Sarah Lepuschitz

Carbapenemase-Producing Enterobacteriaceae Isolates from Edo State, Nigeria

The emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) are a global health problem that is of great concern to public health services (1, 2). The purpose of this study was to determine the frequency of CRE in three Nigerian hospitals and to characterize the resistance mechanisms of such isolates. A total of 218 consecutive clinical isolates of Enterobacteriaceae based on inclusion criteria were collected from March to May 2015 at three medical microbiology laboratories of hospitals in Edo State, Nigeria (see Table S1 in the supplemental material). Screening for carbapenem resistance was performed using meropenem and ertapenem discs (10 g; Oxoid, United Kingdom) according to EUCAST guidelines (3). The KirbyBauer susceptibility testing technique (4) and Etest method were carried out, and results were interpreted using EUCAST criteria (5). Identification of the involved resistance mechanisms was determined by whole-genome sequencing (WGS). Out of 218 consecutive clinical Enterobacteriaceae isolates, 9 (4.1%) were further investigated due to cutoff values above the EUCAST screening recommendations (Table 1). All isolates showed resistance to piperacillin-tazobactam and amoxicillin-clavulanic acid, all but isolate Ec4349 showed resistance to fluoroquinolones and cefotaxime, and all but two isolates each showed resistance to ceftazidime (Ec4349 and Ecl2840_1) and ertapenem (Ec4349 and Ecl10_14_15). Only Ec4349, Ecl2845, Ecl2840_1, and EclQ9 were sensitive to cefepime and aztreonam. The carbapenemase inactivation method (6) revealed positive results for all nine CRE isolates. By application of WGS, one Klebsiella pneumoniae isolate harbored the blaOXA-181 gene; two K. pneumoniae isolates harbored the blaNDM-1 gene. The blaOXA-48 gene was detected in one Escherichia coli isolate, one K. pneumoniae isolate, and four Enterobacter cloacae isolates, respectively. All isolates had a single carbapenemase resistance gene on their draft genome fragment. Thirteen plasmid incompatibility groups were identified among the nine CRE isolates. Multilocus sequence typing (MLST) grouped the nine isolates into five sequence types. Previous reports from Nigeria on molecular characterization of carbapenem resistance genes have identified genes such as blaVIM, blaGES, blaNDM, blaOXA-181, and blaKPC (7–10). blaOXA-48, obtained from our study, has only been determined phenotypically. To the best of our knowledge, our findings, where six out of nine carbapenemaseproducing isolates harbored the blaOXA-48 gene, represent the first molecular determination of the blaOXA-48 gene for Nigeria. The presence of different plasmid replicon types in carbapenemase-producing Enterobacteriaceae (CPE) underlines their importance in the dissemination of resistance genes. The IncL/M plasmid type was found in all of our OXA-48-producing isolates, correlating with previous reports indicating that Accepted manuscript posted online 12 June 2017 Citation Jesumirhewe C, Springer B, Lepuschitz S, Allerberger F, Ruppitsch W. 2017. Carbapenemase-producing Enterobacteriaceae isolates from Edo State, Nigeria. Antimicrob Agents Chemother 61:e00255-17. https://doi .org/10.1128/AAC.00255-17. Copyright

Characterization of a community-acquired-MRSA USA300 isolate from a river sample in Austria and whole genome sequence based comparison to a diverse collection of USA300 isolates.

The increasing emergence of multi-resistant bacteria in healthcare settings, in the community and in the environment represents a major health threat worldwide. In 2016, we started a pilot project to investigate antimicrobial resistance in surface water. Bacteria were enriched, cultivated on selective chromogenic media and species identification was carried out by MALDI-TOF analysis. From a river in southern Austria a methicillin resistant Staphylococcus aureus (MRSA) was isolated. Whole genome sequence analysis identified the isolate as ST8, spa type t008, SCCmecIV, PVL and ACME positive, which are main features of CA-MRSA USA300. Whole genome based cgMLST of the water isolate and comparison to 18 clinical MRSA USA300 isolates from the Austrian national reference laboratory for coagulase positive staphylococci originating from 2004, 2005 and 2016 and sequences of 146 USA300 isolates arbitrarily retrieved from the Sequence Read Archive revealed a close relatedness to a clinical isolate from Austria. The presence of a CA-MRSA USA300 isolate in an aquatic environment might pose a public health risk by serving as a potential source of infection or a source for emergence of new pathogenic MRSA clones.

Petting zoos as sources of Shiga toxin-producing Escherichia coli (STEC) infections

Despite their general low incidence, Shiga toxin-producing Escherichia (E.) coli (STEC) infections are considered an important public health issue due to the severity of illness that can develop, particularly in young children. We report on two Austrian petting zoos, one in Tyrol (2015) and one in Vorarlberg (2016), which were identified as highly likely infection sources of STEC infections. The petting zoo related cases involved a case of hemolytic uremic syndrome (HUS) due to STEC O157:HNM in 2015 and an outbreak of STEC O157:H7 infections affecting five young children and two adults in 2016. The HUS case accounted for 2.8% of the 36 STEC O157:HNM/H7 infections notified in Austria in 2015 (5,9% of 17 HUS cases). The seven cases described for 2016 accounted for 4.0% of the 177 human STEC infections documented for Austria in 2016, and for 19.4% of the 36 STEC O157:HNM/H7 infections notified that year. The evaluation of the STEC infections described here clearly underlines the potential of sequence-based typing methods to offer suitable resolutions for public health applications. Furthermore, we give a state-of-the-art mini-review on the risks of petting zoos concerning exposure to the zoonotic hazard STEC and on proper measures of risk-prevention.

Letter to the editor: Livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA), Austria, 2013

To the editor: In their article titled ‘Livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) among human MRSA isolates, European Union/ European Economic Area countries, 2013’, Kinross et al. recently reported on the occurrence of LA-MRSA in humans [1]. The results were obtained by an ECDC initiated study documenting the identification of LA-MRSA (i.e. CC398 and ‘other’ LA-MRSA) in European Union/ European Economic Area countries (EU/EEA) countries and the MRSA subtyping capacity and availability in EU/EEA national or regional reference laboratories. ECDC National Focal Points for Antimicrobial Resistance (AMR) were invited to designate a primary and alternate contact person with expertise in molecular surveillance of MRSA for public health purposes and with access to data for the survey in their respective countries; 27 of 30 EU/EEA countries responded to this request for data.

Detection of the mcr-1 gene in a multidrug-resistant Escherichia coli isolate from an Austrian patient

ABSTRACT Since colistin resistance based on the plasmid-encoded mcr-1 gene was first described, this resistance gene in Enterobacteriaceae has been found worldwide. These organisms are typically of heterogeneous genetic background and show exceptional clonal diversity. We describe the first confirmation of mcr-1 in a human Escherichia coli strain cultured from a surveillance stool sample of an Austrian oncology patient.

Draft Genome Sequence of a Vancomycin-Resistant and Vancomycin-Dependent Enterococcus faecium Isolate

ABSTRACT Vancomycin-resistant enterococci have emerged as major nosocomial pathogens worldwide. While antimicrobial pressure promotes nosocomial colonization with these enterococci, prolonged exposure to vancomycin may foster the transition from vancomycin resistance to vancomycin dependence. Here, we report the draft genome sequence of a vancomycin-dependent Enterococcus faecium isolate showing partial teicoplanin dependence.