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Journal of Clinical Microbiology, April 2009, p. 951-958, Vol. 47, No. 4
0095-1137/09/$08.00+0 doi:10.1128/JCM.02029-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

State Key Laboratory of Agricultural Microbiology, Laboratory of Animal Infectious Diseases, College of Animal Science and Veterinary Medicine, Huazhong Agricultural University, Wuhan, China,1 Laboratory of Animal Infectious Diseases and Microbiology, College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, China2
Received 19 October 2008/ Returned for modification 5 January 2009/ Accepted 12 January 2009
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Although antimicrobial therapy is a widely available tool for the prevention and control of clinical infections (5, 25, 26), antibiotic resistance in pathogenic bacteria from food-producing animals and environmental sources is recognized as a global problem for public health (6, 37). Over the past decade, the high degree of resistance to common antibiotics and the worldwide emergence of multidrug resistant phenotypes have become of increasing concern (8, 36, 37). Previous studies have reported that the imprudent use of antimicrobials bears a high risk for the selection of resistant bacteria and promotes the spread of resistance genes located on plasmids, integrons, and transposons (23, 25). This has resulted in a reduction in the efficacies of the antimicrobial agents that are currently available for the treatment of infections in food-producing animals (25). Indeed, the antimicrobial classes that are commonly used for the treatment of infections in humans may be misused in animals either for therapy or for the prevention of disease, which has a large potential impact on public health (8, 36).
The pathogenicity of P. multocida is associated with various virulence factors (VFs) (18, 20, 24). The key factors that have been identified to date include the capsule and lipopolysaccharide (10, 21). The recognized VFs of this organism also include diverse adhesins (e.g., filamentous hemagglutinin, type 4 fimbriae, and Flp pilin), toxins (dermonecrotic toxin), siderophores (e.g., iron acquisition proteins), sialidases (which may enhance bacterial virulence by unmasking key host receptors and/or reducing the effectiveness of host defenses), and outer membrane proteins (e.g., OmpA, OmpH, Oma87, and PlpB) (2, 17, 18, 23, 35). These VFs facilitate the colonization and invasion of the host, the avoidance or disruption of host defense mechanisms, injury to host tissues, and/or stimulation of a noxious host inflammatory response (20, 23). Thus, the informed selection of the VFs to be targeted for the prevention of P. multocida infections requires knowledge of which VFs are prevalent in specific clinical syndromes, as may be revealed by epidemiological studies. Furthermore, it was reported that there is an obvious correlation between some VFs and capsular serogroups, with the filamentous hemagglutinin gene pfhA being associated with serogroups A, B, E, and F; the iron acquisition gene tbpA being associated with serogroups A and B; and the dermonecrotoxin toxA gene being associated with serogroup D (17). Because pathogenic behavior is predicted both by the VF repertoire and by the serogroup (20), the clonal associations of VFs must be evaluated.
The current investigation is the first large study in China of the prevalence of P. multocida in clinical samples collected from 16 provinces between 2003 and 2007. To obtain more information about the epidemiology of porcine P. multocida infection and to characterize clinical isolates, we investigated a total of 233 isolates of P. multocida that were associated with clinical disease in swine for the distributions of the capsular serogroups, the phenotypic antimicrobial resistance profiles, and the presence of 19 virulence genes.
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All isolates of P. multocida were subsequently characterized biochemically by using a MicroStation system (Biolog Inc.) and their capsules were serotyped. For samples in which all isolates were identical with respect to their capsular serotype, only one colony was selected. When one sample yielded colonies with different capsular serotypes, one colony of each serotype was selected for further characterization. All isolates were freeze-dried and kept at –80°C.
Capsule typing. The capsular types of the isolates were determined by multiplex capsule PCR typing with the capsule-specific primer pairs (primers specific for capA, capB, capD, capE, and capF) described by Townsend et al. (34). All oligonucleotides were synthesized with a DNA synthesizer (with finishing done by Sangon Biological Engineering Technology Inc., Shanghai, China). The primer sequences used in the multiplex capsule PCR typing assay for P. multocida are listed in Table 1.
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TABLE 1. Primers used for the detection of virulence-associated genes in strains of P. multocida
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Detection of virulence genes by PCR. Nineteen pairs of oligonucleotide primers to be used for the detection of VFs were designed by using the software program Prime (version 5.0; Premier Biosoft International, Palo Alto, CA) and were synthesized commercially (with finishing done by Sangon Biological Engineering Technology Inc.). The base sequences and the predicted sizes of the amplified products for the specific oligonucleotide primers used in this study are shown in Table 1. The bacterial lysates used as templates for the PCR were prepared as follows. A loopful of bacteria from a fresh overnight culture on a tryptic soy agar plate was resuspended homogeneously in 200 µl of sterile water, and the mixture was boiled at 100°C for 5 min to release the DNA and centrifuged. A 4-µl volume of the supernatant was used as a template for each 25-µl PCR mixture. The appropriate positive and negative controls for amplification were generated from clinical isolates of P. multocida by PCR carried out with a GeneAmp PCR system 9700 instrument (Applied Biosystems, Foster City, CA) and were confirmed by sequencing. The amplified products were analyzed in 0.8% agarose gels by electrophoresis, and the results were recorded with a gel documentation system. All tests were repeated three times in parallel with the relevant positive and negative controls. Discrepant results for each VF were investigated further, and samples were sequenced for gene verification.
Clinical data and statistical analysis.
Clinical data were collected by retrospective analysis of the protocols. Statistical testing was performed with SPSS software (version 12.0; SPSS Inc., Chicago, IL). Comparisons of proportions were made by two-tailed Fisher's exact test or the
2 test. Comparisons of the prevalence of different traits within the same population were made by McNemar's test. Aggregate VF scores were compared by the Mann-Whitney U test. P values of <0.05 were considered statistically significant.
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TABLE 2. Isolation of bacterial species and the prevalence of P. multocida in clinical samples from China from June 2003 to September 2007
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All infections with P. multocida detected in this study were from territorial outbreaks on pig farms, and the sources of infection were not identified in most cases. Strains of P. multocida were isolated throughout the year without seasonal variation, and 62.2% of the organisms were detected from growing pigs 60 to 110 days old (145 cases). Eleven toxigenic strains of P. multocida were collected from growing pigs 80 to 100 days old from June to August.
Antimicrobial susceptibility. Two hundred thirty-three isolates of P. multocida recovered from diseased swine were tested for resistance to 20 antibiotics (Table 3). The most prevalent phenotypes detected were resistance to lincomycin (96.6%), sulfamethazine (85.4%), amoxicillin (80.3%), clindamycin (80.3%), trimethoprim-sulfamethoxazole (74.2%), chlortetracycline (65.2%), and tetracycline (58.0%), followed by tilmicosin (28.3%), amikacin (14.2%), gentamicin (13.7%), kanamycin (12.8%), and spectinomycin (12.0%). Less than 10% of the isolates were resistant to erythromycin or chloramphenicol (6.0 and 2.6%, respectively). No resistance to cefazolin, ceftiofur, florfenicol, or ciprofloxacin could be detected. The MIC90s of neomycin and polymyxin B for the P. multocida isolates tested were 32 µg/ml and 4 µg/ml, respectively. The proportion of P. multocida isolates categorized as resistant could not be evaluated in this study because the breakpoints of neomycin and polymyxin B for veterinary use have not been determined according to the CLSI criteria (29). In addition, it was observed that 98.6% of the isolates were resistant to at least one antibiotic and 93.1% were multiresistant (resistant to from 3 to 10 antibiotics). Multiresistance was predominant in isolates of serogroup D, including toxigenic P. multocida strains. Resistance to amoxicillin, chlortetracycline and tetracycline, lincomycin and clindamycin, and sulfamethazine and trimethoprim-sulfamethoxazole was the common feature of these multiresistant isolates. The percentage of isolates with resistant to at least three antimicrobials was equally high in all years from 2003 to 2007 (Fig. 1). Isolates resistant to more than five antimicrobials became more frequent over time. The prevalence increased from 47.8% in 2003, 54.1% in 2004, and 57.6% in 2005 to 81.6% in 2006 and 97.1% in 2007. It is important to note that the proportion of isolates resistant to more than seven antimicrobials increased approximately fourfold between 2003 and 2007, from 16.2% to 62.8% (P < 0.05).
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TABLE 3. MICs for 20 antimicrobial agents against 233 strains of P. multocida
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FIG. 1. Distribution by year of P. multocida isolates that showed phenotypes of multidrug resistance to the antimicrobial agents tested. All determinations of antimicrobial MICs with the P. multocida isolates were performed by broth microdilution methods recommended by the CLSI (29). The breakpoint used for ciprofloxacin was those previously used by Aarestrup et al. (1) for Danish strains of H. parasuis. For the other antimicrobials tested, breakpoint values were taken from the CLSI guidelines (29). Isolates that were nonsusceptible to at least three different antibiotic classes were classified as multidrug resistant. The percentage of isolates resistant to at least three antimicrobials was equally high between 2003 and 2007. The proportion of isolates resistant to more than five antimicrobials became more frequent, with a progressive increase from 47.8% in 2003 to 97.1% in 2007. The proportion of isolates resistant to more than seven antimicrobials increased approximately fourfold between the years 2003 and 2007, from 16.2% to 62.8% (P < 0.05).
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TABLE 4. Distribution of VFs according to capsule serotypes among 233 porcine isolates of P. multocida
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2 test, is presented in Table 4. As anticipated, the great majority of VFs, including ptfA, fimA, hsf-2, exbB, exbD, tonB, nanH, ompA, ompH, oma87, and plpB, were equally distributed in each capsular serogroup. However, when each serogroup was compared with all other capsular serogroups combined, tadD was significantly associated with serogroup A, hsf-1 and nanB were significantly associated with serogroup D, and hgbA and fur were significantly associated with serogroups A and D. The pfhA and pmHAS genes were less common in isolates of serogroup D than in isolates of the other serogroups. It was noted that the toxA gene, which is involved in the pathogenesis of progressive atrophic rhinitis in pigs, was found in only 11 strains, and it was strictly restricted to strains belonging to capsular serogroup D. The different capsular serogroups exhibited disparate median aggregate VF scores: serogroup A, 15.6 (range, 12 to 18); serogroup D, 15.0 (range, 9 to 17); serogroup B, 14.0 (only one strain); and the nonaligned strains (nonserogroup strains), 14.1 (range, 11 to 16). These results did not differ significantly (for all comparisons, P > 0.05, Mann-Whitney U test). |
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Atrophic rhinitis is seldom reported in China; but our investigations have confirmed the presence of atrophic rhinitis in Henan, Shandong, Fujian, Hainan, and Hubei Provinces by the isolation of P. multocida from clinical cases and the use of assays for toxigenicity. In agreement with the findings of previous studies (4, 11), toxigenic P. multocida strains of serogroup D may play a more important role in atrophic rhinitis in China than toxigenic strains of serogroup A. During the study period, other bacterial species, including Haemophilus parasuis and Streptococcus suis, were often coisolated with pathogenic P. multocida strains from the same sample. Although it is not easy to distinguish whether P. multocida is a primary or a secondary pathogen in herds with mixed infections, the fact that various bacterial species may coexist in a given herd should be considered when attempts are made to control disease outbreaks (7).
Treatment for infections with P. multocida commonly includes broad-spectrum antimicrobials (5, 25, 26). The findings of our antibiotic susceptibility studies, like the findings of Kehrenberg et al. (25) in France, Salmon et al. (32) in North America, and Yoshimura et al. (38) in Japan, indicated that cephalosporins (cefazolin, ceftiofur), florfenicol, and fluoroquinolones (ciprofloxacin) were the most active drugs. The aminoglycoside antibiotics usually showed poor activity against P. multocida, as reported by Gutiérrez Martin and Rodríguez Ferri (19) in Spain and Yoshimura et al. (38) in Japan; however, in the present study, spectinomycin, kanamycin, gentamicin, and amikacin exhibited moderate activity against all strains tested. The average prevalence of resistance to conventional antibiotics, including amoxicillin, lincomycin, clindamycin, chlortetracycline, tetracycline, sulfamethazine, and trimethoprim-sulfamethoxazole, among the P. multocida isolates was found to be in excess of 60% for each antibiotic. Therefore, preventive and therapeutic effects on porcine P. multocida strains should no longer be expected from these antibiotics. Furthermore, the increased incidence of multidrug-resistant pathogenic bacteria has been widely reported in the last decade (8, 25, 37). This is presumably attributable at least in part to the use of antibiotic additives in animal feed and the extensive use of antimicrobial agents in veterinary medicine. Here we have shown that P. multocida exhibited a rapid increase in the rate of resistance to a large number of antimicrobial agents. This revealed that a high prevalence of multiple-drug resistance exists among isolates of P. multocida from pigs. If this situation continues, there will be no effective antibiotic therapeutic reserve for some bacterial infections. The implications of a large reservoir of multiresistant organisms, particularly P. multocida, which is not host specific, with resistance that is potentially transferable among livestock species are obvious (3, 12, 24). Therefore, the use of antimicrobial agents in food animals in ways that minimize the emergence of resistance not only in target pathogens but also in zoonotic bacteria is warranted in the future for the protection of public health.
Although the molecular basis of the pathogenicity and host specificity of P. multocida is not well understood, several studies have reported that a number of VFs are correlated with the pathogenic mechanisms (20, 23). The present study has provided novel epidemiological information on the prevalence and distribution of the various VFs of porcine strains of P. multocida. Consistent with previous observations (17), the prevalence of 11 of the 19 VF genes examined, which encode colonization factors (ptfA, fimA, and hsf-2), iron acquisition factors, sialidases (nanH), and outer membrane proteins, were broadly characteristic of the three categories of isolates (serogroup A, serogroup D, and others [1 serogroup B isolate and 12 untypeable isolates]). These distribution patterns would support some lines of evidence that suggest that factors involved in cross-protection may potentially serve as vaccine candidates that can elicit homologous protective immunity against all serotypes of P. multocida (2, 20, 35). However, certain VFs varied significantly among the different serogroups. For example, hsf-1, which has been described to be an autotransporter adhesin in a common avian clone, Pm70 (27), was more frequently seen in serogroup D, whereas tadD, which has been described as putative nonspecific tight adherence protein D in Pm70 (27), was concentrated significantly in serogroup A. pfhA, which governs the adherence of Bordetella pertussis to host cells and which plays a role in the virulence of P. multocida (18, 20, 27), showed a low prevalence in strains of serogroup D compared with its prevalence in serogroup A or untypeable isolates. Various hyaluronan synthases have been described in the last 5 years (13, 14). Preliminary data from a Southern blot analysis suggested that the P. multocida serogroup A hyaluronan synthase PmHAS and the P. multocida serogroup D hyaluronan synthase PmHS1 were not similar at the DNA level (13). However, our study showed that PmHAS not only was prevalent in serogroup A strains but also was found in other serogroups of porcine P. multocida. It seems probable that different VFs have entered P. multocida strains independently at multiple different times in the evolutionary history of the species and at multiple positions within the phylogenetic tree. Moreover, the observed distribution pattern suggests that it is likely that the acquisition of certain VFs has led to divergent patterns of vertical inheritance and horizontal transmission (via pathogenicity-associated islands, plasmids, and transposons) within the P. multocida population.
In conclusion, given that it is a pathogenic microorganism that is not host specific, we believe that the occurrence of P. multocida in food-producing animals should not be forgotten. In China, as in many other countries, strains of P. multocida have frequently been isolated from pigs, and they represent a significant cause of territorial outbreaks of respiratory infections. The high prevalence of multiresistant strains of P. multocida in pigs and the association of such strains with serious disease strongly suggest that more attention should be paid to the prudent use of antimicrobials and to vaccination. Nowadays, many key VFs of P. multocida are slowly being identified. Further work is required to elucidate the mechanisms of pathogenesis and to determine unequivocally the role of these factors in immunity to pasteurellosis.
This study was supported by grants from the National Basic Research Program (973 Program; no. 2006CB504404) and the Science and Technology Brainstorm Project of Hubei Province, China (Emergency Program, 2006-2008).
Published ahead of print on 21 January 2009. ![]()
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