This thesis assessed the prevalence, patterns of antibiotic resistance, and molecular characteristics of ESBL-, AmpC-, and carbapenemase-producing Escherichia coli (EC) and Klebsiella pneumoniae (KPN) isolated from Canadian hospitals. Bacterial isolates were collected as part of the CANWARD national surveillance study. The prevalence of ESBL-EC [2007: 3.4%, 2012: 7.6%], AmpC-EC [2007: 0.7%, 2012: 2.2%], and ESBL-KPN [2007: 1.5%, 2012: 3.6%] increased between 2007 and 2012. Antimicrobials demonstrating the greatest activity against isolates in this study were colistin, amikacin, ertapenem, and meropenem, while 78.8%, 34.9%, and 66.7% of ESBL-EC, AmpC-EC, and ESBL-KPN, respectively, were multidrug resistant. Isolates were generally unrelated by PFGE; however, ST-131 was identified among 56.9% and 31.7% of ESBL-EC and AmpC-EC, respectively. CTX-M-15 was the dominant genotype in ESBL-EC (66.5%) and ESBL-KPN (48.1%), while the dominant genotype in AmpC-EC was CMY-2 (53.2%). Carbapenemase production was identified in 0.03% of EC and 0.05% of KPN, all of which produced KPC-3.

The spread of resistance to the cephalosporins in the Enterobacteriaceae and more specifically within E. coli is a continuing cause of public health concern, with such resistance increasingly seen in community- and nosocomial-acquired infections. Extended-spectrum ß-lactamase (ESBL) and AmpC ß-lactamase (AmpC) enzymes cause most cephalosporin resistance in E. coli by hydrolysis of the antimicrobial and continue to jeopardize patient outcome. The purpose of this thesis was to determine the prevalence of ESBL-producing Enterobacteriaceae and to molecularly characterize ESBL and AmpC producers found to be associated with the increasing cephalosporin resistance among E. coli within Canadian hospitals from 2005 to 2009. Isolates were collected as part of the Canadian Intensive Care Unit and Canadian Ward surveillance studies. ESBL and AmpC producers were molecularly characterized for resistance genes, virulence factors and phylogenetic groups. All strains were typed using PFGE and ESBL-producing E. coli were further typed by MLST. Plasmids bearing the ESBL and AmpC genes were characterized by BglII RFLP analysis and a multiplex PCR for replicon typing. ESBL-producing E. coli and K. pneumoniae and AmpC-producing E. coli were found to be firmly established in Canadian hospitals; whereas, ESBL-producing K. oxytoca and P. mirabilis have yet to emerge. Increasing resistance to several unrelated antimicrobials leading to multi-drug resistance among these pathogens is concerning. The successful dissemination of ESBL-producing E. coli in Canada occurs through a diversity of different mechanisms and does not correspond to a single ESBL determinant, or a single clone, or a single plasmid but rather through the combination of clonal spread of virulent strains and the acquisition of diverse ESBL-bearing plasmids. However, the predominance of CTX-M-15-producing E. coli in this study was mainly due to the virulent ST131 clone and the diverse IncFII plasmids bearing the blaCTX-M-15 gene. Whereas, horizontal transfer of genetically similar IncI1, IncA/C and IncK/B plasmids bearing blaCMY-2 and the clonal spread of virulent strains, including ST131 with ampC promoter/attenuator mutations, appears to be playing a role in the spread of AmpC-producing E. coli isolates in Canadian hospitals. The increasing prevalence of these multi-drug resistant pathogens in Canadian hospitals demonstrates the need for increased surveillance and understanding of these emerging pathogens. The continued surveillance will help guide proper infection control procedures and identify optimal treatment of these clinically important pathogens in Canadian hospitals.

This thesis assessed the prevalence, patterns of antibiotic resistance, and molecular characteristics of ESBL-, AmpC-, and carbapenemase-producing Escherichia coli (EC) and Klebsiella pneumoniae (KPN) isolated from Canadian hospitals. Bacterial isolates were collected as part of the CANWARD national surveillance study. The prevalence of ESBL-EC [2007: 3.4%, 2012: 7.6%], AmpC-EC [2007: 0.7%, 2012: 2.2%], and ESBL-KPN [2007: 1.5%, 2012: 3.6%] increased between 2007 and 2012. Antimicrobials demonstrating the greatest activity against isolates in this study were colistin, amikacin, ertapenem, and meropenem, while 78.8%, 34.9%, and 66.7% of ESBL-EC, AmpC-EC, and ESBL-KPN, respectively, were multidrug resistant. Isolates were generally unrelated by PFGE; however, ST-131 was identified among 56.9% and 31.7% of ESBL-EC and AmpC-EC, respectively. CTX-M-15 was the dominant genotype in ESBL-EC (66.5%) and ESBL-KPN (48.1%), while the dominant genotype in AmpC-EC was CMY-2 (53.2%). Carbapenemase production was identified in 0.03% of EC and 0.05% of KPN, all of which produced KPC-3.

The spread of resistance to the cephalosporins in the Enterobacteriaceae and more specifically within E. coli is a continuing cause of public health concern, with such resistance increasingly seen in community- and nosocomial-acquired infections. Extended-spectrum ß-lactamase (ESBL) and AmpC ß-lactamase (AmpC) enzymes cause most cephalosporin resistance in E. coli by hydrolysis of the antimicrobial and continue to jeopardize patient outcome. The purpose of this thesis was to determine the prevalence of ESBL-producing Enterobacteriaceae and to molecularly characterize ESBL and AmpC producers found to be associated with the increasing cephalosporin resistance among E. coli within Canadian hospitals from 2005 to 2009. Isolates were collected as part of the Canadian Intensive Care Unit and Canadian Ward surveillance studies. ESBL and AmpC producers were molecularly characterized for resistance genes, virulence factors and phylogenetic groups. All strains were typed using PFGE and ESBL-producing E. coli were further typed by MLST. Plasmids bearing the ESBL and AmpC genes were characterized by BglII RFLP analysis and a multiplex PCR for replicon typing. ESBL-producing E. coli and K. pneumoniae and AmpC-producing E. coli were found to be firmly established in Canadian hospitals; whereas, ESBL-producing K. oxytoca and P. mirabilis have yet to emerge. Increasing resistance to several unrelated antimicrobials leading to multi-drug resistance among these pathogens is concerning. The successful dissemination of ESBL-producing E. coli in Canada occurs through a diversity of different mechanisms and does not correspond to a single ESBL determinant, or a single clone, or a single plasmid but rather through the combination of clonal spread of virulent strains and the acquisition of diverse ESBL-bearing plasmids. However, the predominance of CTX-M-15-producing E. coli in this study was mainly due to the virulent ST131 clone and the diverse IncFII plasmids bearing the blaCTX-M-15 gene. Whereas, horizontal transfer of genetically similar IncI1, IncA/C and IncK/B plasmids bearing blaCMY-2 and the clonal spread of virulent strains, including ST131 with ampC promoter/attenuator mutations, appears to be playing a role in the spread of AmpC-producing E. coli isolates in Canadian hospitals. The increasing prevalence of these multi-drug resistant pathogens in Canadian hospitals demonstrates the need for increased surveillance and understanding of these emerging pathogens. The continued surveillance will help guide proper infection control procedures and identify optimal treatment of these clinically important pathogens in Canadian hospitals.

Thesis (M.Phil.)--University of Hong Kong, 2005. / Title proper from title frame. Also available in printed format.

Thesis (Ph.D.)--University of Hong Kong, 1997. / Includes bibliographical references (leaf 129-150) Also available in print.

Thesis (Ph.D.) - University of Queensland, 2005. / Includes bibliography.

Thesis (Ph. D.)--Case Western Reserve University, 2007. / [School of Medicine] Department of Pharmacology. Includes bibliographical references. Available online via OhioLINK's ETD Center.

A capacidade de adquirir, com facilidade, resistência à terapia antimicrobiana torna-se uma das características mais estudadas em Acinetobacter sp., mundialmente conhecido por estar relacionado a surtos de infecções associadas à assistência a saúde (IAAS) e por ser apontado como um grave problema de saúde pública. Embora isolados clínicos desse gênero sejam extensivamente estudados quanto à presença e a diversidade de genes do tipo OXA-carbapenemases,existem poucos estudos sobre essa relação em isolados ambientais. Este trabalho teve como objetivo determinar a presença de carbapenemases do tipo OXA (e sua diversidade), de ISAba1 e de sua relação com as carbapenemases em isolados clínicos e de esgoto hospitalar de Acinetobacter sp. na cidade de Porto Alegre, Rio Grande do Sul. Um total de 310 isolados (145 clínicos e 165 ambientais) foram submetidos a análise por PCR das regiões genéticas de interesse. A diversidade dos genes do tipo blaOXA-51 foi realizada por DGGE. Os resultados indicam a presença do gene blaOXA-58 em um isolado, pela primeira vez no Brasil. A sequência ISAba1 foi frequentemente encontrada (92,9%), porém, a sua associação com blaOXA-51 foi baixa e encontrada em 9,8% dos isolados clínicos e em 6,5% dos isolados ambientais. A análise de diversidade revelou uma baixa freqüência de alelos de OXA-51 entre os isolados estudados, sendo blaOXA-65 a variante mais encontrada. Contudo, podemos afirmar que o esgoto hospitalar analisado constitui-se de uma fonte de contaminação de bactérias patogênicas e que as precárias políticas de saneamento podem proporcionar a disseminação de multirresistência para o meio ambiente. / The ability of easily acquiring resistance to antimicrobial therapy becomes one of the most studied features in Acinetobacter sp., world renowned for being related to outbreaks of infection associated with health care and for being appointed as a serious public health problem. Although clinical isolates of this genus are extensively studied for the presence and diversity of OXAcarbapenemase genes, there are few studies about this relationship in environmental isolates. This study aimed to determine the presence of OXAtype carbapenemases (and yours diversity), of ISAba1 and its relationship with carbapenemases in clinical and hospital sewage isolates of Acinetobacter sp. in Porto Alegre, Rio Grande do Sul. A total of 310 strains (145 of clinical origin and 165 of environmental origin) were subjected to PCR analysis of genetic regions of interest. The diversity of blaOXA-51-like genes was performed by DGGE. The results indicate the presence of the gene blaOXA-58 in an isolated, for the first time in Brazil. ISAba1 was frequently found (92.9%) but its association with blaOXA-51-like was low and was found in 9.8% of clinical isolates and in 6.5% of environmental isolates. The diversity analysis showed that there is a low frequency of alleles of OXA-51 among the studied isolates being blaOXA-65 variant the most often found. However, we can state that the hospital sewage is considered to be a source of pathogenic bacteria contamination and that the poor sanitation politics contributes to the spread of multidrug resistance in the environment.

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