Biology subjects

Webber, M. A.

Publications and source records attributed to Webber, M. A..

3 recordsLinked to original sources

bioRxiv2018

Opening Pandora box - high level resistance to antibiotics of last resort in Gram negative bacteria from Nigeria

Antimicrobial resistance (AMR) is a global problem but information about the prevalence and mechanisms of resistance in sub-Saharan Africa are lacking. We determined the percentage of drug resistant isolates and resistance mechanisms in 307 Gram negative isolates randomly collected from south western Nigeria. Susceptibility testing revealed 78.1%, 92.2% and 52.6% of all isolates were resistant to fluoroquinolones, third generation cephalosporins and carbapenems respectively. There were more resistant isolates from the stools of uninfected patients than from specimens of patients with symptoms of infections. Only a small proportion of E. coli (10%) and Klebsiella (7%) isolates produced a carbapenemase. Whole genome sequencing of selected isolates identified the presence of globally disseminated clones. This depicts a crisis for the use of first line therapy in Nigerian patients, it is likely that Nigeria is playing a significant role in the spread of AMR due to her high population and mobility across the globe.

microbiology↗

bioRxiv2017

Prevalence, mechanisms and comparison of detection methods of fosfomycin resistance in E. coli from urinary tract infections

As numbers of bacterial isolates resistant to first line antibiotics rise there has been a revival in the use of older drugs such as fosfomycin. Fosfomycin is a cell wall inhibitor with a unique mode of action, increasingly used in the treatment of urinary tract infections. In this study, the prevalence of fosfomycin resistant E. coli in a panel of 1000 urine isolates was investigated. Three different clinically used fosfomycin susceptibility testing methods were assessed and genome sequencing used to characterise resistant isolates.\n\nOf the 1000 isolates, 676 were E. coli of which initial susceptibility testing with the MAST Uri(R)system suggested 81 (12%) were fosfomycin resistant. Of these, 62 were subsequently confirmed as being E. coli. However, using micro-broth dilution, agar dilution and E-test strips, a lower rate of 1.3% (8/62) of E. coli isolates were robustly identified as being truly fosfomycin resistant; a prevalence comparable with other similar studies. The use of E-test and 96-well breakpoint plates gave results that were inconsistent and hard to interpret. Resistant isolates of E. coli belonged to diverse MLST types and each had a unique set of chromosomal alterations in genes associated with fosfomycin resistance. Changes in GlpT and UhpT/UhpA transport systems were commonly identified, with 6/8 of the resistant isolates possessing amino-acid changes or deletions absent in susceptible strains. Fosfomycin resistant isolates were not multiply drug resistance and did not carry plasmidic fosfomycin resistance genes. Therefore, the use of fosfomycin may be unlikely to drive selection of a particular clone or movement of transferrable resistance genes.\n\nFosfomycin remains a viable option for the treatment of E. coli in uncomplicated UTIs, different susceptibility testing platforms can give very different results regarding the prevalence of fosfomycin resistance with false positives a potential problem that may unnecessarily limit use of this agent.

microbiology↗

bioRxiv2017

Increased usage of antiseptics is associated with reduced susceptibility in clinical isolates of S. aureus

Hospital acquired infection is a major cause of morbidity and mortality and regimes to prevent infection are crucial in infection control. These include decolonisation of at-risk patients of carriage of MRSA which is commonly achieved by protocols that include the use of chlorhexidine, or octenidine as biocidal agents. There is however no standardised single decolonisation regime agreed upon in the UK or other countries and protocols include a variety of active agents. Antibiotic resistant bacteria cause major problems in hospital medicine and concern has been raised regarding the development of biocide resistance which would cause decolonisation regimes to become unreliable. In this study, we assembled a panel of isolates of S. aureus including isolates collected before the development of chlorhexidine and octenidine through to a contemporaneous panel of isolates from a major hospital trust in the UK during a period when the decolonisation regime was altered. We observed significant increases in the MIC and MBC of chlorhexidine in isolates collected from periods of high usage of chlorhexidine. No isolates had a significantly altered MIC or MBC of octenidine apart from those collected after octenidine was introduced into the trust where isolates with four-fold decreases in susceptibility emerged. There was no suggestion of cross-resistance between the two biocidal agents. A combination of VNTR, PCR for qac genes and whole genome sequencing was used to type isolates and examine possible mechanisms of resistance. The typing data showed no expansion of a single strain was associated with decreased biocide tolerance and isolates with increased chlorhexidine MIC and MBCs were found from different clonal complexes; CC8, CC22 and CC30. Biocide susceptibility did not correlate with carriage of qac efflux pump genes - carriage of qacA and qacB was detected but, with one exception was restricted to isolates of CC8. Analysis of genome sequence data for closely related pairs of strains with differential biocide susceptibility revealed no common mutations or carriage of accessory elements that correlated with biocide tolerance. Mutations with the NorA or NorB efflux pumps, previously associated with chlorhexidine export were identified suggesting this may be an important mechanism of biocide tolerance. The clinical relevance of decreased biocide tolerance in terms of efficacy of decolonisation therapies remains to be established but we present evidence here that isolates are evolving in the face of biocide challenge in patients and that changes to decolonisation regimes are reflected in changes in susceptibility of isolates. More work is needed to assess the impact of these changes to ensure effective and robust decolonisation protocols remain in place.

microbiology↗