Mikrobiol. Z. 2019; 81(1):61-71. Ukrainian.
Phenotypic and Genotypic Determinants of Antibiotic Resistance of Gram-Negative Bacteria -
Etiological Factors of Infectious Complications of War Wounds
Kovalchuk V.P., Kondratiuk V.M., Kovalenko I.M., Burkot V.M.
National Pirogov Memorial Medical University
56 Pirogova Str., Vinnytsya, 21018, Ukraine
For the present day, antibiotic-resistant gram-negative bacterial flora dominates among the pathogens of infectious complications of war wounds. In the process of choosing and predicting the effectiveness of therapeutic measures, the data related to the phenotypic evidence of antibiotic resistance, as well as its genetic determinants are of vital importance. Genetic analysis data will help determine the mechanisms by which the resistance to antibiotics is implemented, establish genes that are inactive, but potentially can compromise the effectiveness of antibiotics. The information on the distribution of antibiotic-resistant genes will determine the tendency of the epidemic situation changing in the system of medical evacuation and assistance to the wounded, as well as develop the anti-epidemic measures.
The purpose of the study was to determine antibiotic resistance phenotypes and antibiotic resistance genes peculiar to gram-negative bacteria, which inflict the infectious complications of war wounds in a modern military conflict in Ukraine.
Methods. Antibiotic susceptibility testing of eighteen gram negative bacteria isolates which caused infectious complications of battle wounds had been studied automatically on the three commercial platforms according to current Clinical and Laboratory Standards Institute guidelines. The isolates underwent analysis by whole genome sequencing with “next – generation sequencing” method on applied biosystems/life technologies platform. Comparison of identified genome sequences had been done with Genbank data using Basic Local Alignment Search Tool technology. Results. Overall, 47 different antibiotic resistance genes were identified among the presented isolates. Acinetobacteria sp. isolates carried beta-lactamases of the classes blaTEM-1B and blaOXA-2, blaOXA-24, blaPER-1. Studied Klebsiella sp., Enterobacteriaceae sp. and P. aeruginosa harbor several narrow-spectrum β-lactamases. The blaCTX-M-15 gene encoding the extended spectrum of beta-lactamase was detected in K. pneumoniae and in all isolates of E. cloacae. A. baumanii, E. cloacae and K. pneumoniae were capable to produce carbapenemases. In Acinetobacteria sp., this phenotype was associated with the blaOXA-23 and blaOXA-24 genes, for Enterobacteriaceae sp. – with blaOXA-48.
Conclusions. The investigated microorganism strains express multidrug-resistant phenotypes. The genome of these strains contains the genes determining the resistance to carbapenems, aminoglycosides, low effectiveness of fluoroquinolones and unprotected cephalosporins, which explains the associated resistance to antibiotics with different mechanisms of antimicrobial activity. It is reasonable to use the obtained data in the process of developing the practical recommendations for the rational use of antibiotics in the treatment of infectious complications of war wounds.
Keywords: gram-negative bacteria, antibiotic resistance, genetic determinants, surgical infection, battle wound.
Full text (PDF, in Ukrainian)
- Huttner A, Harbarth S, Carlet J, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control. 2013; 18(2):31. https://doi.org/10.1186/2047-2994-2-31
- Von Wintersdorff CJH, Penders J, van Niekerk JM, et al. Dissemination of antimicrobial resistance in microbial ecosystems through horizontal gene transfer. Front Microbiol. 2016; 19(7):173. https://doi.org/10.3389/fmicb.2016.00173
- Wallum TE, Yun HC, Rini EA et al. Pathogens present in acute mangled extremities from Afghanistan and subsequent pathogen recovery. Mil Med. 2015; 180(1):97–103. https://doi.org/10.7205/MILMED-D-14-00301
- Pillai S, Gopalan V, Lam AK Review of sequencing platforms and their applications in phaeochromocytoma and paragangliomas. Crit Rev Oncol Hematol. 2017; 116:58–67. https://doi.org/10.1016/j.critrevonc.2017.05.005
- Kovalchuk P. Valentine, Kondratiuk M. Viacheslav Bacterial flora of combat wounds from eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital. BMC Res Notes. 2017; 10(1):152. https://doi.org/10.1186/s13104-017-2481-4
- Kaspar RL, Griffith ME, Mann PB, Lehman DJ. Association of bacterial colonization at the time of presentation to a combat support hospital in a combat zone with subsequent 30-day colonization or infection. Mil Med. 2009; 174(9):899–903. https://doi.org/10.7205/MILMED-D-04-3908
- Kiiru J, Kariuki S, Goddeeris BM, Butaye P. Analysis of β-lactamase phenotypes and carriage of selected β-lactamase genes among Escherichia coli strains obtained from Kenyan patients during an 18-year period. BMC Microbiol. 2012; 12:155. https://doi.org/10.1186/1471-2180-12-155
- Huang XZ, Frye JG, Chahine MA, Glenn LM, et al. Characteristics of plasmids in multi-drug-resistant Enterobacteriaceae isolated during prospective surveillance of a newly opened hospital in Iraq. PLoS One. 2012; 7(7):e40360. https://doi.org/10.1371/journal.pone.0040360
- Doit C, Mariani-Kurkdjian P, Bingen E. Extended-spectrum beta-lactamase producing enterobacteriaceae. Arch Pediatr. 2010; 17(4):140–4. https://doi.org/10.1016/S0929-693X(10)70915-5
- Dunne WM Jr, Jaillard M, Rochas O, Van Belkum A. Microbial genomics and antimicrobial susceptibility testing. Expert Rev Mol Diagn. 2017; 17(3):257–269. https://doi.org/10.1080/14737159.2017.1283220