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Volume 22, Number 9—September 2016
Letter

Carbapenem-Resistant Enterobacter spp. in Retail Seafood Imported from Southeast Asia to Canada

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To the Editor: Carbapenems, antimicrobial drugs of last resort, are recommended only for severe community- and healthcare-associated multidrug-resistant bacterial infections. In Canada, carbapenem-resistant infection rates in hospitals remained low (<0.25 cases/1,000 patient admissions) over 5 years’ (2009–2014) surveillance (1). Carbapenemase-producing bacteria have rarely been detected in the food chain in industrialized countries. However, carbapenemase genes were detected in bacteria isolated from produce in Switzerland (2) and seafood in Canada (3); implicated food items originated from Southeast Asia. We conducted targeted sampling to assess, using selective media, the occurrence of carbapenem-resistant Enterobacteriaceae in imported seafood products sold in Canada.

For testing, we selected 1,328 retail seafood samples: 928 were imported fresh and frozen raw shrimp collected during 2011–2015 by CIPARS (the Canadian Integrated Program for Antimicrobial Resistance Surveillance), and 400 comprised an assortment of imported niche-market fresh and frozen raw seafood collected specifically for this study during January–April 2015. Product information and origin country were recorded for each sample. We used chromID CARBA agar (bioMérieux, St. Laurent, QC, Canada) to select putative colonies. To determine carbapenemase production on nonsusceptible (zone of inhibition <25 mm) isolates, we used disk diffusion susceptibility to ertapenem and meropenem (10 μg each) and the Carba NP test as previously described (4). Isolates were identified to species using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (Bruker Daltonics Ltd, Milton, ON, Canada) and tested for susceptibility using the Sensititre Complete Automated System with the Sensititre NARMS Gram Negative Plate (CMV3AGNF) (Trek Diagnostic Systems, Oakwood Village, OH, USA). We used single and multiplex PCR to screen isolates for the major carbapenemase-conferring (blaNDM, blaKPC, blaIMP, blaVIM, blaGES, blaOXA-48–like, blaNMC) and β-lactamase–conferring (blaSHV, blaTEM, blaCTX-M, blaOXA-1, blaCMY-2) genes (5). We performed pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (Illumina Inc., San Diego, CA, USA) on isolates requiring further comparative testing (6). In silico multilocus sequence typing and replicon typing were conducted using the assembled sequence data (SPAdes 3.5.0 [St. Petersburg genome assembler], http://spades.bioinf.spbau.ru/release3.5.0/manual.html) and services of the Center for Genomic Epidemiology (http://www.genomicepidemiology.org). The transferability of resistance genes was determined by transformation experiments using eletrocompetent Escherichia coli DH10B cells.

Using selective media methodology, we detected carbapenem-resistant Enterobacteriaceae in 8 (0.6% [95% CI 0.26–1.18]) of the 1,328 seafood samples; all 8 were from Southeast Asia (Table). Of the 928 shrimp samples collected as part of CIPARS sampling, 2 (0.2% [95% CI 0.03–0.78]) imported from Vietnam contained Enterobacter cloacae harboring blaIMI −1, and 1 (0.1% [95% CI 0.003–0.599]) from Bangladesh contained E. aerogenes harboring blaIMI-2. Of 101 mollusk samples, 3 (3.0% [95% CI 0.62–8.44]) clam samples imported from Vietnam contained E. cloacae harboring blaIMI −1, and 2 (2.0% [95% CI 0.24–6.97]) clam samples from Vietnam contained E. cloacae harboring blaNDM-1, blaTEM, and blaOXA-1. All isolates with carbapenemase genes were phenotypically resistant to ampicillin, cefoxitin, and amoxicillin/clavulanic acid; some were multiclass-resistant (Table).

Isolates harboring blaIMI-1 genes contained no plasmid DNA. However, using electroporation into E. coli, we showed that the blaIMI-2 gene was plasmid-mediated; the plasmid contained the IncFII(Yp) replicon. The blaNDM-1 genes were nontransformable into E. coli, although the 2 isolates contained IncHI2, IncFIB, and IncFII replicons. The location of the blaNDM-1 gene may therefore be chromosomal or plasmidic. Six different sequence types (STs) of E. cloacae were shown by multilocus sequence typing. PFGE results showed that the 2 E. cloacae ST479 isolates were indistinguishable, whereas the other isolates were distinct. The E. cloacae ST479 isolates harbored blaNDM-1, blaOXA-1, and blaTEM; were phenotypically resistant to 12 tested antimicrobials drugs; and were from clam samples collected at different retail outlets on different dates. Comparison of ST373 fingerprints with the National Microbiology Laboratory PFGE database containing >170 E. cloacae of human origin showed that a human-sourced E. cloacae ST373 isolate harboring blaIMI-1 shared >75% similarity with a clam-sourced E. cloacae isolate. In addition to the carbapenem-resistant Enterobacteriaceae findings described here, our findings also show that 1 sample, from a black tiger shrimp (Penaeus monodon) originating from India, contained a non-O1, non-O139 Vibrio cholerae with a novel class A carbapenemase gene named blaVCC-1 (GenBank accession no. KT818596); this isolate has been described elsewhere (6).

Seafood, such as shrimp and clams, are raised in aquatic environments with a known potential for water-source contamination (7,8). We found multiple retail seafood samples containing Enterobacter spp. harboring blaNDM-1 and blaIMI-type genes. This finding suggests that, for humans, the source of carbapenemase-producing Enterobacter spp. may not be limited to exposure during travel; contaminated food products may also be a source of exposure (9). The identification, in imported clams, of E. cloacae with the same ST and similar DNA fingerprint pattern as an isolate from a human raises concerns of a possible association; however, more work is required before a linkage and direction of transfer can be inferred. Our findings highlight the need for antimicrobial resistance surveillance systems to consider the use of selective media methodology to increase sensitivity for the detection of rare or emerging resistance genes.

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Nicol JaneckoComments to Author , Sarah-Lynn Martz, Brent P. Avery, Danielle Daignault, Andrea Desruisseau, David Boyd, Rebecca J. Irwin, Michael R. Mulvey, and Richard J. Reid-Smith

Author affiliations: Public Health Agency of Canada, Guelph, Ontario, Canada (N. Janecko, S.-L. Martz, B.P. Avery, A. Desruisseau, R.J. Irwin, R.J. Reid-Smith); University of Guelph, Guelph (N. Janecko, S.-L. Martz, R.J. Reid-Smith); Public Health Agency of Canada, St. Hyacinthe, Quebec, Canada (D. Daignault); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (D. Boyd, M.R. Mulvey)

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References

  1. Public Health Agency of Canada, Government of Canada. Antimicrobial resistant organisms (ARO) surveillance: summary report for data from January 1, 2009 to December 31, 2014 [cited 2016 Jan 25]. http://www.healthycanadians.gc.ca/publications/drugs-products-medicaments-produits/antimicrobial-summary-sommaire-antimicrobien/index-eng.php
  2. Zurfluh  K, Poirel  L, Nordmann  P, Klumpp  J, Stephan  R. First detection of Klebsiella variicola producing OXA-181 carbapenemase in fresh vegetable imported from Asia to Switzerland. Antimicrob Resist Infect Control. 2015;4:38. DOIPubMed
  3. Rubin  JE, Ekanayake  S, Fernando  C. Carbapenemase-producing organism in food, 2014. Emerg Infect Dis. 2014;20:12645. DOIPubMed
  4. Nordmann  P, Poirel  L, Dortet  L. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2012;18:15037. DOIPubMed
  5. Mataseje  LF, Bryce  E, Roscoe  D, Boyd  DA, Embree  J, Gravel  D, ; Canadian Nosocomial Infection Surveillance Program. Carbapenem-resistant gram-negative bacilli in Canada 2009–10: results from the Canadian Nosocomial Infection Surveillance Program (CNISP). J Antimicrob Chemother. 2012;67:135967. DOIPubMed
  6. Mangat  CS, Boyd  D, Janecko  N, Martz  SL, Desruisseau  A, Carpenter  M, Characterization of VCC-1, a novel Ambler class A carbapenemase from Vibrio cholerae isolated from imported retail shrimp sold in Canada. Antimicrob Agents Chemother. 2016;60:181925. DOIPubMed
  7. Shuval  H. Estimating the global burden of thalassogenic diseases: human infectious diseases caused by wastewater pollution of the marine environment. J Water Health. 2003;1:5364.PubMed
  8. Finley  RL, Collignon  P, Larsson  DGJ, McEwen  SA, Li  XZ, Gaze  WH, The scourge of antibiotic resistance: the important role of the environment. Clin Infect Dis. 2013;57:70410. DOIPubMed
  9. Woodford  N, Wareham  DW, Guerra  B, Teale  C. Carbapenemase-producing Enterobacteriaceae and non-Enterobacteriaceae from animals and the environment: an emerging public health risk of our own making? J Antimicrob Chemother. 2014;69:28791. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2209.160305

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Table of Contents – Volume 22, Number 9—September 2016

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Nicol Janecko, Public Health Agency of Canada, 160 Research Ln, Ste 103, Guelph, ON N1G 5B2, Canada

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Page created: August 16, 2016
Page updated: August 16, 2016
Page reviewed: August 16, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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