| 1. |
- Atterby, Clara, et al.
(författare)
-
ESBL-producing Escherichia coli in Swedish gulls : A case of environmental pollution from humans?
- 2017
-
Ingår i: PLOS ONE. - San Francisco, CA, United States : PLOS. - 1932-6203. ; 12:12
-
Tidskriftsartikel (refereegranskat)abstract
- ESBL-producing bacteria are present in wildlife and the environment might serve as a resistance reservoir. Wild gulls have been described as frequent carriers of ESBL-producing E. coli strains with genotypic characteristics similar to strains found in humans. Therefore, potential dissemination of antibiotic resistance genes and bacteria between the human population and wildlife need to be further investigated. Occurrence and characterization of ESBL-producing E. coli in Swedish wild gulls were assessed and compared to isolates from humans, livestock and surface water collected in the same country and similar time-period. Occurrence of ESBL-producing E. coli in Swedish gulls is about three times higher in gulls compared to Swedish community carriers (17% versus 5%) and the genetic characteristics of the ESBL-producing E. coli population in Swedish wild gulls and Swedish human are similar. ESBL-plasmids IncF-and IncI1-type carrying ESBL-genes blaCTX-M-15 or blaCTX-M-14 were most common in isolates from both gulls and humans, but there was limited evidence of clonal transmission. Isolates from Swedish surface water harbored similar genetic characteristics, which highlights surface waters as potential dissemination routes between wildlife and the human population. Even in a low-prevalence country such as Sweden, the occurrence of ESBL producing E. coli in wild gulls and the human population appears to be connected and the occurrence of ESBL-producing E. coli in Swedish gulls is likely a case of environmental pollution.
|
|
| 2. |
- Börjesson, Stefan, 1979-, et al.
(författare)
-
Limited Dissemination of Extended-Spectrum β-Lactamase- and Plasmid-Encoded AmpC-Producing Escherichia coli from Food and Farm Animals, Sweden
- 2016
-
Ingår i: Emerging Infectious Diseases. - : U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. - 1080-6040 .- 1080-6059. ; 22:4, s. 634-640
-
Tidskriftsartikel (refereegranskat)abstract
- Extended-spectrum β-lactamase (ESBL)- and plasmid-encoded ampC (pAmpC)-producing Enterobacteriaceae might spread from farm animals to humans through food. However, most studies have been limited in number of isolates tested and areas studied. We examined genetic relatedness of 716 isolates from 4,854 samples collected from humans, farm animals, and foods in Sweden to determine whether foods and farm animals might act as reservoirs and dissemination routes for ESBL/pAmpC-producing Escherichia coli. Results showed that clonal spread to humans appears unlikely. However, we found limited dissemination of genes encoding ESBL/pAmpC and plasmids carrying these genes from foods and farm animals to healthy humans and patients. Poultry and chicken meat might be a reservoir and dissemination route to humans. Although we found no evidence of clonal spread of ESBL/pAmpC-producing E. coli from farm animals or foods to humans, ESBL/pAmpC-producing E. coli with identical genes and plasmids were present in farm animals, foods, and humans.
|
|
| 3. |
- Krarup, Anne L., et al.
(författare)
-
Randomized clinical trial: inhibition of the TRPV1 system in patients with nonerosive gastroesophageal reflux disease and a partial response to PPI treatment is not associated with analgesia to esophageal experimental pain.
- 2013
-
Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 48:3, s. 274-84
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. Many patients with nonerosive reflux disease (NERD) have insufficient relief on proton pump inhibitors (PPIs). Some patients have a hypersensitive esophagus and may respond to transient receptor potential vanilloid 1 (TRPV1) antagonists. Aim. To investigate the effect of the TRPV1 antagonist AZD1386 on experimental esophageal pain in NERD patients. Material and methods. Enrolled patients had NERD and a partial PPI response (moderate-to-severe heartburn or regurgitation ≥3 days/week before enrolment despite ≥6 weeks' PPI therapy). Fourteen patients (21-69 years, 9 women) were block-randomized into this placebo-controlled, double-blinded, crossover study examining efficacy of a single dose (95 mg) of AZD1386. On treatment days, each participant's esophagus was stimulated with heat, distension, and electrical current at teaching hospitals in Denmark and Sweden. Heat and pressure pain served as somatic control stimuli. Per protocol results were analyzed. Results. Of 14 randomized patients, 12 were treated with AZD1386. In the esophagus AZD1386 did not significantly change the moderate pain threshold for heat [-3%, 95% confidence interval (CI), -22;20%], distension (-11%, 95% CI, -28;10%), or electrical current (6%, 95% CI, -10;25%). Mean cutaneous heat tolerance increased by 4.9°C (95% CI, 3.7;6.2°C). AZD1386 increased the maximum body temperature by a mean of 0.59°C (95% CI, 0.40-0.79°C), normalizing within 4 h. Conclusions. AZD1386 had no analgesic effect on experimental esophageal pain in patients with NERD and a partial PPI response, whereas it increased cutaneous heat tolerance. TRPV1 does not play a major role in heat-, mechanically and electrically evoked esophageal pain in these patients. ClinicalTrials.gov identifier: D9127C00002.
|
|
| 4. |
- Ny, Sofia, et al.
(författare)
-
Community carriage of ESBL-producing Escherichia coli is associated with strains of low pathogenicity : a Swedish nationwide study
- 2017
-
Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press. - 0305-7453 .- 1460-2091. ; 72:2, s. 582-588
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Community carriage of ESBL-producing Escherichia coli (EPE) is common worldwide and there is a need to understand the connection between carriage and infection. We compared the molecular characteristics of EPE among Swedish community carriers with those of EPE causing invasive infections.METHODS: We collected 2134 faecal samples from randomly selected Swedish inhabitants and examined them for the presence of EPE. All participating volunteers answered a questionnaire about putative risk factors for EPE carriage. Suspected EPE isolates (n = 418) from patients with bloodstream infection (BSI) were collected from Swedish laboratories. Isolates were genotypically and phenotypically characterized.RESULTS: Our results show that the EPE population found in carriers generally had lower pathogenicity compared with the isolates from BSIs, since carriers had a lower proportion of E. coli belonging to phylogroup B2, ST131 and ST131 subclone H30-Rx. Isolates from carriers also had lower levels of multiresistance. The Swedish carriage rate of EPE was 4.7% (101/2134) among healthy volunteers. Risk factors associated with carriage were travel to countries in Asia (OR = 3.6, 95% CI = 1.4-9.2) and Africa (OR = 3.6, 95% CI = 1.7-7.7) and a diet without pork (OR = 0.5, 95% CI = 0.3-0.8 for pork eaters).CONCLUSIONS: E. coli host factors previously associated with higher pathogenicity were all more common in BSIs compared with carriers. This indicates that the risk of invasive infection with EPE may be relatively modest in many community carriers and that EPE carriage of high-risk strains should be the focus of attention for prevention.
|
|
| 5. |
- Ny, Sofia
(författare)
-
Epidemiology of extended-spectrum β-lactamase-producing Escherichia coli
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Extended-Spectrum β-Lactamase and plasmid mediated AmpC (ESBL/pAmpC)-producing Escherichia coli (E. coli) has during the last decades emerged worldwide and is now an increasing problem in both human and animal health. In order to slow down the spread it is important to study success factors and transmission routes so that preventive measures can be efficient. In paper I we studied what sectors that contribute to human carriage and human clinical infections by investigating the molecular epidemiology of ESBL/pAmpC-producing E. coli in leafy greens, meats, farm animals, human community carriers and human blood stream infections. We found that different ESBL/pAmpC-genes, plasmids and E. coli MLST lineages dominated in isolates from humans compared to isolates in farm animals, foods and meats, but some traits overlapped. All in all, we concluded that a very small proportion of human bloodstream infections with ESBL/pAmpC-producing E. coli could have originated from the foods we consume. To better understand the prevalence of ESBL/pAmpC-producing E. coli in the community we performed two carrier studies described in papers II and III. In paper II we found that 4.7% of the Swedish population carried ESBL/pAmpC-producing E. coli in their intestine. Risk factors associated with carriage was travel to countries in Asia and Africa and a diet that did not include pork. In paper II we also explored which E. coli populations that accumulated in clinical infections compared to carriers and found that the ESBL-gene blaCTX-M-15 and E. coli ST131 and its subclone H30-Rx/C2 were overrepresented in bloodstream infections. In paper III we joined forces with our neighbouring countries around the Baltic Sea, Finland, Latvia, Russia, Poland and Germany to investigate the prevalence of ESBL-producing E. coli and K. pneumoniae in specific populations in all participating countries. We found large differences in prevalence between countries with the highest in Russia (23.4%) and the lowest in Latvia (1.6%). No carbapenemase producing isolates were identified in any of the investigated countries. In paper II E. coli ST131 was identified as the most common ST to cause bloodstream infections in Swedish patients. This lineage is internationally wide-spread and commonly cause severe infections. In paper IV we explored the Swedish epidemiology of this highly pathogenic ESBL-producing E. coli lineage by conducting a phylogenetic comparison between Swedish and international isolates. We found, in accordance with our hypothesis, that several introductions from the international lineage have shaped the Swedish ST131 population. Tight genetic relationships between isolates in clonal clusters makes it difficult to perform outbreak investigations with ST131. In addition, we identified highly conserved plasmids in all clusters with Swedish isolates even though they had been separated for several years indicating a strong co-evolution of plasmids in some ST131 lineages. Taken together our studies show that although there is a high prevalence of ESBL/pAmpC-producing E. coli, particularly in poultry and chicken meat products, the major source for ESBL/pAmpC producing E. coli causing human infections is humans to human transmission. Although we do not see a great contribution from the animal and food sector in Sweden it could change in the future if an epidemiological shift to more human pathogenic strains take place in e.g. poultry. This is why a multi-sectorial approach to reduce the levels of ESBL/pAmpC-producing E. coli in all sectors is needed. Of particular interest is the highly pathogenic E. coli lineage ST131 that is responsible for a large proportion of infection with ESBL/pAmpC-producing E. coli. Carriers of ST131 could therefore be at greater risk of getting an infection and there might be incentive for considering them as high risk carriers. The high clinical relevance of ESBL-producing E. coli ST131 prompts further monitoring since this lineage has large potential to accumulate resistance to last resort drugs such as carbapenems and colistin.
|
|
| 6. |
- Ny, Sofia, et al.
(författare)
-
Genome and plasmid diversity of Extended-Spectrum beta-Lactamase-producing Escherichia coli ST131-tracking phylogenetic trajectories with Bayesian inference
- 2019
-
Ingår i: Scientific Reports. - : NATURE PUBLISHING GROUP. - 2045-2322. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Clonal lineages of ESBL (Extended-Spectrum beta-Lactamase)-producing E. coli belonging to sequence type 131 (ST131) have disseminated globally during the last 30 years, leading to an increased prevalence of resistance to fluoroquinolones and extended-spectrum cephalosporins in clinical isolates of E. coli. We aimed to study if Swedish ESBL-producing ST131 isolates originated from single or multiple introductions to the population by assessing the amount of genetic variation, on chromosomal and plasmid level, between Swedish and international E. coli ST131. Bayesian inference of Swedish E. coli ST131 isolates (n = 29), sequenced using PacBio RSII, together with an international ST131 dataset showed that the Swedish isolates were part of the international ST131 A, C1 and C2 clades. Highly conserved plasmids were identified in three clusters although they were separated by several years, which indicates a strong co-evolution between some ST131 lineages and specific plasmids. In conclusion, the tight clonal relationship observed within the ST131 clades, together with highly conserved plasmids, challenges investigation of strain transmission events. A combination of few SNPs on a genome-wide scale and an epidemiological temporospatial link, are needed to track the spread of the ST131 subclones.
|
|
| 7. |
- Sewunet, Tsegaye, et al.
(författare)
-
High prevalence of bla(CTX-M-15) and nosocomial transmission of hypervirulent epidemic clones of Klebsiella pneumoniae at a tertiary hospital in Ethiopia
- 2021
-
Ingår i: JAC-Antimicrobial Resistance. - : Oxford University Press (OUP). - 2632-1823. ; 3:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Genomic epidemiology of antibiotic resistance is not sufficiently studied in low-income countries. Objectives: To determine prevalence of ESBL production, and resistome and virulome profiles, of Klebsiella pneumoniae isolated at Jimma Medical Center, Ethiopia. Methods: Strains isolated from patients with suspected infections between June and November 2016 were characterized by MALDI-TOF for species identification and disc diffusion for antimicrobial susceptibility testing. All K. pneumoniae isolates were characterized by double disc diffusion for ESBL production and all ESBL-producing strains (ESBL-KP) were subjected to WGS on the Illumina (HiSeq 2500) platform. DNA was extracted by automated systems (MagNA Pure 96). Genome assembly was performed using SPAdes (v. 3.9) and draft genomes were used for analysing molecular features of the strains. Maximum likelihood trees were generated using FastTree/2.1.8 based on SNPs in shared genomic regions to identify transmission clusters. Results: Of the 146 K. pneumoniae strains isolated, 76% were ESBL-KP; 93% of the ESBL-KP strains showed resistance to multiple antimicrobial classes. bla(CTX-M-15) (84.4%) was the most prevalent ESBL gene. Resistance genes for aminoglycosides and/or fluoroquinolones [aac(6)-Ib-cr (65.1%)], phenicols [catB3 (28.4%)], sulphonamides [sul1 (61.2%) and sul2 (60.5%)], trimethoprim [dfrA27 (32.1%)], macrolides [mph(A) (12.8%)] and rifampicin [arr2/arr3 (39.4%)] were prevalent. Plasmids of the IncF and IncR families were prevalent among ST218, ST147, ST15 and ST39. KL64 and KL57 capsular types and O1 and O2 LPSs were prevalent. A high-risk clone, ST218-KL57 encoding rmpA1/rmpA2 and iutA, was detected. Phylogenetic analysis showed a cluster of clonally related strains from different units of the hospital. Conclusions: Prevalence of ESBL-KP was high and bla(CTX-M-15) was the predominant ESBL gene. ESBL genes had spread through both clonal and polyclonal expansion of high-risk and hypervirulent clones. Nosocomial transmission of MDR strains between different units of the hospital was observed.
|
|
| 8. |
- Sewunet, Tsegaye, et al.
(författare)
-
Polyclonal spread of bla CTX-M-15 through high-risk clones of Escherichia coli at a tertiary hospital in Ethiopia
- 2022
-
Ingår i: Journal of Global Antimicrobial Resistance. - : Elsevier BV. - 2213-7173 .- 2213-7165. ; 29, s. 405-412
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The burden of antimicrobial resistance and spread of epidemic clones are rarely reported from low-income countries. We aimed to investigate the genome-based epidemiology of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) at a tertiary hospital in Jimma, Ethiopia. Methods: Bacteria were isolated from clinical specimens at Jimma Medical Center and subjected to species identification (MALDI-TOF), antimicrobial susceptibility testing (disk diffusion) and whole-genome sequencing (Illumina, HiSeq2500). Genomic data analysis was performed using EnteroBase and Center for Genomic Epidemiology bioinformatics pipelines. A maximum likelihood tree was generated using FastTree/2.1.8 based on single nucleotide polymorphisms (SNPs) in shared genomic regions to identify transmission clusters. Results: Escherichia coli isolates (n = 261) were collected from 1087 single non-duplicate clinical specimens over a 5-month period in 2016. The prevalence of ESBL-EC was 54.8% (143/261), 96% of which were resistant to multiple antibiotic classes. The blaCTX-M-15 ESBL gene was present in 88.4.% of isolates (122/138). Genes conferring resistance to aminoglycosides and ciprofloxacin [aac(6′)-Ib-cr, 62.3% (86/138)], phenicols [catB3, 56.5% (78/138)], sulfonamides [sul1, 68.1% (94/138), trimethoprim [dfrA17, 58.0% (80/138)] and macrolides [mph(A), 67.4% (93/138) were detected. The most prevalent sequence types were ST410 (23%), ST648 (17%), ST131 (10%) and ST167 (7%). Isolates of the same sequence type collected from different units of the hospital were highly similar in the SNP analysis. Conclusion: A high prevalence of ESBLs and dissemination of blaCTX-M-15 through multiple high-risk E. coli clones was detected. Nosocomial spread of multidrug-resistant ESBL-EC within the hospital puts vulnerable patients at risk of difficult-to-treat infections.
|
|
