Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 2, February, p. 249–254

doi: 10.17219/acem/94165

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Emergence of Enterobacteriaceae co-producing CTX-M-15, ArmA and PMQR in Poland

Katarzyna Piekarska1,A,D,F, Katarzyna Zacharczuk1,C, Tomasz Wołkowicz1,C, Natalia Wolaniuk1,B, Magdalena Rzeczkowska1,B, Rafał Gierczyński1,E,F

1 Department of Bacteriology, National Institute of Public Health–National Institute of Hygiene, Warszawa, Poland

Abstract

Background. Plasmid-mediated extended-spectrum β-lactamases (ESBLs), 16S rRNA methylases and quinolone resistance mechanisms (PMQRs) are well-known agents conferring resistance to more than 1 antimicrobial in its group. The accumulation of these agents poses, therefore, a serious risk to public health.
Objectives. The objective of this study was to investigate the presence of common ß-lactamases and 16S rRNA methylases in Qnr-producing Enterobacteriaceae and their genetic relatedness.
Material and Methods. We examined 18 Qnr-producing isolates (Klebsiella pneumoniae n = 8, Enterobacter cloacae n = 6 and Escherichia coli n = 4) selected from a collection of 215 ciprofloxacin-resistant strains obtained from patients in a 1030-bed tertiary hospital from 1 March to 31 August 2010. The antibiotics minimum inhibitory concentration (MIC) was determined by E-test. The detection of common ß-lactamases, 16S rRNA methyltransferases and PMQR genes was performed by polymerase chain reaction (PCR) and sequencing. Genetic relatedness was assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).
Results. All the isolates tested were susceptible to carbapenems and colistin, while 16 were multidrug-resistant. Thirteen, 2 and 2 isolates carried qnrB1, qnrA1 and qnrS1, respectively. Ten of 13 qnrB1-positive Enterobacteriaceae also carried genes encoding for aac(6’)-Ib-cr and at least 1 ESBL. The blaCTX-M-15 gene was the most common ESBL. The most prevalent combination of genes was qnrB1+aac(6’)-Ib-cr+blaTEM-1+blaCTX-M-15. Two isolates of K. pneumoniae and E. cloacae were found to bear multiple extended range resistance traits: ArmA, CTX-M-15, QnrB1, and AAC (6’)-Ib-cr. The PFGE showed that most of the isolates exhibited individual DNA patterns, whilst MLST assigned K. pneumoniae (n = 8) to 5 sequence types (STs) (ST15, ST323, ST336, ST147, and ST525), E. coli (n = 4) to 2 (ST131 and ST1431) and E. cloacae (n = 5) to 4 (ST90, ST89, ST133, and the novel ST407).
Conclusion. Our findings reveal the accumulation of resistance traits and their important role in spreading of multiresistant bacteria among hospitalized patients.

Key words

PMQR, ESBLs, MDR, Enterobacteriaceae, Poland

References (19)

  1. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2013. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC , Sweden; 2014. http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-europe-2013.pdf.
  2. Hooper DC, Jacoby GA. Mechanisms of drug resistance: Quinolone resistance. Ann N Y Acad Sci. 2015;1354:13–31.
  3. Piekarska K, Wołkowicz T, Zacharczuk K, et al. Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in tertiary hospital in Warsaw, Poland. Int J Antimicrob Agents. 2015;45(3):238–243.
  4. Dolejska M, Villa L, Dobiasova H, Fortini D, Feudi C, Carattoli A. Plasmid content of a clinically relevant Klebsiella pneumoniae clone from the Czech Republic producing CTX-M-15 and QnrB1. Antimicrob Agents Chemother. 2013;57(2):1073–1076.
  5. Filippa N, Carricajo A, Grattard F, et al. Outbreak of multidrug-resistant Klebsiella pneumoniae carrying qnrB1 and blaCTX-M-15 in a French intensive care unit. Ann Intensive Care. 2013;3:18.
  6. Tóth Á, Kocsis B, Damjanova I, et al. Fitness cost associated with resistance to fluoroquinolones is diverse across clones of Klebsiella pneumoniae and may select for CTX-M-15 type extended-spectrum ß-lactamase. Eur J Clin Microbiol Infect Dis. 2014;33(5):837–843.
  7. Luo Y, Yang J, Zhang Y, Ye L, Wang L, Guo L. Prevalence of β-lactamases and 16S rRNA methylase genes amongst clinical Klebsiella pneumoniae isolates carrying plasmid-mediated quinolone resistance determinants. Int J Antimicrob Agents. 2011;37(4):352–355.
  8. Zacharczuk K, Piekarska K, Szych J, et al. Plazmid-borne 16S rRNA methylase ArmA in aminoglicoside-resistant Klebsiella pneumoniae in Poland. J Med Microbiol. 2011;60(Pt 9):1306–1311.
  9. Pérez-Pérez FJ, Hanson ND. Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol. 2002;40(6):2153–2162.
  10. Piekarska K, Zacharczuk K, Wołkowicz T, et al. Distribution of 16S rRNA methylases among different species of aminoglycoside-resistant Enterobacteriaceae in tertiary care hospital in Poland. Adv Clin Exp Med. 2016;25(3):539–544.
  11. Miyoshi-Akiyama T, Hayakawa K, Ohmagari N, Shimojima M, Kirikae T. Multilocus Sequence Typing (MLST) for characterization of Enterobacter cloacae. PLoS One. 2013;8(6):e66358.
  12. Mellmann A, Bielaszewska M, Kock R, et al. Analysis of collection of hemolytic uremic syndrome-associated enterohemorrhagic Escherichia coli. Emerg Infect Dis. 2008;14(8):1287–1290.
  13. Diancourt L, Passet V, Verhoef J, Grimont PAD, Brisse S. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol. 2005;43(8):4178–4182.
  14. Zacharczuk K, Piekarska K, Szych J, et al. Emergence of Klebsiella pneumoniae coproducing KPC-2 and 16S rRNA methylase ArmA in Poland. Antimicrob Agents Chemother. 2011;55(1):443–446.
  15. Briales A, Rodríguez-Martínez JM, Velasco C, et al. Prevalence of plasmid mediated quinolone resistance determinants qnr and aac(6’)-Ib-cr in Escherichia coli and Klebsiella pneumoniae producing extended-spectrum ß-lactamases in Spain. Int J Antimicrob Agents. 2012;39(5):431–434.
  16. Seiffert SN, Marschall J, Perreten V, Carattoli A, Furrer H, Endimiani A. Emergence of Klebsiella pneumoniae co-producing NDM-1, OXA 48, CTX-M-15, CMY-16, QnrA and ArmA in Switzerland. Int J Antimicrob Agents. 2014;44(3):260–262.
  17. Paltansing S, Kraakman MEM, Ras JMC, Wessels E, Bernards AT. Characterization of fluoroquinolone and cephalosporin resistance mechanisms in Enterobacteriaceae isolated in a Dutch teaching hospital reveals the presence of an Escherichia coli ST131 clone with a specific mutation in parE. J Antimicrob Chemother. 2013;68(1):40–45.
  18. Rodrigues C, Machado E, Ramos H, Peixe L, Novais Â. Expansion of ESBL-producing Klebsiella pneumoniae in hospitalized patients: A successful story of international clones (ST15, ST147, ST336) and epidemic plasmids (IncR, IncFIIK). Int J Med Microbiol. 2014;304(8):1100–1108.
  19. Beaber JW, Hochhut B, Waldor MK. SOS response promotes horizontal dissemination of antibiotic resistance genes. Nature. 2004;427(6969):72–74.