Antimicrobial resistance, MGEs, and their associated virulence factors.
Abstract
The ability of microbes to resist or neutralize the action of drugs that have been used against microbes is considered as antimicrobial resistance (AMR). AMR among different strains of Escherichia coli is considered as a major threat to public health. Drug-resistant in E. coli is found predominantly in the hospital sittings, in the community, and surrounding environment. It has adopted different defensive strategies to minimize the effects of drugs. Extended-spectrum β-lactamase (ESBL), fluoroquinolones, and carbapenemases have been considered as strong resistance strategies being present in most of resistant bacterial strains. Mobile genetic elements (MGEs) have the major contribution in the transfer of resistance genes in between or among bacterial cells. Plasmids are normally present in most of resistant strains, helping in the transfer of genetic material between bacterial cells. Transposons another MGEs, are being considered as one of the major sources of resistance transmission. Collectively, MGEs play an important role in facilitating in exchange, acquisition, and dissemination of resistance genes. Resistance in E. coli has been reported worldwide and there is variation in its resistance pattern. CTX-M ESBLs, carbapenems, colistin-resistant, and ST-131 E. coli resistant clones are considered the most dominant phenotypes. The aforesaid resistant variants are predominantly found in densely populated regions, Sub-Saharan Africa, China, and South Asian countries.
Keywords
- antibiotics resistance
- trends
- mobile genetic elements
- epidemiology
1. Introduction
Antimicrobial resistance is the capability of bacterial pathogens to neutralize the bactericidal effects of antibiotics. Antibiotic resistance arises due to the changes that take place in bacteria in a way that decreases the efficiency of antibiotics, chemicals, or other mediators that are used for infections control [1]. Globally, antimicrobial resistance is the main problem associated with humans’ and animals’ health. With the emergence of resistance clones, those antibiotics that were previously considered as broad-spectrum lost their efficacy, this increasing trend in resistant clone posture serious problem for the clinicians to deal with such pathogens. As we know that antibiotics are categorized according to the type of bactericidal activity, their mode of action, their chemical nature, and their origin. Further, these drugs can be characterized on the basis of their mode of action like their involvement in bringing complexity in the synthesis of the bacterial cell wall, depolarization of cell membrane, inhibiting microbial key protein synthesis, and altering nucleic acid synthesis. In early era, microbial secondary metabolites were considered the main treatment option for microbial infection, but later due to increasing resistance issues, synthetic derivatives of these natural products were being searched. There is a different reason that has pushed microbes to adopt drug resistance strategies. The use and misuse of antimicrobial agents have led to the emergence of resistance [2] Similarly the usage of low-standard antibiotics in some parts of the world particularly in underdeveloped countries may be the source of the emergence of drug resistance [3].
2. AMR trends
Capability of bacterial species to resist the action of a particular antimicrobial agent is referred to as antimicrobial resistance, and this phenomenon has been remarkably proliferated over the years. The availability and usage of antimicrobial have contributed in the increased incidence of resistant strains [9]. Though antimicrobial resistance is a natural phenomenon and was considered under control in the past but recently it is envisaged a high-level risk for world health [10]. Mainly three reasons responsible for antimicrobial resistance are; (a) increase usage of antibiotics, (b) due to unseriousness of the patients about treatments being suggested, (c) replacement of the existing class of antibiotics with a new one. Bacterial resistance to antimicrobial agents is classified into three types, namely intrinsic resistance, adopted resistance, and acquired resistance see in Figure 1.
The most common example of an intrinsic resistance system is the Acr AB/Tol C EPs in
Group of antibiotics | Resistance antibiotics | Enzyme produced | Gene involved | MGEs | Implication in virulence | References |
---|---|---|---|---|---|---|
β-Lactams | β-Lactamases | Plasmid | Mutation and overexpression of genes | [23] | ||
Penicillin | Penicillinases | |||||
Cephalosporin | Cephalosporinases | Plasmid encoded, increased virulence in urinary tract | [24] | |||
Changes in peptidoglycan composition | ||||||
Cephamycin | Amp C β-lactamases | induced hyperproduction | ||||
Fluoroquinolones | Norfloxacin | β-Lactamases ESBL | Plasmid and Transposons | Interfere with nucleic acid synthesis caused mutation | [25] | |
Ciprofloxacin | To inhibit topoisomerase IV | |||||
Aminoglycosides | Tobramycin | Higher risk of illness and death | [26] | |||
Gentamicin | ||||||
Tetracyclines | Increased expression of virulence genes | |||||
Plasmid and Genomic Islands | Completely deactivate the enzyme | |||||
Carbapenems | Imipenem-cilastatin | Carbapenemases metallo-β-lactamases | Plasmid | Degrade the β-lactam, increase the risk for development of acquired resistance | [27] | |
Colistin | Polymyxin E | Plasmid | Cause mutation and reduce the affinity of antibiotics to LPS | [28] | ||
Trimethoprim/sulfamethoxazole | Co-trimoxazole | ESBL | Plasmid | Block formation of nucleic acid inhibit dihydropteroate synthetase (DHPS) | [29] |
3. Mobile genetic elements of E. coli associated with antibiotic resistance genes
Mobile genetic material (MGEs) has an important role in transferring resistance. Mutation has a key role in bringing changes in a particular DNA fragment. Similarly, HGT, transfer of plasmid or transposons have the major contribution in developing resistance to the reagent. Considering if point mutation brings changes in a promotor region, it will have an impact on the expression of genes [32]. Similarly, a point mutation in the gyrase gene has developed to fluoroquinolone-resistant phenotype [30]. Exogenic resistance genes encoded on plasmids, phage, integrons, and transposons can transfer horizontally through conjugation, transformation, or transduction and can encode all the 3-resistance mechanism (intrinsic, adopted, acquired) Details of genes, their mechanisms, and pathways are explained in the following section.
Resistant pathogens are a major source of infectious diseases worldwide. Infections due to MDR bacteria have considerably increased health care costs. Due to resistant pathogens, morbidity and mortality have been reported in different parts of the world. Molecular characterization showed that extensive multi drug-resistant has commonly been accomplished by the acquisition of pre-existing causes followed by amplification in response to selection. The accumulation, retention, and transfer of resistant genes are frequently due to the activities of MGEs of
3.1 Transposons
Transposons (Tn) can be defined as a DNA sequence that has potential to jump into different locations of the genome hence, they are called jumping genes. Transposons are divided into two-main groups: class I (Retrotransposons) and class II (DNA transposons). Retrotransposons are mostly found in eukaryotic organisms while DNA transposons can be found in both prokaryotes and eukaryotes. Prokaryotic DNA transposons harbor antibiotic resistance genes. It has the potential to move from plasmid to plasmids or from chromosomal DNA into a plasmid, as a result, it became the source of resistant genes dissemination [36, 37]. Transposon’s elements have two major characteristics that differentiate them from other genetic elements. on basis of its mobile nature, it can move from one place to another and bring variation in the genetic makeup of the organism. During transpositions process, transposons can transmit resistance genes and can multiply intracellularly. Despite its large number, only few copies get access into an integral part of the genome. Transposons have stability and are maintained by their capability to replicate and maintain their existence [38]. Transposable elements have an important role in genome evolution and organization [39].
3.2 Plasmids
Plasmids are circular, self-replicating extra-chromosomal DNA elements. Besides the genetic information required for the autonomous multiplications, it has extra genetic information needed for suppression of antibiotic actions. It also encodes genes for virulency, involves in the removal of hazardous material, or is required for regulation of other metabolic functions [41]. Plasmids are commonly used cloning vectors and are categorized into different incompatibility (Inc) groups. Inc. groups are designated on basis of the incapability of two plasmids to co-exist together [42]. Same Inc. group of the Inc. plasmids have the same type of replication region and thus have incompatible replication, it cannot co-exist. Plasmids belonging to the IncX family encode different resistance genes, mostly circulated among
3.3 Bacteriophages
Bacterial viruses that cause infections in bacterial cells are called as bacteriophages. it has an important role in the dissemination of virulence-associated and antibiotic resistance genes among foodborne pathogens, As we know viruses are found ubiquitously and are present in oceans, sewage, soils, and various microbial communities [60, 61]. Phages have an important role in protecting the bacterial colonization of mucosal surfaces [62]. In the case of lytic phages, there has an important role in bacterial DNA transfer, and the process is called transduction (generalized transduction), while temperate phages can transmit only some particular genes in the bacterial chromosome (specialized transduction). During this some segments of bacterial DNA are co-edited with the prophage DNA for example tetracycline resistance gene from the
3.4 Genomic islands (GIs)
Genomic islands (GIs) comprise of more than 10 kb DNA in length, exchanged frequently among bacterial isolates. GIs encode proteins for transfer, restriction/alteration, or other proprieties and recombination, for example, gene groups for metabolic adaptation, virulence, and or bacterial resistance [67]. GIs that are involved in the expression of virulence factors is called pathogenicity islands (PAIs) [68]. It encodes VFs comprising of adhesins, invasions, capsule formation, toxins, uptake system of iron, distinct secretion systems. Their GC contents vary in comparison to the genome. Their integration site is situated on the tRNA genes and repeated sequences, which is comprising at least one MGEs containing plasmids remnants, integrons, insertion sequences, and related gene cassettes. For the integration of foreign DNA, tRNA-encoding genes are considered as the hot spot. By site-specific recombination, some PAIs can be edited from bacterial chromosome [69]. Primarily, PAIs have been described in the uropathogenic
4. Global antibiotics resistance in E. coli
As earlier described,
4.1 Emergence of E. coli resistance in Europe
In European countries, particularly in
4.2 Emergence of E. coli resistance in America
In America, increased resistance of fluoroquinolones and cephalosporin in
4.3 Emergence of E. coli resistance e in Africa
Proper prescription of drugs is not strictly followed in the developing world. A similar case is Africa countries where no such policy is implemented. There are several challenges to implement sustainable and effective AMRs monitoring programs in the sub-Saharan Africa to encounter the rapid dissemination of AMRs [92]. Around 50–60% of
4.4 Emergence of E. coli resistance in Asia
4.4.1 China
China was the 2nd largest consumer of antibiotics in 2010 around the world. According to the available data, the prescription of antibiotics for outpatient and inpatient was 52.9% and 77.5% respectively and only 39.4% and 24.6% were considered appropriate respectively. Among BRICS countries only in China usage of antibiotics has been escalated [57%] as compared to other nations [106]. According to European Antibiotic Resistance Monitoring Network (EARS-Net), in
4.4.2 Bangladesh
In 2004 a study conducted in Bangladesh, observed a high frequency of almost 43.2% of ESBL producing
4.4.3 India
India is one of the world most populated country with weak health care systems are exposed to resistant pathogens. In comparison to Pakistan, China, and Iran it has a similar prevalence rate of resistance, In India, the prevalence of ESBLs producing
4.4.4 Pakistan
Pakistan is the 6th largest most populous country in the world. Resistance has increased in
5. Conclusions
Antimicrobial-resistant in
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