Restoring #colistin sensitivity in colistin-resistant #Ecoli: Combinatorial use of MarR inhibitor with efflux pump inhibitor (Sci Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Sci Rep. 2019 Dec 25;9(1):19845. doi: 10.1038/s41598-019-56325-x.

Restoring colistin sensitivity in colistin-resistant E. coli: Combinatorial use of MarR inhibitor with efflux pump inhibitor.

Sundaramoorthy NS1, Suresh P2, Selva Ganesan S2, GaneshPrasad A1, Nagarajan S3.

Author information: 1 Center for Research on Infectious Diseases, School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, Tamil Nadu, India. 2 Department of Chemistry, School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, Tamil Nadu, India. 3 Center for Research on Infectious Diseases, School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, Tamil Nadu, India. sai@scbt.sastra.edu.

 

Abstract

Antibiotics like colistin are the last resort to deal with infections by carbapenem-resistant Enterobacteriaceae (CREB). Resistance to colistin severely restricts therapeutic options. To tackle this dire situation, urgent measures to restore colistin sensitivity are needed. In this study, whole-genome sequencing of colistin-resistant E. coli strain was performed and the genome analysis revealed that the strain belonged to the sequence type ST405. Multiple mutations were observed in genes implicated in colistin resistance, especially those related to the L-Ara-4-N pathway but mgrB was unmutated and mcr1-9 genes were missing. MarR inhibitor salicylate was used to re-sensitize this strain to colistin, which increased the negative charge on the cell surface especially in colistin resistant E. coli (U3790 strain) and thereby facilitated a decrease in colistin MIC by 8 fold. It is indeed well known that MarR inhibition by salicylate triggers the expression of AcrAB efflux pumps through MarA. So, in order to fully restore colistin sensitivity, a potent efflux pump inhibitor (BC1), identified earlier by this group was employed. The combination of colistin with both salicylate and BC1 caused a remarkable 6 log reduction in cell counts of U3790 in time-kill assay. Infection of muscle tissue of zebrafish with U3790 followed by various treatments showed that the combination of colistin + salicylate + BC1 was highly effective in reducing bioburden in infected muscle tissue by 4 log fold. Thus, our study shows that a combination of MarR inhibitor to enhance colistin binding and efflux pump inhibitor to reduce colistin extrusion was highly effective in restoring colistin sensitivity in colistin-resistant clinical isolate of E. coli in vitro and in vivo.

PMID: 31882661 DOI: 10.1038/s41598-019-56325-x

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Colistin; Enterobacteriaceae.

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A #cluster of #colistin- and #carbapenem-resistant #Klebsiella pneumoniae carrying #blaNDM-1 and #mcr-8.2 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

A cluster of colistin- and carbapenem-resistant Klebsiella pneumoniae carrying blaNDM-1 and mcr-8.2

Ke Ma, Yu Feng, Lu Liu, Zhihong Yao, Zhiyong Zong

The Journal of Infectious Diseases, jiz519, https://doi.org/10.1093/infdis/jiz519

Published: 11 December 2019

 

Abstract

Background

Klebsiella pneumoniae resistant to both carbapenems and colistin imposes severe challenges for management. Here we report a cluster of five carbapenem-resistant K. pneumoniae clinical strains belonging to ST1 and K57 types, four of which were also resistant to colistin, from two hospitals.

Methods

The five strains were subjected to whole genome sequencing (WGS) using the short-read Illumina HiSeq platform and two strains were also selected for long-read WGS using MinION. Clonal relatedness of the five strains was determined based on single nucleotide polymorphisms (SNPs). Conjugation experiments were performed to obtain self-transmissible plasmids.

Results

All five strains carried the carbapenemase-encoding gene blaNDM-1, whereas the four colistin-resistant strains also harbored a new variant of the mcr-8 colistin resistance gene, namely mcr-8.2. Mcr-8.2 differs from Mcr-8.1 by four amino acid substitutions (A51V, A232S, N365Y, and N480K). mcr-8.2 was located on a large, hybrid, non-self-transmissible plasmid containing IncQ, IncR, and IncFII replicons, whereas blaNDM-1 was carried by self-transmissible IncX3 plasmids. Phylogenetic analysis based on SNPs revealed that the five strains were likely to have a common origin.

Conclusion

Both the intra- and inter-hospital transfer of strains carrying mcr-8 and blaNDM-1 were identified, which represents an emerging threat for clinical management and infection control.

colistin resistance, mcr, plasmid, Klebsiella pneumoniae

Topic: plasmids – colistin – klebsiella pneumoniae – single nucleotide polymorphism – beta-lactamase ndm-1 – carbapenem resistance – whole genome sequencing

This content is only available as a PDF.

Author notes: These authors contributed equally.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Colistin; Carbapenem; Klebsiella pneumoniae; Nosocomial outbreaks; NDM1.

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#Bloodstream #infections caused by #Escherichia coli carrying #mcr-1 gene in hospitalized patients in northern #Italy from 2012 to 2018 (Infection, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infection. 2019 Nov 22. doi: 10.1007/s15010-019-01377-4. [Epub ahead of print]

Bloodstream infections caused by Escherichia coli carrying mcr-1 gene in hospitalized patients in northern Italy from 2012 to 2018.

Mariani B1, Corbella M2,3, Merla C1,4, Tallarita M1,4, Piralla A1, Girello A1, Castelli M5, Bracchi C6, Marone P1, Cambieri P1.

Author information: 1 UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy. 2 UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Piazzale Golgi 19, 27100, Pavia, Italy. m.corbella@smatteo.pv.it. 3 Servizio Epidemiologia Clinica e Biometria, Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. m.corbella@smatteo.pv.it. 4 Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, Pavia, Italy. 5 Dipartimento di Bioscienze, Centro Romeo ed Enrica Invernizzi Ricerca Pediatrica, Università degli Studi di Milano, Milan, Italy. 6 Unità di analisi del rischio ed epidemiologia genomica, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna, Parma, Italy.

 

Abstract

PURPOSE:

The recurrence of multi-drug resistant (MDR) pathogens to the latest antibiotics and the limited development of new antibacterial agents have reduced the options for the treatment of severe infections. The reintroduction of old antibiotics, such as colistin, represents an effective strategy, since the latest antibiotics are over-consumed and ineffective against MDR pathogens. In 2015, Liu (Lancet Infect Dis 16:161-168, 2016) reported Escherichia coli (E. coli) isolates carrying plasmid-mediated colistin resistance gene mcr-1. The first of mcr-1 positive colistin-resistant (col-R) E. coli from a human blood culture was observed in 2012 in Latin America, while in Italy was reported for the first time by our center in 2016. The present study aimed to describe the prevalence of mcr-1 positive col-R strains in E. coli-related bloodstream infection among patients hospitalized in Fondazione IRCCS Policlinico San Matteo in Pavia, Italy, from 2012 to 2018, including the three cases already published.

METHODS:

All col-R E. coli strains isolated from blood cultures collected during the study period were analyzed. The minimal inhibitory concentration of colistin was determined using broth microdilution and detection of mcr-1 and mcr-2 genes was performed by PCR. The sequence type of E. coli mcr-1 positive was determined according to Multilocus sequence typing.

RESULTS:

Out of 1557 samples, 14 strains (0.90%) were col-R. and positive for the presence of the mcr-1 gene, with no mcr-2 detected. The most common ST was ST10 (n = 3), followed by ST410 (n = 2). The remaining strains exhibited different MLST profiles, indicating that they were genetically unrelated.

CONCLUSIONS:

Proper reporting of the presence of mcr-1 genes is an essential component to anticipate the spread of colistin resistance. This public health issue is particularly alarming in Italy due to the consistent circulation of MDR bacteria.

KEYWORDS: Blood stream infection; Colistin resistance; Drug resistance; Escherichia coli; mcr-1 gene

PMID: 31758437 DOI: 10.1007/s15010-019-01377-4

Keywords: Antibiotics; Drugs Resistance; Colistin; MCR1; E. Coli; Italy.

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#Epidemiology and #antimicrobial #resistance of #MRSA isolates colonizing #pigs with different exposure to #antibiotics (PLOS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolates colonizing pigs with different exposure to antibiotics

Elizeth Lopes, Teresa Conceição, Laurent Poirel, Hermínia de Lencastre, Marta Aires-de-Sousa

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Published: November 20, 2019 / DOI: https://doi.org/10.1371/journal.pone.0225497

 

Abstract

Background

In 2016, very high rates of methicillin-resistant Staphylococcus aureus (MRSA)-ST398 (99%) were found in Portuguese pig farms that used colistin, amoxicillin, and zinc oxide as feed additives. Since then, farms A and B banned the use of colistin, and farm C banned the use of both antibiotics.

Objective

The aim of the present study was to evaluate the impact of the ban of colistin and amoxicillin on pig MRSA carriage rates, clonal types and antimicrobial resistance, compared to the results obtained in 2016.

Methods

In 2018, 103 pigs (52 from farm B using amoxicillin only as a feed additive and 51 from farm C where no antibiotics were included in the feed regimen) were nasally swabbed for MRSA colonization. Isolates were tested for antimicrobial susceptibility, and characterised by spa typing, SCCmec typing and MLST. Whole genome sequencing (WGS) was performed for representative isolates.

Results

Overall, 96% of the pigs swabbed in 2018 carried MRSA, mostly ST398-SCCmec V-spa types t011/t108. MRSA from pigs not receiving antibiotics in the feed regimen showed susceptibility to a higher number of antibiotics, namely erythromycin, ciprofloxacin, gentamicin, and chloramphenicol. Notably, most of these isolates (n = 52) presented an unusual erythromycin-susceptibility/clindamycin-resistance phenotype. WGS showed that these isolates lacked the erm and the lnu genes encoding resistance to macrolides and lincosamides, respectively, but carried the vgaALC gene encoding resistance to lincosamides, which is here firstly identified in S. aureus ST398.

Conclusion

After two years the ban of colistin and amoxicillin as feed additives had no significant impact on the MRSA nasal carriage rates. Nevertheless, the MRSA strains circulating in those farms showed resistance to a lower number of antibiotic classes.

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Citation: Lopes E, Conceição T, Poirel L, de Lencastre H, Aires-de-Sousa M (2019) Epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolates colonizing pigs with different exposure to antibiotics. PLoS ONE 14(11): e0225497. https://doi.org/10.1371/journal.pone.0225497

Editor: Tara C. Smith, Kent State University, UNITED STATES

Received: September 6, 2019; Accepted: November 6, 2019; Published: November 20, 2019

Copyright: © 2019 Lopes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This work was partly supported by project PTDC/DTP-EPI/0842/2014 from Fundação para a Ciência e a Tecnologia (FCT), Portugal, and Project LISBOA-01-0145-FEDER-007660 (Microbiologia Molecular, Estrutural e Celular) funded by FEDER funds through COMPETE2020 – Programa Operacional Competitividade e Internacionalização (POCI) and by national funds through FCT. This work was also partially supported by ONEIDA project (LISBOA-01-0145-FEDER-016417) co-funded by FEEI – “Fundos Europeus Estruturais e de Investimento” from “Programa Operacional Regional Lisboa 2020” and by national funds from FCT. Elizeth Lopes was supported by grant 03/BI/2017 from FCT, Portugal.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Antibiotics; Drugs Resistance; Amoxicillin; Colistin; Staphylococcus aureus; Pigs; MRSA; Portugal.

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A novel #plasmid-encoded #mcr-4.3 gene in a #colistin-resistant #Acinetobacter baumannii clinical strain (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

A novel plasmid-encoded mcr-4.3 gene in a colistin-resistant Acinetobacter baumannii clinical strain

Natacha Martins-Sorenson, Erik Snesrud, Danilo Elias Xavier, Luciana Camila Cacci, Anthony T Iavarone, Patrick McGann, Lee W Riley, Beatriz Meurer Moreira

Journal of Antimicrobial Chemotherapy, dkz413, https://doi.org/10.1093/jac/dkz413

Published: 03 October 2019

 

Abstract

Objectives

To identify the molecular mechanism of colistin resistance in an MDR Acinetobacter baumannii clinical strain isolated in 2008 from a meningitis case in Brazil.

Methods

Long- and short-read WGS was used to identify colistin resistance genes in A. baumannii strain 597A with a colistin MIC of 64 mg/L. MS was used to analyse lipid A content. mcr was cloned into pET-26b (+) and transformed into Escherichia coli BL21(λDE3)pLysS for analysis.

Results

A novel plasmid (pAb-MCR4.3) harbouring mcr-4.3 within a Tn3-like transposon was identified. The A. baumannii 597A lipid A MS spectra showed a main molecular ion peak at m/z = 2034, which indicated the addition of phosphoethanolamine to the lipid A structure. E. coli BL21 transformed with pET-26b-mcr-4.3 gained colistin resistance with a colistin MIC of 8 mg/L.

Conclusions

Colistin resistance in A. baumannii 597A was correlated with the presence of a novel plasmid-encoded mcr-4.3 gene.

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; MCR4; Colistin; Acinetobacter baumannii; Brazil.

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#Colistin #resistance-mediated #bacterial surface #modification sensitizes #phage infection (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Colistin-resistance-mediated bacterial surface modification sensitizes phage infection

Guijuan Hao, Annie I. Chen, Ming Liu, Haijian Zhou, Marisa Egan, Xiaoman Yang, Biao Kan, Hui Wang, Mark Goulian, Jun Zhu

DOI: 10.1128/AAC.01609-19

 

ABSTRACT

Colistin is a drug of last resort for the treatment of many multidrug resistant Gram-negative bacteria, including Klebsiella pneumoniae. However, bacteria readily acquire resistance to this antibiotic via lipopolysaccharide modifications caused by spontaneous mutations or from enzymes acquired by lateral gene transfer. The fitness cost associated with these modifications remains poorly understood. In this study, we show that colistin-resistant K. pneumoniae are more susceptible to killing by a newly isolated lytic phage than the colistin sensitive parent strain. We observe this behavior for colistin-resistance conferred by a horizontally transferred mcr-1 containing plasmid and also from the inactivation of the chromosomal gene mgrB. By measuring zeta potentials, we found that the phage particles were negatively charged at neutral pH and that colistin-resistant bacteria had less negative zeta potentials than did wildtype. These results suggest that the decreased negative surface charge of colistin-resistant cells lowers the electrostatic repulsion between the phage and bacteria, thereby promoting phage adherence and subsequent infection. To further explore this, we tested the effect of phage treatment on K. pneumoniae growing in several different environments. We found that colistin-resistant cells were more susceptible to phage than were the wildtype cells when growing in biofilms or infected moth larvae and when colonizing the mammalian gut. A better understanding of these fitness costs may lead to new treatment approaches that minimize the emergence and spread of colistin-resistant pathogens in human and environmental reservoirs.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Colistin; MCR1; Klebsiella pneumoniae; Bacteriophages.

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A ten-year review of #ESBL and non-ESBL #Escherichia coli #bloodstream #infections among #children at a tertiary referral #hospital in South Africa [#ZA] (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa

Oliver Ombeva Malande , James Nuttall, Vashini Pillay, Colleen Bamford, Brian Eley

Published: September 24, 2019 / DOI: https://doi.org/10.1371/journal.pone.0222675

 

Abstract

Introduction

There are few studies describing Escherichia coli (E. coli) bloodstream infection (BSI) among children in Africa, yet E.coli is increasing in importance as a cause of antibiotic resistant infection in paediatric settings.

Methods

In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended-spectrum β-lactamase (ESBL)-producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease.

Results

There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes, having an underlying chronic illness other than HIV infection at the time of the E. coli BSI and having a temperature of 38° Celsius or higher at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus.

Conclusions

These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospital-acquired BSI and help inform prevention strategies.

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Citation: Malande OO, Nuttall J, Pillay V, Bamford C, Eley B (2019) A ten-year review of ESBL and non-ESBL Escherichia coli bloodstream infections among children at a tertiary referral hospital in South Africa. PLoS ONE 14(9): e0222675. https://doi.org/10.1371/journal.pone.0222675

Editor: Surbhi Leekha, University of Maryland School of Medicine, UNITED STATES

Received: April 30, 2019; Accepted: September 3, 2019; Published: September 24, 2019

Copyright: © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: There was no special funding for this work, except patient folders and clinical records and staff input from the Red Cross Hospital Children’s Hospital – Paediatric infectious Diseases unit and University of Cape Town.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Carbapenem; Colistin; Beta-lactams; Bacteremia; Pediatrics; South Africa.

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Conjugative IncX 1 #plasmid harboring #colistin #resistance gene #mcr-5.1 in #E coli isolated from #chicken rice retailed in #Singapore (Antimicrob Agents Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Conjugative IncX 1 plasmid harboring colistin resistance gene mcr-5.1 in E. coli isolated from chicken rice retailed in Singapore

Siyao Guo, Moon Y.F. Tay, Aung Kyaw Thu, Kelyn Lee Ghee Seow, Yang Zhong, Lee Ching Ng, Joergen Schlundt

DOI: 10.1128/AAC.01043-19

 

ABSTRACT

Colistin is regarded as one of the last resort antimicrobials to Gram-negative bacterial infection (1).…

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Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Colistin; MCR5; Plasmids; Food Safety; Singapore.

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#Control and #Elimination of #XDR #Acinetobacter baumanii in an #ICU (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 10—October 2019 / Dispatch

Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit

Amanda Chamieh1, Tania Dagher Nawfal1, Tala Ballouz1, Claude Afif, George Juvelekian, Sani Hlais, Jean-Marc Rolain, and Eid Azar

Author affiliations: University of Balamand, Beirut, Lebanon (A. Chamieh, T. Ballouz, C. Afif, G. Juvelekian, E. Azar); Aix-Marseille University, Marseille, France (T.D. Nawfal, J.-M. Rolain); Saint Joseph University and American University of Beirut, Beirut (S. Hlais)

 

Abstract

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

Keywords: Antibiotics; Drugs Resistance; Colistin; Acinetobacter baumannii; Lebanon; ICU.

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Detection of a novel #mcr-5.4 gene variant in #hospital tap #water by shotgun #metagenomic sequencing (J Antimicrob Chemother., summary)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Summary, edited.]

Detection of a novel mcr-5.4 gene variant in hospital tap water by shotgun metagenomic sequencing

Giuseppe Fleres, Natacha Couto, Leonard Schuele, Monika A Chlebowicz,Catarina I Mendes, Luc W M van der Sluis, John W A Rossen, Alex W Friedrich,Silvia García-Cobos

Journal of Antimicrobial Chemotherapy, dkz363, https://doi.org/10.1093/jac/dkz363

Published: 23 August 2019

Issue Section: Research letter

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Sir,

Colistin is considered a last-resort antibiotic for treating serious infections caused by MDR Gram-negative bacteria. The efficacy of this antibiotic is challenged by the emergence and global spread of mobile colistin resistance (mcr) determinants, which threaten human, animal and environmental health. The first mobile colistin resistance gene (mcr-1) was reported in 2015 and since then up to eight different variants have been described.1 In 2017, Borowiak et al.2 described a new transposon-associated phosphoethanolamine transferase mediating colistin resistance, named mcr-5, in d-tartrate-fermenting Salmonella enterica subsp. enterica serovar Paratyphi B isolated from poultry. The mcr-5.3 variant has been recently reported in Stenotrophomonas spp. from sewage water.3 Here we report for the first time (to the best of our knowledge) the detection of an mcr-5 gene in a hospital water environment using short-read metagenomic sequencing (SRMseq) and subsequent characterization using long-read metagenomic sequencing (LRMseq) to reveal its genetic environment.

(…)

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Acknowledgements

We would like to thank Erwin C. Raangs for technical assistance.

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement 713660 (MSCA-COFUND-2015-DP ‘Pronkjewail’), which includes in-kind contributions by commercial partners. None of the commercial partners had any influence on interpretation of reviewed data and conclusions drawn, or on drafting of the manuscript. This work was partly supported by the INTERREG VA (202085)-funded project EurHealth-1Health, part of a Dutch–German cross-border network supported by the European Commission, the Dutch Ministry of Health, Welfare and Sport (VWS), the Ministry of Economy, Innovation, Digitalization and Energy of the German Federal State of North Rhine-Westphalia and the German Federal State of Lower Saxony.

Transparency declarations

None to declare.

Keywords: Antibiotics; Drugs Resistance; Colistin; MCR5; Germany.

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