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Antimicrobial Agents and Chemotherapy, April 2008, p. 1238-1243, Vol. 52, No. 4
0066-4804/08/$08.00+0 doi:10.1128/AAC.01285-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Department of Bacteriology and Immunology, CODA-CERVA-VAR, Groeselenberg 99, 1180 Brussels, Belgium,1 Department of Pathology, Bacteriology and Avian Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium,2 Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium,3 Institute for Agricultural and Fisheries Research, Unit Technology and Food, Brusselsesteenweg 370, B-9090 Melle, Belgium,4 Scientific Institute of Public Health, J. Wytsmanstraat 14, 1050 Brussel, Belgium5
Received 5 October 2007/ Returned for modification 28 November 2007/ Accepted 16 January 2008
| ABSTRACT |
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| INTRODUCTION |
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In gram-negative bacteria, resistance to extended-spectrum cephalosporins has been associated with the production of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated class C β-lactamases (4). Class A ESBLs (CTX-M or enzymes derived from TEM-1 and SHV-1) and plasmidic class C β-lactamases have already been described in E. coli but also in other bacteria including Klebsiella, Salmonella, Proteus, and Enterobacter species (2, 9, 35). ESBLs confer resistance to most β-lactam antibiotics, including oxyimino-β-lactams such as ceftazidime, ceftiofur, and aztreonam, but are not active against cephamycins, like cefoxitin, and carbapenems and they can be inactivated by clavulanic acid. This is in contrast to class C β-lactamases, which usually confer resistance to all β-lactams with the exception of dipolar ionic methoxy-imino-cephalosporins such as cefepime and the carbapenems (9, 32, 40).
Since the first ESBL was detected in the mid-1980s, the number of different ESBLs has increased rapidly (http://www.lahey.org/studies/inc_webt.asp), but plasmidic class C β-lactamases have also taken their entry (9, 34, 35).
Antimicrobial resistance in commensal Enterobacteriaceae of food animals may play an important role in the ecology of resistance and may serve as an important reservoir for these transmissible resistance genes (31).
Recently, reports concerning E. coli and Salmonella strains carrying β-lactamases isolated from farm animals have been published worldwide (11, 22, 27, 46). Those reports focused on the characterization of β-lactamases and monitored the prevalence of broad-spectrum β-lactamases. Knowledge about the diversity of broad-spectrum β-lactamases among Enterobacteriaceae within a farm remains limited.
In Belgium, resistance to extended-spectrum cephalosporins has been reported in isolates of Salmonella enterica serovars Virchow and Infantis from poultry, food, and humans (6, 13). The diversity and prevalence of broad-spectrum β-lactamases among other Enterobacteriaceae and the epidemiology of these bacteria at the poultry farm level in Belgium are still unknown.
To better understand the epidemiology of ESBL- and class C β-lactamase-carrying bacteria in poultry, the prevalence of commensal ceftiofur-resistant E. coli in broilers was studied, the resistance phenotype of these isolates was determined, and their broad-spectrum β-lactamases were characterized.
| MATERIALS AND METHODS |
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Antimicrobial susceptibility testing. The antimicrobial susceptibilities of the E. coli isolates were determined using the Kirby Bauer disk diffusion test. Clinical Laboratory Standards Institute (CLSI; formerly NCCLS) guidelines were followed for inoculum standardization, medium and incubation conditions, and internal quality control organisms (E. coli ATCC 25922). Briefly, after standardization of the inoculum in phosphate-buffered saline (0.5 McFarland standard) (Densimat; Biomérieux, Marcy l'Etoile, France), the inoculum was triple streaked (60° rotation of the round petri dishes within streaks) on Mueller-Hinton II agar (Oxoid), and antimicrobial tablets were then brought onto the medium by means of a dispenser (30). E. coli isolates were tested for resistance against β-lactams (ampicillin [33 µg], ceftazidime [30 µg], ceftriaxone [30 µg], cefepime [30 µg], ceftiofur [30 µg], aztreonam [30 µg], amoxicillin-clavulanic acid [30 and 15 µg, respectively], imipenem [15 µg], and cefoxitin [60 µg]) (Neo-Sensitabs; Rosco Diagnostica, Taastrup, Denmark) to confirm the presence of an ESBL or a class C β-lactamase. ESBL producers were identified when the marked synergistic effect between extended-spectrum cephalosporins and amoxicillin with clavulanic acid was observed. This β-lactam resistance phenotype is the ESBL phenotype. The absence of this synergistic effect but resistance to both cefoxitin and β-lactamase inhibitors (clavulanic acid) or reduced susceptibility to β-lactamase inhibitors and with reduced susceptibility to expanded-spectrum cephalosporins suggested the presence of a class C β-lactamase and is the AmpC phenotype.
Further susceptibility to aminoglycosides (apramycin [40 µg], gentamicin [40 µg], kanamycin [100 µg], neomycin [120 µg], and streptomycin [100 µg]), amphenicols (chloramphenicol [60 µg] and florphenicol [30 µg]), tetracycline (80 µg), quinolones (nalidixic acid [130 µg]), fluoroquinolones (enrofloxacin [10 µg]), trimethoprim (5.2 µg), and sulfonamides (240 µg) (Neo-Sensitabs; Rosco Diagnostica) was also assessed.
Intermediate zones of inhibition were counted as susceptible in this study.
rep-PCR. E. coli strains were genotyped using repetitive extragenic palindromic-PCR (rep-PCR) to assess the diversity of the isolates and to allow the selection of isolates for further analysis.
DNA was extracted by inoculating a single colony of each isolate from a blood agar plate into 1 ml of Luria broth. After overnight incubation at 37°C, cells were harvested after centrifugation at 16,000 x g for 5 min. The pellet was resuspended in 1 ml of distilled water, and cells were lysed by heating at 95°C for 5 min. Cellular debris was removed by centrifugation at 16,000 x g for 5 min.
rep-PCR was adapted from a method described previously by Rademaker and de Bruijn (36). The primers used were REP 1R (5'-III ICG ICG ICA TCI GGC-3') and REP 2I (5'-ICG ICT TAT CIG GCC TAC-3') (15, 16). PCR mixtures were prepared by using 2 µl template DNA, 12.5 µl PCR master mix {2.5 U/reaction Taq DNA polymerase, 1x PCR buffer [Tris-Cl, KCl, (NH4)2SO4, 1.5 mM Mg Cl2] (pH 8.7)}, 200 µM deoxynucleoside triphosphate (Qiagen, Venlo, The Netherlands), and 1.5 µl of each primer (10 µM; Eurogentec, Seraing, Belgium) in a volume of 25 µl. PCR conditions were 95°C for 6 min; 30 cycles each of 94°C for 1 min, 40°C for 1 min, and 65°C for 8 min; and a final step at 65°C for 16 min (15). Ten microliters of each mixture was separated on a 1.5% agarose gel in 0.5x Tris-borate-EDTA buffer at a constant voltage of 70 V for 18 h at 4°C. A 100-bp (100 to 3,000 bp) PCR molecular ruler (Bio-Rad, Nazareth, Belgium) was used as a standard. Gel images were analyzed with BioNumerics software (Applied Maths, Kortrijk, Belgium). Only PCR products that were 0.5 to 3.0 kb long were considered for analysis in this study. Dice similarity coefficients were determined in order to quantify the similarity between DNA fingerprints. A dendrogram was constructed by using the unweighted-pair group method with arithmetic averages.
Characterization of β-lactamases. For isoelectric focusing (IEF), cultures were grown overnight at 37°C in 10 ml of brain heart infusion broth with 100 µg/ml ampicillin. Bacterial suspensions were disrupted by sonication (two bursts of 30 s on ice at an amplitude of 12 µm in an MSE Ultrasonic Disintegrator Mark II) and centrifuged (15 min at 10,000 x g at 4°C). The supernatants containing the crude enzyme extract was loaded onto a Ampholine PAGplate pH 3.5 to 9.5 IEF gel (GE-Amersham Bioscience, Uppsala, Sweden) and run at 1,500 V for 90 min. β-Lactamase bands were visualized by overlaying the gel with 0.1 mg/ml nitrocefin (Oxoid). The pI values were determined and compared with the pI values of known β-lactamases: PER-1 (pI 5.3), TEM-24 (pI 6.5), VEB-1 (pI 7.4), and CMY-4 (pI 9.2).
Based on the IEF results, PCR for the detection of genes encoding TEM-, SHV-, CTX-M-, and CMY-type enzymes was performed on genomic DNA extracted as described above. PCR mixtures were prepared using 20 µl PCR master mix {2.5 U/reaction Taq DNA polymerase, 1x PCR buffer [Tris-Cl, KCl, (NH4)2SO4, 1.5 mM Mg Cl2] (pH 8.7), 200 µM deoxynucleoside triphosphate (Qiagen)}, 2.4 µl of each primer (10 µM; Eurogentec), and 2 µl template DNA in a volume of 40 µl. Primers specific for these β-lactamases and the conditions for these reactions were reported previously (19, 34). Isolates that contained a blaCTX-M-type gene were further analyzed using primers to differentiate between CTX-M-1, CTX-M-2, and CTX-M-9 groups (19). Isolates that tested positive for the blaCMY gene were further analyzed to differentiate between the blaCMY-1 and blaCMY-2 genes (34). Positive controls (Enterobacter aerogenes 3/30187 [blaTEM-24], E. aerogenes 3/30186 [blaSHV-4] [obtained from G. Claeys], Klebsiella pneumoniae 2974 [blaCMY-4] [obtained from G. Arlet], and S. enterica serovar Virchow 968/03 [blaCTX-M-9] [obtained from S. Pournaras]) as well as negative controls were included in each type of PCR. All PCR products were purified using a Nucleospin Extract II kit (Macherey-Nagel GmbH & Co. KG) and sequenced using an Applied Biosystems GeneAmp PCR 9700 sequencer. The PCR primers were used for sequencing. The obtained nucleotide sequences were compared with those previously described for bla genes (BLAST database [http://www.ncbi.nlm.nih.gov/BLAST/]).
The chromosomal ampC gene including its promoter and attenuator regions was amplified and sequenced by using primers Int-B2 (5'-TTCCTGATGATCGTTCTGCC-3') and Int-HN (5'-AAAAGCGGAGAAAAGGTCCG-3') as described previously (29). PCR amplifications yielded a 1,315-bp amplification product. Mutations in the promoter and attenuator regions were studied by comparing the sequences with the sequence of the same region in the E. coli K-12 ampC gene (24).
| RESULTS |
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β-Lactamase characterization. Of the 51 selected cephalosporin-resistant E. coli isolates, crude protein extracts were characterized by IEF. Different pIs were observed (5.4, 6.0, and 8.0 to 9.0) among these 51 isolates.
Based on these results, PCRs with primers specific for the blaTEM, blaSHV, blaCTX-M-type, and blaCMY genes were performed. Twenty-six (55%) isolates were found to carry a blaTEM gene, 22 (43%) isolates carried the blaCTX-M-type gene, and 25 (49%) isolates carried the blaCMY gene. No blaSHV genes were found. Sequence analysis revealed the following ESBLs: TEM-52 (n = 7), TEM-106 (n = 1), CTX-M-1 (n = 14), CTX-M-2 (n = 4), CTX-M-14 (n = 3), and CTX-M-15 (n = 1) (Table 3). The only plasmidic AmpC β-lactamase found in this study was the CMY-2 enzyme (n = 25). Mutations in the promoter and attenuator regions of the chromosomal ampC gene were found in eight isolates and in association with blaCMY-2 (n = 4) genes or ESBL (blaCTX-M-1 [n = 3] and blaTEM-52 [n = 1]) genes as shown in Table 4. Important promoter mutations in the –35 box and –10 box and at positions –42 and –11 were not detected. The distance between the two conserved regions also plays an important role in the strength of the promoter, and the optimal distance is 17 bp (12). In our isolates, the distance was 16 bp.
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At the farm level, many differences between farms were noted (Table 3). The CMY-2 gene was found in all farms and was the single gene causing extended resistance to β-lactam antibiotics in farm 3. The other farms were characterized by different TEM, CTX-M, and CMY enzymes as shown in Table 3. The ESBLs TEM-52 and CTX-M-1 were present in multiple farms, in contrast to the other ESBLs. The CTX-M family was the most abundant family of ESBLs. In three isolates, the combination of an ESBL (CTX-M-1) with a plasmidic AmpC β-lactamase (CMY-2) was found. This phenomenon was seen in farm 4 and farm 5.
| DISCUSSION |
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Approximately one-half of the ceftiofur-resistant strains were also resistant to tetracycline and nalidixic acid, and more than half were resistant to trimethoprim and sulfonamides. Otherwise, the prevalence of resistance against antimicrobials other than the β-lactams was rather low. For Enterobacteriaceae, resistance to quinolones is generally acquired in a two-step mutation process. A first mutation in the quinolone resistance-determining region of the gyrA gene gives full resistance to narrow-spectrum quinolones, such as nalidixic acid, and decreased susceptibility to fluoroquinolones. A second mutation in one of the gyr or par genes gives full resistance to fluoroquinolones (39). We found nearly 50% of the strains to be resistant to nalidixic acid, and fluoroquinolone resistance was detected in only one farm. The high prevalence of nalidixic acid resistance, however, increases the risk for the development of fluoroquinolone resistance.
Many of the ceftiofur-resistant E. coli isolates also showed acquired resistance to several other classes of antimicrobials, and some were highly multiresistant. At this time, resistance to therapeutically important antimicrobial agents is becoming a particular concern. The genetic homology among all isolates was relatively low, even within a farm, as expected, since E. coli has a polyclonal population structure.
Although only five farms were sampled, a multitude of six different ESBLs and one plasmidic AmpC β-lactamase were detected, indicating a high diversity of resistance genes in E. coli strains in Belgian broilers.
The CTX-M group of β-lactamases was the predominant ESBL type identified in our isolates, and the CTX-M-1 enzyme was the most abundant. It must be noted that isolates carrying a CTX-M enzyme were also resistant to sulfonamides and trimethoprim. The CTX-M-2 enzyme found in Salmonella from Belgian poultry has been localized in a complex class 1 integron, which also contains the resistance genes of sulfonamides and trimethoprim (6, 21). Previously reported analyses of the surrounding regions of CTX-M enzymes have shown the association of β-lactamase genes with the insertion sequence ISEcp1 (19). Furthermore, those analyses confirmed the predominant role of ISEcp1 in the mobilization of blaCTX-M genes of the CTX-M-1 group (of human isolates) and the presence of a novel complex class 1 integron (18). The CTX-M-14 enzyme of a clinical E. coli isolate and the CTX-M-9 enzyme of a Salmonella isolate from healthy food animals were also part of a complex class 1 integron (3, 37). Further analysis to determine the genetic environment of these genes is needed to confirm whether the CTX-M enzymes found in our study are also located in similar structures. Also, in Belgium, CTX-M-2 was reported in extended-spectrum cephalosporin-resistant S. enterica serovar Virchow strains from poultry and humans (6), and CTX-M enzymes belonging to groups 1, 2, and 9 emerged in human E. coli strains in 2002 (38). The presence of CTX-M-type extended-spectrum β-lactamases in farm animals has also been reported in other countries (7, 17, 28).
Another class A ESBL reported among several farms was the TEM-52 enzyme. In Belgium and France, the presence of TEM-52 was demonstrated in Salmonella enterica serovars isolated from poultry and humans (13). In The Netherlands, TEM-52 was the most common ESBL detected in Salmonella and was found mainly in Salmonella serovar Paratyphi B from poultry, poultry products, and humans (22). Other European reports also described the presence of TEM-52 E. coli producers in animals (7, 14).
Another TEM-type ESBL found in one isolate was the TEM-106 enzyme. This TEM derivative differs from the TEM-52 enzyme in only four nucleotides. To our knowledge, this is the first time that the presence of this enzyme has been described in bacteria from food-producing animals.
Of the plasmidic class C β-lactamases, only the CMY-2 enzyme was identified. CMY-2 was the most frequently isolated β-lactamase among farms and was present in all farms investigated in this study.
E. coli and Salmonella strains carrying the CMY-2 β-lactamase have already been reported in food-producing animals and humans in Europe, Africa, Asia, and the United States (5, 7, 20, 26, 28, 45, 46). In the United States, CMY-2 is highly prevalent among E. coli and Salmonella strains from food-producing animals and humans. The transfer of CMY-2 between different bacterial species and between animals and humans has been suggested (46). This is the first description of the CMY-2 enzyme in E. coli from animals in Belgium.
The mutations in the promoter and attenuator regions of the ampC gene were probably not important for the resistance phenotypes found. Mutations at positions –42, –32, and –11 were not found in this study, although these mutations would be important for the overexpression of the chromosomal ampC gene (12). In the ESBL strains, no additional resistance to amoxicillin with clavulanic acid or the lack of inhibition effect of clavulanic acid was seen. However, it has been suggested that the mutation at position –18, creating a new –10 box and also found in our study, plays an important role in the expression of the chromosomal ampC gene (12, 42). Mutations at positions –28, –18, –1, and +58 in combination with an ESBL in clinical E. coli isolates were described previously (10).
In the strains expressing a plasmid-mediated ampC gene, resistance to cefoxitin might be explained by the expression of the blaCMY-2 gene, although the effect of the chromosomal ampC gene on the resistance of mutations in the promoter (positions –18 and –28) and the attenuator (position +17) region found in our study cannot be evaluated. The effect could have been masked. Not only mutations in the promoter region but also mutations in the attenuator region (position +17) are important and are thought to contribute to AmpC overproduction by destabilizing the hairpin structure, resulting in increased transcription (42). Mutations at positions –18, –1, and +58 in association with a blaCMY-2 gene in farm animals were described previously (27). Further studies are necessary to determine the real role of the mutations found in our study.
A possible explanation for the high prevalence of β-lactamases with an extended spectrum among E. coli strains from broilers may be coselection due to the use of other non-β-lactam antimicrobials. Resistance genes against these antimicrobial agents may be located in the same mobile genetic element as genes encoding broad-spectrum β-lactamases (e.g., transposons or integrons) (8, 21). Further studies are needed to confirm this hypothesis.
The presence of ESBLs and ampC genes in the microbiota of broilers may pose a human health hazard since these bacteria may represent a reservoir of resistance genes for pathogens causing disease in humans and animals (43, 44). Further studies on the location and transfer possibilities of these genes should be carried out to elucidate if a common reservoir exists.
In conclusion, this is the first detailed documentation of a high diversity of β-lactamases with an extended spectrum in E. coli at the poultry farm level. This finding necessitates a follow-up evaluation of extended-spectrum β-lactam resistance in commensal E. coli of poultry in order to be able to estimate the public and animal health burden.
| ACKNOWLEDGMENTS |
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We thank Danielle Vandergheynst and Veronique Collet for their skilled technical assistance. We are grateful to Geert Claeys, Spyros Pournaras, and Arlet Guillaume for providing strains.
| FOOTNOTES |
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Published ahead of print on 28 January 2008. ![]()
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