- Volume 66, Issue 5, 2017

Purpose. Enterobacteriaceae is a large family of Gram-negative bacteria that are considered as normal gut flora. They are the most common human pathogens. The main objective of this study was to investigate the carbapenemase genes in clinical isolates of Enterobacteriaceae resistant to carbapenem antibiotics and determine their clonal relationship using pulsed-field gel electrophoresis (PFGE).

Methodology. In the present study, bacteria were isolated and identified via conventional biochemical tests and API 20NE. Antibiotic susceptibility was evaluated by using the disc diffusion method and MIC was carried out using the E-test. Phenotypic determination of carbapenemases was performed by employing a modified Hodge test (MHT). Carbapenemase genes including IMP, VIM, KPC, NDM and OXA-48 were amplified by PCR. The relationships between their clonal types with l restriction enzyme were examined using PFGE.

Results. Out of 40 isolates that were resistant or moderately susceptible to carbapenem antibiotics, 29 (72.5 %) strains were positive for carbapenem enzymes phenotypically. Moreover, six isolates contained carbapenemase genes including IMP, VIM, NDM and OXA-48, but the KPC gene was not found in any of the isolates. PFGE results showed that E. coli strains in our area were clustered into eight pulsotypes (A–H), Klebsiella spp. isolates five pulsotypes (A–E) and Proteus spp. had two pulsotypes (A, B). The high resistance to antimicrobial agents in the A, B and F pulsotypes was attributed to E. coli clinical isolates.

Conclusions. Our results could reflect some hospital multidrug-resistant strains in nosocomial infections. The widespread emergence of carbapenem-resistant isolates has caused increasing concern in recent years. Therefore, specific strategies should be designed and evaluated for the control of resistant strains.

Purpose. Class 1 integrons are among the main vehicles that facilitate the spread of antibiotic-resistance genes, with serious public health consequences. The aim of this cross-sectional study was to investigate the presence of class 1 integrons and to characterize their variable regions, as well as the antimicrobial resistance profiles and phylogenetic groups of a collection of Escherichia coli isolates recovered from healthy subjects (n=42) and those with urinary infection (n=40).

Methodology. The methods used included PCR, sequencing and antimicrobial susceptibility testing.

Results. PCR screening for the integrase gene (intI1) revealed a higher incidence of class 1 integrons in uropathogenic E. coli (65 %, UPEC) than in commensal isolates (11.9 %). Eight of 31 intI1-positive isolates, all of them UPEC, harboured empty integrons. The variable regions of the other 23 contained gene cassettes encoding resistance to β-lactams (blaOXA-1), aminoglycosides (aadA1 and aadA5), trimethoprim (dfrA1 and dfrA17) and an ORF. To our knowledge this is the first report of an ORF identified as a putative phage tail protein associated with a class 1 integron. The aadA1 and dfrA17-addA5 arrays prevailed in commensal E. coli and UPEC, respectively. UPEC isolates were highly resistant to the antimicrobials tested, in contrast to commensal isolates. The E. coli isolates carrying gene cassettes associated with class 1 integrons were found to be unrelated to any phylogroup or multiresistance.

Conclusion. Co-resistance to clinically relevant fluoroquinolone and trimethoprim-sulfamethazole in all UPEC isolates is a cause for concern. These results expand the current knowledge of gene cassettes in both commensal and pathogenic E. coli.

Purpose. We previously identified an association between CC22 meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection isolates with an elevated vancomycin MIC (V-MIC) in the susceptible range (1.5–2 mg l−1) and endocarditis. This study explores whether these isolates have a specific phenotype consistent with the clinical findings.

Methodology. CC22 and CC30 MRSA isolates with high (1.5–2 mg l−1) and low (≤0.5 mg l−1) V-MICs were tested for fibrinogen and fibronectin binding, virulence in a Galleria mellonella caterpillar model, phenol soluble modulin production and accessory gene regulator (agr) expression.

Results. CC22 high V-MIC, but not CC30 high V-MIC isolates, showed sustained fibrinogen binding through a stationary growth phase and increased PSM production, specifically PSMα1, compared with respective low V-MIC isolates. Expression was lower in both CC22 and CC30 high V-MIC isolates compared with respective low V-MIC isolates, although there was no associated reduction in virulence in the caterpillar model.

Conclusions. The identification of a distinct phenotype for CC22 high V-MIC isolates supports the hypothesis that bacterial factors contribute to the mechanism underlying their association with endocarditis. Further study of these isolates could shed light on the molecular mechanism of endocarditis in humans.

Purpose. Haemophilus influenzae is a commensal organism found in the upper respiratory tract of humans. When H. influenzae becomes a pathogen, these bacteria can move out of their commensal niche and cause multiple respiratory tract diseases such as otitis media, sinusitis, conjunctivitis and bronchitis in children, and chronic obstructive pulmonary disease in adults. However, H. influenzae is currently considered a non-flagellate bacterium.

Methodology and Results. In this study, 90 clinical isolates of H. influenzae strains (typeable and non-typeable) showed different degrees of the swarm-motility phenotype in vitro.

Keys findings. One of these strains, NTHi BUAP96, showed the highest motility rate and its flagella were revealed using transmission electron microscopy and Ryu staining. Moreover, the flagellar genes fliC and flgH exhibited high homology with those of Actinobacillus pleuropneumoniae, Escherichia coli and Shigella flexneri. Furthermore, Western blot analysis, using anti-flagellin heterologous antibodies from E. coli, demonstrated cross-reaction with a protein present in NTHi BUAP96.

Conclusion. This study provides, for the first time, information on flagellar expression in H. influenzae, representing an important finding related to its evolution and pathogenic potential.

Purpose. The aim of the study was to characterize clinical and environmental Staphylococcus pettenkoferi isolates with regard to genomic diversity and antibiotic susceptibility pattern. Repetitive-sequence-based PCR and core genome phylogenetic analysis of whole-genome sequencing (WGS) data verified the presence of distinct clades comprising closely related S. pettenkoferi isolates from different geographical locations and origins.

Methodology. Phylogenetic relationships between 25 S . pettenkoferi isolates collected from blood cultures and intra-operative air sampling were determined by repetitive-sequence-based PCR typing and analysis of ~157 000 SNPs identified in the core genome after WGS. Antibiotic susceptibility testing and tests for biofilm production (microtitre plate assay) were performed.

Results. Repetitive-sequence-based PCR as well as WGS data demonstrated the close relatedness of clinically significant blood culture isolates to probable contaminants, as well as to environmental isolates. Antibiotic-susceptibility testing demonstrated a low level of antimicrobial resistance. The mecA gene was present in two cefoxitin-resistant isolates. No isolates were found to produce biofilm.

Conclusion. Close genomic relatedness of S. pettenkoferi isolates from different geographical locations and origins were found within clades, but with substantial genomic difference between the two major clades. The ecological niche of S. pettenkoferi remains unconfirmed, but the presence of S. pettenkoferi in the air of the operating field favours the suggestion of a role in skin flora. Identification of S. pettenkoferi in clinical samples should, in a majority of cases, most likely be regarded as a probable contamination, and its role as a possible pathogen in immunocompromised hosts remains to be clarified.

Background. Antimicrobial resistance is an emerging global health issue. Data on the epidemiology of multidrug-resistant organisms are scarce for Africa, especially in HIV-infected individuals who often have frequent contact with healthcare. We investigated the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in stool among HIV-infected children attending an HIV outpatient department in Harare, Zimbabwe.

Methods. We recruited children who were stable on antiretroviral therapy (ART) attending a HIV clinic from August 2014 to June 2015. Information was collected on antibiotic use and hospitalization. Stool was tested for ESBL-E through combination disc diffusion. API20E identification and antimicrobial susceptibility was performed on the positive samples followed by whole genome sequencing.

Results. Stool was collected from 175/202 (86.6 %) children. Median age was 11 [inter-quartile range (IQR) 9–12] years. Median time on ART was 4.6 years (IQR 2.4–6.4). ESBL-Es were found in 24/175 samples (13.7 %); 50 % of all ESBL-Es were resistant to amoxicillin-clavulanate, 100 % to co-trimoxazole, 45.8 % to chloramphenicol, 91.6 % to ceftriaxone, 20.8 % to gentamicin and 62.5 % to ciprofloxacin. ESBL-Es variously encoded CTX-M, OXA, TEM and SHV enzymes. The odds of ESBL-E carriage were 8.5 times (95 % CI 2.2–32.3) higher in those on ART for less than one year (versus longer) and 8.5 times (95 % CI 1.1–32.3) higher in those recently hospitalized for a chest infection.

Conclusion. We found a 13.7 % prevalence of ESBL-E carriage in a population where ESBL-E carriage has not been described previously. Antimicrobial resistance (AMR) in Africa merits further study, particularly given the high HIV prevalence and limited diagnostic and therapeutic options available.

Purpose. The aim of this study was to investigate the urinary pharmacokinetics (PK) of orbifloxacin (OBFX) administered at 5 mg kg−1 in six healthy dogs. A further aim was to use an ex vivo model to evaluate the urinary PK and pharmacodynamics (PD) of OBFX to determine its urinary bactericidal titre (UBT), which represents the maximal dilution of urine allowing bactericidal activity.

Methodology. Fourteen urinary tract infection (UTI) pathogenic strains of five bacterial species (Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis and Staphylococcus pseudintermedius) were used. Urine samples were obtained every 4 h for the first 24 h after OBFX administration, for measurement of urine drug concentration and UBT.

Results/Key findings. The urine OBFX concentration peaked at 0–4, 4–8 or 4–8 h after administration, with a maximum concentration of 383±171 µg ml−1. Overall, the fluctuation in median UBT closely correlated with that of the mean urine OBFX concentration. In addition, the median areas under the UBT-time curves (AUBTs) were significantly inversely correlated with the MICs for OBFX in the tested strains (P<0.01). Notably, median UBTs and AUBTs were extremely low (0–0.5 and 2–5, respectively) in OBFX-resistant E. coli strains with MIC ≥8 µg ml−1.

Conclusion. The fluctuation of UBTs closely correlated with that of urine concentration, and UBT values depended on the susceptibility of the bacterial strains to OBFX. We believe that ex vivo modelling to determine UBTs is useful to evaluate the urinary PK/PD of antimicrobials indicated for UTIs in dogs.

Purpose. To compute diagnostic test properties of C-reactive protein (CRP) and serum procalcitonin (PCT) levels in bloodstream infections in children with cancer and suspected sepsis, in comparison with blood culture as the gold standard.

Methodology. Consecutive paediatric cancer patients, aged ≤14 years, with clinically suspected bloodstream infections were evaluated with blood culture and assay of PCT and CRP levels. Blood culture was taken as the gold standard for comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and receiver operating characteristic (ROC) with area under ROC curve (AUC) were calculated to assess the diagnostic test performance for PCT and CRP.

Results/Key findings. The ROC curve for PCT was better than that for CRP, with an AUC of 0.751 for PCT at a cut-off of 2.25 ng ml−1. The AUC for CRP was 0.638 at a cut-off of 8.0 mg dl−1. Among the three cut-off values of PCT selected from the ROC curve applicable to the patients under study, the cut-off value of ≥0.49 ng ml−1 had the maximum sensitivity of 81.4 % and an NPV of 94.67 %; ≥2.25 ng ml−1 had a sensitivity and specificity of 65.12 and 71.6 %, respectively, and ≥6.47 ng ml−1 had a maximum specificity of 82.10 %. For CRP, the cut-off value of ≥5.3 mg dl−1 had the maximum sensitivity of 72.09 %; ≥8.0 mg dl−1 had a sensitivity and specificity of 58.14 and 68.09 %, respectively, and ≥8.4 mg dl−1 had the maximum specificity of 70.04 %.

Conclusion. PCT is a better serological marker for excluding bloodstream infections than CRP. The cut-off value of 0.49 ng ml−1 with a negative predictive value of 94.67 % will be ideal in a clinical setting of immune-compromised children with suspected sepsis.

Purpose. We tested the efficacy of the esterase encoded by cp1002_RS09720 from Corynebacterium pseudotuberculosis in recombinant subunit and DNA caseous lymphadenitis (CLA) vaccines. This target was predicted as one of the best CLA vaccine candidates by mature epitope density analysis.

Methodology. Gene cp1002_RS09720 was cloned into two different vectors (pAE for subunit vaccine and pTARGET for DNA vaccine). Four groups of 15 mice each were immunized with the recombinant esterase rCP09720 associated with aluminium hydroxide adjuvant (G1), pTARGET/cp09720 DNA vaccine (G2), a naked pTARGET (G3) or PBS as a negative control (G4). Immunization occurred in two doses intercalated by a 21 day interval. Twenty-one days after the last dose administration, animals were challenged with a virulent C. pseudotuberculosis MIC-6 strain.

Results. G1 showed high levels of IgG1 and IgG2a on days 21 and 42 post-immunization and a significant level of IFN-γ (P<0.05), suggesting a Th1 response. The protection levels obtained were 58.3 and 16.6 % for G1 and G2, respectively.

Conclusion. The subunit vaccine composed of the recombinant esterase rCP09720 and Al(OH)3 is a promising antigenic formulation for use against CLA.

Purpose. In Japan, the 7-valent pneumococcal vaccine (PCV7) was introduced in 2010 and, in 2013, the PCV7 was replaced with the 13-valent pneumococcal vaccine (PCV13). This study was conducted to investigate serotypes, antimicrobial resistance and prevalence of pilus islets in pneumococcal isolates from inpatients in a Japanese tertiary hospital.

Methodology. From April 2011 to February 2016, 151 isolates [95 (18 children, 77 adults) and 56 (19 children, 37 adults) in the PCV7 and PCV13 periods, respectively] were collected. All isolates were serotyped using genetic methods and were tested for susceptibility to 18 antimicrobials. Unaltered penicillin-binding protein (PBP) genes, macrolide resistance genes and pilus islets were identified by PCR.

Results. Between the two periods, the prevalence of non-PCV13 serotypes was shown to increase from 50.0 to 78.9 % in children, and serotype 3 increased from 14.3 to 24.3 % in adults. Six of seven isolates from invasive diseases were assigned to non-PCV13 serotypes. Overall, multidrug resistance (MDR) was detected in 46.4 % of isolates, which included the dominant non-PCV13 serotypes 6E, 15A and 23A (prevalence≥75.0 %). gPRSP (three altered genes pbp1a, pbp2b and pbp2x) and macrolide resistance genes [erm(B) and/or mef(A/E)] were detected in 35.8 and 93.4 % of all isolates, respectively. Pilus islets [PI-1 (clade I, II and III) and/or PI-2] were found in 22.5 % (34/151) of isolates belonging to six different serotypes (19F, 23F, 19A, 6E, 15B and 35B) and 88.2 % (30/34) of these exhibited MDR.

Conclusion. This study revealed the spread of MDR in several non-PCV13 serotypes and in isolates with pilus islets.

Purpose. Carrier pigs have been considered as the major reservoir of Streptococcus suis and couldbe a significant source of human infection. Therefore, we investigated the prevalence and characteristics of latent S. suis in asymptomatic pigs in the pig-farming area of central Thailand, and compared the data to those previously reported in other regions.

Methodology. We collected samples from 340 asymptomatic pigs. S. suis isolates from the samples were confirmed by species-specific PCR (recN PCR). The capsular polysaccharide synthesis gene (cps) types, virulence-associated gene profiles and sequence types (STs) of the isolates were investigated.

Results/Key findings. The prevalence of S. suis found in this study was 37 % (125/340 pigs). The most prevalent genotype was mrp −/epf −/sly −. Among the 16 cps-types identified in 135 isolates, cps-type 16 was the most frequent (11 %), whereas 44 % of the isolates were non-typable. In common with the strains causing human sepsis in Thailand, two cps-type 9 isolates and a cps-type 24 isolate from slaughtered pigs belonged to ST16 and ST221, respectively. All the isolated cps-type 2 strains were confirmed as serotype 2 by co-agglutination tests, and these belonged to ST104, the unique ST commonly found in Thai patients; however, in contrast to the endemic areas, the prevalence of serotype 2 strains was relatively low (2 %) and no ST1 isolate was found.

Conclusion. Our results showed the population structure differences between S. suis in central Thailand and other regions; however, zoonotic S. suis is certainly latent in asymptomatic pigs in this intensive swine production area.

Purpose. To determine the bactericidal efficacy of a new topical antiseptic for preoperative skin preparation, olanexidine gluconate (development code: OPB-2045G), against transient or resident bacterial flora on the skin of cynomolgus monkeys.

Methodology. After measuring baseline bacterial counts on test sites marked on the abdomens, we applied olanexidine, chlorhexidine or povidone–iodine. After 10 min (fast-acting effect) and 6 h (long-lasting effect), bacterial counts were measured again and log10 reductions were calculated. In addition, we determined the bactericidal effects on the skin contaminated with blood before or after applying the antiseptics.

Results. In the non-blood-contaminated condition, the mean log10 reductions of olanexidine at doses of 1–2 % were significantly higher than those of saline (negative control), but did not significantly differ from those of 0.5 % chlorhexidine and 10 % povidone–iodine at either time point. But olanexidine was significantly more effective at both time points than chlorhexidine and povidone–iodine when applied after the site was contaminated with blood. Olanexidine was also significantly more effective than chlorhexidine and as effective as or more effective than povidone-iodine at both time points when skin was contaminated with blood after the antiseptics were applied.

Conclusion. The bactericidal effects of olanexidine were comparable to those of commercial antiseptics such as chlorhexidine and povidone–iodine in non-blood-contaminated conditions. More importantly, the effect of olanexidine was hardly affected by blood unlike commercial antiseptics. Thus, it is considered that olanexidine has a favourable property for skin preparation in various types of surgical treatments.