Aminoglycoside-modifying Enzyme Genes Research Articles

Potential transmission opportunity of CTX-M-producing Escherichia coli on a large-scale chicken farm in Vietnam.

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli have disseminated worldwide. This study investigated blaCTX-M-positive E. coli on a large-scale Vietnamese chicken farm and analysed whether there was any difference in prevalence and molecular characteristics of blaCTX-M-positive E. coli between the farm and the Vietnamese community. Faecal samples were collected from 24 human individuals and 38 chickens from the large-scale chicken farm as well as 51 humans and 36 chickens from the community. All samples were collected between June 2013 and June 2014 in Bavi Province in the Red River Delta region of Vietnam. Molecular characterisation of CTX-M-producing E. coli and genetic relatedness among the isolates were evaluated by conventional typing methods. Antimicrobial susceptibility of the isolates was evaluated by the disk diffusion method. The prevalence of blaCTX-M-positive E. coli was 83.3%, 71.1%, 54.9% and 13.9% in farm workers, farm chickens, community individuals and community backyard chickens, respectively. On average, blaCTX-M-positive E. coli isolates from farm chickens were resistant to 8.3 different antibiotics. The average number of detected aminoglycoside-modifying enzyme genes (3.4 genes) and the detection rate of the plasmid-mediated colistin resistance gene mcr-1 (33.3%) were higher in blaCTX-M-positive E. coli isolated from farm chickens compared with other sampling groups. In addition, two types of indistinguishable pulsed-field gel electrophoresis (PFGE) patterns were observed in six blaCTX-M-65-positive E. coli and three blaCTX-M-55-positive E. coli from farm chickens. These results suggest a more frequent transmission opportunity of blaCTX-M-positive E. coli on the large-scale Vietnamese chicken farm.

Prevalence of Aminoglycoside-Modifying Enzymes in Escherichia coli and Klebsiella pneumoniae Producing Extended Spectrum β-Lactamases Collected in Two Multicenter Studies in Spain.

The in vitro activity of amikacin, gentamicin, kanamycin, tobramycin, neomycin, and netilmicin against 420 Escherichia coli producing extended spectrum β-lactamases (Ec-ESBLs) and 139 Klebsiella pneumoniae producing extended spectrum β-lactamase (Kp-ESBL) collected in two multicenter studies performed in Spain in 2000 and 2006 was determined. The presence of genes encoding aminoglycoside-modifying enzymes (AMEs) and 16S ribosomal RNA (rRNA) methylases [aac(3)-Ia, aac(3)-IIa, aac(3)-IVa, aac(6')-Ib, ant(2")-Ia, ant(4')-IIa, aph(3')-Ia, aph(3')-IIa, armA, rmtB, and rmtC] was also investigated. The resistance to (one or more) aminoglycosides was significantly higher in Kp-ESBL (104/139, 74.8%) than in Ec-ESBL (171/420, 40.7%; p < 0.0001). The lowest resistance rates for both species in the two studies were observed for amikacin. The prevalence of AME genes was significantly different in Ec-ESBL (161/420, 38.3%) than in Kp-ESBL (115/139, 82.7%; p < 0.0001). The most prevalent AME genes in Ec-ESBL and Kp-ESBL were aac(6')-Ib (16.2% and 44.6%) and aac(3)-IIa (14.7% and 43.1%), respectively. The expected phenotypic profile correlated with the found AMEs encoding genes in 59.6% Ec-ESBL and 26.1% Kp-ESBL. In Ec-ESBL, aac(6')-Ib was usually associated in 2000 with blaSHV (26.6%), but with blaCTX-M-1 group (34.8%) in 2006, while aac(3)-IIa was coincident in 2000 with blaTEM (14.6%) and with blaCTX-M-1 group (16.3%) in 2006. Among Kp-ESBL, the aac(6')-Ib and aac(3)-IIa genes were more frequent in strains with blaTEM (22.0% and 44.0%) in 2000 and with blaCTX-M-1 group (46.4% and 34.0%) in 2006. Resistance to aminoglycosides in Ec-ESBL and Kp-ESBL is frequent and related to production of AMEs; this limits the clinical use of aminoglycosides against these organisms.

Prevalence study of plasmid-mediated AmpC β-lactamases in Enterobacteriaceae lacking inducible ampC from Saudi hospitals.

Enterobacteriaceae encoding plasmid-mediated AmpC (pAmpC) β-lactamases confer resistance to the third generation cephalosporins. pAmpC association with extended spectrum β-lactamases (ESBLs), plasmid-mediated quinolone resistance (PMQR) and aminoglycoside modifying enzymes (AMEs) is well documented. There are limited data regarding the epidemiology and clinical significance of pAmpC in Saudi Arabia. This study aimed to determine the prevalence of pAmpC and its coexistence with ESBLs, PMQR and AMEs in Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis isolates in Saudi hospitals from January to December 2015. The VITEK 2 system was used for organism identification and susceptibility testing. PCR and sequencing were used to detect pAmpC, ESBL, AME and PMQR genes. Out of 3625 isolates of E. coli, K. pneumoniae and P. mirabilis, 200 cefoxitin-resistant isolates were identified, making the prevalence of cefoxitin resistance 5.5 % (200/3625). CMY-2 and DHA were detected in 24 and 12 isolates, respectively. The prevalence of pAmpC was 1 % (36/3625). In several isolates, pAmpC β-lactamases were associated with PMQR genes including aac(6')-Ib-cr and qnrB and/or with AMEs including aacA4, aacC2, aadA1, aphA6, armA and rmtB genes. No ESBLs were detected in pAmpC β-lactamase-harbouring isolates. To our knowledge, this is the first study determining the prevalence of pAmpC β-lactamases and their association with PMQR and/or AME genes in Saudi Arabia and the Gulf States. CMY-2 is the most prevalent pAmpC β-lactamase in this study. These data emphasize the importance of surveillance studies and implementation of antimicrobial stewardship programmes to reduce infections caused by such resistant organisms.

Detection of tetracycline resistance genes, aminoglycoside modifying enzymes, and coagulase gene typing of clinical isolates of Staphylococcus aureus in the Southwest of Iran.

Objective(s):The aim of the present study was to determine the aminoglycoside modifying enzymes (AMEs) encoded genes, tetracycline resistance genes, and the coa based typing of Staphylococcus aureus isolates in the Southwest of Iran.Materials and Methods:Antimicrobial susceptibility of isolates was carried out by agar disk diffusion methods. Two sets of multiplex PCR mixture were used for detection of AME genes and tet genes. All of the isolates were typed with the coagulase gene typing method. Of the 121 isolates, 29.75% and 47.93% were resistant to at least one aminoglycosides and tetracyclines, respectively.Results:The aac(6’)-Ie-aph(2”) was the most frequent gene (97.22%), and aph (3’)-IIIa and ant (4’)-Ia genes were detected in 61.11% and 11.11% of aminoglycoside resistant isolates, respectively. The tetK and tetM genes were detected in 82.75% and 56.9% of tetracycline resistant isolates, respectively. Overall 31.4% of isolates were MRSA. Totally 17 distinct coa gene RFLP patterns, numbered C1 to C17, were observed. The C5 was the most frequent coa type with 31 isolates.Conclusion:The aac(6’)-Ie-aph(2”) and aph (3’)-IIIa genes were the most important genes contributing to aminoglycosides resistance, while resistance to tetracyclines was mediated by tetK and tetM genes. Interestingly all S. aureus with C5 as the most prevalent coa-type were resistant to at least one of the aminoglycoside antibiotics and tetracycline simultaneously. Moreover, 30 out of 31 isolates with this coa type were MRSA, indicating the importance of the C5 coa-type in MRSA strains and also in isolates that were resistant to aminoglycosides and tetracycline.

Characterization of high level ampicillin- and aminoglycoside-resistant enterococci isolated from non-hospital sources.

High level ampicillin- and aminoglycoside-resistant enterococci are being increasingly reported from non-hospital sources. This study was carried out to characterize these strains from non-hospital sources in Nigeria. A collection of Enterococcus faecium isolated from vegetables, soil, farm animals and manure and observed to be resistant to ampicillin (n=63) and gentamicin (n=37) discs, were screened for resistance to high levels of ampicillin and aminoglycoside using E-test strips. Putative high level ampicillin- and aminoglycoside-resistant strains were screened for pbp5 and aminoglycoside modifying enzyme genes, respectively, by PCR. The C-terminal region of the amplified pbp5 gene was also sequenced. Five (5/63) and thirty-five (35/37) of the ampicillin- and aminoglycoside-resistant strains were identified as high level ampicillin- and aminoglycoside-resistant E. faecium strains, respectively, based on the MIC results. The amplified pbp5 gene from the high level ampicillin-resistant isolates displayed 96-99 % nucleotide sequence similarity with the reference strains and three novel insertions (500Glu→Leu, 502Asp→Arg and 614Ile→Phe) in the amino acid sequence. Aminoglycoside modifying enzyme genes aac(6')-Ie-aph(2″) (100 %), aph(2')-Ic (88.8 %), aph(3')-IIIa (90 %) and ant(4')-Ia (40 %) were detected among the high level aminoglycoside-resistant isolates. This is the first report on the characterization of high level ampicillin- and aminoglycoside-resistant Enterococcus faecium among animals and vegetables in Nigeria. The results show that non-hospital sources can constitute a reservoir for potential dissemination of these strains and genes to humans via the food chain or by direct contact.

Occurrence of aminoglycoside-modifying enzymes among isolates of Escherichia coli exhibiting high levels of aminoglycoside resistance isolated from Korean cattle farms.

This study investigated 247 Escherichia coli isolates collected from four cattle farms to characterize aminoglycoside-modifying enzyme (AME) genes, their plasmid replicons and transferability. Out of 247 isolates a high number of isolates (total 202; 81.78%) were found to be resistant to various antibiotics by disc diffusion. Of the 247 strains, 139 (56.3%) were resistant to streptomycin, and other antibiotic resistances followed as tetracycline (12.15%), ampicillin (7%), chloramphenicol (5.7%) and trimethoprim-sulfamethoxazole (0.8%). Among 247 isolates B1 was the predominant phylogenetic group identified comprising 151 isolates (61.1%), followed by groups A (27.9%), D (7%) and B2 (4%). Out of 139 isolates investigated for AME, 130 (93.5%) isolates carried at least one AME gene. aph3″-1a and aph3″-1b (46%) were the principal genes detected, followed by aac3-IVa (34.5%). ant2″-1a was the least detected gene (2.2%). Nine (6.5%) strains carried no AME genes. Twelve (63.2%) among 19 isolates transferred an AME gene to a recipient and aph3΄-1a was the dominant transferred gene. Transferability mainly occurred via the IncFIB replicon type (52.6%). Pulsed-field gel electrophoresis typing demonstrated a higher degree of diversity with 14 distinct cluster types. This result suggests that commensal microflora from food-producing animals has a tremendous ability to harbor and transfer AME genes, and poses a potential risk by dissemination of resistance to humans through the food chain.

In-vitro activity of several antimicrobial agents against methicillin-resistant Staphylococcus aureus (MRSA) isolates expressing aminoglycoside-modifying enzymes: potency of plazomicin alone and in combination with other agents

This study investigated the in-vitro activity of clinically relevant aminoglycosides and new antimicrobial agents—plazomicin, ceftobiprole and dalbavancin—against 55 methicillin-resistant Staphylococcus aureus (MRSA) isolates producing aminoglycoside-modifying enzymes (AMEs). The checkerboard method was used to assess synergism between plazomicin and four antibiotics (fosfomycin, ceftobiprole, cefoxitin and meropenem), and time–kill assays were performed for the most active combinations. Among the aminoglycosides tested, plazomicin was the most active agent against MRSA, with >90% of isolates being inhibited at a minimum inhibitory concentration (MIC) of ≤1 mg/L. MIC50 and MIC90 values for ceftobiprole and dalbavancin were 2 and 4 mg/L, and 0.125 and 0.125 mg/L, respectively. The most prevalent AME gene was aac(6′)Ie-aph(2″)Ia (87.3%), followed by ant(4′)Ia (52.7%) and aph(3′)IIIa (52.7%). Plazomicin activity was not affected by the type or number of enzymes detected. In checkerboard and time–kill assays, indifference was the most common result achieved for the antibiotic combinations. Notably, no antagonism was observed with any combination tested. Overall, plazomicin in combination with meropenem had the highest synergistic effect, demonstrating synergy against seven isolates in the checkerboard assay and three isolates in time–kill curves. In conclusion, plazomicin showed potent activity against aminoglycoside-resistant MRSA isolates, regardless of the number and type of AMEs present. These findings indicate the potential utility of plazomicin in combination with meropenem for the treatment of MRSA infections.

Dissemination of Genes Encoding Aminoglycoside-Modifying Enzymes and armA Among Enterobacteriaceae Isolates in Northwest Iran.

Enzymatic inactivation is one of the most important mechanisms of resistance to aminoglycosides. The aim of this study was to investigate the prevalence of armA and diversity of the genes encoding aminoglycoside-modifying enzymes (AMEs) and their associations with resistance phenotypes in Enterobacteriaceae isolates. Three hundred and seven Enterobacteriaceae isolates were collected from five hospitals in northwest Iran. The disk diffusion method for amikacin, gentamicin, tobramycin, kanamycin, and streptomycin, as well as the minimum inhibitory concentration for amikacin, gentamicin, tobramycin, and kanamycin were done for susceptibility testing. Thirteen AME genes and armA methylase were screened using the PCR and sequencing assays. Two hundred and twenty (71.7%) of isolates were resistant to aminoglycosides and 155 (70.5%) of them were positive for aminoglycoside resistance genes. The most prevalent AME genes were ant(3″)-Ia and aph(3″)-Ib with the frequency 35.9% and 30.5%, respectively. Also, 21 (9.5%) of resistant isolates were positive for armA methylase gene. The prevalence of resistance to aminoglycoside is high and AME genes frequently are disseminated in Enterobacteriaceae isolates. There is an association between phenotypic resistance and the presence of some aminoglycoside genes.

Plazomicin Activity against 346 Extended-Spectrum-β-Lactamase/AmpC-Producing Escherichia coli Urinary Isolates in Relation to Aminoglycoside-Modifying Enzymes.

The activity of plazomicin and clinically relevant aminoglycosides was tested against 346 extended-spectrum-β-lactamase/AmpC-producing Escherichia coli urinary isolates, and the results were correlated with the presence of aminoglycoside-modifying enzymes (AMEs). Data showed that plazomicin was very active against all ESBL/AmpC-producing E. coli urinary isolates. Its activity was not related to the AME genes studied.

Analysis of Aminoglycoside Modifying Enzyme Genes Responsible for High-Level Aminoglycoside Resistance among Enterococcal Isolates.

Enzymatic modification results in high-level resistance to aminoglycoside (HLAR), which eliminates the synergistic bactericidal effect of combined exposure to a cell wall-active agent and an aminoglycoside. So aim of the study was to determine prevalence of HLAR enterococcal isolate and to study distribution of aminoglycoside modifying enzyme genes in them. A total of 100 nonrepeat isolates of enterococci from various clinical samples were analyzed. As per Clinical and Laboratory Standards Institute guidelines enterococci were screened for HLAR by Kirby-Bauer disc diffusion method. Minimum inhibitory concentration of all isolates for gentamicin and streptomycin was determined by E-test. Multiplex polymerase chain reaction (PCR) was carried out for HLAR enterococcal isolates to identify aminoglycoside modifying enzymes genes responsible for resistance. 60% isolates were found to be high-level gentamicin resistant (HLGR) whereas 45% isolates were found to be high-level streptomycin resistant (HLSR). By multiplex PCR 80% HLGR isolates carried bifunctional aminoglycoside modifying enzyme gene aac(6′)-Ie-aph(2′′)-Ia whereas 18 out of 45 high-level streptomycin resistant, that is, 40%, isolates carried aph(3′)-IIIa. However, aph(2′′)-Ib, aph(2′′)-Ic, aph(2′′)-Id, and ant(4′)-Ia genes which encode other aminoglycosides modifying enzymes were not detected. Bifunctional aminoglycoside modifying enzyme gene aac(6′)-Ie-aph(2′′)-Ia is the predominant gene responsible for HLAR.

Molecular detection of aminoglycoside-modifying enzyme genes in Acinetobacter baumannii clinical isolates.

Acinetobacter baumannii is a major opportunistic pathogen in healthcare settings worldwide. In Iran, there are only few reports on the prevalence of aminoglycoside resistance genes among A. baumannii isolates. The aim of this study was to investigate the existence of aminoglycoside-modifying enzyme (AME) genes from A. baumannii strains collected at a university teaching hospital in Iran. One hundred A. baumannii strains were collected between 2014 and 2015 from hospitalized patients at Loghman Hakim Hospital, Tehran, Iran. Antimicrobial susceptibility was determined by disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations. The DNA was extracted using a kit obtained from Bioneer Co. (Korea) and was used as a template for polymerase chain reaction. The most active antimicrobial agent against these strains was colistin. The rate of extended-spectrum cephalosporin resistance was 97%. The aadA1, aadB, aac(6')-Ib, and aac(3)-IIa genes were found in 85%, 77%, 72%, and 68% of A. baumannii isolates, respectively. This study showed a high prevalence rate of AME genes in A. baumannii. This prevalence rate has explained that further aminoglycoside resistance genes may have role in the resistance of clinical isolates of A. baumannii. Therefore, control and treatment of serious infections caused by this opportunistic pathogen should be given more consideration.

Prevalence of carbapenemases among high-level aminoglycoside-resistant Acinetobacter baumannii isolates in a university hospital in China.

The prevalence of aminoglycoside resistant enzymes has previously been reported and extended-spectrum β-lactamase among Acinetobacter baumannii. To track the risk of multidrug-resistant A. baumannii, the present study aimed to determine the prevalence of carbapenemases in high-level aminoglycoside resistant A. baumannii over two years. A total of 118 strains of A. baumannii were consecutively collected in the First Affiliated Hospital of Chengdu Medical College, Chengdu, China. These isolates were investigated on the genetic basis of their resistance to aminoglycosides. The results showed that 75 (63.56%) isolates were high-level resistant to aminoglycosides, including gentamicin and amikacin (minimum inhibitory concentration, ≥256 µg/ml). Aminoglycoside-resistant genes ant(2″)-Ia, aac(6′)-Ib, aph(3′)-Ia, aac(3)-Ia, aac(3)-IIa, armA, rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA, and carbapenem-resistant genes blaOXA-23, blaOXA-24, blaOXA-51, blaOXA-58, blaSIM, blaIMP, blaNDM-1 and blaKPC, were analyzed using polymerase chain reaction. The positive rate of ant(2″)-Ia, aac(6′)-Ib, aph(3′)-Ia, aac(3)-Ia and aac(3)-IIa was 66.95, 69.49, 42.37, 39.83 and 14.41%, respectively. armA was present in 72.0% (54/75) of A. baumannii isolates with high-level resistance to aminoglycosides. The remaining nine 16S ribosomal RNA methlyase genes (rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH and npmA) and aminoglycoside-modifying enzyme gene aac(6′)-Ib-cr were not detected. Among the 54 armA-positive isolates, the prevalence of the carbapenem resistant blaOXA-23 and blaOXA-51 genes was 79.63 and 100%, respectively. armA, ant(2″)-Ia and aac(6′)-Ib were positive in 43 isolates. The results of multilocus sequence typing revealed 31 sequence types (STs) in all clinical strains. Among these STs, the high-level aminoglycoside-resistant A. baumannii ST92, which mostly harbored blaOXA-23, was the predominant clone (29/75). In conclusion, A. baumannii harboring carbapenemases and aminoglycoside-resistant enzymes are extremely prevalent in western China, emphasizing the need to adopt surveillance programs to solve the therapeutic challenges that this presents.

Distribution of genes encoding aminoglycoside-modifying enzymes among clinical isolates of methicillin-resistant staphylococci

The objective of this study was to determine the distribution of genes encoding aminoglycoside-modifying enzymes (AMEs) and staphylococcal cassette chromosome mec (SCCmec) elements among clinical isolates of methicillin-resistant staphylococci (MRS). Antibiotic susceptibility test was done using Kirby–Bauer disk diffusion method. The presence of SCCmec types and AME genes, namely, aac (6′)-Ie-aph (2″), aph (3′)-IIIa and ant (4′)-Ia was determined using two different multiplex polymerase chain reaction. The most encountered AME genes were aac (6′)-Ie-aph (2″) (55.4%) followed by aph (3′)-IIIa (32.3%) and ant (4′)-Ia gene (9%). SCCmec type I (34%) was predominant in this study. In conclusion, the aac (6′)-Ie-aph (2″) was the most common AME gene and SCCmec type I was most predominant among the MRS isolates.

The prevalence of aminoglycoside-modifying enzyme and virulence genes among enterococci with high-level aminoglycoside resistance in Inner Mongolia, China.

This study highlights the prevalence of aminoglycoside-modifying enzyme genes and virulence determinants among clinical enterococci with high-level aminoglycoside resistance in Inner Mongolia, China. Screening for high-level aminoglycoside resistance against 117 enterococcal clinical isolates was performed using the agar-screening method. Out of the 117 enterococcal isolates, 46 were selected for further detection and determination of the distribution of aminoglycoside-modifying enzyme-encoding genes and virulence determinants using polymerase chain reaction -based methods. Enterococcus faecium and Enterococcus faecalis were identified as the species of greatest clinical importance. The aac(6′)-Ie-aph(2″)-Ia and ant(6′)-Ia genes were found to be the most common aminoglycoside-modifying enzyme genes among high-level gentamicin resistance and high-level streptomycin resistance isolates, respectively. Moreover, gelE was the most common virulence gene among high-level aminoglycoside resistance isolates. Compared to Enterococcus faecium, Enterococcus faecalis harbored multiple virulence determinants. The results further indicated no correlation between aminoglycoside-modifying enzyme gene profiles and the distribution of virulence genes among the enterococcal isolates with high-level gentamicin resistance or high-level streptomycin resistance evaluated in our study.

Occurrence of aminoglycoside-modifying enzymes genes (aac(6')-I and ant(2″)-I) in clinical isolates of Pseudomonas aeruginosa from Southwest Nigeria.

Enzymatic modification of aminoglycosides is the primary mechanism of resistance by Pseudomonas aeruginosa. We investigated the occurrence and mechanism of aminoglycosides resistance in P. aeruginosa isolates from hospitals in SouthWest Nigeria. A total of 54 consecutive, non-duplicate clinical isolates of P. aeruginosa were studied for the presence of aminoglycosides -modifying enzymes (AMEs) by PCR amplification and sequencing of genes encoding AMEs. Two types of AME genes [aac (6') - I and ant (2″) - I] were found in 12 isolates out of 54. Seven strains harboured one or more types of enzymes of which aac (6') - I was the most frequently found gene (10/54 isolates, 18.5%). None of the isolates investigated in this study were positive for aph, aac (3) and aac (6″) - II genes. Prevalence of P. aeruginosa producing AME genes in this study may suggest aminoglycosides use in Nigeria. This study highlights need for functional antimicrobial surveillance system in Nigeria.

Aminoglycoside and chlorhexidine resistance genes in Staphylococcus aureus isolated from surgical wound infections

Hamdia Askar1, Wafaa Badawy2  and Enas Hammad11Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Egypt2MD.MansouraUniversity Students'Hospital,Egypt. Background:  Staphylococcus aureus is a major human pathogen resistant to many antimicrobial agents especially the methicillin-resistant Staphylococcus aureus (MRSA). In surgical site infections, MRSA is known to be an important etiologic factor. Infections range from skin and soft-tissue infections to deep tissue infections such as osteomyelitis, bacteremia, and endocarditis that are much more common in hospital environment. In staphylococci the main mechanism of aminoglycoside resistance is the drug inactivation by aminoglycoside-modifying enzymes (AMEs) and reduced biocide susceptibility is associated with the acquisition of quaternary ammonium compound (qac) gene-encoding for Qac efflux proteins.Aim of the work: To investigate the prevalence of the aminoglycosides resistance genes aac(6′)aph(2″), aph(3′)-IIIa, Ant(4′)-Ia) and the biocide resistance genes (qacA/qacB, qacC) in S. aureus isolated from surgical site infections.Methods: Swabs from 280 infected surgical sites were sent to our laboratory from different surgical words at Mansoura University Hospitals between January 2014 and December 2014. Sixty- six staphylococcal strains were isolated and included in this study. Verification of the presence of methicillin resistance gene (mecA), chlorhexidine MIC and qac resistance genes (qacA/qacB, qacC) were detected by PCR. The presence of aminoglycoside resistance genes [(aac(6′)/aph (2″), ant (4′)-1a and aph(3′)-IIIa)] in S. aureus was also tested by PCR.Results:  Seventeen of the 66 S. aureus isolates (25.75 %) were phenotypically MRSA and mecA gene was detected in 19 S. aureus isolates (28.7 %) by PCR. Aminoglycoside resistant S. aureus were 21/66 (31.8%). AME genes were detected in all aminoglycoside-resistant S. aureus; aac(6′)/aph (2″) was the most frequently detected 11/21(52.4%) followed by aph(3′)-IIIa 6/21 (28.6%) and the least frequent was ant (4′)-1a 4/21(19%). Aminoglycoside resistance in 9 out of the 21 (42.9%) aminoglycoside resistance S. aureus isolates was solely plasmid mediated being lost after plasmid curing. A total of 14 out of the 21 aminoglycoside-resistant S. aureus isolates (66.7 %) carried the mecA gene. Among the 45 aminoglycoside-sensitive S. aureus isolates 5 (11.1%) were mecA positive. Nine of the 21 aminoglycoside-resistant S. aureus isolates (42.9%) were positive for qacA/qacB genes and in all of them mecA gene co-existed. Five aminoglycoside resistant S. aureus isolates were qacC positive (23.8%).  Conclusion: In the Staphylococcus aureus isolated from infected surgical wounds, quaternary ammonium compounds resistance genes were positive at a considerable ratio and co-existed with aminoglycosides and methicillin-resistance genes in S. aureus isolates. Â

Mutational and acquired carbapenem resistance mechanisms in multidrug resistant Pseudomonas aeruginosa clinical isolates from Recife, Brazil.

An investigation was carried out into the genetic mechanisms responsible for multidrug resistance in nine carbapenem-resistant Pseudomonas aeruginosaisolates from different hospitals in Recife, Brazil. Susceptibility to antimicrobial agents was determined by broth microdilution. Polymerase chain reaction (PCR) was employed to detect the presence of genes encoding β-lactamases, aminoglycoside-modifying enzymes (AMEs), 16S rRNA methylases, integron-related genes and OprD. Expression of genes coding for efflux pumps and AmpC cephalosporinase were assessed by quantitative PCR. The outer membrane proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The blaSPM-1, blaKPC-2 and blaGES-1 genes were detected in P. aeruginosaisolates in addition to different AME genes. The loss of OprD in nine isolates was mainly due to frameshift mutations, premature stop codons and point mutations. An association of loss of OprD with the overexpression of MexAB-OprM and MexXY-OprM was observed in most isolates. Hyper-production of AmpC was also observed in three isolates. Clonal relationship of the isolates was determined by repetitive element palindromic-PCR and multilocus sequence typing. Our results show that the loss of OprD along with overexpression of efflux pumps and β-lactamase production were responsible for the multidrug resistance in the isolates analysed.

MALDI-TOF MS as a Tool To Detect a Nosocomial Outbreak of Extended-Spectrum-β-Lactamase- and ArmA Methyltransferase-Producing Enterobacter cloacae Clinical Isolates in Algeria.

Enterobacter cloacae is among the most important pathogens responsible for nosocomial infections and outbreaks. In this study, 77 Enterobacter isolates were collected: 27 isolates from Algerian hospitals (in Constantine, Annaba, and Skikda) and 50 isolates from Marseille, France. All strains were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Antibiotic susceptibility testing was performed by the disk diffusion method. PCR was used to detect extended-spectrum-beta-lactamase (ESBL)-encoding, fluoroquinolone resistance-encoding, and aminoglycoside-modifying enzyme (AME) genes. Epidemiological typing was performed using MALDI-TOF MS with data mining approaches, along with multilocus sequence typing (MLST). Sixty-eight isolates (27 from Algeria, 41 from Marseille) were identified by MALDI-TOF MS as E. cloacae. Resistance to antibiotics in the Algerian isolates was significantly higher than that in the strains from Marseille, especially for beta-lactams and aminoglycosides. Eighteen of the 27 Algerian isolates and 11 of the 41 Marseille isolates possessed at least one ESBL-encoding gene: blaCTX-M and/or blaTEM. AME genes were detected in 20 of the 27 Algerian isolates and 8 of the 41 Marseille isolates [ant(2″)-Ia, aac(6')-Ib-cr, aadA1, aadA2, and armA]. Conjugation experiments showed that armA was carried on a transferable plasmid. MALDI-TOF typing showed three separate clusters according to the geographical distribution and species level. An MLST-based phylogenetic tree showed a clade of 14 E. cloacae isolates from a urology unit clustering together in the MALDI-TOF dendrogram, suggesting the occurrence of an outbreak in this unit. In conclusion, the ability of MALDI-TOF to biotype strains was confirmed, and surveillance measures should be implemented, especially for Algerian patients hospitalized in France.

Molecular identification of aminoglycoside-modifying enzymes in clinical isolates of Escherichia coli resistant to amoxicillin/clavulanic acid isolated in Spain

The activity of eight aminoglycosides (amikacin, apramycin, arbekacin, gentamicin, kanamycin, neomycin, netilmicin and tobramycin) against a collection of 257 amoxicillin/clavulanic acid (AMC)-resistant Escherichia coli isolates was determined by microdilution. Aminoglycoside resistance rates, the prevalence of aminoglycoside-modifying enzyme (AME) genes, the relationship between AME gene detection and resistance phenotype to aminoglycosides, and the association of AME genes with mechanisms of AMC resistance in E. coli isolates in Spain were investigated. Aminoglycoside-resistant isolates were screened for the presence of genes encoding common AMEs [aac(3)-Ia, aac(3)-IIa, aac(3)-IVa, aac(6′)-Ib, ant(2″)-Ia, ant(4′)-IIa and aph(3′)-Ia] or 16S rRNA methylases (armA, rmtB, rmtC and npmA). In total, 105 isolates (40.9%) were resistant to at least one of the aminoglycosides tested. Amikacin, apramycin and arbekacin showed better activity, with MIC90 values of 2mg/L (arbekacin) and 8mg/L (amikacin and apramycin). Kanamycin presented the highest MIC90 (128mg/L). The most common AME gene was aac(6′)-Ib (36 strains; 34.3%), followed by aph(3′)-Ia (31 strains; 29.5%), ant(2″)-Ia (29 strains; 27.6%) and aac(3)-IIa (23 strains; 21.9%). aac(3)-Ia, aac(3)-IVa, ant(4′)-IIa and the four methylases were not detected. The ant(2″)-Ia gene was usually associated with OXA-1 [21/30; 70%], whilst 23/25 (92%) strains producing CTX-M-15 had the aac(6′)-Ib gene. The most prevalent AME gene was aac(6′)-Ib (18/41; 44%) in nosocomial isolates, whilst ant(2″)-Ia and aph(3′)-Ia genes (20/64; 31%) were more frequent in strains of community origin. In 64.6% isolates the phenotypic profile correlated with the presence of commonly encountered AMEs.

Prevalence of integrons and Antimicrobial Resistance Genes Among Clinical Isolates of Enterobacter spp. From Hospitals of Tehran

Background: Enterobacter infections are increasingly recognized as an important nosocomial infection. Here we describe the prevalence of three classes of integrons in clinical isolates of Enterobacter spp. and the prevalence of antibiotic resistance genes among isolates with integron. Objectives: Here we describe the prevalence of integrons genes among clinical isolates of Enterobacter spp. and antibiotic susceptibility pattern, ESBL production and the prevalence of resistance genes among clinical isolates of Enterobacter spp. Materials and Methods: A total of 110 Enterobacter isolates collected from four hospitals in Tehran during 2012-2013. Enterobacter species were identified by using API 20E system. The existence of integron classes was investigated by PCR assay through the amplification of integrase genes. Then, antibacterial susceptibility and confirmation of ESBL phenotype was determined. Then, the bla groups, blaTEM, blaSHV, blaCTX-M-1 and aminoglycoside modifying enzymes genes were identified by PCR with specific primers. Results: The prevalence of Enterobacter species were E. cloacae (78.2 %), E. aerogenes (13.6 %) and E. sakazakii (8.2%). They were from different clinical sources. Forty five of Enterobacter isolates have integron but there was not detected class 3 of integrons. All isolates with integron were susceptible to imipenem. Ten isolates of Enterobacter with integron showed ESBL phenotype. The frequency of blaTEM, blaSHV and blaCTX-M-1 genes are 20%, 0% and 15.6%, respectively. The frequency of genes encoding ANT (2˝)-Ia, APH (3΄)-Ia, AAC (6΄)-Ib and AAC (3)-IIa were 11.1%, 13.3%, 13.3 % and 20 %, respectively. Conclusions: The high prevalence of integron-positive isolates in our MDR Enterobacter isolates indicates that these mobile genetic elements are common among different Enterobacter spp. and associate with reduced susceptibility to the first-line antimicrobial drugs. This so highlight the continued monitoring of drug resistance in clinical settings.