Aspects of constitutive and acquired antibioresistance in Aeromonas hydrophila strains isolated from water sources.
Over the last three decades, the literature pointed out the implications of Aeromonas species in human pathology. These species were described as being involved in intestinal (several outbreaks of acute gastroenteritis of choleric/dysenteric form or chronic diarrhoea, ulcerative colitis, etc.) in normal adults or children, as well as in extraintestinal infections in immunocompromised hosts. This last aspect included a large range of cutaneous injuries (micronecrosis, abscesses, bums, cellulites, furunculosis), joint, bones, respiratory, urinary tract, ocular infections up to meningitis, endocarditis, peritonitis, hepatobilliary disease, endotoxic shock and septicemia (as consequence of leech microvascular surgery). During the last decade, the literature reported a high mortality in Aeromonas infections determined by certain phenospecies (A. hydrophila and A. veronii) especially in extraintestinal infections in immunocompromised patients. In microbiologists' opinion this high rate of mortality was probably due to poor knowledge concerning the aspects of antibioresistance in Aeromonas strains, to empiric treatments with antibiotics to which these bacteria exhibiting constitutive resistance lead to insuccessful results, and at last to the increasing trend of aeromonads resistance to certain antibiotics after 1996. The literature mentioned also that for a great number of Beta-lactamase producing Aeromonas strains, the use of microdilution method (by comparison to disk diffusion in agar medium) giving false results made more difficult the true knowledge of Aeromonas antibioresistance patterns. At the same time, in 2002, the literature mentioned 4 ecological compartments considered as "reservoirs for dissemination and transfer of microbial antibioresistance i.e. humans, animals, plants and natural soil and water. In the last time, more and more data of the literature revealed that some bacteria with role of reservoir of antibioresistance in the natural environment, even without a direct medical impact, however they could play an indirect one remaining permanent sources of R genes for bacterial strains with pathogenic abilities implicated in human pathology (i.e. Aeromonas infections in man related to different professional activities such as fishing, surfing, swimming, diving, etc.). The purpose of this work was to determine the aspects related to constitutive and acquired antibioresistance in 35 A. hydrophila strains isolated in aquatic environment of Danube Delta (10 salmaster waters, 5 aquatic plants, 5 fish intestinal content, 5 fish sapling, 5 snake and oyster shells). The strains were biochemically identified by using API20E and API20NE kits. The antibioresistance spectrum was determined by disk diffusion method following NCCLS 2000 recommendations. The choice and disposal of antibiotics on the Mueller Hinton plate was done to allow the interpretive reading and the phenotypic detection of different antibioresistance mechanisms, as follows: beta-lactamases (PEN, ME, AMX, AMC, CAZ) and carbapenemase (IMP) production; porin deficiency (FOX); efflux mechanism (C, TE, NOR). All tested strains exhibited high resistance to penicillin, aspect pleading for constitutive penicillinase production in Aeromonas strains. With reference to other penicillins (ME, AMX, AMC) and cephalosporins (CAZ, FOX) the tested strains exhibited 2 different antibioresistance patterns: AMX-R, AMC-S, CAZ-S (65%) indicating the presence of beta-lactamase sensitive to inhibitors and AMX-R, AMC-R, CAZ-S (22%) indicating the presence of beta-lactamase resistant to inhibitors. Resistance to FOX in 8% of strains signifies a phenotypical marker for the presence of porin deficiency. Only one Aeromonas strain (2.8%) was resistant to IMP. Three strains (8%) were simultaneous resistant to TE and TMP/SMX, NOR and CHL probably due to the presence of a resistance plasmid (codifying an efflux/ enzymatic mechanism). These aspects are pleading for the necessity to investigate the bacterial antibioresistance patterns of bacterial strains isolated from the environment, in the purpose to identify the factors responsible for the spreading of certain antibioresistance mechanisms in the external medium as risk factors for the colonization process with possible impact upon the human pathology.