Molecular analysis of ampicillin-resistant sporadic Salmonella typhi and Salmonella paratyphi B clinical isolates

Objective: To study the mechanisms of antibiotic resistance in Salmonella typhi and Salmonella paratyphi B clinical isolates, and the clonality of resistant strains.
Method: Antibiotic susceptibility was tested by disk-agar diffusion. Conjugation experiments and plasmid analysis by agarose gel electrophoresis after Eco RI digestion were followed by hybridization to a digoxigenin-labeled TEM-type β-lactamase probe. DNA fingerprints were obtained by pulsed-field gel electrophoresis of Xba I-digested chromosomal DNA.
Results: Three S. typhi isolates (7% of the isolates studied), of which one was ampicillin resistant and the other two multiresistant (ampicillin, chloramphenicol, tetracycline, sulfamethoxazole/trimethoprim and streptomycin), and two ampicillin-resistant S. paratyphi B isolates (25% of the isolates studied) were further evaluated. A 34-MDa conjugative plasmid, previously isolated from Salmonella enteritidis , conferred ampicillin resistance. A 100-MDa conjugative plasmid encoded resistance to chloramphenicol, tetracycline and sulfamethoxazole/trimethoprim, as well as ampicillin. Chromosomal fingerprinting revealed two distinct resistant strains for each serovar which were different from a matched set of sensitive S. typhi strains.
Conclusions: Two conjugative, TEM-type β-lactamase-encoding plasmids conferred ampicillin resistance to S. typhi and S. paratyphi B. The 34-MDa plasmid was identical to that previously characterized from S. enteritidis , while the 100-MDa plasmid also encoded resistance to chloramphenicol, tetracycline and sulfamethoxazole/trimethoprim. Resistant isolates did not belong to a single clone but rather represented distinct strains.     

Characterization of plasmids in bacterial fish pathogen.

Plasmid profiles of representative fish pathogens, Aeromonas salmonicida, Aeromonas hydrophila, Vibrio anguillarum, Pasteurella piscicida, Yersinia ruckeri, Edwardsiella tarda, and Renibacterium salmoninarum, were determined by agarose gel electrophoresis with four different plasmid detection methods. A combination of two methods was required to detect the plasmids present in these strains and to calculate precisely the molecular weights of the plasmids. Of 38 strains, 28 harbored one or more plasmids, with the majority of strains demonstrating multiplasmid banding. Similarity in plasmid banding between strains was noted and related to geographic source. Five strains of A. salmonicida possessed six plasmid bands having molecular weights of 8.6 X 10(6), 8.4 X 10(6), 8.1 X 10(6), 3.6 X 10(6), 3.5 X 10(6), and 3.4 X 10(6). Four P. piscicida isolates shared three plasmid bands having molecular weights of 37 X 10(6), 15 X 10(6), and 5 X 10(6), and five A. hydrophila strains harbored a common plasmid having a molecular weight of ca. 20 X 10(6) to 30 X 10(6). The highest-molecular-weight plasmids (145 X 10(6) and 130 X 10(6) were detected in V. anguillarum. From curing experiments, it was found that in A. hydrophila strain 79-62, a loss of resistance to tetracycline was associated with loss of plasmid content in all susceptible derivatives, suggesting plasmid-mediated tetracycline resistance. Cell surface characteristics and metabolic properties were also modified in cured derivatives of A. hydrophila strain 79-62.     

Serum resistance and hemagglutination ability of marine vibrios pathogenic for fish.

Representative strains of marine vibrios pathogenic for fish were shown to be resistant to the bactericidal activity of normal (nonimmmune) rainbow trout (Salmo gairdneri) serum, and loss of this resistance coincided with a marked reduction in virulence. Thermal lability and a requirement for Mg2+, but not for Ca2+, suggested that a mechanism for serum killing was the alternative complement pathway. In the case of Vibrio anguillarum, serum resistance was not coded for by the virulence plasmid pJM1. Additional testing showed that these pathogenic vibrios were able to agglutinate a variety of eucaryotic cells and that selected strains agglutinated trout erythrocytes; however, a correlation between strain virulence and the ability to agglutinate fish erythrocytes was not apparent. Moreover, whereas mannose was found to inhibit the agglutinating activity of several strains, two of the high-virulence strains displayed a transient, mannose-resistant hemagglutinating activity. No relationship between the carriage of pJM1 by the V. anguillarum strains and hemagglutinating activity was demonstrable.     

Evidence for plasmid contribution to the virulence of fish pathogen Vibrio anguillarum.

Analysis of the plasmid deoxyribonucleic acid complement of high- and low- virulent strains of the fish pathogen Vibrio anguillarum showed a correlation between enhanced virulence and the presence of a 50-megadalton plasmid class. All 50-megadalton plasmids isolated from different high-virulent V. anguillarum strains were homologous as judged by the analysis of plasmid deoxyribonucleic acid-deoxyribonucleic acid hybridization. The 50-megadalton plasmid class did not have polynucleotide sequences in common with plasmids of different incompatibility groups.     

Acquisition of a gene encoding mannose-resistant haemagglutinating fimbriae by a resistance plasmid during long-term urinary infection

Urine was collected twice weekly from one patient during a 25-month period. Escherichia coli harbouring a resistance plasmid, pUK28, which confers trimethoprim, ampicillin, sulphamethoxazole, spectinomycin and streptomycin resistance was identified in the urine. Carriage of strains containing plasmid pUK28 was observed during three separate periods which totalled 16 months, even though the patient did not receive antibacterial drug therapy for most of that time. The plasmid was able to acquire the genes responsible for mannose-resistant haemagglutination and these genes were increasingly associated with the plasmid towards the end of the study period.     

A transmissible plasmid determining lactose fermentation and multiple antibiotic resistance in a strain of Klebsiella pneumoniae.

In a wild strain of Klebsiella pneumoniae the plasmid that determined lactose fermentation also determined resistance to chloramphenicol, ampicillin, tetracyclines, streptomycin, spectinomycin, and sulphonamides. The plasmid transferred at a very low rate to Escherichia coli K12 and Salmonella typhi. By implanting other transfer factors in the strain the rate of transfer and the recipient range were increased. Plasmid transfer from the modified strain to Salm. typhimurium and Salm. gallinarum was detected in the alimentary tract of experimentally infected chicks fed diets containing ampicillin.     

Haemophilus influenzae: comparison of respiratory tract isolates with genitourinary tract isolates.

Haemophilus influenzae isolates recovered from the genitourinary (GU) tract were shown to have a significantly different biotype distribution compared with respiratory tract isolates. Biotype IV strains were recovered more commonly from the GU tract, and most strains were non-serotypable. Antibiotic-susceptible strains isolated from the GU tract more frequently harbored plasmids of less than 10 megadaltons than did antibiotic-susceptible respiratory tract strains. One 2.8-megadalton plasmid resident in a GU tract isolate and one 1.8-megadalton plasmid resident in a respiratory tract isolate were shown to be related to the small ampicillin resistance plasmids previously described in H. influenzae, Haemophilus parainfluenzae, Haemophilus ducreyi, and Neisseria gonorrhoeae. This supports the suggestion that these ampicillin resistance plasmids originated by transposition or recombination of the ampicillin transposon (TnA) with cryptic endogenous Haemophilus plasmids.     

Plasmid-linked ampicillin resistance in haempohilus influenza type b.

Four ampicillin-resistant, beta-lactamase-producing strains of Haempohilus influenzae type b were examined for the presence of plasmid deoxyribonucleic acid (DNA). Three resistant strains contained a 30 x 10-6-dalton (30Mdal) plasmid and one resitant strain contained a 3-Mdal plasmid. The ampicillin-sensitive Haemophilus strains examined did not contain plasmid DNA. Transformation of a sensitive H. influenzae strain to ampicillin resistance with isolated plasmid DNA preparations revealed that the structural gene for beta-lactamase resided on both plasmid species. DNA-DNA hybridization studies showed that the 30-Mdal Haemophilus plasmid contained the ampicillin translocation DNA segment (TnA) found on some R-factors of enteric origin of the H. influenzae plasmids.     

Outer membrane proteins induced under conditions of iron limitation in the marine fish pathogen Vibrio anguillarum 775.

Cells of the marine fish pathogen Vibrio anguillarum 775 harboring a plasmid associated with virulence can grow unaffected in the presence of iron-binding compounds such as transferrin. In contrast, the growth of isogenic plasmidless derivatives is inhibited by the presence of iron chelators. Radioactive from (55Fe3+) uptake experiments indicate that this plasmid-linked ability of V. anguillarum cells to grow under conditions of iron limitation is indeed due to a more rapid and efficient iron uptake mediated by the virulence plasmid. In addition, V. anguillarum cells growing under iron limitation show at least two novel outer membrane proteins. One of them, a 86,000-dalton protein we called OM2, is inducible only in those cells in which the virulence plasmid is present.     

Beta-lactam resistance in aerobic faecal flora from general practice patients in the UK

One hundred faecal specimens submitted to a diagnostic laboratory in Edinburgh and found to be negative for gastrointestinal pathogens were examined for the presence of antibiotic-resistant bacteria. The results were compared with findings in the healthy population in the same area. The highest incidence of resistance was observed to cefuroxime (65 %) and ampicillin (60 %). Of the ampicillin-resistant isolates, 62 % could transfer their resistance determinants to a standardEscherichia coli host strain. In 100 % of these transconjugants ampicillin resistance was shown to result from the presence of the TEM-1 -lactamase which was identified in a heterogeneity of plasmid profiles. These plasmids commonly mediated resistance to streptomycin and tetracycline in addition to ampicillin.     

Biotypes, antibiotic resistance and plasmids coding for CFA/I and STa in enterotoxigenic Escherichia coli strains of serotype O153:H45 isolated in Spain

Enterotoxigenic Escherichia coli (ETEC) strains of serotype O153:H45 have been found recently to be a frequent cause of sporadic cases and outbreaks of neonatal diarrhoea in Spain and the most important cause of infant diarrhoea in Chile. Relationships between sugar fermentation patterns, resistance to antibiotics and plasmid profiles were analysed in nine E. coli O153:H45 strains isolated in Spain that synthesised CFA/I antigen and STa enterotoxin. Derivative strains obtained by curing with acridine orange, and transconjugants rendered antibiotic resistant, were characterised phenotypically and analysed for plasmid content. Two fermentation patterns were recognised: rhamnose fermenters (four strains) and rhamnose non-fermenters (five strains). The ability to ferment rhamnose was the only differential characteristic found among 49 carbohydrate fermentation tests used to establish fermentation patterns. All nine strains possessed similar plasmid profiles of three or four plasmids of 52-87 Mda. A non-conjugative large plasmid of 82 Mda or 87 Mda, depending upon the strain, was identified as that responsible for production of both CFA/I and STa. Resistance to antibiotics was determined by plasmids other than those coding for CFA/I and STa. Two conjugative resistance factors were identified: a 52-Mda plasmid coding for resistance to ampicillin, streptomycin and sulphonamide in rhamnose-fermenting strains, and a 77-Mda plasmid coding for resistance to ampicillin, streptomycin, kanamycin, tetracycline and sulphonamide in rhamnose non-fermenting strains. Our results support the hypothesis that the prevalence and distribution of ETEC strains belonging to serotype O153:H45 in Spain and Chile could be due to the extensive cultural relations between Spain and South American from the past.     

Analysis of phenotype resistance of clinical strains of Escherichia coli

The multiplasmid clinical E. coli KL4 strain isolated from urine of a patient was examined for resistance to antibacterial substances and the number of plasmids. The distribution of resistance genes to antibiotics in different plasmids was assessed. All assessed resistances were transmitted by the mechanism of bacterial conjugation. By means of conjugation of the clinical E. coli strain KL4 and E. coli DH1, transformation of the DH1 strain by plasmid DNA and electrophoretic analysis two R plasmids were identified. The largest plasmid carries the gene for resistance against tetracycline and it is conjugative. Another three plasmids were mobilized by this plasmid during conjugation. The largest among them codes resistance against ampicillin, azlocillin and ticarcillin. From the total of five plasmids of the KL4 strain three were cryptic with regard to the resistance phenotype.     

Linkage of heat-stable enterotoxin activity and ampicillin resistance in a plasmid isolated from an Escherichia coli strain of human origin.

In an Escherichia coli strain of human origin, ampicillin resistance and heat-stable enterotoxin activity were shown by EcoRI restriction endonuclease and genetic analysis to be in an 80-megadalton plasmid.     

Characterization of multiple-antibiotic-resistant Salmonella typhimurium stains: molecular epidemiology of PER-1-producing isolates and evidence for nosocomial plasmid exchange by a clone.

We characterized epidemiologic and genetic features of nosocomially originated multiple-antibiotic-resistant Salmonella typhimurium isolates from two hospitals. A total of 32 multiply resistant strains, isolated during a 28-month period, were studied. Four resistance phenotypes were distinguished on the basis of the results of disc diffusion tests. Group 1 was resistant to chloramphenicol, gentamicin, tobramycin, amikacin, and the newer cephalosporins because of the production of an extended-spectrum beta-lactamase (PER-1). Group 2 exhibited the same pattern plus resistance to sulfamethoxazole-trimethoprim (Sxt). Except for Sxt resistance, dominant phenotypes of both groups were transferred on an identical plasmid, pSTI1 (81 MDa). Group 3 was resistant to ampicillin, chloramphenicol, gentamicin, tobramycin, and Sxt. This pattern was also transferred on an 81-MDa plasmid (pSTI2) which differed from pSTI1 on the basis of EcoRI and HindIII restriction fragments. Group 4 was resistant to ampicillin, chloramphenicol, and tetracycline, and a 74-MDa nonconjugative plasmid was detected. Restriction fragment length polymorphism of RNA-encoding DNA and arbitrarily primed PCR tests revealed that bacteria from groups 1, 2, and 3 were clonally related. Epidemiologic data also supported the clonal-dissemination hypothesis. We concluded that S. typhimurium isolates acquire and exchange multiple-resistance plasmids in hospital microflora.     

Outbreak of dysentery Is Kenya due to multi-resistant polyclonal strain of Shigella dysenteriae type 1

Sixty-eight strains of multi-drug resistant Shigella dysenteriae type 1 were isolated from outbreaks of severe dysentery in three areas of Kenya, namely, Kisumu, Mombassa and Nairobi. The strains were tested for their susceptibility to seven antibiotics. Plasmids were extracted to study their variety and conjugated with Escherichia coli K12 to identify the plasmid coding for the resistance gese. All the strains were resistant to ampicillin, trimethoprim-sulfamethoxazole (S-T), tetracyciine and chloramphenicol. They were sensitive to gentamicin, kanamycin and nalidixic acid. Part of the resistance was found to be plasmid mediated and the sizes of plasmids coding resistance gene wereSMDaand 19MDa. These piasmids coded resistance for ampicillin, trimethoprim-sulfamethoxazole, tetracyciine and chloramphenicol. Verotoxin (VT) production was demonstrated in 80% of the strains by oligonucleotide DNA-DNA gybridization of whole cells with the VT-probe. In view of the extent of drug resistance exhibited by Shigella dysenteriae Type 1 in this study, we recommend the use of nalidixic acid as a first choice of treatment in multiresistant S. dysenteriae Type 1 dysentery outbreaks. Compared to the other two agents that the pathogen was sensitive to, nalidixic acid is relatively cheap with the cost of 7 days treatment for an adult being approximately five US dollars. Resistance to nalidixic acid has to be, however, closely monitored as S. dysenteriae Type 1 has been reported to develop resistance to this drug over time.     

Characterization of endemic Shigella flexneri strains in Somalia: antimicrobial resistance, plasmid profiles, and serotype correlation.

One hundred twelve Shigella flexneri strain isolated from children with diarrheal disease in Somalia in 1983, 1984, 1988, and 1989 were analyzed for serotype, plasmid profile, and genetic location of antimicrobial resistance determinants. The prevalent serotypes were 4 (46% of the isolates), 1b (16%), 2a (16%), 3a (12%), and 6 (8%). Each serotype was associated with a characteristic predominant plasmid profile, whereas no specific correlation between antimicrobial resistance patterns and single serotypes was found. All but three of the strains were resistant at least to ampicillin, chloramphenicol, spectinomycin, and tetracycline. Of these resistant strains, 41 were resistant to sulfonamide and streptomycin and 14 were resistant to trimethoprim or trimethoprim and kanamycin. The genes for resistance to ampicillin, chloramphenicol, spectinomycin, and tetracycline formed a linkage group located on the chromosome of the strains of all serotypes. The genes for resistance to sulfonamide and streptomycin were located on a 6.3-kb plasmid in strains of serotypes 1b, 2a, and 4. Conjugative trimethoprim or trimethoprim and kanamycin resistance plasmids with lengths of 80 to 110 kb were present in strains of serotypes 1b, 2a, 3a, and 4. The systematic presence of a chromosomal component in this uncommon genetic plasmid-chromosome configuration may play a role in the emergence of increased genetic stability of resistance patterns in S. flexneri.     

Variation in clonality and antibiotic-resistance genes among multiresistant Salmonella enterica serotype typhimurium phage-type U302 (MR U302) from humans, animals, and foods

Since 1990 multiresistant (MR) Salmonella enterica serotype Typhimurium definitive phage-type (DT) 104 (MR DT104) and closely related phage types have emerged as a worldwide health problem in humans and food animals. In this study the presence of the blaCARB-2 (ampicillin), cmlA (chloramphenicol), aadA2 (streptomycin/spectinomycin), sul1 (sulphonamide), and tetG (tetracycline) resistance genes in isolates of one such phage type, U302, have been determined. In addition blaTEM primers have been used for the detection of TEM-type beta-lactamases. Isolates have also been characterized by plasmid profile and pulsed field gel electrophoresis (PFGE). Thirty-three of 39 isolates were positive for blaCARB-2, cmlA, aadA2, sul1 and tetG, four for blaTEM, aadA2 and sul1, one for aadA2 and sul1, and one for blaTEM only. blaTEM-mediated ampicillin resistance was transferred to Escherichia coli K12 from three isolates along with other resistance markers, including resistance to chloramphenicol, streptomycin, spectinomycin, sulphonamides, and tetracyclines. Strains carried up to 6 plasmids and 34 plasmid profiles were identified. Although the majority of strains (33/39) produced a PFGE profile identical to that predominant in MR DT104, six different patterns were generated demonstrating the presence of various clones within MR U302. The results show that the majority of the MR U302 strains studied possessed the same antibiotic resistance genes as MR DT104. However, isolates with distinctive PFGE patterns can have different mechanisms of resistance to ampicillin, chloramphenicol, streptomycin, sulphonamides, and tetracyclines. Such resistance genes may be borne on transmissible plasmids.     

Molecular characterization of amoxicillin-clavulanate resistance in a clinical isolate of Escherichia coli

The resistance phenotype of the clinical isolate of Escherichia coli 1941 was characterized by high-level resistance to penicillins and to combinations amoxicillin-ticarcillin/clavulanate and ampicillin/sulbactam. This resistance was carried by the conjugative plasmid pEC1941 that encoded a beta-lactamase activity. The purified enzyme focused at pI 5.4 and was strongly inhibited in vitro by clavulanic acid (IC50 = 0.09 microM). Nucleotide sequence analysis revealed identity between the plasmid borne blaTEM gene of E. coli 1941 and the blaTEM-1B gene, except for a single C-to-T substitution at position 32 in the promoter region leading to the overlapping promoters Pa and Pb. No alterations in the expression of outer membrane porins OmpC and OmpF have been detected. These findings show that the resistance of E. coli 1941 to the combinations of beta-lactams with beta-lactamase inhibitors is related to high-level production of TEM-1 enzyme expressed from the strong promoters Pa and Pb.     

Increased production of the siderophore anguibactin mediated by pJM1-like plasmids in Vibrio anguillarum.

The virulence of the fish pathogen Vibrio anguillarum 775 is mediated by the pJM1 plasmid-specified iron uptake system which is expressed under conditions of iron limitation. Other V. anguillarum strains isolated from various geographical locations harbor plasmids that are highly related to pJM1 and that are also associated with the high-virulence phenotype of these strains. In this work, we found that a pJM1-like plasmid, pJHC1, from one of these virulent strains encoded an iron uptake system that resulted in an increased level of production of the siderophore anguibactin. The gene(s) responsible for increased anguibactin production was included within the iron uptake region of plasmid pJHC1. The cloned iron uptake regions of pJHC1 and pJM1 possessed identical restriction endonuclease maps, suggesting that the DNA region encoding those genes in pJHC1 may have diverged subtly from that in pJM1. Analysis of the iron uptake system from other V. anguillarum strains carrying pJM1-like plasmids demonstrated that strains originating from diseased fish from the Atlantic coast carry plasmids encoding an increased-siderophore-production phenotype, while strains isolated from Pacific Ocean locations behaved as the 775 strain.     

Analysis of antibiotic resistance determinants inProteus penneri

The plasmid profiles of 65 strains ofProteus penneri were analyzed to determine whether resistance was determined chromosomally or by plasmids. Only seven strains harboured one to three plasmids, although these strains exhibited resistance to a wide range of antibiotics. Markers for ampicillin and tetracycline resistance could be transferred toEscherichia coli by transformation. Plasmids carried resistance to chloramphenicol in two strains and resistance to sulfonamides in one strain. The results showed that resistance is determined chromosomally rather than by plasmids, however the possibility that these bacteria may acquire resistance plasmids which change their antibiotic susceptibility pattern cannot be excluded.