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Multidrug-Resistant Salmonella Strains Expressing Emerging Antibiotic Resistance Determinants

Identifieur interne : 002E86 ( Istex/Corpus ); précédent : 002E85; suivant : 002E87

Multidrug-Resistant Salmonella Strains Expressing Emerging Antibiotic Resistance Determinants

Auteurs : Patrice Nordmann ; Laurent Poirel ; Jennifer K. Mak ; Peter A. White ; Christopher J. Mciver ; Peter Taylor

Source :

RBID : ISTEX:F87BFE6F2CA005B4D5F425BD605D9280476B874B
Url:
DOI: 10.1086/524898

Links to Exploration step

ISTEX:F87BFE6F2CA005B4D5F425BD605D9280476B874B

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<body>
<p>T
<sc>o the</sc>
E
<sc>ditor—</sc>
<italic>Salmonella enterica</italic>
is a common cause of human gastroenteritidis and bacteremia worldwide. Human infections with nontyphoidal
<italic>Salmonella</italic>
are commonly caused by ingestion of food that has been contaminated with animal feces. In recent years, antimicrobial drug resistance among
<italic>Salmonella</italic>
species has increasingly been reported [
<xref rid="ref1" ref-type="bibr">1</xref>
]. A
<italic>Salmonella</italic>
isolate that produced 2 emerging antibiotic resistance determinants was identified; these determinants compromise the efficacy of the main antibiotic families for treating
<italic>Salmonella</italic>
infection (i.e., quinolones and expanded-spectrum β-lactams).</p>
<p>In May 2007, an 87-year-old Australian woman who had been hospitalized in a nursing home for several years had a urinary tract infection due to a
<italic>Salmonella</italic>
species that was typed as
<italic>Salmonella waycross</italic>
at the State Reference Laboratory in Sydney, Australia. She had had no regular contact with animals. Routine antibiograms revealed that the isolate was resistant or of intermediate susceptibility to most β-lactams, including imipenem, cefotaxime, and ceftriaxone, nalidixic acid, gentamicin, and amikacin. The patient was treated with trimethoprim. She developed diarrhea 10 days later, and an identical strain was isolated from a fecal sample. Mating-out assays using an azide-resistant
<italic>Escherichia coli</italic>
J53 reference strain identified transferable resistance determinants, including resistance to carbapenems and quinolones. PCR amplification with integron-specific primers identified a class-1 integron harboring the gene cassettes
<italic>bla</italic>
IMP-4,
<italic>qacG, aacA4</italic>
, and
<italic>catB3</italic>
[
<xref rid="ref2" ref-type="bibr">2</xref>
]. The
<italic>bla</italic>
IMP-4 gene encodes a β-lactamase with the broadest spectrum of hydrolysis (i.e., a carbapenemase) [
<xref rid="ref2" ref-type="bibr">2</xref>
]. The presence of such carbapenemase genes in
<italic>Salmonella</italic>
species has been reported only once [
<xref rid="ref3" ref-type="bibr">3</xref>
]; these genes have mostly been identified in
<italic>Pseudomonas aeruginosa, Acinetobacter baumannii</italic>
, and nosocomial acquired enterobacterial species worldwide, including in Australia [
<xref rid="ref2" ref-type="bibr">2</xref>
]. The
<italic>aacA4</italic>
gene cassette provides resistance to aminoglycosides,
<italic>qacG</italic>
encodes antiseptic resistance, and
<italic>catB3</italic>
confers resistance to chloramphenicol. The class-1 integron array was located on an 80-kb conjugative plasmid identified after plasmid extraction of both the clinical isolate and the transconjugant. The plasmid also harbored a quinolone resistance determinant,
<italic>qnrB4</italic>
, encoding QnrB4. Plasmid-mediated quinolone resistance determinants of
<italic>qnrA, qnrB</italic>
, and
<italic>qnrS</italic>
types are of recent recognition and, thus far, have only been found in
<italic>Enterobacteriaceae</italic>
, including
<italic>Salmonella</italic>
species [
<xref rid="ref4" ref-type="bibr">4</xref>
,
<xref rid="ref5" ref-type="bibr">5</xref>
]. These Qnr determinants confer resistance to nalidixic acid and reduced susceptibility to fluoroquinolones [
<xref rid="ref4" ref-type="bibr">4</xref>
].</p>
<p>This report underlines that
<italic>Salmonella</italic>
species may be a reservoir for 2 of the most important and emerging antibiotic resistance determinants, which confer resistance to at least carbapenems, cephalosporins, and quinolones. This first identification of both of these resistance determinants in a single isolate indicates that quinolones may select for carbapenem resistance or vice versa. In the absence of molecular tools, widespread detection of such resistances would be difficult in other enterobacterial species, both from the community and from the health care centers, which raises the problem of the environmental origin of the resistance determinants.</p>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p>
<bold>
<italic>Financial support</italic>
</bold>
. Ministère de l'Education Nationale et de la Recherche (UPRES-EA3539) and Université Paris XI.</p>
<p>
<bold>
<italic>Potential conflicts of interest</italic>
</bold>
. All authors: no conflicts.</p>
</ack>
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