Dataset Information

Antibiotic susceptibility and molecular analysis of invasive Haemophilus influenzae in Canada, 2007 to 2014.

ABSTRACT:

Background

Previously we studied the antibiotic susceptibility of invasive Haemophilus influenzae collected in Canada from 1990 to 2006 and characterized isolates by serotype, MLST and ftsI gene sequencing for significant PBP3 mutations.

Objectives

To provide an update based on isolates collected from 2007 to 2014.

Methods

A total of 882 case isolates were characterized by serotype using slide agglutination and PCR. MLST was carried out to determine ST. Isolates were tested for β-lactamase production, presence of significant PBP3 mutations and antibiotic susceptibility by disc diffusion against 14 antibiotics. MIC values of three antibiotics were determined for 316 isolates using microbroth dilution.

Results

Non-typeable H. influenzae accounted for 54.6% of the isolates and 45.4% were serotypeable, predominantly type a (23.1%), type b (8.3%) and type f (10.8%). The overall rate of ampicillin resistance due to β-lactamase production was 16.4% and increased from 13.5% in 2007-10 to 19% in 2011-14. Significant PBP3 mutations were identified in 129 isolates (14.6%) with 23 (2.6%) also producing β-lactamase. MLST identified related STs (ST-136, ST-14 and ST-367) associated exclusively with genetically β-lactamase-negative, ampicillin-resistant isolates and confirmed previously reported associations between significant PBP3 mutations and ST.

Conclusions

A significant increase in β-lactamase-producing isolates was observed from 2007 to 2014; the rate of significant PBP3 mutations has increased since previously reported and 52.5% of non-typeable H. influenzae now show resistance markers. Resistance to trimethoprim/sulfamethoxazole was common and no resistance to fluoroquinolones or third-generation cephalosporins was found.

SUBMITTER: Tsang RSW

PROVIDER: S-EPMC5890693 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Antibiotic susceptibility and molecular analysis of invasive Haemophilus influenzae in Canada, 2007 to 2014.

Tsang Raymond S W RSW Shuel Michelle M Whyte Kathleen K Hoang Linda L Tyrrell Gregory G Horsman Greg G Wylie John J Jamieson Frances F Lefebvre Brigitte B Haldane David D Gad Rita R RR German Gregory J GJ Needle Robert R

The Journal of antimicrobial chemotherapy 20170501 5

<h4>Background</h4>Previously we studied the antibiotic susceptibility of invasive Haemophilus influenzae collected in Canada from 1990 to 2006 and characterized isolates by serotype, MLST and ftsI gene sequencing for significant PBP3 mutations.<h4>Objectives</h4>To provide an update based on isolates collected from 2007 to 2014.<h4>Methods</h4>A total of 882 case isolates were characterized by serotype using slide agglutination and PCR. MLST was carried out to determine ST. Isolates were tested ...[more]

PMID: 28137937

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Project description:Haemophilus influenzae can cause serious invasive disease. We report the epidemiology and antimicrobial susceptibility of invasive H. influenzae in Ontario, Canada, from 2014 to 2018 from laboratory-based data. Blood was the most common specimen source (89.5%). Consistent with widespread vaccination against serotype b (Hib), the incidence of Hib in Ontario remained low (0.04 cases per 100,000 population). H. influenzae disease primarily afflicted those <1 and ≥65 years of age. From 2014 to 2018, cases of invasive H. influenzae increased 5.6%, from 1.67 to 2.06 cases per 100,000 population, the majority of which were attributed to a 7.6% increase in the incidence of H. influenzae in those ≥65 years old. H. influenzae disease was primarily caused by nontypeable H. influenzae (NTHi) (74.2%) and, to a much lesser extent, serotype a (Hia) (8.9%) and serotype f (Hif) (10.2%). Serotype-dependent trends in antimicrobial susceptibility were observed. Hia and Hif isolates were predominantly susceptible to all antibiotics tested, while 27.2% of NTHi isolates were nonsusceptible to ampicillin. Resistance to ceftriaxone and meropenem, first-line antibiotics for invasive disease treatment, was nonexistent. The incidence of invasive H. influenzae in Ontario is increasing. The incidence and antimicrobial susceptibility of all serotypes and nontypeable H. influenzae should be monitored. IMPORTANCE H. influenzae can cause serious invasive, life-threatening disease and is considered 1 of 12 priority pathogens by the World Health Organization. Widespread vaccination against H. influenzae serotype b (Hib) has resulted in very low incidence of Hib in Ontario and other regions that have vaccination programs. However, the epidemiology of non-Hib serotypes and nontypeable H. influenzae (NTHi) remains poorly understood. Here, we describe the epidemiology of all invasive H. influenzae isolates (N = 1,338) received by our laboratory over the 5-year period and report on the antimicrobial susceptibility patterns by serotype. Overall, we observed an increase in the incidence of invasive disease over the study period, primarily driven by NTHi. Serotype-dependent trends in antimicrobial susceptibility were also observed. This work contributes to the global understanding of H. influenzae epidemiology and antimicrobial resistance and is additionally important for further vaccine planning initiatives.

Project description:Invasive Haemophilus influenzae (Hi) disease has decreased in countries that included Hi type b (Hib) vaccination in their childhood immunization programs in the 1990s. Non-typeable (NT) and non-b strains are now the leading causes of invasive Hi disease in Europe, with most cases reported in young children and the elderly. Concerningly, no vaccines toward such strains are available and beta-lactam resistance is increasing. We describe the epidemiology of invasive Hi disease reported to the Norwegian Surveillance System for Communicable Diseases (MSIS) (2017-2021, n = 407). Whole-genome sequencing (WGS) was performed on 245 isolates. We investigated the molecular epidemiology (core genome phylogeny) and the presence of antibiotic resistance markers (including chromosomal mutations associated with beta-lactam or quinolone resistance). For isolates characterized with both WGS and phenotypic antibiotic susceptibility testing (AST) (n = 113) we assessed correlation between resistance markers and susceptibility categorization by calculation of sensitivity, specificity, and predictive values. Incidence rates of invasive Hi disease in Norway ranged from 0.7 to 2.3 per 100,000 inhabitants/year (mean 1.5 per 100,000) and declined during the COVID-19 pandemic. The bacterial population consisted of two major phylogenetic groups with subclustering by serotype and multi-locus sequence type (ST). NTHi accounted for 71.8% (176). The distribution of STs was in line with previous European reports. We identified 13 clusters, including four encapsulated and three previously described international NTHi clones with bla TEM-1 (ST103) or altered PBP3 (rPBP3) (ST14/IIA and ST367/IIA). Resistance markers were detected in 25.3% (62/245) of the isolates, with bla TEM-1 (31, 50.0%) and rPBP3 (28, 45.2%) being the most frequent. All isolates categorized as resistant to aminopenicillins, tetracycline or chloramphenicol possessed relevant resistance markers, and the absence of relevant substitutions in PBP3 and GyrA/ParC predicted susceptibility to cefotaxime, ceftriaxone, meropenem and quinolones. Among the 132 WGS-only isolates, one isolate had PBP3 substitutions associated with resistance to third-generation cephalosporins, and one isolate had GyrA/ParC alterations associated with quinolone resistance. The detection of international virulent and resistant NTHi clones underlines the need for a global molecular surveillance system. WGS is a useful supplement to AST and should be performed on all invasive isolates.

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Project description:BackgroundHaemophilus influenzae (Hi) is known as a cause of invasive and non-invasive diseases. Especially ear, nose and throat (ENT) infections are common reasons for antibiotic prescriptions in outpatient settings in Germany. Therefore, antibiotic resistance surveillance is important to provide the basis of recommendations for the empirical usage of antibiotic agents.ObjectivesTo provide data on susceptibility rates of oral antibiotics for non-invasive clinical Hi isolates in Germany and to investigate molecular resistance patterns of β-lactams, ciprofloxacin, doxycycline and trimethoprim/sulfamethoxazole.MethodsIsolates were collected from a sentinel network of diagnostic laboratories in a prospective multicentre prevalence study. Antibiotic susceptibility testing was done with a commercial broth microdilution kit. MICs were interpreted according to EUCAST guidelines. Resistance gene sequencing and WGS were performed to analyze molecular antibiotic resistance patterns and genetic relationships between the isolates.ResultsIn total, 215 Hi isolates were collected from 23 laboratories across Germany. The highest resistance rates were found for amoxicillin (n = 30; 14%), cefuroxime (n = 40; 18.6%) and trimethoprim/sulfamethoxazole (co-trimoxazole) (n = 34; 15.8%). Resistance to amoxicillin was mainly due to blaTEM-1 (n = 29; 96.7%). PBP3 alterations were found in 39 of 40 cefuroxime-resistant isolates (97.5%). Two of the cefuroxime-resistant isolates harboured PBP3 mutation patterns that have not yet been associated with cefuroxime resistance; in one of them, a known lpoA mutation was found. One isolate showed no mutations in PBP3 or lpoA. All co-trimoxazole-resistant isolates (15.8%) showed known mutations in folA and its promoter region. Additionally, point mutations in folP were identified in a subset of these isolates. The most frequent sequence types (STs) were ST57 (n = 10) and ST103 (n = 10). Genetic cluster analysis identified six clusters, but no epidemiological link could be confirmed.ConclusionResistance to oral antibiotics in non-invasive clinical Hi isolates in Germany was generally low. Amoxicillin is estimated to cover 86% of infections involving non-invasive Hi and, therefore, is still effective for the first-line empirical treatment for ENT infections in Germany. Further surveillance of antimicrobial susceptibility in non-invasive Hi isolates is important to ensure the data basis for guidelines of antibiotic usage.

Dataset Information

Antibiotic susceptibility and molecular analysis of invasive Haemophilus influenzae in Canada, 2007 to 2014.

Background

Objectives

Methods

Results

Conclusions

Publications

Antibiotic susceptibility and molecular analysis of invasive Haemophilus influenzae in Canada, 2007 to 2014.

Similar Datasets

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