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Survival in the environment is a possible key factor for the expansion of Escherichia coli strains producing extended-spectrum beta-lactamases
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
2014 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 1, p. 59-67Article in journal (Refereed) Published
Abstract [en]

Acquired resistance to cephalosporins in Enterobacteriaceae is a global problem. After an outbreak at Uppsala University Hospital of extended-spectrum -lactamase (ESBL)-positive Klebsiella pneumoniae producing CTX-M-15, there was a shift from AmpC to ESBL production among Escherichia coli isolates. To explore the basis for this epidemiological shift, 46 E. coli isolates (ESBLs, n=23; AmpC, n=23) were characterized with regard to genetic relatedness, -lactamase, replicon and integron types, antibiotic resistance profiles, and genes encoding virulence factors. In addition, the survival in the environment and on hospital-associated materials was analysed. CTX-M-15 was the most frequent ESBL (78%). Only three (13%) of the AmpC enzymes were harboured on plasmids (CMY-2, DHA-1). Independent of plasmid-mediated beta-lactamase, IncF plasmids predominated and only class I integrons were detected. The ESBL producers carried more virulence genes (p=0.04), exhibited a broader resistance phenotype (p=0.01) and survived significantly longer (p=0.03) on different materials than the AmpC-producing isolates. In conclusion, ESBL-producing isolates had properties which are likely to augment their competitiveness. Apart from antibiotic resistance and virulence factors, extended survival in the environment could be a selective trait for successful ESBL-producing E. coli strains.

Place, publisher, year, edition, pages
2014. Vol. 122, no 1, p. 59-67
Keywords [en]
E-coli, AmpC, ESBL, environment, virulence genes, plasmids
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-216726DOI: 10.1111/apm.12102ISI: 000328909100008OAI: oai:DiVA.org:uu-216726DiVA, id: diva2:691212
Available from: 2014-01-27 Created: 2014-01-24 Last updated: 2018-12-12Bibliographically approved
In thesis
1. Dissemination of Multiresistant Bacteria: Their Selection, Transmission, Virulence and Resistance
Open this publication in new window or tab >>Dissemination of Multiresistant Bacteria: Their Selection, Transmission, Virulence and Resistance
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Multiresistant bacteria are an emerging threat in modern medicine. Consumption of antimicrobial agents among humans, animals and in agriculture causes a selection of resistance genes. Dissemination of bacteria carrying resistance genes occurs both globally and locally, and hospital settings pose a special risk for spread when staff, environment and vulnerable patients interact. The overall aim of this thesis was to analyse underlying factors that facilitate the dissemination of multiresistant pathogenic bacteria in hospital settings.

Clusters of resistant bacteria from six occasions were investigated. Vancomycin-Resistant Enterococci (VRE), Methicillin-Resistant Staphylococcus pseudintermedius (MSRP), ESBL-producing Escherichia coli and Klebsiella pneumoniae, and carbapenemase-producing Pseudomonas aeruginosa were analysed by a range of methods, from cultures on broth to PCR and whole genome sequencing. Type of resistance, clonality, virulence factors, mobile genetic elements, epidemiology, survival in the environment, and patient history were examined variously depending on study.

The results showed that VRE resistance genes can be acquired during treatment with vancomycin. Furthermore, contamination of the hospital environment could quickly cause an outbreak, when patients are frequently relocated and exposition to contaminated rooms increase. Resistant bacteria emerging among companion animals, such as the dog-associated MRSP, can pose a zoonotic threat, when a virulent clone finds a new niche in humans.

The ability of Gram-negative bacteria to survive in a hospital environment is probably better than expected, given the right prerequisites; incorrect use of sinks enabled the spread of ESBL-producing K. pneumoniae and carbapenemase-producing P. aeruginosa. Additionally, the survival on hospital associated materials was longer for ESBL-producing E. coli than the AmpC-producing counterpart, which could tell part of why ESBL-producing E. coli is increasing. Hence, the survival in the environment calls for consideration when choosing materials and equipment for hospitals and nursing homes.

Exchange of bacteria occurs continuously between humans and our surroundings. Outbreaks of multiresistant bacteria are rare in Sweden but expose the weaknesses in healthcare when occurring. The organization, materials and equipment of hospitals facilitate the dissemination of resistant bacteria, as does animals and humans around us and even the genes in our own microbiota.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 84
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1527
National Category
Infectious Medicine
Research subject
Clinical Bacteriology
Identifiers
urn:nbn:se:uu:diva-369302 (URN)978-91-513-0537-0 (ISBN)
Public defence
2019-02-15, Jupiter, The Hub, Science Park, Dag Hammarskjölds väg 38, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2019-01-22 Created: 2018-12-12 Last updated: 2019-02-18

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