The objectives of the present work were: i) to assess the rates of antibiotic resistance of Salmonella Typhimurium isolates from various regions of Greece, during the period 1989-1997, ii) to investigate the genotypic variability and relationships among isolates belonging to various resistance phenotypes and sources of origin, iii) to study the mechanisms of resistance of multirésistant isolates, and iv) to investigate the presence of extended spectrum ß-lactamases in ß-lactam-resistant isolates..
Initially, the resistance rates of 328 S. Typhimurium isolates to seventeen antibiotics of various classes were determined. Resistance rates to the majority of antibiotics had significantly increased during the period 1989-1996, while, during the last year of the study, the resistance rates seemed to remain stable or decline. The most frequent among the 26 observed resistance phenotypes was streptomycin/ sulfonamides. Furthermore, since 1993, a significant increase in the number of multi-resistant isolates (resistance to three or more antibiotics of different classes) was observed, particularly those with the “core” pattern of resistance to ampicillin, chloramphenicol, streptomycin, sulfonamides and tetracycline (ACSSuT-isolates), which were compatible with the multirésistant phage type DTI04.
Fourteen ACSSuT-isolates were selected for further analysis by pulsed field gel electrophoresis (PFGE), and for investigation of their mechanisms of resistance to antibiotics by the polymerase chain reaction. Eleven of the 14 isolates belonged to the phage type DTI04, two to the closely related phage type DTI04b, and one to phage type DTI 93. PFGE discerned six distinct types, A-F. Six isolates belonged to PFGE type A, while the remaining belonged to the PFGE types B (two isolates), C (two), D (two), E (one) and F (one). A variety of type I intégrons were detected among the DTI 04 isolates. The majority harbored the antibiotic resistance genes pse-1 and aadA, which encoded resistance to ampicillin and streptomycin, respectively. Some remaining non-integron associated isolates possessed tern-1, instead of pse-1.
The chromosomal fingerprints of 231 isolates belonging to the various resistance phenotypes, were generated by PFGE. Twenty-six distinct PFGE types were detected. A total of 78.5% of the isolates belonged to the three PFGE types A, B and C. These occurred across the entire range of resistance phenotypes and sources of origin, contrary to, for example, type L, which was present only among susceptible isolates, or type O, present only among non-human isolates. PFGE type A, major among detected types, was more frequent among multi-resistant isolates compared to the
susceptible or to streptomycin and/or sulfonamides resistant isolates. Conversely, PFGE types B and C were more common among the susceptible and the streptomycin and/or or sulfonamides resistant isolates. Seven PFGE types were unique for isolates not directly involved in the human food chain, but originated for example, from pets or the environment. In general, there was greater genetic variability among isolates of non-human origin compared to those of human origin.
Finally, resistance to third generation cephalosporins (cefotaxime and ceftriaxone) and also to the amoxycillin/clavulanate combination was observed in a clinical isolate of 1996. In this isolate, an enzyme with isoelectric point 8.4 was found, and its corresponding gene was sequenced. Nucleotide sequencing determined that this β- lactamase belonged to the CTX-M family, and was nominated CTX-M-6.
In conclusion, increasing resistant rates to most antibiotics were observed, which remained stable or declined during the last year of the study. At least six genotypically distinct clones with differing chromosomal backgrounds and mechanisms of resistance to antibiotics were involved in multi-drug resistant DTI04. Although the majority of the examined population was composed of three genomic types, some minor types were related to specific resistance phenotypes or isolates from a specific source, whilst the detection of a resistance gene which encoded for an extended spectrum ß-lactamase, located on a small size transferable plasmid makes possible its fiirther dissemination among other salmonella serotypes or enterobacteriae species.