Mechanisms of carbapenem resistance among a collection of Enterobacteriaceae clinical isolates in a Texas city.
ABSTRACT Fourteen Enterobacteriaceae isolates with ertapenem MIC >2 mg/mL were analyzed to identify mechanisms of resistance. All isolates produced extended-spectrum beta-lactamase or AmpC beta-lactamase with variable, but decreased, expression of outer membrane proteins. One Enterobacter cloacae produced derepressed AmpC beta-lactamase, 1 Escherichia coli expressed plasmid-mediated AmpC beta-lactamase, and 1 E. cloacae produced a carbapenemase.
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ABSTRACT: Enterobacteriaceae other than Escherichia spp. and Klebsiella spp. are recognisable for their increasing resistance. Plasmid-mediated beta-lactamases, including extended-spectrum beta-lactamases (ESBLs), plasmid-mediated AmpC beta-lactamases (pAmpCs) and the newly emerged KPC, play an important role in beta-lactam resistance. In this study, we investigated the genetic characteristics of plasmid-mediated beta-lactamases amongst non-Escherichia, non-Klebsiella Enterobacteriaceae that were non-susceptible to at least a broad-spectrum cephalosporin. A total of 143 (23.9%) of 598 isolates during the 6-month study period met the screening criteria, amongst which 142 (99.3%) and 99 (69.2%) isolates carried ESBL and pAmpC genes, respectively. Resistance genotypes were described. bla(KPC) was not detected in isolates with reduced susceptibility to carbapenems. This study provides an insight into plasmid-mediated resistance determinants amongst cephalosporin-non-susceptible Enterobacteriaceae other than Escherichia spp. and Klebsiella spp.International journal of antimicrobial agents 10/2010; 36(4):343-7. · 3.03 Impact Factor
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ABSTRACT: To investigate the in vitro susceptibilities to various carbapenems amongst clinical Gram-negative bacteria isolated from patients in intensive care units of ten major teaching hospitals in Taiwan in 2009, a survey was conducted to determine the minimum inhibitory concentrations (MICs) of ertapenem, imipenem, meropenem and doripenem against isolates of Enterobacteriaceae (n=594), Pseudomonas aeruginosa (n=185), Acinetobacter baumannii (n=192) and Burkholderia cepacia (n=23) using the agar dilution method. Susceptibilities were determined according to 2009, 2011 and 2012 MIC breakpoints recommended by the CLSI as well as 2012 MIC breakpoints recommended by EUCAST. Based on CLSI 2012 criteria, the ertapenem susceptible rate was 93%, 81%, 68% and 92% for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae and Serratia marcescens, respectively. All Proteus mirabilis and Morganella morganii isolates were susceptible to ertapenem; however, 64% of P. mirabilis and all M. morganii isolates were non-susceptible to imipenem. Meropenem and doripenem had better activities than imipenem against ertapenem-non-susceptible Enterobacteriaceae isolates. E. coli, K. pneumoniae and E. cloacae with ertapenem MICs≥4mg/L were synchronously not susceptible to imipenem, meropenem and doripenem. Imipenem susceptibility was 65% and 29% for P. aeruginosa and A. baumannii, respectively. Additionally, P. aeruginosa and A. baumannii isolates with imipenem MICs≥8mg/L were also not susceptible to meropenem and doripenem. These data provide a better understanding of choosing appropriate carbapenem agents to treat infections caused by ertapenem-non-susceptible Enterobacteriaceae as well as P. aeruginosa and A. baumannii isolates with imipenem MICs≥4mg/L.International journal of antimicrobial agents 03/2013; · 3.03 Impact Factor
Article: CTX-M Enzymes: Origin and Diffusion.[show abstract] [hide abstract]
ABSTRACT: CTX-M β-lactamases are considered a paradigm in the evolution of a resistance mechanism. Incorporation of different chromosomal bla(CTX-M) related genes from different species of Kluyvera has derived in different CTX-M clusters. In silico analyses have shown that this event has occurred at least nine times; in CTX-M-1 cluster (3), CTX-M-2 and CTX-M-9 clusters (2 each), and CTX-M-8 and CTX-M-25 clusters (1 each). This has been mainly produced by the participation of genetic mobilization units such as insertion sequences (ISEcp1 or ISCR1) and the later incorporation in hierarchical structures associated with multifaceted genetic structures including complex class 1 integrons and transposons. The capture of these bla(CTX-M) genes from the environment by highly mobilizable structures could have been a random event. Moreover, after incorporation within these structures, β-lactam selective force such as that exerted by cefotaxime and ceftazidime has fueled mutational events underscoring diversification of different clusters. Nevertheless, more variants of CTX-M enzymes, including those not inhibited by β-lactamase inhibitors such as clavulanic acid (IR-CTX-M variants), only obtained under in in vitro experiments, are still waiting to emerge in the clinical setting. Penetration and the later global spread of CTX-M producing organisms have been produced with the participation of the so-called "epidemic resistance plasmids" often carried in multi-drug resistant and virulent high-risk clones. All these facts but also the incorporation and co-selection of emerging resistance determinants within CTX-M producing bacteria, such as those encoding carbapenemases, depict the currently complex pandemic scenario of multi-drug resistant isolates.Frontiers in Microbiology 01/2012; 3:110.