Molecular drivers of emerging multidrug resistance in Proteus mirabilis clinical isolates from Algeria

J Glob Antimicrob Resist. 2019 Sep:18:249-256. doi: 10.1016/j.jgar.2019.01.030. Epub 2019 Feb 21.

Abstract

Objectives: The aim of this study was to characterise the molecular drivers of multidrug resistance in Proteus mirabilis isolated from Algerian community and hospital patients.

Methods: A total of 166 P. mirabilis isolates were collected from two hospitals and eight private laboratories from four cities (Khemis Miliana, Aïn Defla, Oran and Chlef) located in northwestern Algeria. All isolates were identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). Antimicrobial susceptibility testing was performed by the disk diffusion and Etest methods. Genes encoding AmpC β-lactamases, extended-spectrum β-lactamases (ESBLs), quinolone resistance and aminoglycoside-modifying enzymes (AMEs) as well as plasmid replicon typing were characterised by PCR. Clonal relationships were also determined by enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) typing and were compared with MALDI-TOF/MS proteomic typing.

Results: Of the 166 P. mirabilis isolates, 14 (8.4%) exhibited resistance to important antibiotics, including amoxicillin, amoxicillin/clavulanic acid, cefotaxime, gentamicin and ciprofloxacin, of which 4/14 (28.6%) had an ESBL genotype (blaCTX-M-2) and 10 (71.4%) had an AmpC/ESBL genotype (blaCMY-2/blaTEM-1). AME genes were detected in all isolates, including ant(2'')-I, aac(3)-I, aac(6')-Ib-cr and aac(3)-IV. The qnrA gene was identified in 13 isolates (7.8%). ERIC-PCR showed one predominant clone, with eight blaCMY-2-producing isolates from UHC Oran belonging to profile A clustering together in the MALDI-TOF/MS dendrogram.

Conclusion: Here we report the first description of AME and plasmid-mediated quinolone resistance genes among ESBL- and/or AmpC β-lactamase-producing P. mirabilis isolates from community- and hospital-acquired infections in northwestern Algeria.

Keywords: Algeria; Aminoglycoside-modifying enzyme; AmpC; ESBL; Extended-spectrum β-lactamase; Proteus mirabilis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Algeria
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics*
  • Bacterial Typing Techniques
  • Child, Preschool
  • Cross Infection / microbiology
  • Disk Diffusion Antimicrobial Tests
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae Infections / microbiology
  • Female
  • Genotype
  • Hospitals
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Molecular Typing
  • Plasmids / genetics
  • Proteomics
  • Proteus Infections / epidemiology
  • Proteus Infections / microbiology
  • Proteus mirabilis / drug effects
  • Proteus mirabilis / genetics*
  • Proteus mirabilis / isolation & purification
  • Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
  • beta-Lactamases / genetics*

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-lactamase CTX-2
  • AmpC beta-lactamases
  • beta-Lactamases