31 research outputs found
Plasmid evolution in carbapenemaseâproducing Enterobacteriaceae : a review
Please read abstract in the article.Table S1. Metadata of plasmids deposited at GenBank and included in this study.Supplementary dataset. Nucleotide sequences of plasmids included in this study and obtained from Genbank.https://nyaspubs.onlinelibrary.wiley.com/journal/174966322020-12-01hj2019Medical Microbiolog
Global epidemiology, genetic environment, risk factors and therapeutic prospects of MCR genes : a current and emerging update
BACKGROUND : Mobile colistin resistance (mcr) genes modify Lipid A molecules
of the lipopolysaccharide, changing the overall charge of the outer membrane.
RESULTS AND DISCUSSION: Ten mcr genes have been described to date within
eleven Enterobacteriaceae species, with Escherichia coli, Klebsiella
pneumoniae, and Salmonella species being the most predominant. They are
present worldwide in 72 countries, with animal specimens currently having the
highest incidence, due to the use of colistin in poultry for promoting growth
and treating intestinal infections. The wide dissemination of mcr from food
animals to meat, manure, the environment, and wastewater samples has
increased the risk of transmission to humans via foodborne and vectorborne routes. The stability and spread of mcr genes were mediated by
mobile genetic elements such as the IncHI2 conjugative plasmid, which is
associated with multiple mcr genes and other antibiotic resistance genes. The
cost of acquiring mcr is reduced by compensatory adaptation mechanisms.
MCR proteins are well conserved structurally and via enzymatic action. Thus,
therapeutics found effective against MCR-1 should be tested against the
remaining MCR proteins.
CONCLUSION: The dissemination of mcr genes into the clinical setting, is
threatening public health by limiting therapeutics options available.
Combination therapies are a promising option for managing and treating
colistin-resistant Enterobacteriaceae infections whilst reducing the toxic
effects of colistin.The National Health Laboratory Service (NHLS) and the National Research Foundation.https://www.frontiersin.org/journals/cellular-and-infection-microbiologydm2022Medical Microbiolog
Current and emerging polymyxin resistance diagnostics : a systematic review of established and novel detection methods
The emergence of polymyxin resistance, due to transferable mcr genes, threatens public
and animal health as there are limited therapeutic options. As polymyxin is one of the
last-line
antibiotics, there is a need to contain the spread of its resistance to conserve its
efficacy. Herein, we describe current and emerging polymyxin resistance diagnostics to
inform faster clinical diagnostic choices. A literature search in diverse databases for studies
published between 2016 and 2020 was performed. English articles evaluating colistin
resistance methods/diagnostics were included. Screening resulted in the inclusion of 93
journal articles. Current colistin resistance diagnostics are either phenotypic or molecular.
Broth microdilution is currently the only gold standard for determining colistin MICs
(minimum inhibitory concentration). Phenotypic methods comprise of agar-based
methods
such as CHROMagar⢠Col-APSE,
SuperPolymyxin, ChromIDÂŽ Colistin R, LBJMR
and LB medium; manual MIC-determiners
viz., UMIC, MICRONAUT MIC-Strip
and
ComASP Colistin; automated antimicrobial susceptibility testing systems such as BD
Phoenix, MICRONAUT-S,
MicroScan, Sensititre and Vitek 2; MCR-detectors
such as
lateral flow immunoassay (LFI) and chelator-based
assays including EDTA-and
DPA-based
tests, that is, combined disk test, modified colistin broth-disk
elution (CBDE),
Colispot, and Colistin MAC test as well as biochemical colorimetric tests, that is, Rapid
Polymyxin NP test and Rapid ResaPolymyxin NP test. Molecular methods only characterize
mobile colistin resistance; they include PCR, LAMP and whole-genome
sequencing.
Due to the faster turnaround time (â¤3 h), improved sensitivity (84%â100%)
and specificity (93.3%â100%)
of the Rapid ResaPolymyxin NP test and FastinovÂŽ, we recommend
this test for initial screening of colistin-resistant
isolates. This can be followed
by CBDE with EDTA or the LFI as they both have 100% sensitivity and a specificity of
âĽ94.3% for the rapid screening of mcr genes. However, molecular assays such as LAMP
and PCR may be considered in well-equipped
clinical laboratories.We hereby regretfully report the death of our colleague
Professor Nontombi Marylucy Mbelle, who died during
the submission of this article. This work is dedicated to her
memory.The National Health Laboratory Service (NHLS)http://wileyonlinelibrary.com/journal/jamam2022Medical Microbiolog
Antimicrobial susceptibility and serotype distribution of Streptococcus agalactiae rectovaginal colonising isolates from pregnant women at a tertiary hospital in Pretoria, South Africa : an observational descriptive study
BACKGROUND. Streptococcus agalactiae or group B streptococcus (GBS) is a significant cause of neonatal sepsis. Intrapartum antibiotic
prophylaxis is recommended for pregnant women identified to be rectovaginally colonised between 34 and 37 weeksâ gestational age to
decrease the risk of invasive disease in their newborns. An effective multivalent GBS vaccine may prevent a broader scope of GBS-associated
diseases, such as GBS early-onset disease, GBS late-onset disease, spontaneous abortion, stillbirth and maternal bacteraemia. Serotype
distribution of GBS isolates is essential to determine the efficacy of such a vaccine.
OBJECTIVES. To investigate serotype distribution and antimicrobial susceptibility patterns of GBS isolates cultured from rectovaginal
specimens during pregnancy.
METHODS. Sixty-nine archived maternal colonising isolates were tested against penicillin, erythromycin, clindamycin, vancomycin and
levofloxacin. Minimum inhibitory concentration testing was performed using the ETEST method. Serotyping was performed by the latex
agglutination method.
RESULTS. The most common serotypes detected were Ia (54%), III (20%), V (16%), II (6%), IV (2%) and Ib (1%). All isolates were fully
susceptible to penicillin, vancomycin and levofloxacin. Eight (11%) and 50 (56%) isolates showed intermediate resistance to erythromycin
and clindamycin, respectively, and 1 isolate was resistant to erythromycin. The macrolide-lincosamide-streptogramin B (MLSB) phenomenon
was noted in 3 (4%) of the isolates.
CONCLUSIONS. GBS-colonising isolates remain susceptible to penicillin, which remains the drug of choice for intrapartum antibiotic
prophylaxis and treatment of invasive disease in newborns. Macrolides should only be used if clinically indicated due to the high prevalence
of intermediate resistance. A pentavalent GBS vaccine currently in phase I trials should provide coverage for 97% of the isolates identified
in this study.The National Health Laboratory Service (NHLS) and the Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg.http://www.samj.org.zaam2021Medical Microbiolog
Comparison of Xpert GBS v. culture for rapid detection of group B streptococcus in pregnant women : sensitivity, specificity and predictive values
BACKGROUND. Group B streptococcus (GBS) is a leading cause of invasive disease, particularly in newborns. Seventy-five percent of neonates
will be colonised by mothers carrying the organism. Confirmation of maternal colonisation with GBS is essential for prompt treatment and
prevention of neonatal sepsis. The current gold standard of culture for isolation of GBS has a disadvantage of long turnaround time (24 -
72 hours). Rapid assays are required to determine maternal carriage of GBS.
OBJECTIVES. To determine the usefulness of the Xpert GBS technology v. culture methods to detect GBS carriage in pregnant women.
METHODS. This was a prospective observational study of 284 pregnant women between 26 and 37 weeksâ gestation. Two vaginorectal
swabs were collected from each participant. One swab was processed using the gold-standard culture method, while the second swab was
processed using the Xpert GBS assay. The performance of the Xpert GBS assay was then compared with that of the culture method.
RESULTS. Two swabs were processed from each of 284 pregnant women between 26 and 37 weeksâ gestation. Culture detected 70 GBS isolates
from a total of 279 specimens (25.1%), whereas the Xpert GBS detected 66 positive specimens (23.7%). The Xpert GBS assay had a sensitivity
of 87% and specificity of 98%, with a positive predictive value of 92% and a negative predictive value of 96%.
CONCLUSIONS. The Xpert GBS assay is a rapid and sensitive tool for prenatal detection of GBS. The assay should ideally be available in every
labour ward, where women can be screened for GBS on arrival.The research described in this article was an MMed project
of MS, the main author.A National Health Laboratory
Services Research Grant (no. 94443) in fulfilment of MSâs MMed project.http://www.samj.org.zaam2019Medical MicrobiologyObstetrics and Gynaecolog
A comparative evaluation of the new Genexpert MTB/RIF ultra and other rapid diagnostic assays for detecting tuberculosis in pulmonary and extra pulmonary specimens
Studies evaluating the new GeneXpert Ultra with other rapid diagnostic assays are limited, particularly
in diferent geographical settings. The performance of the GeneXpert Ultra, the GeneXpert G4, the
Line probe assays (LPA) and auramine smear microscopy in detecting TB in pulmonary and extrapulmonary samples were thus evaluated. Remnants (n=205 samples) of pulmonary (n=125 samples)
and extra-pulmonary (n=80 samples) specimens from TB suspects were prospectively collected. Each
sample was divided for diagnosis using microscopy, GeneXpert MTB/RIF assays, and LPA; these were all
comparatively evaluated, using the MGIT 960 culture as a gold standard. The sensitivity and specifcity
of microscopy, Xpert Ultra, Xpert G4 and MTBDRplus (ver 2) in pulmonary samples were respectively:
82.00% and 90.28%; 88.00% and 58.57%; 79.59% and 90.28%; 80.00% and 11.11%. For extrapulmonary specimen, the sensitivity and specifcity were respectively: 53.85% and 98.51%; 69.23% and
49.25%; 50.00% and 97.01%; 69.23% and 25.37%. The new and improved GeneXpert Ultra assay was
more sensitive than GeneXpert G4 and LPA in both pulmonary and extra pulmonary samples, albeit
with lower specifcity than the GeneXpert G4. The auramine and LPA tests were also highly sensitive,
although the LPA was less specifc.University of Pretoria; National Research Foundation; Medical Research Council of South Africahttps://www.nature.com/sreppm2020Medical Microbiolog
Molecular characteristics and genotypic diversity of enterohaemorrhagic Escherichia coli O157:H7 isolates in Gauteng region, South Africa
Enterohaemorrhagic Escherichia coli (EHEC) O157:H7 is one of the major foodborne and waterborne pathogens causing severe diseases and outbreaks worldwide. There is scarcity of EHEC O157:H7 data in South Africa. This study was carried out to determine the molecular characteristics and genotypic diversity of EHEC O157:H7 isolates in the Gauteng region, South Africa. Samples were cultured on selective chromogenic media. Antibiotic susceptibility profile of isolates was determined using the VITEKÂŽ-2 automated system. Isolates were characterised using multiplex PCR assays and the genetic diversity was determined using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 520 samples of which 270 environmental water samples and 250 stool specimens were collected and analysed. Overall, EHEC O157:H7 was recovered from 2.3% (12/520) of samples collected. Environmental water samples and clinical stool specimens showed a prevalence of 4.07% (11/270) and 0.4% (1/250) respectively. Antibiotic susceptibility profile varied from isolates with full susceptibility to isolates with resistance to multiple antibiotics. Most resistance was detected to the penicillins, specifically ampicillin (7/12), amoxicillin (3/12) and piperacillin/Tazobactam (3/12) followed by one of the folate inhibitors, trimethoprim (3/12) and the carbapenems, imipenem and meropenem (2/12) each. Three isolates harboured a combination of Shiga-toxins (Stx)-2, intimin (eae) and enterohaemolysin (hlyA) genes, while two isolates harboured the Stx-1, Stx-2 and hlyA genes. The PFGE performed showed that EHEC O157:H7 isolates were genetically diverse, with two minor pulsotypes and eight singletons. The MLST analysis identified three sequence types (STs) (ST10, ST11 and ST1204) that have been previously reported associated with outbreaks. The STs identified in this study pose a potential public health risk to consumers of untreated environmental water and closed human contacts. There is necessity to enhance surveillance in reducing the propagation of this bacterium which is a public health problem.The National Health Laboratory Service (NHLS), National Research Foundation (NRF), Rand Water and University of Pretoria, South Africa.http://www.elsevier.com/locate/scitotenv2020-11-20hj2019Medical Microbiolog
Non-vaccine serotype pneumococcal carriage in healthy infants in South Africa following introduction of the 13-valent pneumococcal conjugate vaccine
BACKGROUND. Pneumococcal carriage studies provide a baseline for measuring the impact of pneumococcal conjugate vaccines (PCVs). The
advent of conjugate vaccines has led to reductions in vaccine serotypes (VTs) in pneumococcal carriage. However, increasing non-vaccine
serotypes (NVTs) remain a significant concern, necessitating continued surveillance of serotypes in the 13-valent PCV vaccine (PCV13) era.
OJECTIVES. To investigate pneumococcal carriage, serotype distribution and risk factors for pneumococcal colonisation among children
presenting for routine immunisation at two clinics in Gauteng Province, South Africa (SA), 10 years after PCV introduction into the SA
Expanded Programme on Immunisation (EPI-SA).
METHODS. Nasopharyngeal swabs were collected from 322 healthy children aged between 6 weeks and 5 years at two clinic centres in 2014
and 2016. Demographic data, risk factors for colonisation and vaccination details were recorded. The pneumococcal isolates were serotyped
and tested for antimicrobial susceptibility.
RESULTS. Pneumococci were isolated from 138/316 healthy children (43.7%) presenting for routine immunisation at two clinics. The
median age was 8.3 months and the age range 1.4 months - 5 years. Carriage varied across the age groups: 6 - 14 weeks 35.5%, 9 months
27.5%, 18 months 21.7%, and 5 years 15.2%. Risk factors significantly associated with pneumococcal colonisation included young age (9 -
18 months (odds ratio OR 3.5; 95% confidence interval (CI) 1.9 - 5.9), type of dwelling (single room (OR 8.1; 95% CI 1.3 - 52.3) or informal
dwelling (OR 2.4; 95% CI 1.2 - 4.5)) and Haemophilus influenzae carriage (OR 5.6; 95% CI 0.6 - 2.5). Of the 26 serotypes detected, 19F
(10/121; 8.3%) was the most frequent. The most frequent NVTs were 23B (16/121; 13.2%), 15B/C (14/121; 11.6 %) and 35B (11/121; 8.2%).
Children aged 9 months carried the highest proportion of NVTs (33/101; 32.7%). Penicillin non-susceptibility was observed in 20 NVT
isolates (20/36; 55.6%) and 2 VT isolates (2/36; 5.6%).
CONCLUSIONS. The pneumococcal carriage prevalence described in our study varied across the age groups and was lower compared with
other African studies that looked at pneumococcal carriage post PCV. The study gave insight into the common NVTs encountered at two
immunisation clinics in Gauteng. Given that pneumococcal carriage precedes disease, common colonisers such as 15B/C and 35B may be
sufficiently prevalent in carriage for expansion to result in significant disease replacement.NHLS Research Trust Development grant.http://www.samj.org.zadm2022Medical Microbiolog
Genomic analysis of two drug-resistant clinical Morganella morganii strains isolated from UTI patients in Pretoria, South Africa
Morganella morganii is an opportunistic bacterial pathogen of the Enterobacteriaceae family that is occasionally isolated from clinical (animal and human) specimens with varying resistance profiles. Detailed genomic analyses of drugâresistant M. morganii strains are relatively limited, particularly in Africa, which is also due to their relatively low isolation rates from clinical settings. Here we report on two multidrugâresistant clinical M. morganii isolates from urine specimens of two hospitalized patients in South Africa who presented with urinary tract infections in 2013. The isolates, M006 and E042, were only susceptible to carbapenems, amikacin and tigecycline. One strain, M006, had a novel class 1 integron, ln1484, associated with aadA7, sul1and gcuD gene cassettes and a Col3M plasmid replicase gene. The ln1484 intI1:aadA7:sul1 genes were bracketed by a TnAs3 composite transposon while a tet(B) gene was found on an IS4 family transposon. The rare blaDHAâ4 and blaDHAâ1 AmpC βâlactamase genes were identified on the isolatesâ chromosome. The isolates were phylogenetically distant and closely related to other international strains, suggesting that they were not obtained from a single epidemiological source. Further molecular surveillance is necessary to establish the prevalence of these MDR strains in the tertiary hospital. Moreover antibiotic stewardship and antibiotic sensitivity testing of all clinical isolates should be undertaken after empirical treatment to inform tailored therapy as well as reduce escalation of resistance and associated morbidities and mortalities.Supplementary Data S1. Metadata of isolates included in phylogenomic analysis.The National Health Laboratory Services (Grant No.: 94445), the University of Pretoria (Grant No.: A0702) and the South African Medical Research Council.https://onlinelibrary.wiley.com/journal/1472765x2021-01-01hj2020Medical Microbiolog
Molecular screening of clinical multidrug-resistant gram-negative bacteria shows endemicity of carbapenemases, coexistence of multiple carbapenemases, and rarity of mcr in South Africa
Please read abstract in the article.The NHLS and the National Research Foundation of South Africa.https://home.liebertpub.com/publications/microbial-drug-resistance/44hj2023Medical Microbiolog