The scientific literature indicates several toxins produced by
Owing to their ability to produce various toxins, strains belonging to the species
The term
From the point of view of epidemiology and future management in cases of recurring NSTI in the same hospital, it is important to identify the differences and similarities among bacterial strains from every patient. The use of molecular methods allows for fast and precise identification of the bacteria isolated. The objective of this study is a comparative phenotypic and genetic analysis of
The study involved the microbiological analysis of
Patient 2. A man, aged 60, admitted urgently on 31.05.2017 to the General Surgery Department due to anorectal abscess. In the course of the diagnostics undertaken, disseminated sigmoid colon cancer was eventually diagnosed. Past medical history revealed a stay in the same unit in May 2014, when the patient underwent surgery due to right-sided incarcerated inguinal hernia.
During the relevant hospitalization, on 31.05.2017, abscess contents were collected from the patient for microbiological diagnostics. Microbiological testing of the purulent content detected the growth of
The prevention of epidemic outbreak and epidemiological investigations were initiated
In view of the fact that the same bacterial species,
The strains 8554/M/17 and 8567/M/17 were stored with the use of Cryobank (BioMaxima) at −70°C.
Antibiotic susceptibility for
Isolate no. | Penicillins | Cephalo sporins | Carbapenems | Fluoroquinolones | Glycopeptide and lipo-glycopeptides | Macrolides, incosamides | Tetracyclines | Miscellaneous agents | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
AML | P | PRL | XL | CRO | CTX | DOR | ETP | IMP | MEM | MXF | TEC | VA | E | DA | TE | C | M | RD | |
8554/M/17 (Patient 1) | MIC | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 1.5 | 0.047 | 0.50 | 0.50 | 0.50 | 4 | 0.19 | 0.016 | 0.032 |
S/R | S | S | S | S | S | S | S | S | S | R | S | S | R | S | R | S | S | S | |
8567/M/17 (Patient 2) | MIC | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 0.016 | 2 | 0.047 | 0.50 | 0.50 | 0.50 | 4 | 0.125 | 0.016 | 0.032 |
S/R | S | S | S | S | S | S | S | S | S | R | S | S | R | S | R | S | S | S |
AML - amoxicillin, P - penicillin, PRL - piperacillin, XL - amoxicillin/clavulanic acid, CRO - ceftriaxone, CTX - cefotaxime, DOR - doripenem, ETP - ertapenem, IMP - imipenem, MEM - meropenem, MXF - moxifloxacin, TEC - teicoplanin, VA - vancomycin, E - erythromycin, DA - clindamycin, TE - tetracycline, C - chloramphenicol, M - metronidazole, RD - rifampicin, MIC - Minimal Inhibitory Concentration, S/R - susceptibility, R - resistant, S - susceptible
The profiles of the strains under investigation that were obtained using PCR multiplex and PFGE were compared with restriction patterns of the strains that came from the event in 2015, when in the Orthopedics and Traumatology Department of the same hospital, three cases of gas gangrene caused by
The two
Multiplex PCR confirmed the presence of the
As a result of the molecular analysis conducted using PFGE, two genetically different, unique restriction profiles were found corresponding to two different clones of the
Profiles of the strains under investigation that were obtained using PFGE were then compared with restriction patterns of the strains from the event in 2015 (Brzychczy-Włoch et al. 2016). A comparative analysis of PFGE profiles from 2017 and the results from the event from 2015 found one identical and genetically unique restriction profile, corresponding to one clone of
Due to this fact, an attempt was undertaken to find a connection between patient No. 2 from 2017 and patient No. 3 from 2015. In the course of an epidemiological investigation, it was only found that both patients were hospitalized in the same hospital, but they were in different wards at different times. The patient from whom the strain no. 7143 was isolated (patient No. 3) was hospitalized in April 2015 at the Department of Orthopedics and Traumatology. The currently described patient No. 2 from whom strain no. 8567/M/17 was isolated in 2017 was in the General Surgery Department in May 2014. Both patients underwent surgery in the main operating block of the hospital. Kinship, close contact, possession of the same animals and residence in each other’s neighborhood were excluded.
The cases presented above illustrate the clinical picture of necrotizing soft tissue infection, caused by
The results of microbiological testing with phenotypic methods (biochemical patterns and antibiotic susceptibility testing) did not demonstrate differences between the strains isolated from biological specimens from the patients. On the other hand, the application of molecular methods allowed to characterize each of them accurately and compare them with strains isolated during the epidemiological investigation, which took place in the same hospital during the event in 2015 (Brzychczy-Włoch et al. 2016).
Determination of the toxinotype of
Molecular diagnostics of the strains isolated also allowed their final differentiation and an attempt to determine their origin. Owing to macrorestriction analysis of chromosomal DNA combined with PFGE, it was possible to determine that the strain of the described patient No. 1 turned out to be different from the strains isolated from the patient No. 2. However, the identification of an identical restriction profile for the
Our research has some limitation as there are no environmental or hospital staff studies that could have precisely demonstrated the source where