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Johann D D Pitout, Rebekah DeVinney
A single extra-intestinal pathogenic Escherichia coli (ExPEC) clone, named sequence type (ST) 131, is responsible for millions of global antimicrobial-resistant (AMR) infections annually. Population genetics indicate that ST131 consists of different clades (i.e. A, B, and C); however, clade C is the most dominant globally. A ST131 subclade, named C1-M27, is emerging in Japan and has been responsible for the recent increase in AMR ExPEC in that country. The sequential acquisition of several virulence and AMR genes associated with mobile genetic elements during the 1960s to 1980s primed clade C (and its subclades C1 and C2) for success in the 1990s to 2000s...
2017: F1000Research
Gisele Peirano, Patricia A Bradford, Krystyna M Kazmierczak, Liang Chen, Barry N Kreiswirth, Johann D D Pitout
This study was designed to determine the global distribution of clonal complex (CC) 258 and IncFIIK2-like plasmids with blaKPC among 522 global Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates. CC258 (i.e., ST258 [clades I and II], ST11, ST340, and ST512) and ST147 were statistically associated with IncFIIK2-like KPC-containing plasmids and may possess an epidemiological advantage over isolates that harbored non-IncF KPC-harboring plasmids.
April 2017: Antimicrobial Agents and Chemotherapy
Yasufumi Matsumura, Gisele Peirano, Mary R Motyl, Mark D Adams, Liang Chen, Barry Kreiswirth, Rebekah DeVinney, Johann D D Pitout
International data on the molecular epidemiology of Enterobacteriaceae with IMP carbapenemases are lacking. We performed short-read (Illumina) whole-genome sequencing on a global collection of 38 IMP-producing clinical Enterobacteriaceae (2008 to 2014). IMP-producing Enterobacteriaceae (7 varieties within 11 class 1 integrons) were mainly present in the South Pacific and Asia. Specific blaIMP-containing integrons (In809 with blaIMP-4, In722 with blaIMP-6, and In687 with blaIMP-14) were circulating among different bacteria in countries such as Australia, Japan, and Thailand...
April 2017: Antimicrobial Agents and Chemotherapy
Zaira Raquel Palacios-Baena, Belén Gutiérrez-Gutiérrez, Marina De Cueto, Pierluigi Viale, Mario Venditti, Alicia Hernández-Torres, Antonio Oliver, Luis Martínez-Martínez, Esther Calbo, Vicente Pintado, Oriol Gasch, Benito Almirante, José Antonio Lepe, Johann Pitout, Murat Akova, Carmen Peña-Miralles, Mitchell J Schwaber, Mario Tumbarello, Evelina Tacconelli, Julia Origüen, Nuria Prim, German Bou, Helen Giamarellou, Joaquín Bermejo, Axel Hamprecht, Federico Pérez, Manuel Almela, Warren Lowman, Po-Ren Hsueh, Carolina Navarro-San Francisco, Julián Torre-Cisneros, Yehuda Carmeli, Robert A Bonomo, David L Paterson, Álvaro Pascual, Jesús Rodríguez-Baño
Background.: Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30 day mortality. Methods.: A multinational retrospective cohort study including consecutive episodes of BSI due to ESBL-E was performed; cases were randomly assigned to a derivation cohort (DC) or a validation cohort (VC)...
March 1, 2017: Journal of Antimicrobial Chemotherapy
Yasufumi Matsumura, Johann D D Pitout, Ryota Gomi, Tomonari Matsuda, Taro Noguchi, Masaki Yamamoto, Gisele Peirano, Rebekah DeVinney, Patricia A Bradford, Mary R Motyl, Michio Tanaka, Miki Nagao, Shunji Takakura, Satoshi Ichiyama
The Escherichia coli sequence type (ST) 131 C2/H30Rx clade with the blaCTX-M-15 gene had been most responsible for the global dissemination of extended-spectrum β-lactamase (ESBL)-producing E. coli. ST131 C1/H30R with blaCTX-M-27 emerged among ESBL-producing E. coli in Japan during the late 2000s. To investigate the possible expansion of a single clade, we performed whole-genome sequencing for 43 Japan and 10 global ST131 isolates with blaCTX-M-27 (n = 16), blaCTX-M-14 (n = 16), blaCTX-M-15 (n = 13), and others (n = 8)...
November 2016: Emerging Infectious Diseases
Nicole Stoesser, Anna E Sheppard, Gisele Peirano, Robert Sebra, Tarah Lynch, Luke Anson, Andrew Kasarskis, Mary R Motyl, Derrick W Crook, Johann D Pitout
OXA-48-like enzymes have emerged as important extended-spectrum β-lactamases/carbapenemases in Escherichia coli sequence type 131 (ST131). We report the structures of the first fully sequenced blaOXA-163 plasmid and of two other blaOXA-48 plasmids in this lineage. blaOXA-163 was located on a 71-kb IncN plasmid with other resistance genes. blaOXA-48 was present on IncL/M plasmids, genetically similar to other blaOXA-48 plasmid sequences, and consistent with interspecies/interlineage spread. The presence of blaOXA-48-like genes on epidemic plasmids in ST131 is of concern...
November 2016: Antimicrobial Agents and Chemotherapy
Wei Xin Khong, Kalisvar Marimuthu, Jeanette Teo, Yichen Ding, Eryu Xia, Jia Jun Lee, Rick Twee-Hee Ong, Indumathi Venkatachalam, Benjamin Cherng, Surinder Kaur Pada, Weng Lam Choong, Nares Smitasin, Say Tat Ooi, Rama Narayana Deepak, Asok Kurup, Raymond Fong, My Van La, Thean Yen Tan, Tse Hsien Koh, Raymond Tzer Pin Lin, Eng Lee Tan, Prabha Unny Krishnan, Siddharth Singh, Johann D Pitout, Yik-Ying Teo, Liang Yang, Oon Tek Ng
OBJECTIVES: Owing to gene transposition and plasmid conjugation, New Delhi metallo-β-lactamase (NDM) is typically identified among varied Enterobacteriaceae species and STs. We used WGS to characterize the chromosomal and plasmid molecular epidemiology of NDM transmission involving four institutions in Singapore. METHODS: Thirty-three Enterobacteriaceae isolates (collection years 2010-14) were sequenced using short-read sequencing-by-synthesis and analysed. Long-read single molecule, real-time sequencing (SMRTS) was used to characterize genetically a novel plasmid pSg1-NDM carried on Klebsiella pneumoniae ST147...
November 2016: Journal of Antimicrobial Chemotherapy
Tarah Lynch, Liang Chen, Gisele Peirano, Dan B Gregson, Deirdre L Church, John Conly, Barry N Kreiswirth, Johann D Pitout
During 2013, ST278 Klebsiella pneumoniae with blaNDM-7 was isolated from the urine (KpN01) and rectum (KpN02) of a patient in Calgary, Canada. The same strain (KpN04) was subsequently isolated from another patient in the same unit. Interestingly, a carbapenem-susceptible K. pneumoniae ST278 (KpN06) was obtained 1 month later from the blood of the second patient. Next-generation sequencing (NGS) revealed that the loss of carbapenem-resistance in KpN06 was due to a 5-kb deletion on the blaNDM-7-harboring IncX3 plasmid...
September 1, 2016: Journal of Infectious Diseases
Nicole Stoesser, Anna E Sheppard, Gisele Peirano, Robert P Sebra, Tarah Lynch, Luke W Anson, Andrew Kasarskis, Mary R Motyl, Derrick W Crook, Johann D Pitout
The blaIMP-14 carbapenem resistance gene has largely previously been observed in Pseudomonas aeruginosa and Acinetobacter spp. As part of global surveillance and sequencing of carbapenem-resistant Escherichia coli, we identified a sequence type 131 strain harboring blaIMP-14 within a class 1 integron, itself nested within an ∼54-kb multidrug resistance region on an epidemic IncA/C2 plasmid. The emergence of blaIMP-14 in this context in the ST131 lineage is of potential clinical concern.
August 2016: Antimicrobial Agents and Chemotherapy
Johann D Pitout, Wilson W Chan, Deirdre L Church
INTRODUCTION: Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare settings. A wide variety of bacteria are responsible for causing UTIs, however extra-intestinal pathogenic E. coli or ExPEC) remains the most common etiological agent. Since 2000, resistance to antibiotics emerged globally among ExPEC and is causing delays in appropriate therapy with subsequent increased morbidity and mortality. AREAS COVERED: The aim of this review article is to provide an overview on the definitions, etiology, treatment guidelines (including agents for infections due to antimicrobial resistant bacteria) of lower UTIs and to highlight recent aspects on antimicrobial resistance of ExPEC...
July 2016: Expert Review of Anti-infective Therapy
Belén Gutiérrez-Gutiérrez, Salvador Pérez-Galera, Elena Salamanca, Marina de Cueto, Esther Calbo, Benito Almirante, Pierluigi Viale, Antonio Oliver, Vicente Pintado, Oriol Gasch, Luis Martínez-Martínez, Johann Pitout, Murat Akova, Carmen Peña, José Molina, Alicia Hernández, Mario Venditti, Nuria Prim, Julia Origüen, German Bou, Evelina Tacconelli, Mario Tumbarello, Axel Hamprecht, Helen Giamarellou, Manel Almela, Federico Pérez, Mitchell J Schwaber, Joaquín Bermejo, Warren Lowman, Po-Ren Hsueh, Marta Mora-Rillo, Clara Natera, Maria Souli, Robert A Bonomo, Yehuda Carmeli, David L Paterson, Alvaro Pascual, Jesús Rodríguez-Baño
The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients)...
July 2016: Antimicrobial Agents and Chemotherapy
Yasufumi Matsumura, Johann D Pitout
Carbapenemase-producing Enterobacteriaceae (CPE), mainly Klebsiella pneumoniae and Escherichia coli, have been increasing rapidly on a global scale and are considered to be significant health threats. The most common carbapenemases are KPCs, NDMs, OXA-48-like, IMPs and VIMs but their distribution and prevalence differs between countries. The accurate, simple, cost effective and rapid detection of carbapenemases in clinical laboratories is an important initial step to control the spread of CPE within institutions...
July 2016: Expert Review of Molecular Diagnostics
Belén Gutiérrez-Gutiérrez, Robert A Bonomo, Yehuda Carmeli, David L Paterson, Benito Almirante, Luis Martínez-Martínez, Antonio Oliver, Esther Calbo, Carmen Peña, Murat Akova, Johann Pitout, Julia Origüen, Vicente Pintado, Elisa García-Vázquez, Oriol Gasch, Axel Hamprecht, Nuria Prim, Mario Tumbarello, German Bou, Pierluigi Viale, Evelina Tacconelli, Manel Almela, Federico Pérez, Helen Giamarellou, José Miguel Cisneros, Mitchell J Schwaber, Mario Venditti, Warren Lowman, Joaquín Bermejo, Po-Ren Hsueh, Marta Mora-Rillo, Irene Gracia-Ahulfinger, Alvaro Pascual, Jesús Rodríguez-Baño
OBJECTIVES: Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E. METHODS: A multinational retrospective cohort study (INCREMENT project) was performed ( identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared...
2016: Journal of Antimicrobial Chemotherapy
L F Mataseje, G Peirano, D L Church, J Conly, M Mulvey, J D Pitout
This study describes 3 different blaNDM-1 genetic platforms in 3 different species obtained from the same patient who was directly transferred to an institution in Calgary, Alberta, Canada, following a prolonged hospital stay in India. The blaNDM-1 in the Escherichia coli isolate was located on a 176-kb IncA/C plasmid contained within an ISCR1 region. The blaNDM-1 in the Providencia rettgeri isolate was located on a 117-kb IncT plasmid contained within Tn3000, while the blaNDM-1 in the Pseudomonas aeruginosa isolate was located on the chromosome within an ISCR3 region...
January 11, 2016: Antimicrobial Agents and Chemotherapy
L Chen, G Peirano, T Lynch, K D Chavda, D B Gregson, D L Church, J Conly, B N Kreiswirth, J D Pitout
Enterobacteriaceae with blaNDM-7 are relatively uncommon and had previously been described in Europe, India, the United States, and Japan. This study describes the characteristics of Enterobacteriaceae (Klebsiella pneumoniae [n = 2], Escherichia coli [n = 2], Serratia marcescens [n = 1], and Enterobacter hormaechei [n = 1] isolates) with blaNDM-7 obtained from 4 patients from Calgary, Canada, from 2013 to 2014. The 46,161-bp IncX3 plasmids with blaNDM-7 are highly similar to other blaNDM-harboring IncX3 plasmids and, interestingly, showed identical structures within the different isolates...
December 7, 2015: Antimicrobial Agents and Chemotherapy
Adeel A Butt, Nawal Al Kaabi, Mohammed Saifuddin, Kalpana M Krishnanreddy, Maqsood Khan, Waleed H Jasim, Tehmina Khan, Masalam Sara, Marthinus Pitout, Stefan Weber
BACKGROUND: Infectious disease (ID) clinicians and multidisciplinary teams may have a beneficial impact on patient outcomes. This study was conducted to determine the impact of dedicated ID team rounding in an adult noncardiac intensive care unit (ICU) on antimicrobial costs, length of stay and mortality. METHODS: The authors instituted dedicated ICU ID team rounds at a large tertiary care hospital ICU ("intervention"), with the ID team conducting rounds in the ICU every weekday...
September 2015: American Journal of the Medical Sciences
Johann D D Pitout, Patrice Nordmann, Laurent Poirel
The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e...
October 2015: Antimicrobial Agents and Chemotherapy
Amy J Mathers, Gisele Peirano, Johann D D Pitout
Escherichia coli sequence type 131 (ST131) and Klebsiella pneumoniae ST258 emerged in the 2000s as important human pathogens, have spread extensively throughout the world, and are responsible for the rapid increase in antimicrobial resistance among E. coli and K. pneumoniae strains, respectively. E. coli ST131 causes extraintestinal infections and is often fluoroquinolone resistant and associated with extended-spectrum β-lactamase production, especially CTX-M-15. K. pneumoniae ST258 causes urinary and respiratory tract infections and is associated with carbapenemases, most often KPC-2 and KPC-3...
July 2015: Clinical Microbiology Reviews
Amy J Mathers, Gisele Peirano, Johann D D Pitout
Escherichia coli ST131 emerged during the early to mid-2000s is an important human pathogen, has spread extensively throughout the world, and is responsible for the rapid increase in antimicrobial resistance among E. coli. ST131 is known to cause extraintestinal infections, being fluoroquinolone resistant, and is associated with ESBL production most often due to CTX-M-15. Recent molecular epidemiologic studies using whole-genome sequencing and phylogenetic analysis have demonstrated that the H30 ST131 lineage emerged in early 2000s that was followed by the rapid expansion of its sublineages H30-R and H30-Rx...
2015: Advances in Applied Microbiology
Vikas P Chaubey, Johann D D Pitout, Bruce Dalton, Daniel B Gregson, Terry Ross, Kevin B Laupland
BACKGROUND: The objective of this study was to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to AmpC producing Enterobacteriaceae (AE) in a large centralized Canadian region over a 9-year period. METHODS: An active surveillance cohort design in Calgary, Canada. RESULTS: A cohort of 458 episodes of BSIs caused by AE was assembled for analysis. The majority of infections were of nosocomial origin with unknown sources...
2014: BMC Infectious Diseases
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