Investigating the broad clonal diversity of β-lactamases producing Enterobacteriaceae strains recovered from bloodstream infection in five hospitals
DOI:
https://doi.org/10.34119/bjhrv8n2-151Keywords:
enterobacteria, hemocultures, beta-lactamases, resistance markers, clonal diversityAbstract
Background: Detecting β-lactamases-producing Enterobacteriaceae is underestimated due to difficulties in clinical laboratory procedures. Objectives: Identify β-lactamases in Enterobacteriaceae recovered from bloodstream infection patients in five different hospitals. Methods: Phenotypic and genetic methods were used. PCR were used to detect blaTEM, blaSHV, blaCTX-M, blaGES, blaAmpC, blaCMY, blaFOX, blaDHA, blaKPC and blaNDM genes and ERIC-PCR investigated the genetic diversity. Findings: K. pneumoniae, Enterobacter cloacae complex, Enterobacter aerogenes, and Escherichia coli were recovered. ESBL production was detected in 56.8% (Double-Disk Synergy Test) and 55.6% (Etest) of all strains. Modified Hodge Test was positive for K. pneumoniae (39.2%) and Enterobacter spp. (11.1%). ESBL genes were observed in 79.5% of all strains, blaTEM in 61.3% and blaSHV in 42%. The simultaneous presences of ESBL-encoding genes were observed (37.5%). The gene blaKPC was detected in 45% of K. pneumoniae and 18.5% of Enterobacter strains. Main conclusions: Phenotypic and molecular tests detected several types of β-lactamases among the bacterial strains recovered. The obtained results also suggest that several clonal populations circulate among hospitals, and some strains were genetically identical, showing that cross infection practices must be used for all patients, in all healthcare services.
References
MARTINS APS, DA MATA CPSM, DOS SANTOS UR, DE ARAÚJO CA, LEITE EMM, DE CARVALHO LD, VIDIGAL PG, VIEIRA CD, DOS SANTOS-KEY SG. Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study. Front Public Health. 8;11:1297350. Jan, 2024.
RIBEIRO PC, MONTEIRO AS, MARQUES SG, MONTEIRO SG, MONTEIRO-NETO V, COQUEIRO MM, MARQUES AC, DE JESUS GOMES TURRI R, SANTOS SG, BOMFIM MR. Phenotypic and molecular detection of the blaKPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil. BMC Infect Dis. v. 16, p. 1-17, 2016.
ZHA L, LI S, GUO J, HU Y, PAN L, WANG H, ZHOU Y, XU Q, LU Z, KONG X, TONG X, CHENG Y. Global and regional burden of bloodstream infections caused by carbapenem-resistant Gram-negative bacteria in 2019: A systematic analysis from the MICROBE database. Int J Infect Dis. 24;153:107769, Dec, 2024.
OLIVEIRA J, REYGAERT WC. Gram-Negative Bacteria. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30855801.
BUSH, KAREN; FISHER, JED F. Epidemiological Expansion, Structural Studies, and Clinical Challenges of New β-Lactamases from Gram-Negative Bacteria. Annu Rev Microbiol. v. 65, p. 455-478, 2011.
MONTOYA-URREGO D, TELLEZ-CARRASQUILLA S, VANEGAS JM, QUICENO JNJ. High frequency of colonization by extended-spectrum beta-lactamase-producing Gram-negative bacilli in hemodialysis patients and their household contacts in Colombia: dissemination between the community and the hospital. Epidemiol Health. v. 44, e2022069, Aug, 2022.
SASIREKHA B, SHIVAKUMAR S. Occurrence of Plasmid-Mediated AmpC b-Lactamases among Escherichia coli and Klebsiella pneumonia. Clinical Isolates in a Tertiary Care Hospital in Bangalore. Indian J Med Microbiol. v. 2, p. 174-179, 2012.
PITOUT JDD, LE PG, MOORE KL, CHURCH DL, GREGSON DB. Detection of AmpC beta-lactamases in Escherichia coli, Klebsiella spp., Salmonella spp. and Proteus mirabilis in a regional clinical microbiology laboratory. Clin Microbiol Infect. v. 16, n. 2, p. 165-70, Feb, 2010.
SAKALAUSKIENĖ GV, MALCIENĖ L, STANKEVIČIUS E, RADZEVIČIENĖ A. Unseen Enemy: Mechanisms of Multidrug Antimicrobial Resistance in Gram-Negative ESKAPE Pathogens. Antibiotics. v. 14, n. 1), p. 63, 2025.
DRIEUX L, BROSSIER F, SOUGAKOFF W, JARLIER V. Phenotypic detection of extended-spectrum beta-lactamase production in Enterobacteriaceae: review and bench guide. Clin Microbiol Infect. v. 14, Suppl 1, p. 90-103, Jan, 2008.
COUDRON PE. Inhibitor-Based Methods for Detection of Plasmid-Mediated AmpC. J Clin Microbiol. v. 43, p. 4163-4167, 2005.
MAGIORAKOS AP, SRINIVASAN A, CAREY RB, CARMELI Y, FALAGAS ME, GISKE CG, HARBARTH S, et al.. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. v. 18, n. 3, p. 268-81, Mar, 2012.
CLINICAL AND LABORATORY STANDARDS INSTITUTE-CLSI. Performance Standards for Antimicrobial Suscetibility Testing. 24th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute, 2014.
CLINICAL AND LABORATORY STANDARDS INSTITUTE - CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 33rd ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute. 2023.
GALES AC, CASTANHERIA M, JONES RN, SADER HS. Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008–2010). Diagn Microbiol Infect Dis. v. 73, p. 354-360, 2012.
HAMMAMI S, GHOZZI R, SAÏDANI M, BEN REDJEB S. Carbapenem-resistant Acinetobacter baumannii producing the carbapenemase OXA-23 in Tunisa. Tunis Med. v. 89, p. 638-643, 2011.
ODEH R, KELKAR S, HUJER AM, BONOMO RA, SCHRECKENBERGER PC, QUINN JP. Broad Resistance Due to Plasmid-Mediated AmpC b-Lactamases in Clinical Isolates of Escherichia coli. Clin Infect Dis. v.35, p.140-145, 2002.
HO PL; LI Z; LAI EL; CHIU SS, CHENG VC. Emergence of NDM-1-producing Enterobacteriaceae in China. J Antimicrob Chemother. v. 67, n. 6, p. 1553-5, Jun, 2012.
JONES-DIAS D, MANAGEIRO V, FERREIRA E, LOURO D. Diversity of extended-spectrum and plasmid-mediated ampcβ-lactamases in Enterobacteriaceae isolates from Portuguese Health Care Facilities. J Microbiol. v. 52, P. 496-503, 2014.
DALLENNE C, DA COSTA A, DECRÉ D, FAVIER C, ARLET G. Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J Antimicrob Chemother. v. 65, n. 3, p. 490-5 Mar, 2010.
SILBERT S, PFALLER MA, HOLLIS RJ, BARTH AL, SADER HS. Evaluation of three molecular typing techniques for nonfermentative Gram-negative bacilli. Infect Control Hosp Epidemiol. v. 25, n. 10, p. 847-51, Oct, 2004.
BARROS LM, BENTO JNC, CAETANO JA, MOREIRA RAN, PEREIRA FGF, FROTA NM, ARAUJO TM, SOARES E. Prevalência de microrganismo e sensibilidade antimicrobiana de infecções hospitalares em unidade de terapia intensiva de hospital público no Brasil. Revista de Ciências Farmacêuticas Básica e Aplicada. v. 33, n. 3, p.429-435, 2012.
MARTINS APS, DA MATA CPSM, DE ARAÚJO CA. GOMES LDR, LEITE EMM, DOS SANTOS UR, VIEIRA CD, DOS SANTOS-KEY SG. Surveillance of multi-resistant microrganisms and epidemiological investigation of intensive care unit patients. Brazilian Journal of Development. v. 8, n. 12, p. 79867–79886, 2022.
PALMER AC, KISHONY R. Understanding, predicting and manipulating the genotypic evolution of antibiotic resistance. Nature Reviews. v. 14, p.243-248, abr. 2013.
SAMPAIO JL, GALES AC. Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins. Braz J Microbiol. v. 47, Suppl 1, p. 31-37, Dec, 2016.
OJULONG J, GEBRU GN, DUDUYEMI B, GBENDA E, JANNEH ML, SHARTY J, MONTEIRO L, KOWUOR D, AMEH S, OGBUANU IU. Prevalence of Antimicrobial Resistance in Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli Isolates among Stillbirths and Deceased Under-Five Children in Sierra Leone: Data from the Child Health and Mortality Prevention Surveillance Sites from 2019 to 2022. Microorganisms. v. 13, n. 8, p. 1657, Aug, 2024.
NOGUEIRA KS, DAUR AV, REASON IT, GALES AC, COSTA LM. Cefepime WILLEMSversus extended spectrum β-lactamase-producing Enterobacteriaceae. Braz J Infect Dis. v. 15, n. 2, p. 167-9, Mar-Apr, 2011.
CARVALHAES CG, PICÃO RC, NICOLETTI AG, XAVIER DE, GALES AC. Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother. v. 65, n. 2, p. 249-5, Feb, 2010.
KAŁUŻNA E, ZALAS-WIĘCEK P, GOSPODAREK E. Comparison of detection methods for extended-spectrum beta-lactamases in Escherichia coli strains. Postepy Hig Med Dosw (Online). v. 12, n. 68, p. 808-13, Jun, 2014.
TOFTELAND S, HALDORSEN B, DAHL KH, SIMONSEN GS, STEINBAKK M, WALSH TR, SUNDSFJORD A; Norwegian ESBL Study Group. Effects of phenotype and genotype on methods for detection of extended-spectrum-beta-lactamase-producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in Norway. J Clin Microbiol. v. 45, n. 1, p. 199-205, Jan, 2007.
BIRGY A, BIDET P, GENEL N, DOIT C, DECRÉ D, ARLET G, BINGEN E. Phenotypic screening of carbapenemases and associated β-lactamases in carbapenem-resistant Enterobacteriaceae. J Clin Microbiol.v. 50, n. 4, p. 1295-302, Apr, 2012.
MAHMUD B, WALLACE MA, RESKE KA, ALVARADO K, MUENKS CE, RASMUSSEN DA, BURNHAM CD, LANZAS C, DUBBERKE ER, DANTAS G. Epidemiology of Plasmid Lineages Mediating the Spread of Extended-Spectrum Beta-Lactamases among Clinical Escherichia coli. mSystems. v. 26, n. 7, e0051922, Oct, 2022..
TSANG KK, LAM MMC, WICK RR, WYRES KL, BACHMAN M, BAKER S, BARRY K, BRISSE S, CAMPINO S, et al. Diversity, functional classification and genotyping of SHV β-lactamases in Klebsiella pneumoniae. Microb Genom. v. 10, n. 10, 001294, Oct, 2024.
NAIROUKH YR, MAHAFZAH AM, IRSHAID A, SHEHABI AA. Molecular Characterization of Multidrug Resistant Uropathogenic E. Coli Isolates from Jordanian Patients. Open Microbiol J. v. 31, n. 12, p. 1-7, Jan, 2018.
POIREL L, BONNIN RA, NORDMANN P. Genetic support and diversity of acquired extended-spectrum β-lactamases in Gram-negative rods. Infect Genet Evol. v. 12, n. 5, p. 883-93, Jul, 2012.
NOGUEIRA KS, PAGANINI MC, CONTE A, COGO LL, TABORDA DE MESSIAS REASON I, DA SILVA MJ, DALLA-COSTA LM. Emergence of extended-spectrum β-lactamase producing Enterobacter spp. in patients with bacteremia in a tertiary hospital in southern Brazil. Enferm Infect Microbiol Clin. v. 32, n. 2, p. 87-92, Feb, 2014.
BRESCINI L, D'ACHILLE G, PAPALINI C, PALLOTTA F, TEODORI L, PIETRELLA D, MENCACCI A, CANOVARI B, PIERETTI B, MINGOIA M, MONTALTI R, MORRONI G, PASTICCI MB, BARCHIESI F. Clinical and molecular characteristics of KPC-producing Klebsiella pneumoniae bloodstream infections: results of a multicentre study. J Glob Antimicrob Resist. v. 24, S2213-7165(25)00020-7, Jan, 2025.
SEKI LM, PEREIRA PS, DE SOUZA MDA P, CONCEIÇÃO MDE S, MARQUES EA, PORTO CO, COLNAGO EM, ALVES CDE F, GOMES D, ASSEF AP, SAMUELSEN Ø, ASENSI MD. Molecular epidemiology of KPC-2- producing Klebsiella pneumoniae isolates in Brazil: the predominance of sequence type 437. Diagn Microbiol Infect Dis. v. 70, n. 2, p. 274-7, Jun, 2011.
BAHR G, GONZÁLEZ LJ, VILA AJ. Metallo-β-lactamases in the Age of Multidrug Resistance: From Structure and Mechanism to Evolution, Dissemination, and Inhibitor Design. Chem Rev. v. 14; n. 13, p. 7957-8094, Jul, 2021.
THOMSON KS. Extended-spectrum-beta-lactamase, AmpC, and Carbapenemase issues. J Clin Microbiol. v. 48, n. 4, p. 1019-25, Apr, 2010.
CALISKAN-AYDOGAN O, ALOCILJA EC. A Review of Carbapenem Resistance in Enterobacterales and Its Detection Techniques. Microorganisms. v. 3, n. 6, p. 1491, Jun, 2023.
SOUNA D, AMIR AS, BEKHOUCHA SN, BERRAZEG M, DRISSI M. Molecular typing and characterization of TEM, SHV, CTX-M, and CMY-2 β-lactamases in Enterobacter cloacae strains isolated in patients and their hospital environment in the west of Algeria. Med Mal Infect. v. 44, n. 4, p. 146-52, Apr, 2014.
DAVIN-REGLI A, LAVIGNE JP, PAGÈS JM. Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and Emerging Antimicrobial Resistance. Clin Microbiol Rev. v. 32, n. 4, p. e00002-19, Jul, 2019.
CHUKWU EE, AWODERU OB, ENWURU CA, AFOCHA EE, LAWAL RG, AHMED RA, OLANREWAJU I, ONWUAMAH CK, AUDU RA, OGUNSOLA FT. High prevalence of resistance to third-generation cephalosporins detected among clinical isolates from sentinel healthcare facilities in Lagos, Nigeria. Antimicrob Resist Infect Control. v. 11, n. 1, p. 134, Nov, 2022.


