Eurosurveillance: MRC-1 In Denmark

E. coli  - Credit Wikipedia


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Last month in MCR-1: The Return Of The Plasmids we looked at the emergence in China of a new plasmid-mediated colistin resistance mechanism called MCR-1 in both animals and humans.

This is important since - despite its nephrotoxic side effects - colistin (a polymixin) is considered the antibiotic of last resort for some types of resistant gram negative bacteria like E. coli and Klebsiella.

The resistance gene - MCR-1 - can travel easily between different bacteria riding on a plasmid (a tiny snippet of DNA) spreading resistance to new colonies (and types) of bacteria, much in the way we've seen with NDM-1 ( New Delhi metallo-ß-lactamase-1) and carbapenum resistance (seeCarbapenemases Rising).


In a case of - if you look for it, you just might find it - yesterday the ECDC journal Eurosurveillance published a Rapid Communications on the discovery of MCR-1 in the bloodstream of a Danish patient, and in raw chicken in Denmark.  

A sign that the feared spread of MCR-1 has already begun.  

As this study points out, should a bacteria like E. coli achived both Carbapenum and Colistin resistance, there would be few if any treatment options available.

Rapid communication

Detection of mcr-1 encoding plasmid-mediated colistin-resistant Escherichia coli isolates from human bloodstream infection and imported chicken meat, Denmark 2015

H Hasman ¹ , AM Hammerum ¹ , F Hansen ¹ , RS Hendriksen ² , B Olesen ³ , Y Agersø ² , E Zankari ² , P Leekitcharoenphon ² , M Stegger ^{1 4} , RS Kaas ² , LM Cavaco ² , DS Hansen ³ , FM Aarestrup ² , RL Skov ¹

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Citation style for this article: Hasman H, Hammerum A, Hansen F, Hendriksen R, Olesen B, Agersø Y, Zankari E, Leekitcharoenphon P, Stegger M, Kaas R, Cavaco L, Hansen D, Aarestrup F, Skov R. Detection of mcr-1 encoding plasmid-mediated colistin-resistant Escherichia coli isolates from human bloodstream infection and imported chicken meat, Denmark 2015. Euro Surveill. 2015;20(49):pii=30085. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2015.20.49.30085

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The plasmid-mediated colistin resistance gene, mcr-1, was detected in an Escherichia coli isolate from a Danish patient with bloodstream infection and in five E. coli isolates from imported chicken meat. One isolate from chicken meat belonged to the epidemic spreading sequence type ST131. In addition to IncN2, an incX4 replicon was found to be linked to mcr-1. This report follows a recent detection of mcr-1 in E. coli from animals, food and humans in China. 

(SNIP)

In conclusion, this study is to our knowledge, the first proof of colistin-resistant mcr-1 positive E. coli outside China. The human isolate was only susceptible to very few antimicrobial classes such as carbapenems. Should an isolate like this acquire carbapenem resistance, it would leave very few, if any, suitable treatment options.

Finally, our findings underline the importance of continuous microbiological surveillance programs and not the least the benefit of employing comprehensive WGS-based surveillance of antimicrobial resistance, as it allows for rapid re-analysis of large datasets in silico and thus make early detection and risk assessment possible when new resistance genes emerge.

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