Use of Fourier-transform infrared spectroscopy for real-time outbreak investigation of OXA-48-producing Escherichia coli
Hadas KonMor N. Lurie-WeinbergerCarmela LugassyDafna ChenVered SchechnerMitchell J. SchwaberKhetam HusseinTamar AlonJalal TarabeiaMoran HamoIbraheem FiranWorood AboalhegaElena LomansovSigal MendelsohnAlona Keren‐PazYehuda Carmeli
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Abstract Background Efficient infection control during carbapenem-resistant Enterobacterales outbreaks demands rapid and simple techniques for outbreak investigations. WGS, the current gold standard for outbreak identification, is expensive, time-consuming and requires a high level of expertise. Fourier-transform infrared (FTIR) spectroscopy (IR Biotyper) is a rapid typing method based on infrared radiation applied to samples, which provides a highly specific absorption spectrum. Objectives To investigate an outbreak of OXA-48-producing Escherichia coli in real-time using FTIR and subsequently compare the results with WGS. Methods Twenty-one isolates were collected during a nosocomial outbreak, and identification and antibiotic susceptibilities were confirmed by VITEK®2. FTIR was conducted for all isolates, and nine representative isolates were sequenced. Results FTIR was able to correctly determine the clonal relatedness of the isolates and to identify the outbreak cluster, as confirmed by WGS. By WGS, isolates in the main FTIR cluster belonged to the same MLST type and core-genome MLST type, and they harboured similar plasmids and resistance genes, whereas the singletons external to the FTIR cluster had different genetic content. Conclusions FTIR can operate as a rapid, efficient and reliable first-line tool for outbreak investigations during a real-time ongoing E. coli outbreak, which can contribute to limiting the spread of pathogens.Keywords:
Multilocus sequence typing
Εισαγωγή: Τα καμπυλοβακτηρίδια (Campylobacter spp.) αποτελούν παγκοσμίωςμαζί με τις σαλμονέλλες τα συχνότερα αίτια βακτηριακής γαστρεντερίτιδας. Σκοπόςτης παρούσας μελέτης ήταν η διερεύνηση της μοριακής επιδημιολογίας τουCampylobacter στην Ελλάδα, σε κλινικά στελέχη που απομονώθηκαν από παιδιά μεγαστρεντερίτιδα, εφαρμόζοντας τη μέθοδο προσδιορισμού αλληλουχίαςπολυγενετικού τόπου (Multilocus Sequence Typing, MLST).Υλικά και μέθοδοι: Χρησιμοποιήθηκαν 88 στελέχη Campylobacter spp. γνωστούοροτύπου και αντιμικροβιακής ευαισθησίας, των οποίων η απομόνωση και η αρχικήταυτοποίηση πραγματοποιήθηκαν με συμβατικές μεθόδους (καλλιέργεια σεεκλεκτικό υλικό Skirrow, μικροσκοπική εικόνα, υδρόλυση ιππουρικού οξέος, καιταυτοποίηση με το σύστημα εμπορίου API Campy). Όλα τα στελέχη τυποποιήθηκανμοριακά με: 1) ανάλυση του γονιδίου flaA («φλαγγελοτυπία»), 2) ηλεκτροφόρηση σεμεταβαλλόμενο ηλεκτρικό πεδίο (PFGE) και 3) βάσει τις αλληλουχίες εφτάδιαχειριστικών γονιδίων (MLST). Επίσης πραγματοποιήθηκε ταξινόμηση σε«γονοτύπους» με φυλογενετική ανάλυση η οποία στηρίχτηκε α) στα αποτελέσματατης PFGE μετατρέποντας τα ηλεκτροφορητικά πρότυπα σε δυαδικούς αριθμούς καιβ) στις αλληλουχίες των γονιδίων από την MLST. Πραγματοποιήθηκε στατιστικήανάλυση για να διερευνηθούν οι πιθανοί συσχετισμοί μεταξύ των γονοτυπικώνμεθόδων, καθώς επίσης και η πιθανή συσχέτιση αυτών με την αντοχή σε αντιβιοτικά.Αποτελέσματα-Συμπεράσματα: Η εφαρμογή των μοριακών τεχνικών ανέδειξε 33«φλαγγελότυπους», 42 PFGE τύπους και 55 MLST τύπους, αποκαλύπτοντας τηνυψηλή διακριτική ικανότητα της MLST μεθόδου έναντι των άλλων γονοτυπικώντεχνικών. Η MLST μέθοδος υπερέχει αφενός γιατί μπορεί να δώσει περισσότερουςγονότυπους και αφετέρου γιατί λόγω της ανάλυσης αλληλουχίας τα δεδομένα πουπροκύπτουν είναι άμεσα συγκρίσιμα με αυτά άλλων μελετών. Ποιο αναλυτικά, τουψηλό ποσοστό των 55 διαφορετικών STs (13 νέοι και 42 ήδη καταχωρημένοι) στα88 στελέχη που εξετάστηκαν, φανερώνει από επιδημιολογική σκοπιά ότι υπάρχειέντονη ST ποικιλομορφία εντός του συγκεκριμένου γένους στην περιοχή της Αττικής,επιβεβαιώνοντας την γενετική ποικιλομορφία του Campylobacter spp. και τηνσποραδικότητα των κρουσμάτων. Επίσης δεν παρατηρήθηκε επικράτηση κάποιουσυγκεκριμένου ST έναντι των άλλων. Όσον αφορά τα 7 διαχειριστικά γονίδια που χρησιμοποιήθηκαν σ’ αυτήν την τυποποίηση δεν παρατηρήθηκε στατιστικάσημαντική επικράτηση κάποιου αλληλόμορφου για το κάθε γονίδιο. Από τααποτελέσματα της MLST παρουσιάστηκαν 20 στελέχη που άνηκαν σε MLST τύπουςCampylobacter coli. Ακολούθησε φυλογενετική ανάλυση, η οποία έδειξε πως αυτάομαδοποιούνταν μόνα τους στατιστικά σημαντικά, σε διαφορετική φυλογενετικήομάδα (cluster) από τα υπόλοιπα στελέχη. Προς επιβεβαίωση των ανωτέρωναποτελεσμάτων, επαναλήφθηκε η κλασσική φαινοτυπική ταυτοποίηση με τηνυδρόλυση του ιππουρικού οξέος, τηρώντας πιστά τις οδηγίες πρόσφατων μελετώνπου έθιγαν το θέμα και πιστοποιήθηκε, ότι πράγματι αυτά τα στελέχη ήτανCampylobacter coli. Συμπερασματικά, οι μέθοδοι MLST και PFGE μας παρέχουνσημαντικές δυνατότητες αξιόπιστης τυποποίησης στελεχών Campylobacter γιαεπιδημιολογικές μελέτες, επιπλέον δε η μέθοδος MLST μπορεί να δώσει και πολύαξιόπιστες ταυτοποιητικές πληροφορίες. Η φυλογενετική ανάλυση είναι ένα πολύχρήσιμο εργαλείο για την επιβεβαίωση των ταυτοποητικών δυνατοτήτων της MLSTκαι την αποκάλυψη του γενετικού μωσαϊκού κάποιων στελεχών C. coli και C. jejuni.Επιπλέον, από την στατιστική επεξεργασία των αποτελεσμάτων της MLST μεθόδουπροέκυψαν στατιστικώς σημαντική συσχέτιση κάποιων συγκεκριμένωναλληλομόρφων γονιδίων με αντοχή σε συγκεκριμένα αντιβιοτικά, η οποία θέλειπεραιτέρω διερεύνηση. Τέλος δημιουργήθηκε για πρώτη φορά στην Ελλάδα μια βάσηδεδομένων για Campylobacter spp. η οποία περιέχει χαρακτηριστικά υψηλούεπιδημιολογικού ενδιαφέροντος.
Multilocus sequence typing
Campylobacter coli
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Molecular strain typing is essential for deciphering the epidemiology of Campylobacter jejuni infections. We applied two different methods, multilocus sequence typing (MLST) and analysis of the flaA short variable repeat (SVR), to 289 isolates (163 human, 56 chicken, 34 raw milk, and 36 environmental water isolates) collected in the province of Québec, Canada, over 3 years; in addition, the analysis included the pulsed-field gel electrophoresis (PFGE) typing results for a subset of 131 isolates studied previously. MLST defined 96 sequence types (STs) and 20 clonal complexes (CCs), including 49 STs (73 isolates, 25%) and 39 alleles not previously documented in an international database. The frequency of new STs was significantly higher among water isolates than among isolates from other sources (18/36 [50%] and 55/253 [22%], respectively; P < 0.001). Nine of the 10 most prevalent CCs included isolates from humans and at least one other source; five CCs comprised exclusively or mostly human and chicken isolates. However, water and milk were the predominant nonhuman sources among the remaining CCs, suggesting that sporadic C. jejuni infections in humans may frequently arise from sources other than chickens. All three typing systems were discriminatory (discriminatory index > 0.9). Among 131 isolates analyzed by PFGE, each of the 20 types represented by two or more isolates corresponded to a single CC. In contrast, among the 14 most prevalent types detected by analysis of the flaA SVR (5 to 27 isolates each), 8 (57%) included isolates that represented multiple different CCs. The basis for these discordant results was uncertain. Antimicrobial resistance was randomly distributed among the CCs and appeared to be more closely related to the source of an isolate than its genotype. Although MLST is labor-intensive and expensive, it remains the single best method for the genotyping of C. jejuni isolates and deciphering the epidemiologic relationships among isolates.
Multilocus sequence typing
Molecular Epidemiology
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ABSTRACT The choice of adequate methods for epidemiological purposes remains a challenging problem in Neisseria gonorrhoeae molecular monitoring. In this study, the collection of geographically unrelated gonococci ( n = 103) isolated in Russian clinics was comparably tested by (i) a traditional serotyping scheme, (ii) por typing, (iii) Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST), and (iv) multilocus sequence typing (MLST). It is shown that, according to sequencing data, a third of the strains carried new porB1 alleles, as well as tbpB ones, and more than half of the samples had new sequence types (STs) as determined by NG-MAST or MLST. The discriminatory power for each typing method was calculated by using the Hunter-Gaston discriminatory index, D . Commonly, modern nucleic acid-based typing methods ( por typing, NG-MAST, and MLST) appeared to be more efficient than the classical serotyping scheme. While the traditional serotyping gave a D value of 0.82, the por typing, NG-MAST, and MLST approaches yielded D values of 0.97, 0.98, and 0.91, respectively. Each typing technique revealed the distribution of gonococci slightly correlated with their geographical sources. However, only the MLST method STs were highly associated with certain phenotypes. Although ST1594, ST1892, and ST6720 were typical for susceptible gonococci, ST1901 and ST6716 were undoubtedly associated with a multidrug-resistant phenotype. We conclude that every tested nucleic acid-based typing method is suitable for N. gonorrhoeae molecular surveillance. However, the MLST method seems to serve large-scale epidemiological purposes, whereas the NG-MAST and por typing approaches are more appropriate for the investigation of local outbreaks.
Multilocus sequence typing
Neisseria gonorrhoeae
Molecular Epidemiology
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Replicon
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We investigated the relationship between colonizing and invasive isolates from patients with candidaemia. Molecular typing was performed using random amplification of polymorphic DNA (RAPD) and multilocus sequence typing (MLST). We found MLST to be sufficient for typing Candida isolates, and that surveillance cultures are helpful in predicting concomitant invasive isolates, but not necessarily the pathogen involved in subsequent episodes.
Multilocus sequence typing
Concomitant
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ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in India, and up to 70% methicillin resistance has been reported from hospitals in various parts of India. Hospitals use phenotyping for the most part, and molecular genotyping is not done. Here we report on the genotyping of 82 single-patient isolates from two hospitals in Bangalore, South India, for the first time. Most of the strains possessed type III or IIIA staphylococcal cassette chromosome ( SCCmec ) cassettes, and we did not detect strains with type I, IA, or II cassettes. Most isolates also contained the type III cassette chromosome recombinase ( ccr ) AB region. Multilocus sequence typing (MLST) and staphylococcal protein A ( spa ) typing of a selected number of isolates have been carried out. Although most isolates that were chosen for MLST and spa typing had the same patterns, they were quite diverse in their pulsed-field gel electrophoresis (PFGE) patterns. PFGE, MLST, and spa typing of the Indian strains revealed that they are related to the previously described Hungarian and Brazilian clones.
Multilocus sequence typing
SCCmec
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108 isolates of Staphylococcus aureus, belonging to six large ribogroups according to the automated Ribo-Printer® system, were studied with two highly used molecular methods for epidemiological studies, namely multi-locus sequence typing (MLST) and spa typing, followed by BURP and eBURST v3 analysis for clustering spa types and sequence (ST) types. The aim was to evaluate whether automated ribotyping could be considered a useful screening tool for identifying S. aureus genetic lineages with respect to spa typing and MLST. Clarifying the relationship of riboprinting with these typing methods and establishing whether ribogroups fit single clonal complexes were two main objectives. Further information on the genetic profile of the isolates was obtained from agr typing and the search for the mecA, tst genes, and the IS256 insertion sequence. Automated ribotyping has been shown to predict spa clonal complexes and MLST clonal complexes. The high cost and lower discriminatory power of automated ribotyping compared to spa and MSLT typing could be an obstacle to fine genotyping analyzes, especially when high discriminatory power is required. On the other hand, numerous advantages such as automation, ease and speed of execution, stability, typeability and reproducibility make ribotyping a reliable method to be juxtaposed to gold standard methods.
Multilocus sequence typing
Ribotyping
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Multilocus sequence typing
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Phenotypic methods were initially used for bacterial typing yet they have a number of drawbacks limiting their use. Methods of molecular and genetic typing have become wide-spread today. Among these methods, bacterial typing based on multilocus sequence typing (Multilocus Sequence Typing - MLST) has been developing at the fastest rate. However, schemes of molecular and genetic typing of STD pathogens as compared to other bacteria are insufficiently developed, which considerably complicates the planning of measures aimed at the reduction of their spread.
Multilocus sequence typing
Neisseria gonorrhoeae
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We explored the relevance of a Clustered regularly interspaced short palindromic repeats (CRISPR)-based genotyping tool for Streptococcus agalactiae typing and we compared this method to current molecular methods [multi locus sequence typing (MLST) and capsular typing]. To this effect, we developed two CRISPR marker schemes (using 94 or 25 markers, respectively). Among the 255 S. agalactiae isolates tested, 229 CRISPR profiles were obtained. The 94 and 25 markers made it possible to efficiently separate isolates with a high diversity index (0.9947 and 0.9267, respectively), highlighting a high discriminatory power, superior to that of both capsular typing and MLST (diversity index of 0.9017 for MLST). This method has the advantage of being correlated with MLST [through analysis of the terminal direct repeat (TDR) and ancestral spacers] and to possess a high discriminatory power (through analysis of the leader-end spacers recently acquired, which are the witnesses of genetic mobile elements encountered by the bacteria). Furthermore, this “one-shot” approach presents the benefit of much-reduced time and cost in comparison with MLST. On the basis of these data, we propose that this method could become a reference method for group B Streptococcus (GBS) typing.
Multilocus sequence typing
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