Ronan Kelly
Retired 2020
Third-Generation Cephalosporin?Resistant Vibrio cholerae, India
Jharna Mandal, Vilwanathan Sangeetha, Vithiya Ganesan, Mohamudha Parveen, Venkatesan Preethi, Belgode Narasimha Harish, Sampath Srinivasan, and Subhash Chandra Parija
Vibrio cholerae resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum β-lactamase and positive for the AmpC disk test, modifi ed Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profi le of V. cholerae should be monitored.
Vibrio cholerae has developed enormous capabilities to combat antimicrobial drug effect. It possesses efflux pumps that act on multiple classes of antimicrobial drugs and elaborates enzymes that can hydrolyze complex
antimicrobial drugs. It also can share antimicrobial resistance genes through integrons and conjugative plasmids that enable easy transfer of antimicrobial
drug resistance genes and thus contribute to spread of antimicrobial resistance (1).
Even though fluid replacement plays a major role in treating cholera during outbreaks, antimicrobial drugs are crucial for controlling the disease and its spread. Antimicrobial therapy reduces shedding of the Vibrio cholerae bacillus in feces from >5 days to 1?2 days, thereby reducing the volume of diarrheic stool and the duration of illness, hastening recovery, and decreasing the chances of disease spread. In the absence of effective antimicrobial
therapy, infected persons shed the bacillus for >5 days. Reported resistance to most commonly used antimicrobial drugs, i.e., tetracycline and ciprofl oxacin (1), has limited options for therapy. Such drug-resistant V. cholerae strains threaten public health (2). Resistance to third-generation cephalosporins has rarely been reported (1). Our goal was to determine the mechanism(s) of resistance to thirdgeneration cephalosporin by phenotypic and genotypic methods.
...
Conclusions
We isolated a clinical strain of V. cholerae producing an AmpC β-lactamase and a carbapenemase. Our findings, although perhaps not an issue for treatment of cholera, have other implications. The critical role of all bacteriology laboratories needs to be emphasized for determining not only resistance patterns but also the mechanisms of resistance. Health care?associated networks need to be strengthened to ensure justified and appropriate use of antimicrobial agents that will result in safe drinking water
and improved sanitation; these can have remarkable effect in reducing the spread of many communicable diseases, such as cholera, and can go a long way in controlling the growing menace of antimicrobial drug resistance. In light of the above findings, the antimicrobial drug profile of organisms, such as V. cholerae, needs to be under constant surveillance in the community.
...
Full paper at http://wwwnc.cdc.gov/eid/article/18/8/pdfs/11-1686.pdf
Jharna Mandal, Vilwanathan Sangeetha, Vithiya Ganesan, Mohamudha Parveen, Venkatesan Preethi, Belgode Narasimha Harish, Sampath Srinivasan, and Subhash Chandra Parija
Vibrio cholerae resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum β-lactamase and positive for the AmpC disk test, modifi ed Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profi le of V. cholerae should be monitored.
Vibrio cholerae has developed enormous capabilities to combat antimicrobial drug effect. It possesses efflux pumps that act on multiple classes of antimicrobial drugs and elaborates enzymes that can hydrolyze complex
antimicrobial drugs. It also can share antimicrobial resistance genes through integrons and conjugative plasmids that enable easy transfer of antimicrobial
drug resistance genes and thus contribute to spread of antimicrobial resistance (1).
Even though fluid replacement plays a major role in treating cholera during outbreaks, antimicrobial drugs are crucial for controlling the disease and its spread. Antimicrobial therapy reduces shedding of the Vibrio cholerae bacillus in feces from >5 days to 1?2 days, thereby reducing the volume of diarrheic stool and the duration of illness, hastening recovery, and decreasing the chances of disease spread. In the absence of effective antimicrobial
therapy, infected persons shed the bacillus for >5 days. Reported resistance to most commonly used antimicrobial drugs, i.e., tetracycline and ciprofl oxacin (1), has limited options for therapy. Such drug-resistant V. cholerae strains threaten public health (2). Resistance to third-generation cephalosporins has rarely been reported (1). Our goal was to determine the mechanism(s) of resistance to thirdgeneration cephalosporin by phenotypic and genotypic methods.
...
Conclusions
We isolated a clinical strain of V. cholerae producing an AmpC β-lactamase and a carbapenemase. Our findings, although perhaps not an issue for treatment of cholera, have other implications. The critical role of all bacteriology laboratories needs to be emphasized for determining not only resistance patterns but also the mechanisms of resistance. Health care?associated networks need to be strengthened to ensure justified and appropriate use of antimicrobial agents that will result in safe drinking water
and improved sanitation; these can have remarkable effect in reducing the spread of many communicable diseases, such as cholera, and can go a long way in controlling the growing menace of antimicrobial drug resistance. In light of the above findings, the antimicrobial drug profile of organisms, such as V. cholerae, needs to be under constant surveillance in the community.
...
Full paper at http://wwwnc.cdc.gov/eid/article/18/8/pdfs/11-1686.pdf