Cefoxitin Resistance Research Articles

Molecular Study of Methicillin Resistant Staphylococcus aureus Isolated from Different Hospitals in Najaf-Iraq

1 Professor of microbiology, College of Medicine, Kufa University 2 Lecturer in Molecular Biology, College of medicine, Kufa University 3 MSc, Student, Department of Microbiology, College of Medicine, Kufa University Email: hkrooz7@yahoo.com Abstract Aim of Study: The aim is to do molecular characterization of Staphylococcus aureus isolated from hospital staff and environment, in order to determine the gene(s) that is (are) responsible for antibiotics resistance especially mecA and SCCmec. Methodology: This study that aimed to detect methicillin resistant Staphylococcus aureus in isolates from AlSader Teaching Hospital and al-Hakeem General Hospital in Annajaf during the period from November 2015 to April 2016. From a total of 250 clinical samples that were collected to isolate Staphylococcus aureus from the hospital staff (nurses, doctors, workers, medical student ---etc.), and also from different parts of hospital environments. A total of 50 Staphylococcus aureus isolate were detected and confirmed by different morphological and biochemical confirmatory test. Results: These 50 isolates then studied by VITEC2 and also by cefoxitin disc susceptibility test .It was able to detect only 41 isolates that had cefoxitin resistance which represented 82% of the total Staphylococcus isolates which are regarded as Methicillin Resistant Staphylococcus aureus phenotypically. Polymerase chain reaction test was done to find out the genes that are responsible for methicillin resistance in these isolates, using three types of primers one was for Sa442 gene which was designed to confirm that the isolates were Staphylococcus aureus and two other genes to confirm that the isolates were methicillin resistant which were mecA and SCCmec with the different subtypes of the last gene, and it was found that from the 41 isolates which were phenotypically confirimed to be methicillin resistant only 32 were found to harbor these genes which represented only 78% of the phenotypically confirmed MRSA; It was found also that the subtype SCCmec type IV was the most dominant gene among SCCmec types in these isolates as it was detected in 23 out of 32 isolates (71.9%), followed by SCCmec type III Which was found in 5(15.6%) of the isolates. Conclusions: Polymerase chain reaction is the golden slandered for identification of methicillin resistant Staphylococcus aureus MRSA. The SCC mec type IV was the most dominant among SCCmec genotypes of MRSA strains that were isolated from hospitals in the present study. Recommandation: Vancomycin resistant staphylococcus aureas (VRSA) should be taken in consideration when we are working with hospital cross infection. Further studies on large scale should be performed in order to study MRSA in the whole country. Antibiotic prescribing policy should be put under observation and guidenece inside and outside hospitals.

Countrywide dissemination of a DHA-1-type plasmid-mediated AmpC β-lactamase-producing Klebsiella pneumoniae ST11 international high-risk clone in Hungary, 2009–2013

The first plasmid-mediated AmpC β-lactamase-producing Klebsiella pneumoniae (pAmpC KP) isolate was detected in December 2009 in Hungary. Hungarian microbiological laboratories were asked to send all KP strains showing cefoxitin resistance and decreased susceptibility or resistance to any third-generation cephalosporins to the Reference Laboratories at the National Center for Epidemiology. Investigation was conducted in order to outline spatio-temporal distribution and genetic characterization of pAmpC-KP isolates in Hungary. Between December 2009 and December 2013, 312 consecutive KP clinical isolates were confirmed as producing pAmpCs. All isolates showed resistance to third-generation cephalosporins, aminoglycosides and fluoroquinolones, and 77 % were non-susceptible to at least one carbapenem. Analysis of β-lactamase genes showed blaDHA-1 in all and additionally blaCTX-M-15 in 90 % of isolates. PFGE typing revealed 12 pulsotypes; of these, KP053 (262/312) and KP070 (38/312) belonged to sequence type ST11 and comprised 96 % of the isolates. The blaDHA-1 and blaCTX-M-15 co-producing KP053/ST11 clone affected 234 patients and spread to 55 healthcare centres across Hungary during the study period. Three KP053 isolates were also resistant to colistin. In two of these, the mgrB gene was truncated by IS10R, while in the third isolate, insertional inactivation of mgrB by ISKPn14 was identified. Hungary is the first European country showing endemic spread of blaDHA-1 facilitated by the international high-risk clone ST11. The rapid countrywide spread of this multidrug-resistant clone seriously endangers Hungarian healthcare facilities and warrants strengthening of infection control practices and prudent use of carbapenems and colistin.

Emergence of co-production of plasmid-mediated AmpC beta-lactamase and ESBL in cefoxitin-resistant uropathogenic Escherichia coli.

Plasmid-mediated AmpC (pAmpC) and ESBL co-production was detected in Escherichia coli a major etiologic agent of urinary tract infection. Isolates resistant to cefoxitin by CLSI methodology were tested for pAmpC beta-lactamase using phenylboronic acid and ESBLs by combined disk diffusion method. pAmpC/ESBL genes were characterized by PCR and sequencing. Transconjugation experiments were done to study the transfer of pAmpC and ESBL production from clinical isolates as donor to E. coli J53 AziR as recipient. Incompatibility groups of transmissible plasmids were classified by PCR-based replicon typing (PBRT). Among 148 urine culture positive isolates, E. coli was reported in 39.86% (59/148), with 93.22% (55/59) of cefoxitin resistance. pAmpC production was detected in 25, with varied distribution of blaCMY-2 and blaDHA-1type genes alone (n = 13 and 7 respectively) or in combination (n = 5). ESBL co-production was observed in 88% (22/25) of pAmpC producing isolates with predominance of blaTEM (n = 20). Twenty-three transconjugants showed transmission of pAmpC-and ESBL-resistant genes with co-carriage of blaCMY-2 and blaTEM (n = 15) in plasmids of IncF type (n = 9) being predominant, followed by IncI1 (n = 4) and IncH1 (n = 2) in combination. All clinical isolates were clonally diverse. Resistance against different beta-lactams in uropathogenic E. coli has been an emerging concern in resource- poor countries such as India. Knowledge on the occurrence of AmpC beta-lactamases and ESBL amongst this pathogen and its transmission dynamics may aid in hospital infection control.

Detection of AmpC β-lactamase producing bacteria isolated in neonatal sepsis.

Objective:The objective of this study was to determine the occurrence and antimicrobial profile of AmpC β-lactamase producing bacteria.Methods:The study was conducted at The Children’s Hospital and The Institute of Child Health Lahore, Pakistan, during September 2011 to June 2012. A total number of 1,914 blood samples of suspected neonatal septicemia were processed. Isolates were identified using Gram’s staining, API 20E and API 20NE tests. Gram negative isolates were screened for AmpC β-lactamase production against ceftazidime, cefotaxime and cefoxitin resistance and confirmed by inhibitor based method.Results:Total number of 54 (8.49%) Gram positive and 582 (91.5%) Gram negative bacteria were identified. Among Gram negative isolates 141 (22%) were AmpC producers and found to be 100% resistant to co-amoxiclav, cefoxitin, ceftazidime, cefotaxime, cefuroxime, cefixime, ceftriaxone, cefpodoxime, gentamicin, amikacin and aztreonam. Less resistance was observed against cefepime (30.4%), sulbactam-cefoperazone (24.8%), piperacillin-tazobactam (10.6%), ciprofloxacin (20.5%) and meropenem (2.1%). All the isolates were found sensitive to imipenem. The patients harbored AmpC β-lactamases were on various interventions in which intravenous line was noted among (51.1%), naso-gastric tube (37.6%), ambu bag (8.5%), endotracheal tube (3.5%), ventilator (2.1%) and surgery (0.7%).Conclusion:Extensive use of invasive procedures and third generation cephalosporins should be restricted to avoid the emergence of AmpC beta-lactamases in neonates.

Frequency of Plasmid-Mediated AmpC β-Lactamases in Escherichia coli Isolates from Urine Samples in São Paulo, Brazil.

Plasmid-mediated AmpC β-lactamases (PMACBLs) in Enterobacteriaceae encode resistance to third-generation cephalosporins, and these can mediate carbapenem resistance when associated with porin loss. However, no standardized phenotypic method is available for detecting these enzymes in the clinical microbiology laboratory. Limited data are available concerning the frequency of PMACBLs in Enterobacteriaceae in Brazil. This study was conducted in response to an increased cefoxitin (CFO) resistance rate of 3.7% in Escherichia coli isolates from urine samples from patients with suspected urinary tract infections during 2010. We collected 2,266 E. coli isolates prospectively during January 2012. A total of 109 (4.8%) isolates were nonsusceptible to CFO. These strains were further examined using multiplex PCR for the presence of genes encoding PMACBLs and using inhibitor assays with CFO and ceftazidime (CAZ) disks with and without phenylboronic acid. Pulsed-field gel electrophoresis was used to evaluate clonal dissemination. Genes encoding PMACBLs were detected in 1.8% of the isolates from inpatients and 0.46% of isolates from outpatients. The most prevalent gene was blaCMY-2 and blaCMY-4 was also detected. The phenotypic analysis showed 100% sensitivity and specificity for CMY-2 and CMY-4 when CFO-resistant isolates with a minimum zone diameter difference of 5 mm for CAZ or CAZ and CFO were considered positive. Although most of the isolates were nonclonal, one clonal group with two isolates was observed. Thus, the most frequent PMACBL in E. coli from São Paulo, Brazil is CMY-2, and both clonal and plasmid-mediated dissemination occur.

Aerobic bacterial profile and antibiotic resistance in patients with diabetic foot infections

This study aimed to determine the frequencies of bacterial isolates cultured from diabetic foot infections and assess their resistance and susceptibility to commonly used antibiotics. This prospective study included 41 patients with diabetic foot lesions. Bacteria were isolated from foot lesions, and their antibiotic susceptibility pattern was determined using the Kirby-Bauer disk diffusion method and/or broth method [minimum inhibitory concentration (MIC)]. The most common location of ulceration was the toe (54%), followed by the plantar surface (27%) and dorsal portion (19%). A total of 89 bacterial isolates were obtained from 30 patients. The infections were predominantly due to Gram-positive bacteria and polymicrobial bacteremia. The most commonly isolated Gram-positive bacteria were Staphylococcus aureus, followed by Staphylococcus saprophyticus, Staphylococcus epidermidis, Streptococcus agalactiae, and Streptococcus pneumoniae. The most commonly isolated Gram-negative bacteria were Proteus spp. and Enterobacterspp., followed by Escherichia coli, Pseudomonasspp., and Citrobacterspp. Nine cases of methicillin-resistant Staphylococcus aureus (MRSA) had cefoxitin resistance, and among these MRSA isolates, 3 were resistant to vancomycin with the MIC technique. The antibiotic imipenem was the most effective against both Gram-positive and Gram-negative bacteria, and gentamicin was effective against Gram-negative bacteria. The present study confirmed the high prevalence of multidrug-resistant pathogens in diabetic foot ulcers. It is necessary to evaluate the different microorganisms infecting the wound and to know the antibiotic susceptibility patterns of the isolates from the infected wound. This knowledge is crucial for planning treatment with the appropriate antibiotics, reducing resistance patterns, and minimizing healthcare costs.

Antibiotic Resistance Profile in Relation to Phylogenetic Background in Escherichia coli Isolated From Fecal Samples of Healthy Ostrich

Background: E. coli is regarded as a reservoir for antibiotic resistance in foods of animal origin. E. coli can be categories into four main phylogenetic groups (A, B1, B2 and D). The commensal E. coli strains mostly are assigned to the phylo-groups A and B1. Objectives: The purposes of this study were to determine the phylogenetic group/subgroups and antibiotic resistance patterns of ostrich E. coli isolates in Iran. Materials and Methods: A total of 126 E. coli isolates were obtained from cloacae swabs of the healthy ostrich in Kerman, Iran. The E. coli isolates were confirmed using biochemical API 20E identification system. The confirmed isolates were studied to determine phylogenetic background by PCR. The isolates were tested for antibiotic resistance against 12 different antibiotic disk by disk diffusion method. Results: Phylotyping of E. coli isolates indicated that 74 isolates belonged to A, 27 isolates to B1, 7 isolates to B2, and 18 isolates to D groups. Also the isolates fell into six phylogenetic subgroups, including 34 isolates in A 0 , 40 isolates in A 1 , one isolate in B2 2 , 6 isolates in B2 3 , 11 isolates in D 1 and 7 isolates in subgroup D 2 . In the examined E. coli isolates, the maximum rate of resistance was against tetracycline, and the minimum rate of resistance was against amoxicillin. Twenty three antibiotic resistance patterns were detected among the isolates. The cefoxitin and tetracycline resistance pattern was the most prevalent in the isolates that belonged to phylo-group A. Conclusions: In conclusion, the result of the present study revealed a low frequency of antibiotic resistance in ostrich E. coli isolates. The antibiotic resistance patterns were in relation to A and D phylogenetic groups. Further studies are needed to better understand the distribution of phylogenetic groups in poultry isolates.

Molecular characterization and epidemiology of cefoxitin resistance among Enterobacteriaceae lacking inducible chromosomal ampC genes from hospitalized and non-hospitalized patients in Algeria: description of new sequence type in Klebsiella pneumoniae isolates

In this study, 922 consecutive non-duplicate clinical isolates of Enterobacteriaceae obtained from hospitalized and non-hospitalized patients at Bejaia, Algeria were analyzed for AmpC-type β-lactamases production. The ampC genes and their genetic environment were characterized using polymerase chain reaction (PCR) and sequencing. Plasmid incompatibility groups were determined by using PCR-based replicon typing. Phylogenetic grouping and multilocus sequence typing were determined for molecular typing of the plasmid-mediated AmpC (pAmpC) isolates.Of the isolates, 15 (1.6%) were identified as AmpC producers including 14 CMY-4-producing isolates and one DHA-1-producing Klebsiella pneumoniae. All AmpC-producing isolates co-expressed the broad-spectrum TEM-1 β-lactamase and three of them co-produced CTX-M and/or SHV-12 ESBL. Phylogenetic grouping and virulence genotyping of the E. coli isolates revealed that most of them belonged to groups D and B1. Multilocus sequence typing analysis of K. pneumoniae isolates identified four different sequence types (STs) with two new sequences: ST1617 and ST1618. Plasmid replicon typing indicates that blaCMY-4 gene was located on broad host range A/C plasmid, while LVPK replicon was associated with blaDHA-1. All isolates carrying blaCMY-4 displayed the transposon-like structures ISEcp1/ΔISEcp1-blaCMY-blc-sugE.Our study showed that CMY-4 was the main pAmpC in the Enterobacteriaceae isolates in Algeria.

Phenotypic detection of MBL, Ampc beta-lactamase and carbapenemases in multi drug resistant isolates ofAcinetobacter baumannii

Introduction: Acinetobacter baumannii is one of the major pathogens causing nosocomial infections due to emergence of resistance to various antimicrobial agents. Resistance due to antimicrobial degrading enzymes is now a worldwide problem and a major reason of concern for the treating physicians. Keeping this in mind, the present study was designed to isolate Acinetobacter baumannii and study various antimicrobial resistance mechanisms in them. Materials and methods: A total of 50 A.baumannii isolates from various clinical samples were screened for meropenem resistance for the detection of Carbapenemase and MBL production. Carbapenemase production was confirmed by Modified Hodge Test whereas MBL by Disk Potentiation Test. Cefoxitin resistance was used as a screening test for AmpC beta-lactamase production which was confirmed by AmpC disk test. Results: Maximum isolation of A.baumannii was found in patients admitted in the Intensive care unit with respiratory tract infection. Among the 50 A.baumannii strains, Carbapenemase production was observed in 26.4%, MBL production in 52.9% and AmpC beta lactamase production in 56%. Conclusion: Our study emphasizes on multi-drug resistant A.baumannii highlighting the antibiotic crisis as a result of emergence of various bacteria that show resistance to various antibiotics. Acinetobacter epitomises this trend, as it is an important nosocomial pathogen with a capability of cross-infection particularly in ICUs and a grave limitation of treatment options, thus, requiring an urgent need to control the spread of MDR strains in the hospitals.

Increased expression levels of chromosomal AmpC β-lactamase in clinical Escherichia coli isolates and their effect on susceptibility to extended-spectrum cephalosporins.

Forty-nine clinical Escherichia coli isolates, both extended-spectrum β-lactamase (ESBL) negative and ESBL positive, were studied to investigate whether increased AmpC expression is a mechanism involved in cefoxitin resistance and if this influences the third-generation cephalosporin activity. Nine of 33 (27.2%) cefoxitin-resistant (minimum inhibitory concentration [MIC] >8 mg/L) isolates showed hyperproduction of chromosomal AmpC (c-AmpC) based on (1) at least two positive tests using AmpC inhibitors, (2) mutations in the promoter/attenuator regions, and (3) a 6.1- to 163-fold increase in c-ampC expression by quantitative reverse transcription-polymerase chain reaction. In ESBL-negative isolates, MICs of ceftazidime and cefotaxime were mostly above the wild-type (WT) level, but below the S/I breakpoint (EUCAST guideline), except for one isolate with MICs of 4 mg/L. No plasmid-mediated AmpCs were found. Periplasmic extracts of nine c-AmpC hyperproducers were preincubated with or without cefuroxime or ceftazidime and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Cefuroxime and ceftazidime were stable to hydrolysis but acted as inhibitors of the enzyme. None of these isolates showed loss of porins. Thus, cefoxitin resistance has low specificity for detecting upregulated c-AmpC production. c-AmpC hyperproducing E. coli is mostly still susceptible to third-generation cephalosporins but less than WT E. coli. Surveillance of cefoxitin-resistant E. coli to monitor developments in the activity of third-generation cephalosporins against c-AmpC hyperproducers is warranted.

Characterization of methicillin-resistant coagulase-negative staphylococci in milk from cows with mastitis in Brazil.

Staphylococci are one of the most prevalent microorganisms in bovine mastitis. Staphylococcus spp. are widespread in the environment, and can infect animals and humans as opportunistic pathogens. The objective of this study was to determine the frequency of methicillin-resistance (MR) among coagulase-negative staphylococci (CoNS) previously obtained from milk of mastitic cows in Brazil and to characterize the antimicrobial resistance phenotype/genotype and the SCCmec type of MRCoNS isolates. Identification of MRCoNS was based on both biochemical and molecular methods. Susceptibility testing for eleven antimicrobials was performed by disk-diffusion agar. Antimicrobial resistance genes and SCCmec were investigated by specific PCRs. Twenty-six MRCoNS were detected (20% of total CoNS), obtained from 24 animals, and were identified as follows: S. epidermidis (7 isolates), S. chromogenes (7), S. warneri (6), S. hyicus (5) and S. simulans (1). All MRCoNS isolates carried mecA while the mecC gene was not detected in any CoNS. The SCCmec IVa was demonstrated in nine MRCoNS, while the remaining 17 isolates harbored non-typeable SCCmec cassettes. In addition to oxacillin and cefoxitin resistance, MRCoNS showed resistance to tetracycline (n=7), streptomycin (n=6), tobramycin (n=6), and gentamicin (n=4), and harbored the genes tet(K) (n=7), str (n=3), ant(4') (n=6) and aac(6')-aph(2″) (n=4), respectively. In addition, seven strains showed intermediate resistance to clindamycin and two to streptomycin, of which two harboured the lnu(B) and lsa(E) genes and two the aad(E) gene, respectively. One isolate presented intermediate erythromycin and clindamycin resistance and harbored an erm(C) gene with an uncommon 89-bp deletion rendering a premature stop codon. MRCoNS can be implicated in mastitis of cows and they constitute a reservoir of resistance genes that can be transferred to other pathogenic bacteria.

Detection of a new mecC allotype, mecC2, in methicillin-resistant Staphylococcus saprophyticus

Detection of a new mecC allotype, mecC2, in methicillin-resistant Staphylococcus saprophyticus

Epidemiology and molecular characterization of methicillin-resistant Staphylococcus aureus nasal carriage isolates from bovines.

BackgroundStaphylococcus aureus is a common bacterium usually found on skin and mucous membranes of warm blooded animals. Resistance in S. aureus has been increasingly reported though depending on the clonal lineage. Indeed, while hospital acquired (HA)-methicillin resistant S. aureus (MRSA) are typically multi-resistant, community associated (CA)-MRSA are by large more susceptible to many antibiotics. Although S. aureus isolated from animals are often susceptible to most antibiotics, multi-resistant livestock associated (LA)-MRSA have been recovered from bovine mastitis.In this study, we investigated the prevalence and types of MRSA present in the nose of healthy bovines of different age groups and rearing practices. Since no validated methods for MRSA isolation from nasal swabs were available, we compared two isolation methods. Molecular characterization was performed by means of spa-typing, MLST, SCCmec typing and microarray analysis for the detection of antimicrobial resistance and virulence genes.ResultsMRSA between herd prevalence in bovines was estimated at 19.8%. There was a marked difference between rearing practices with 9.9%, 10.2% and 46.1% of the dairy, beef and veal calve farms respectively being MRSA positive. No significant difference was observed between both isolation methods tested. Most isolates were ST398 spa type t011 or closely related spa types. Few ST239 spa type t037 and t388 and ST8 spa type t121 were also found. SCCmec types carried by these strains were mainly type IV(2B), IV(2B&5) and type V. Type III and non-typeable SCCmec were recovered to a lesser extent. All isolates were multi-resistant to at least two antimicrobials in addition to the expected cefoxitin and penicillin resistance, with an average of resistance to 9.5 different antimicrobials. Isolates selected for microarray analysis carried a broad range of antimicrobial resistance and virulence genes.ConclusionMRSA were mainly present in veal farms, compared to the lower prevalence in dairy or beef farms. Multi-resistance in these strains was high. Though mainly CC398 spa t011 was found, the genetic diversity was higher than what was found for pigs in Belgium. CC8 strains, a typically human lineage but also recently found also in association with bovines, has been retrieved here also.

Prevalence of plasmid-mediated AmpC β-lactamases inEscherichia coliandKlebsiella pneumoniaeat tertiary care hospital of Islamabad, Pakistan

Enterobacteriaceae produces AmpC β-lactamases that make them resistant to commonly used antibiotics. AmpC β-lactamases can be chromosomal-mediated or plasmid-mediated AmpC β-lactamases (PABLs). The present study was undertaken to determine the occurrence of PABLs production in clinical isolates in Escherichia coli and Klebsiella pneumoniae. Among 1328 culture positive samples, 511 isolates were identified as E. coli (81.02%, n = 414) and K. pneumonia (18.98%, n = 97). Cefoxitin resistance was observed in E. coli (19.57%, n = 81) and K. pneumoniae (22.68%, n = 22). Out of these cefoxitin resistant isolates, 40.74% (n = 33) E. coli and 54.55% (n = 12) K. pneumoniae came out to be PABL producers. Prevalence of both PABLs and ESBLs in E. coli and K. pneumoniae was 29.24% (n = 8) and 47% (n = 5), respectively. Isolates coproducing PABLs and ESBL exhibited increased minimum inhibitory concentrations (MICs) for selected cephalosporins. This study documented a high frequency of PABLs producing isolates from hospital which may lead to serious therapeutic problem.

Escherichia coli ve Klebsiella pneumoniae Kan Kültürü İzolatlarında Plazmid Aracılı AmpC Beta-Laktamaz Varlığının Araştırılması

The aim of this study was to investigate the prevalence and types of plasmid-mediated AmpC (pAmpC) beta-lactamase enzymes in Escherichia coli and Klebsiella pneumoniae strains isolated from blood cultures of hospitalized patients in Dokuz Eylul University Hospital between 2007 and 2012. A total of 261 isolates which consisted of 184 E.coli (70.5%) and 77 K.pneumoniae (29.5%) were included in the study. All isolates were resistant to cefotaxime and/or ceftazidime but susceptible to imipenem. Cefoxitin resistance was investigated as an indicator of AmpC type enzymes. A total of 57 (21.8%) isolates which were cefoxitin-resistant (32 E.coli, 25 K.pneumoniae), were screened for pampC genes by a multiplex polymerase chain reaction (PCR) assay. Additionally, 10 of each cefoxitin susceptible isolates per year were chosen randomly and screened by the same PCR assay to detect the presence of ACC enzymes, which can not hydrolyze cefoxitin. Positive PCR results were confirmed by sequence analysis. Plasmid analysis and macrorestriction analysis were performed for pampC-positive isolates. The presence of pAmpC enzymes has been shown in 9.4% (3/32) of cefoxitin-resistant E.coli, and 8% (2/25) of cefoxitin-resistant K.pneumoniae strains. It was noted that there were no strains producing this enzyme isolated in 2007 and 2008, however the prevalence of pAmpC was detected as 1.6% in 2009 (one ACT-1 producing K.pneumoniae), increasing to 4.8% in 2011 (one ACT-1 producing K.pneumoniae) and 6.4% in 2012 (three CMY-2 producing E.coli). These enzymes were found to be carried on 81 kb size plasmids in K.pneumoniae isolates and on a 9 kb size plasmid in E.coli isolates. Macrorestriction analysis indicated that two of the three CMY-2 producing E.coli had the same PFGE (Pulsed-field gel electrophoresis) pattern. If these two strains are considered as identical, it can be concluded that the prevalence of pAmpC was low in the strains isolated between 2007-2012 (4/261; 1.5%) in our institution. On the other hand, the increasing prevalence of pAmpC in 2011 and 2012 should be considered as a warning for the implementation of infection control measures and monitorization of the prevalence in order to prevent the dissemination of pAmpC. As far as the current literature is concerned, this is the first study that demonstrated the presence of the ACT-1 enzyme in K.pneumoniae isolates in Turkey.

Phenotypic detection of Extended Spectrum Beta-Lactamases and Amp C Beta- Lactamases among nosocomial isolates in a tertiary care hospital

Background & objectives: Extended-Spectrum Beta-Lactamases (ESBLs) is an important resistance mechanism in Enterobacteriaceae infections. Lack of standard guidelines from Clinical Laboratory Standards Institute (CLSI) for Amp C beta-lactamase detection poses a problem. This study was undertaken to detect ESBLs by phenotypic tests and Amp C beta-lactamase by inhibitor based method. Material and Methods: 200 consecutive non-repetitive isolates of E.coli, Klebsiella and Proteus from clinical samples were screened for ESBLs as per CLSI guidelines and confirmed by PCDT, DDST and E-tests (AB Biodisk, Biomerieux). Amp C beta lactamases were screened by cefoxitin resistance and confirmed by inhibitor (Cloxacillin) based method. Simultaneous occurrence of Amp C and ESBLs was detected by combined disk test (Neo-Sensitabs and Diatabs). Descriptive and Kappa statistics were used. Results: Out of 200 isolates studied, 131 were initially screened as ESBL producers and later 114 (57%) were confirmed by phenotypic methods. E-Test was found most sensitive phenotypic test as compared to PCDT and DDST. 13 strains resistant to cefoxitin (30?g) were found to be pure Amp C producers. Combined disk test detected 36 to be ESBL and Amp C co-producers. Surprisingly, six isolates found sensitive to cefoxitin disk were confirmed as Amp C producers by cloxacillin disk inhibition test. Conclusion: 57% ESBLs and 27.5% Amp C producers were isolated from nosocomial pathogens showing significant resistance to 3rd generation cephalosporins. Phenotypic confirmation by E-test, PCDT & DDST were useful for ESBL identification and for detection of Amp C, cloxacillin was found to be an effective inhibitor. DOI: http://dx.doi.org/10.3329/bjms.v12i4.13309 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 378-384

Phenotypic detection of plasmid-acquired AmpC in Escherichia coli—evaluation of screening criteria and performance of two commercial methods for the phenotypic confirmation of AmpC production

The phenotypic detection of plasmid-acquired AmpC (pAmpC) in Escherichia coli is challenging, and molecular methods are required for confirmation. In addition to cefoxitin resistance, multiresistance and high-level resistance to cephalosporins have both been suggested as criteria for targeting isolates with pAmpC, but data to support these proposed criteria are lacking. A Swedish collection of 378 isolates with either putative chromosomal hyperproduction of AmpC (cAmpC) or pAmpC were subjected to disk diffusion and minimum inhibitory concentration (MIC) determination with the Etest. The frequency of resistance to gentamicin, ciprofloxacin, and trimethoprim among cAmpC and pAmpC was compared to elucidate the issue of multidrug resistance. Lastly, methods for the phenotypic confirmation of pAmpC were compared. One in-house disk diffusion method, one method employing NeoSensitabs (Rosco), and one Etest method (bioMérieux) were compared. The analysis of histograms based on both disk diffusion and the Etest showed that resistance [according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST)] to cefotaxime and/or ceftazidime occurred in almost all isolates. By coining resistance instead of non-susceptibility, the number of isolates required to subject to phenotypic testing/genotypic confirmation dropped by more than 40 %, without compromising the sensitivity substantially. Further, almost 70 % of isolates with pAmpC were non-multidrug resistant, clearly indicating that this is an inappropriate criterion for further investigation. The phenotypic tests all had more than 90 % sensitivity, and the best sensitivities were obtained with the in-house method and with the ceftazidime ± cloxacillin NeoSensitab. In conclusion, clinical resistance to cefotaxime and/or ceftazidime seems to be an appropriate criterion for pAmpC screening, and several phenotypic methods perform well for the phenotypic confirmation of AmpC production prior to genotypic confirmation.

The prevalence of antibiotic resistance genes in Bacteroides fragilis group strains isolated in different European countries

From the 2008–2009 European Bacteroides antibiotic resistance survey, we selected 161 strains for detection of antibiotic resistance genes (cepA, cfxA, cfiA, nim, ermB, ermF, ermG, linA, mefA, msrSA, tetM, tetQ, tetX, tetX1, tet36 and bexA). To facilitate the throughput, the genes were detected by Real-Time PCR. The presence of the genes was correlated with the known MIC data of the strains for the appropriate antibiotics. For the β-lactams, the cepA gene was found in 70.8% of the tested strains (all resistant to ampicillin), but its presence did not correlate with the ampicillin MIC values. The cepA gene occurred at different frequencies among Bacteroides fragilis and non-fragilis Bacteroides strains. The cfxA gene was not a major factor in determining cefoxitin resistance and it was found with higher prevalence in non-fragilis Bacteroides strains than in B. fragilis. Among the five possible clindamycin resistance genes, ermF was the most common and had the highest effect on clindamycin resistance after linA. The ermG-mefA-msrSA combination was found in a set of strains and their linked occurrence implied that they were harbored by the conjugative transposon CTnGERM1. All strains tested were susceptible to metronidazole and none of them harbored nim genes. TetQ was prevalent among both the B. fragilis and non-fragilis Bacteroides strains (78.9 and 84.8%, respectively) and no gene could be clearly linked to tigecycline resistance other than tetQ. BexA, which codes for the fluoroquinolone efflux pump, was found in 7.5% of strains and occurred at different frequencies among B. fragilis and non-fragilis Bacteroides strains, but was represented only in a minor proportion of moxifloxacin-resistant strains.

Characteristics of ciprofloxacin and cephalosporin resistant Escherichia coli isolated from turkeys in Great Britain

1. A field study was performed to investigate the presence and characteristics of ciprofloxacin-resistant, extended spectrum β-lactamase (ESBL) and AmpC Escherichia coli from turkeys in Great Britain. E. coli were isolated from ∼9000 boot swab samples from 27 different farms owned by four different companies. Between 1 and 14 visits were made to each farm (mean 3) at between 0 and 15 m intervals (mean ∼ 5 m). 2. CHROMagar ECC with and without ciprofloxacin or cephalosporin antibiotics was used as selective isolation media. Representative isolates with different phenotypes were tested for mutations in gyrA and for: qnrA, B, S, qepA and aac(6′)-Ib genes, for ESBL phenotype, the presence of bla CTX-M genes and plasmid type, and for ampC genes. Representative ciprofloxacin-resistant and CTX-M isolates were further tested for serotype and PFGE type. On ciprofloxacin selective media 55% of samples yielded ciprofloxacin resistant E. coli and of those further analysed, most had ciprofloxacin MICs >4 mg/l and mutations in gyrA. 3. For the different companies, the mean number of samples per farm with cefoxitin- or cefotaxime-resistant isolates ranged from 1·0% to 61·9% and 4·7% to 31·7% respectively. Cefotaxime-resistance was most commonly associated with an ESBL phenotype, a CTX-M-1 or CTX-M-14 sequence type and an I1-γ or K plasmid inc type. The mechanism of cefoxitin resistance was not determined for most isolates, but where determined it was bla CMY-2. 4. PFGE and serotyping showed clonally-related isolates persisting over multiple visits suggesting both more prudent use of antibiotics and improved farm hygiene are needed to address the issue of antimicrobial resistance in isolates from turkeys.

Comparison of various methods for detection of AmpC β-lactamase enzyme

Fifty multidrug-resistant bacterial isolates were tested for extended-spectrum β-lactamase (ESBL) and AmpC β-lactamase enzyme production. Cefoxitin (30 μg) resistance was used as the screening test for AmpC enzyme detection. Phenotypic confirmation was done by conventional three-dimensional enzyme extract test (TDET), AmpC disc test and modified three-dimensional test (MDT). A total of 45 (90%) strains were AmpC positive by the screening test. Out of these 45 strains, 40 strains were positive by AmpC disc test, 39 strains by TDET and 38 strains by MDT. Cefoxitin resistance can be used as the screening test. AmpC disc test is simple to perform and gives rapid result. So, it can be used as a phenotypic method for detection of AmpC enzyme production in resource-limited settings where genotypic detection methods are not available.