the emergence of carbapenemase-producing Enterobacteriaceae. The aim of the present study consisted to explore (i) the epidemiological situation of carbapenem-resistant Enterobacteriaceae isolated in North Lebanon between 2008 and 2012, (ii) the identification of the resistance mechanisms, and (iii) the characterization of pathogenicity and genetic background of the corresponding strains. We observed a 4-fold increase in the prevalence of Enterobacteriaceae exhibiting decreased susceptibility or resistance to carbapenems in the clinical isolates collected at hospital during 2008-2012. The prevalence of fecal carriage of carbapenemase-producing Enterobacteriaceae was estimated to 1.5% in healthy children of the community. OXA-48 was the only carbapenemase identified among non-redundant isolates which spread to seven species. E. coli and K. pneumoniae were the main represented species. The OXA-48-encoding gene (blaOXA-48) was carried by three novel IncL/M plasmids of 49 kb, 63 kb and 84 kb. However, 67% of E. coli strains encoded blaOXA-48 chromosome-mediated. The sequencing of the previously mentioned genetic structures by high -throughput approaches showed that they are the product of genetic rearrangements involving the Tn21-like transposon, the insertion sequence IS1R and a novel composite transposon designed Tn6237. The chromosomal insertion of blaOXA-48 was due to the acquisition of element Tn6237 leading consequently to the transposition of 20 kb plasmid fragment into different sites of E. coli chromosome. The pathogenicity profile of K. pneumoniae strains showed that they did not belong to highly virulent capsular genotypes K1 and K2, but harbored factors promoting virulence and host colonization. E. coli isolates belonged to different phylogroups, including phylogroups B2 and D known to contain the extra-intestinal pathogenic strains. An E. coli strain was characterized by a broad accumulation of pathogenicity islands (n=8). In addition, this strain induced an unusually high lethality in a mouse model of sepsis. In conclusion, the acquisition of the blaOXA-48 gene is linked to the spread of related IncL/M plasmids, which are marked by a plasticity leading to a chromosomal location of blaOXA-48 and probably promoting its persistence. It leads to a multiclonal diffusion of K. pneumoniae and especially E. coli potentially highly virulent. This association between E. coli and the carbapenemase OXA-48 is worrying because E. coli represent a putative important reservoir and a pathogen agent responsible for frequent infections that can be a life threatening

IncFII k plasmid harbouring an amplification of 16S rRNA methyltransferase-encoding gene rmtH associated with mobile element IS CR2

International audienceObjectives: To investigate the resistance mechanisms and genetic support underlying the high resistance level of the Klebsiella pneumoniae strain CMUL78 to aminoglycoside and b-lactam antibiotics.Methods: Antibiotic susceptibility was assessed by the disc diffusion method and MICs were determined by the microdilution method. Antibiotic resistance genes and their genetic environment were characterized by PCR and Sanger sequencing. Plasmid contents were analysed in the clinical strain and transconjugants obtained by mating-out assays. Complete plasmid sequencing was performed with PacBio and Illumina technology.Results: Strain CMUL78 co-produced the 16S rRNA methyltransferase (RMTase) RmtH, carbapenemase OXA-48 and ESBL SHV-12. The rmtH-and bla SHV-12-encoding genes were harboured by a novel 115 kb IncFII k plasmid designated pRmtH, and bla OXA-48 by a 62 kb IncL/M plasmid related to pOXA-48a. pRmtH plasmid possessed seven different stability modules, one of which is a novel hybrid toxin-antitoxin system. Interestingly, pRmtH plasmid harboured a 4-fold amplification of an rmtH-ISCR2 unit arranged in tandem and inserted within a novel IS26-based composite transposon designated Tn6329.Conclusions: This is the first known report of the 16S RMTase-encoding gene rmtH in a plasmid. The rmtH-ISCR2 unit was inserted in a composite transposon as a 4-fold tandem repeat, a scarcely reported organization

Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae , France

International audienceWe recovered 2 carbapenem-resistant K2-ST86 hypermucoviscous Klebsiella pneumoniae isolates from patients in France. The isolates had genetic attributes of hypervirulent K. pneumoniae but differed in ability to cause mouse lethality. Convergence of hypervirulent K. pneumoniae toward resistance could cause a health crisis because such strains could be responsible for severe and untreatable infections

Diversity of DHA-1-encoding plasmids in Klebsiella pneumoniae isolates from 16 French hospitals

International audienceObjectives: To provide new insights into the spread of plasmidic cephalosporinase DHA-1, 16 strains of Klebsiella pneumoniae and a strain of Klebsiella variicola producing DHA-1 were isolated between January 2012 and December 2013 in six regions of France and two French overseas departments and territories. Methods: Disc diffusion assays, isoelectric focusing and PCRs were used to characterize the plasmidic DHA-1 beta-lactamase. Plasmid analysis was performed by the method of Kado and Liu and WGS. Virulence of the strains was studied by biofilm formation and the survival of Drosophila. Results: The strains were of low virulence and had one to three plasmids including one of various sizes (similar to 40 to 319 kb) mediating DHA-1. Nine strains belonged to ST11 and possessed a pKPS30-type DHA-1 plasmid of the IncR (incompatibility) group. A strain of ST307 possessed pENVA, a DHA-1 plasmid of the IncH-type group. The seven remaining plasmids were unknown. Three belonged to the IncL/M group. They were closely related and their sequences were determined. One of the four remaining strains was chosen for further investigation. This strain of ST16 had two plasmids, a pUUH239.2-related plasmid and a new DHA-1 plasmid of similar to 319 kb of IncHI2 type. Conclusions: These findings demonstrate the major role of the pKPS30-type plasmid in the spread of DHA-1 cephalosporinase in France and provide evidence of two new emerging plasmids carrying this enzyme

Role of megaplasmids and chromosomal integration in acquisition of CTX-M-encoding genes by Pseudomonas aeruginosa

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