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National and International Spread of Antimicrobial Resistance: Clones and Genes

National and International Spread of Antimicrobial Resistance: Clones and Genes. Professor Alan Johnson, Health Protection Services - HPA . Antimicrobial Resistance. Streptococcus pneumoniae Staphylococcus aureus Escherichia coli.

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National and International Spread of Antimicrobial Resistance: Clones and Genes

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  1. National and International Spread of Antimicrobial Resistance: Clones and Genes Professor Alan Johnson, Health Protection Services - HPA

  2. Antimicrobial Resistance • Streptococcus pneumoniae • Staphylococcus aureus • Escherichia coli

  3. Global Spread of Multi-Resistant Clone of Streptococcus pneumoniae (Spain23F-1) Finland France BM4200 1978 ? Cleveland Spain South Korea Tennessee Taiwan Mexico Hong Kong Philippines Thailand Colombia Malaysia Singapore Brazil Chile South Africa Uruguay Argentina Munoz et al . J Infect Dis 1991; 164:302-06

  4. Pneumococcal Molecular Epidemiology Network PMEN, Pneumococcal Molecular Epidemiology Network: http://www.sph.emory.edu/PMEN/

  5. Pneumococcal Bacteraemia in a British District General Hospital, Jan 2000-Mar 2001 • 56 cases of pneumococcal bacteraemia • 18 isolates (32%) were antibiotic-resistant • Three isolates of Spain9V-3 clone (pen-R) • 14 isolates of England14-9 clone (ery-R) • One isolate of Spain6B-2 clone (multi-R) Birtles A et al. J Med Microbiol 2004;53: 1241-1246

  6. Pneumococcal vaccines • Pneumococci comprise ~90 serotypes • Polysaccharide capsule is a virulence determinant (inhibits phagocytosis) • Capsule antigens form basis for vaccines • 7-valent conjugate vaccine (2006) • 13-valent conjugate vaccine

  7. Erythromycin Resistance in Invasive Pneumococci, England and Wales PCV-7 2mo to <2yrs Older patients Henderson K et al. J Antimicrob Chemother 2010; 65: 369-70.

  8. Bacteraemia Due to MRSA, England & Wales % MRSA

  9. Hospitals in England & Wales Sending EMRSA-15/16 to Reference Laboratory

  10. Correlation of MRSA and Use of Macrolides, Cephalosporins and Fluoroquinolones Monnet DL et al. EID 2004; 10:1432-41.

  11. Spread of EMRSA-15/16 • Ciprofloxacin is excreted in sweat • Disruption of normal skin microflora? • Colonization of skin by ciprofloxacin-resistant MRSA?

  12. Distributionof MRSA Spa Types in Europe

  13. Epidemiology of Cephalosporin Resistance in UK is Changing… • 1980-90s: • Nosocomial (e.g. ICUs) • Commonly Klebsiella spp. • TEM/SHV ESBLs • Since 2003: • Commonly E. coli • CTX-M type ESBLs • UTIs in elderly patients in the community (difficult to determine if community or HCAI)

  14. PFGE Profile of CTX-M-producing E. coli • 5 related strains • Serotype O25:H4 • MLST 131 • Other isolates diverse Woodford N et al.J Antimicrob Chemother 2004; 54: 735-43

  15. Spread of E. coli Strain A • CTX-M-15 • Serotype O25:H4 • Sequence type 131 • Global spread

  16. International Spread of E. coli 025:H4 ST131 with CTX-M-15

  17. PFGE Profile of CTX-M-producing E. coli • 5 related strains • Serotype O25:H4 • MLST 131 • Other isolates diverse Woodford N et al.J Antimicrob Chemother 2004; 54: 735-43

  18. Bacterial Plasmids

  19. Conjugating bacteria

  20. Spread of AMR • Vancomycin-resistant enterococci • Klebsiella pneumoniae • Acinetobacter baumanii • MDR TB • Cephalosporin-resistant gonococci • Carbapenemase-producing Gram-negative bacteria

  21. What We Do and Don’t Know • Antibiotic resistance involves both strain and gene spread • Why are some strains epidemic and others not? • How do we prevent strain spread (local/national/international)? • Can we prevent plasmid spread? • How important is plasmid spread in the gut? • Epidemiology of resistance in commensal bacteria? • Interventions (e.g. rapid tests; antibiotic stewardship)?

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