Dissemination of IncF-type plasmids in multiresistant CTX-M-15-producing Enterobacteriaceae isolates from surgical-site infections in Bangui, Central African Republic

BMC Microbiology

Sebastien Breurec³  Benoit Garin⁵  Bertrand Tekpa¹  Eugene Serdouma⁴  Luc Nghario⁶  Jean-Robert Mbecko⁷  Alfred Gaudeuille²  Alexandre Manirakiza⁸  Thierry Frank⁷  Clotaire Rafaï⁷ 

[1] Hôpital Communautaire, Department of Orthopaedic Surgery, Avenue des Martyrs, Bangui, Central African Republic;Complexe Pédiatrique, Department of Paediatric Surgery, Avenue de l’Independance, Bangui, Central African Republic;University of Antilles, Faculty of Medecine, Pointe-à-Pitre, French West Indies;Hôpital de l’Amitié, Department of Gynaecology and Obstetrics, Avenue de l’Independance, Bangui, Central African Republic;Institut Pasteur, Laboratory of Bacteriology, Antananarivo, Madagascar;Hôpital de l’Amitié, Department of General Surgery, Avenue de l’Independance, Bangui, Central African Republic;Institut Pasteur, Laboratory of Bacteriology, Avenue de l’Independance, Bangui, Central African Republic;Institut Pasteur, Unit of Epidemiology, Avenue de l’Independance, Bangui, Central African Republic

关键词: Africa;    Enterobacteriaceae;    Surgical-site infection;    IncF;    CTX-M-15;    Antimicrobial resistance;   

Others  :  1170519
DOI  :  10.1186/s12866-015-0348-1

 received in 2014-09-26, accepted in 2015-01-14,  发布年份 2015

【 摘 要 】

Background

Surgical-site infection is the most frequent health care-associated infection in the developing world, with a strikingly higher prevalence than in developed countries We studied the prevalence of resistance to antibiotics in Enterobacteriaceae isolates from surgical-site infections collected in three major tertiary care centres in Bangui, Central African Republic. We also studied the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae.

Results

Between April 2011 and April 2012, 195 patients with nosocomial surgical-site infections were consecutively recruited into the study at five surgical departments in three major tertiary care centres. Of the 165 bacterial isolates collected, most were Enterobacteriaceae (102/165, 61.8%). Of these, 65/102 (63.7%) were 3GC-R, which were characterized for resistance gene determinants and genetic background. The bla_CTX-M-15 and aac(6′)-Ib-cr genes were detected in all strains, usually associated with qnr genes (98.5%). Escherichia coli, the most commonly recovered species (33/65, 50.8%), occurred in six different sequence types, including the pandemic B2-O25b-ST131 group (12/33, 36.4%). Resistance transfer was studied in one representative strain of the resistance gene content in each repetitive extragenic palindromic and enterobacterial repetitive intergenic consensus sequence-PCR banding pattern. Plasmids were characterized by PCR-based replicon typing and sub-typing schemes. In most isolates (18/27, 66.7%), bla_CTX-M-15 genes were found in incompatibility groups F/F31:A4:B1 and F/F36:A4:B1 conjugative plasmids. Horizontal transfer of both plasmids is probably an important mechanism for the spread of bla_CTX-M-15 among Enterobacteriaceae species and hospitals. The presence of sets of antibiotic resistance genes in these two plasmids indicates their capacity for gene rearrangement and their evolution into new variants.

Conclusions

Diverse modes are involved in transmission of resistance, plasmid dissemination probably playing a major role.

【 授权许可】

   
2015 Rafaï et al.; licensee BioMed Central.

【 参考文献 】

• [1]Bradford PA: Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001, 14:933-51.
• [2]Clermont O, Dhanji H, Upton M, Gibreel T, Fox A, Boyd D, et al.: Rapid detection of the O25b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains. J Antimicrob Chemother 2009, 64:274-7.
• [3]Strahilevitz J, Jacoby GA, Hooper DC, Robicsek A: Plasmid-mediated quinolone resistance: a multifaceted threat. Clin Microbiol Rev 2009, 22:664-89.
• [4]Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al.: Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011, 377:228-41.
• [5]Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al.: A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009, 360:491-9.
• [6]Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D: Health-care-associated infection in Africa: a systematic review. Bull World Health Organ 2011, 89:757-65.
• [7]Pena C, Pujol M, Ricart A, Ardanuy C, Ayats J, Linares J, et al.: Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum beta-lactamase in the intensive care unit. J Hosp Infect 1997, 35:9-16.
• [8]Naseer U, Natas OB, Haldorsen BC, Bue B, Grundt H, Walsh TR, et al.: Nosocomial outbreak of CTX-M-15-producing Escherichia coli in Norway. APMIS 2007, 115:120-6.
• [9]Rogers BA, Sidjabat HE, Paterson DL: Escherichia coli O25b-ST131: a pandemic, multiresistant, community-associated strain. J Antimicrob Chemother 2011, 66:1-14.
• [10]Naseer U, Sundsfjord A: The CTX-M conundrum: dissemination of plasmids and Escherichia coli clones. Microb Drug Resist 2011, 17:83-97.
• [11]Aibinu I, Odugbemi T, Koenig W, Ghebremedhin B: Sequence type ST131 and ST10 complex (ST617) predominant among CTX-M-15-producing Escherichia coli isolates from Nigeria. Clin Microbiol Infect 2012, 18:E49-51.
• [12]Ben Sallem R, Ben Slama K, Estepa V, Jouini A, Gharsa H, Klibi N, et al.: Prevalence and characterisation of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates in healthy volunteers in Tunisia. Eur J Clin Microbiol Infect Dis 2012, 31:1511-6.
• [13]Peirano G, van Greune CH, Pitout JD: Characteristics of infections caused by extended-spectrum beta-lactamase-producing Escherichia coli from community hospitals in South Africa. Diagn Microbiol Infect Dis 2011, 69:449-53.
• [14]Banerjee R, Johnson JR: A new clone sweeps clean: the enigmatic emergence of Escherichia coli sequence type 131. Antimicrob Agents Chemother 2014, 58:4997-5004.
• [15]Bonnedahl J, Drobni M, Gauthier-Clerc M, Hernandez J, Granholm S, Kayser Y, et al.: Dissemination of Escherichia coli with CTX-M type ESBL between humans and yellow-legged gulls in the south of France. PLoS One 2009, 4:e5958.
• [16]Coque TM, Novais A, Carattoli A, Poirel L, Pitout J, Peixe L, et al.: Dissemination of clonally related Escherichia coli strains expressing extended-spectrum beta-lactamase CTX-M-15. Emerg Infect Dis 2008, 14:195-200.
• [17]Karisik E, Ellington MJ, Pike R, Warren RE, Livermore DM, Woodford N: Molecular characterization of plasmids encoding CTX-M-15 beta-lactamases from Escherichia coli strains in the United Kingdom. J Antimicrob Chemother 2006, 58:665-8.
• [18]Sherley M, Gordon DM, Collignon PJ: Species differences in plasmid carriage in the Enterobacteriaceae. Plasmid 2003, 49:79-85.
• [19]Carattoli A: Plasmids in Gram negatives: molecular typing of resistance plasmids. Int J Med Microbiol 2011, 301:654-8.
• [20]Dolejska M, Brhelova E, Dobiasova H, Krivdova J, Jurankova J, Sevcikova A, et al.: Dissemination of IncFII(K)-type plasmids in multiresistant CTX-M-15-producing Enterobacteriaceae isolates from children in hospital paediatric oncology wards. Int J Antimicrob Agents 2012, 40:510-5.
• [21]Breurec S, Guessennd N, Timinouni M, Le TA, Cao V, Ngandjio A, et al.: Klebsiella pneumoniae resistant to third-generation cephalosporins in five African and two Vietnamese major towns: multiclonal population structure with two major international clonal groups, CG15 and CG258. Clin Microbiol Infect 2013, 19:349-55.
• [22]Moquet O, Bouchiat C, Kinana A, Seck A, Arouna O, Bercion R, et al.: Class D OXA-48 carbapenemase in multidrug-resistant enterobacteria, Senegal. Emerg Infect Dis 2011, 17:143-4.
• [23]Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR: Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999, 20:250-78.
• [24]Harrois D, Breurec S, Seck A, Delaune A, Le Hello S, Pardos de la Gandara M, et al.: Prevalence and characterization of extended-spectrum beta-lactamase-producing clinical Salmonella enterica isolates in Dakar, Senegal, from 1999 to 2009. Clin Microbiol Infect 2014, 20:O109-16.
• [25]Eckert C, Gautier V, Saladin-Allard M, Hidri N, Verdet C, Ould-Hocine Z, et al.: Dissemination of CTX-M-type beta-lactamases among clinical isolates of Enterobacteriaceae in Paris, France. Antimicrob Agents Chemother 2004, 48:1249-55.
• [26]Carattoli A, Bertini A, Villa L, Falbo V, Hopkins KL, Threlfall EJ: Identification of plasmids by PCR-based replicon typing. J Microbiol Methods 2005, 63:219-28.
• [27]Villa L, Garcia-Fernandez A, Fortini D, Carattoli A: Replicon sequence typing of IncF plasmids carrying virulence and resistance determinants. J Antimicrob Chemother 2010, 65:2518-29.