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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 E. coli ST131. We report the structure of the first fully sequenced blaOXA-163 plasmid, and of two other blaOXA-48 plasmids in this lineage. blaOXA-163 was located on a 71kb 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 inter-species/inter-lineage spread. The presence of blaOXA-48-like genes on epidemic plasmids in ST131 is of concern...
September 6, 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...
August 2, 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...
June 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...
March 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
Chulsoo Ahn, Adeel A Butt, Jesabel I Rivera, Maidah Yaqoob, Sara Hag, Alaa Khalil, Marthinus Pitout, Yohei Doi
OXA-48-producing isolates were identified in approximately 4% and less than 1% of ESBL-producing and non-ESBL-producing E. coli and K. pneumoniae causing bacteremia at the largest tertiary hospital in Abu Dhabi.
January 2015: International Journal of Infectious Diseases: IJID
Joshua T Freeman, Joseph Rubin, Gary N McAuliffe, Gisele Peirano, Sally A Roberts, Dragana Drinković, Johann Dd Pitout
BACKGROUND: Generic epidemiological differences between extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), are poorly defined. Nonetheless, defining such differences and understanding their basis could have strategic implications for infection control policy and practice. METHODS: Between 2009 and 2011 patients with bacteraemia due to ESBL-EC or ESBL-KP across all three acute hospitals in the city of Auckland, New Zealand, were eligible for inclusion...
2014: Antimicrobial Resistance and Infection Control
Liang Chen, Barun Mathema, Johann D D Pitout, Frank R DeLeo, Barry N Kreiswirth
UNLABELLED: Carbapenem-resistant Enterobacteriaceae (CRE), especially Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae, pose an urgent threat in health facilities in the United States and worldwide. K. pneumoniae isolates classified as sequence type 258 (ST258) by multilocus sequence typing are largely responsible for the global spread of KPC. A recent comparative genome study revealed that ST258 K. pneumoniae strains are two distinct genetic clades; however, the molecular origin of ST258 largely remains unknown, and our understanding of the evolution of the two genetic clades is incomplete...
2014: MBio
Joseph E Rubin, Gisele Peirano, Abdool K Peer, Chetna N Govind, Johann D D Pitout
We describe 4 patients infected with NDM-1 Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens from South Africa that co-produced SHV-12, CTX-M-3, and CTX-M-15 and were positive for qnrS, qnrA, aac(6')-Ib-cr, rmtF, rmtC, and armA. Plasmids belonged to IncN, IncA/C replicon types with ccdAB and vagC/D addiction factors. Local and imported cases of NDM-producing bacteria co-exist within South Africa.
July 2014: Diagnostic Microbiology and Infectious Disease
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