Antimicrobial Resistance Genes, Virulence Genes, and Associated Mobile Genetic Elements of Eight Multidrug-Resistant Enterobacterales Isolated from Hospital-Acquired Urinary Tract Infections in Sri Lanka.

The study describes the first isolation of multidrug-resistant (MDR) Klebsiella pneumoniae ST16, Escherichia coli ST131 (Esc), and Enterobacter hormaechei subsp. steigerwaltii ST93 (Enterobacter cloacae complex [ECC]) in Sri Lanka. Eight MDR strains of uropathogenic Enterobacterales isolated from hospital acquired urinary tract infections (UTIs) were analyzed using genomic sequencing and comparative genomics. Isolates carried multiple carbapenemase, AmpC, and ESBL (extended-spectrum ß-lactamase) genes. ECC manifested both blaNDM-4 and blaOXA-181. The K. pneumoniae strains harbored fimbrial genes that facilitate pathogenesis of UTI. Several extraintestinal pathogenic E. coli associated virulence genes were identified in Esc. The efflux pump gene, acrA, and the T6SS gene cluster were detected in ECC. Many antimicrobial resistance (AMR) and virulence genes were identified associated with mobile genetic elements. ISEcp1 flanked upstream of blaCTX-M-15. The carbapenemase genes were carried on ColKP3 plasmids and were associated with ISEcp1. In Esc, the AMR gene blaTEM-1B and virulence gene traT were found on an IncF plasmid replicon. In K. pneumoniae the AMR genes sul1 and tetB present on IncR plasmid replicons and were associated with the insertion sequence IS6100. In Kp5, blaLAP-2 and qnrS1 coexisted and were flanked by ISEcl. AMR gene clusters, conferring resistance to multiple antimicrobial classes, flanked by mobile elements were identified in seven isolates.

Phenotypic and genotypic distribution of ESBL, AmpC ß-lactamase and carbapenemase-producing Enterobacteriaceae in community-acquired and hospital-acquired urinary tract infections in Sri Lanka.

OBJECTIVES: Although Sri Lanka belongs to a region with a high prevalence of extended-spectrum ß-lactamase (ESBL), AmpC ß-lactamase and carbapenemase-producing Enterobacteriaceae, data regarding antimicrobial resistance (AMR) is limited. We studied the prevalence and diversity of ß-lactamases produced by Enterobacteriaceae urinary pathogens from two hospitals in the Western Province of Sri Lanka. METHODS: ESBL, AmpC ß-lactamase and carbapenemase production was detected by phenotypic testing followed by genotyping. RESULTS: The species responsible for urinary tract infections (UTI) were Escherichia coli (69%), Klebsiella pneumoniae (16%) and Enterobacter sp (6%). The prevalence of ESBL (50%), AmpC ß-lactamase (19%) and carbapenemase (11%) phenotypes was high, and greater in hospital-acquired (HA-UTI) (75%) than in community-acquired UTI (CA-UTI) (42%). Identification of CA-UTI caused by carbapenemase-producing Enterobacteriaceae (5%) is alarming. Only one ESBL gene, blaCTX- M-15, was detected. AmpC ß-lactamase genes found in E. coli and K. pneumoniae were blaCMY-2, blaCMY-42 and blaDHA-1, while Enterobacter sp. carried blaACT-1. Carbapenemase genes were blaNDM-1, blaNDM-4, blaOXA-181 and blaOXA-232, while blaKPC, blaIMP and blaVIM were absent. Co-occurrence of multiple bla genes, with some isolates harbouring six different bla genes, was common. Carbapenem-resistant isolates without carbapenemase genes displayed mutations in the outer membrane porin genes, ompF of E. coli and ompK36 of K. pneumoniae. Factors associated with UTI with ß-lactamase-producing Enterobacteriaceae were age ≥50 years, previous hospitalization, presence of an indwelling urinary catheter, history of diabetes mellitus or other chronic illness and recurrent urinary tract infections. CONCLUSION: This study adds to the currently scarce data on AMR in Sri Lanka.

Typhoid Fever due to Extended Spectrum ß-Lactamase-Producing Salmonella enterica Serovar Typhi: A Case Report and Literature Review.

Emergence of cephalosporin-resistant strains of Salmonella enterica serovar Typhi is a cause of concern in the management of enteric fever. Cephalosporin resistance in Salmonella species is mainly due to the production of extended-spectrum ß-lactamases (ESBLs). The majority of ESBLs in Salmonella enterica serovar Typhi are derivatives of the TEM, SHV, and CTX-M ß-lactamase families. Of these, CTX-M appears to be predominant. This paper discusses the detection and molecular characterization of an ESBL-producing Salmonella enterica serovar Typhi strain isolated from a patient who was admitted to a private hospital in Sri Lanka. The three main types of ß-lactamases such as TEM, SHV, and CTX-M were identified in this isolate. This case report from Sri Lanka contributes to the knowledge of the increasingly reported cases of typhoid fever due to Salmonella enterica serovar Typhi resistant to ß-lactamase by ESBL production.

Non-dermatophyte mold onychomycosis in Sri Lanka.

Dermatophytic and non-dermatophytic onychomycosis (NDM) was indistinguishable clinically in our case series. Making a clinical diagnosis of onychomycosis without mycology is the routine practice in Sri Lanka. The prevalence of NDM (45.8%) was very high in our patient population, followed by yeasts (34.1%); dermatophyte infection made up only 20%. Therefore, the treatment of onychomycosis with griseofulvin seems futile. Close contact with soil, the habit of walking barefoot, frequent emersion of hands in water, and a hot, humid climate partly explain the variation in causative pathogens in this case series.

Onychomycosis caused by Fusarium sp in Sri Lanka: prevalence, clinical features and response to itraconazole pulse therapy in six cases.

OBJECTIVES: The aims of our study were to ascertain the proportion of Fusarium onychomycosis among patients with suspected onychomycosis, to record clinical features and to assess the efficacy of itraconazole pulse therapy in treatment. METHODS: Six patients with positive isolates of Fusarium sp were treated in an open, prospective manner with itraconazole: two pulses for fingernails and three pulses for toenails. Significant growth of Fusarium sp was considered when both microscopy of direct mounts in KOH and culture were positive for mold. Efficacy parameters were mycological cure and clinical cure. Mycological cure was negative direct microscopy (KOH) and culture. Clinical cure was complete absence of signs of onychomycosis. RESULTS: Prevalence of Fusarium onychomycosis was 6.25% (8/128). Three women and three men were studied. All had bilateral big toenails involved which were of the distal and lateral onychomycosis. Three of them had associated fingernail onychomycosis with periungual inflammation. All our patients were immunocompetent. At month 12 from the start of treatment, mycological cure was 100% while only three out of five patients showed normal nail growth and clinical cure. There were no significant clinical or laboratory adverse effects. CONCLUSIONS: Our data reconfirmed that Fusarium nail infections are difficult to eradicate. Since the therapeutic reservoir in toenails is 11 months, these patients should be followed up for a total of 12 months before coming to the final conclusion.

Fatal septicaemia caused by Chromobacterium violaceum.

We report a case of Chromobacterium violaceum septicaemia in a 10-year old boy admitted to hospital in September 2001, two weeks after he suffered a crush injury of the left foot. In spite of surgical debridement and antibiotics his condition worsened and he developed multiple liver and lung abscesses. He died one week after admission and a blood culture grew Chromobacterium violaceum.