1. Introduction
Piscine lactococcosis is considered an emerging bacterial disease for fish farming worldwide [
1], and the number of hosts in which
Lactococcus garvieae,
L. petauri and
L. formosensis have been detected has expanded [
2,
3,
4,
5,
6,
7]. The disease is currently a significant health challenge for
Oncorhynchus mykiss and
Oreochromis niloticus production, causing high mortality rates and significant economic losses [
8,
9,
10].
One of the main methods for controlling outbreaks of bacterial diseases in fish farms is antibiotic therapy [
11]. However, there are already reports of
Lactococcus spp. strains becoming resistant to the main drugs used in aquaculture [
12,
13]. The indiscriminate use of antimicrobials has been reported by producers and technicians from different fish farms, which can result in bacterial resistance to specific drug [
14]. As a result, a substance already used by a producer may no longer be effective in treating bacteriosis, thereby necessitating the use of another antibiotic. Additionally, it is worth mentioning that the rate of approval for new drugs is slower than the evolution of bacterial resistance, leading producers to use off-label drugs [
15].
One way to monitor antimicrobial resistance in lactococcosis-causing bacteria is through the use of laboratory methods such as disk diffusion [
10] and broth dilution [
16] methods. The former is considered an inexpensive, reliable and simple technique that can be easily applied in a laboratory routine, while in comparison the latter is technically demanding and labor-intensive [
17]. However, in Brazil, few studies have evaluated these methodologies for testing
Lactococcus spp. strains, whether using isolates from terrestrial mammals or aquatic animals. In Brazil, the disk diffusion assay has been performed for isolates of
L. petauri from farmed
Oreochromis niloticus, and resistance for some isolates to amoxicillin, erythromycin, florfenicol and norfloxacin was identified. In addition, all the isolates evaluated were considered resistant to trimethoprim/sulfamethoxazole [
10]. Bacteria of the genus
Lactococcus have also been isolated from native Brazilian fish species [
2], and little is known about the use of antimicrobials in these species and their antimicrobial susceptibility profiles.
The main problem in determining the sensitivity of bacterial fish pathogens to antimicrobials is the lack of reference values. Without these values, it is not possible to determine whether an isolate is sensitive or resistant. There are no internationally recognized epidemiological cut-off values for disk diffusion data for
Lactococcus spp. strains in the Clinical Laboratory Standards Institute (CLSI) or the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Previous studies have generated provisional epidemiological cut-off values for
L. petauri from disk diffusion zone data using the normalized resistance interpretation (NRI) method [
10] for
L. garvieae and
L. petauri from minimum inhibitory concentration data using NRI and ECOFFinder approaches [
16]. Nevertheless, for disk diffusion zone data, there are no reports of established cut-off values in the literature for
L. garvieae and
L. formosensis.
Therefore, the aim of this study was to evaluate the susceptibility profile of Lactococcus spp. strains obtained from native Brazilian fish species to different antimicrobials and to calculate the provisional epidemiological cut-off values (pECVs) for Lactococcus garvieae.
4. Discussion
Currently, antimicrobial resistance is one of the biggest threats to public health [
33], especially with the emergence of multidrug-resistant strains [
34]. The antimicrobial susceptibility profile in lactococcosis-causing bacteria strains has been studied by several different institutions and researchers using various techniques, such as disk diffusion [
35,
36], broth dilution [
12,
37] and the Etest [
38]. Studies have shown that most of the isolates evaluated are resistant to ampicillin [
36,
39], florfenicol [
40], flumequine [
35], nalidixic acid [
39,
41,
42], norfloxacin [
40], tetracycline [
13] and trimethoprim/sulfamethoxazole [
35,
39,
41,
43]. Although detected at lower percentages, there are also records of resistance to amoxicillin (16-23%), bacitracin (42%), ciprofloxacin (4%), chloramphenicol (18%), enrofloxacin (33-67%), erythromycin (16-52%), kanamycin (33%), oxytetracycline (4-44%) and streptomycin (33%) [
13,
35,
36,
39,
42,
43].
In the scientific literature, it is possible to observe heterogeneity in the antimicrobial resistance profiles for
Lactococcus spp. strains, which may be related to the different species within the genus. This is because most of the articles, including some recent ones, did not perform the correct taxonomic classification of the isolates, which is currently recommended [
44]. Only three studies assessed the antimicrobial resistance profile after correct species identification, using the disk diffusion [
10,
45] and broth dilution [
16]. Furthermore, Öztürk et al. [
16] suggest that this heterogeneity is related to the overuse or misuse of antimicrobials at the farm level and the lack of established susceptibility cut-off values for each of the three species that cause piscine lactococcosis. Here, we evaluated the antimicrobial resistance profiles of
L. formosensis,
L. garvieae and
L. petauri strains isolated from native fish species in Brazil using disk diffusion susceptibility testing and established pECVs for five out of seven antimicrobials for
L. garvieae strains.
Regardless of the bacterial species evaluated in our study, the trimethoprim/sulfametoxazole resistance phenotype stood out (
L. formosensis = 100%,
L. garvieae = 88.2%,
L. petauri = 95.8%) (
Figure 1). Resistance to this drug has previously been reported in the literature for
Lactococcus spp. strains isolated from
Oncorhynchus mykiss,
Dicentrarchus labrax and
Oreochromis niloticus [
6,
10,
35,
39,
40,
41,
43]. For the other drugs, interspecies variation has been observed.
Unfortunately, due to the limited number of isolates identified as
L. formosensis in our study, it was not possible to establish a pECV and, therefore, classification as WT or NWT could not be performed. However, we considered those isolates for which no inhibition zones were observed for the antimicrobials tested to be NWT. Thus, in addition to trimethoprim/sulfametoxazole, all the isolates were considered NWT for norfloxacin. This result is in disagreement with the study conducted by Lin et al. [
46], in which all the
L. formosensis strains isolated from milk samples of a cow with clinical mastitis were susceptible to quinolones via broth dilution testing. We also did not observe the formation of inhibition zones in four isolates (three from
Arapaima gigas and one from
Pseudoplatystoma sp.) for oxytetracycline, nor in one
Pseudoplatystoma sp. isolate (LG91-23) for florfenicol (
Figure 2a). Chan et al. [
45] evaluated susceptibility using the disk diffusion method for an
L. formosensis strain obtained from a human with bacteremia and found that the isolate was susceptible to tetracycline. There is no mention in the literature regarding resistance profiles to florfenicol, regardless of the host evaluated; however, a previous study demonstrated resistance to another amphenicol, chloramphenicol, for all the isolates evaluated [
46]. Although we cannot determine susceptibility for other drug classes, the literature mentions
L. formosensis resistance to aminoglycosides and macrolides, and susceptibility to β-lactams [
45,
46]. If we consider the pECV of
L. garvieae and
L. petauri from this study, all the isolates would be classified as WT for amoxicillin, erythromycin, florfenicol and neomycin, which would corroborate the previous information. Additionally, the AM-LG05 strain would be classified as NWT for oxytetracycline, increasing the number of multidrug-resistant isolates. It was possible to observe that the antimicrobial resistance profile was similar among the
Arapaima gigas isolates, as all the isolates share the same geographic origin.
For the
L. petauri strains, we compared the results using the previously established pECV. All the isolates evaluated were classified as WT for neomycin, thereby corroborating with Egger et al. [
10]. For amoxicillin and erythromycin, our isolates demonstrated a low frequency of NWT detection, 4.1% and 33.3%, respectively, when compared to other antimicrobials. A previous study demonstrated resistance of 6% and 25% for
L. petauri strains isolated from
Oncorhynchus mykiss for erythromycin and amoxicillin, respectively [
16]. For isolates obtained from
Oreochromis niloticus, the NWT percentages were lower, around 3% for both antimicrobials [
10]. A high percentage of isolates classified as NWT for norfloxacin was observed in our study (91.7%) compared to the results obtained in
Oreochromis niloticus (16.75%) [
10]. Regarding florfenicol and oxytetracycline, 11.4% and 91.6% of the isolates were classified as NWT, respectively. In
Oncorhynchus mykiss and
Oreochromis niloticus isolates, NWT values of 0% and 12.5% for oxytetracycline and 3.4% to 9.4% for florfenicol have been observed [
10,
16]. The resistance profile was similar among the
Pseudoplatystoma sp. isolates from the states of Mato Grosso and Minas Gerais, as well as most of the
Arapaima gigas isolates from Bahia (
Supplementary Table 1). However, for isolates obtained from this latter fish species in the northern region of Brazil, individual variation was detected, as were the cases with
Colossoma macropomum and
Brycon amazonicus isolates (
Figure 2c).
There are no studies that have standardized cut-off values, even provisional ones, for
L. garvieae strains following its correct taxonomic identification. Therefore, our study is the first to do so. However, we emphasize that the ECVs presented here are provisional. To generate ECVs that are relevant to disk diffusion data for
L. garvieae, a larger number of isolates (over 100 observations) from at least five different laboratories would be required [
28]. As previously mentioned, all the isolates evaluated were classified as being WT for amoxicillin, erythromycin and neomycin. In contrast, isolates from
Oncorhynchus mykiss exhibited varying susceptibility to these antimicrobials. Approximately 2.6%, 24.4% and 6.4-11.5% of the isolates were resistant to amoxicillin, erythromycin and aminoglycosides, respectively [
16]. A total of 47% of the isolates from native fish species in Brazil were considered to be NWT for norfloxacin, in contrast to previous studies that reported low (7.7%) or no resistance to quinolones [
16,
45]. A total of 5.8% and 29.4% of the isolates were classified as NWT for florfenicol and oxytetracycline, respectively. However, the literature reports resistance rates of 26.9% for florfenicol and 17.9% for oxytetracycline [
16]. The antimicrobial resistance profile observed in our study for the
L. garvieae strains was not consistent among the aquatic host species analyzed or with the origin of the isolates, demonstrating a heterogeneous profile (
Figure 2b).
Our study showed that the
L. garvieae strains tend to be more sensitive to antimicrobials when compared to the
L. formosensis and
L. petauri strains. Furthermore, the proportion of
L. garvieae isolates with a MAR index greater than 0.3 (11.7%) was lower than that found in
L. formosensis (66.7%) and
L. petauri (87.5%) (
Figure 3). The most efficient measure to control bacterial diseases is the use of antimicrobials [
11]. However, since the isolates evaluated in this study were classified as multi-resistant to several antimicrobials (
Supplementary Table 1), treating piscine lactococcosis in native Brazilian fish species becomes challenging. Unfortunately, little is known about the use of antimicrobials in native fish species in Brazil. However, prophylactic and metaphylactic use of antimicrobials, especially oxytetracycline, in larviculture of native species and during the feeding training of carnivorous species like
Pseudoplatystoma sp. and
Arapaima gigas has been reported by producers and technicians in the country. Additionally, it is known that commercial fish farming in Brazil involves off-label use of amoxicillin, enrofloxacin and norfloxacin [
15,
47]. In the central-western region of Brazil, fluoroquinolones, especially norfloxacin and enrofloxacin, intended for the treatment of cattle, have also been used off-label in
Pseudoplatystoma sp.. Therefore, the widespread use of these antimicrobials may have contributed to the increase in resistance among
Lactococcus spp. strains. It is also worth mentioning that when MAR index values exceed 0.2 (in our case, over 0.3 due to the number of antibiotics tested), a high environmental risk of spreading antimicrobial resistance is predicted [
32]. In this context, the shared production of native fish species and
Oreochromis niloticus could pose a risk of transmitting antimicrobial-resistant
Lactococcus spp. strains, or it could enable
L. petauri isolates from
Oreochromis niloticus to acquire resistance genes in this production environment, resulting in an unsatisfactory therapeutic approach during disease outbreaks. Therefore, monitoring of antimicrobial resistance in
Lactococcus spp. strains becomes essential.
Sun et al. [
48] report that acquired resistance in microorganisms occurs for two reasons: the natural resistance of bacteria to certain antimicrobials and acquired resistance due to continuous exposure to antimicrobials. Once the bacteria becomes resistant, this resistance can be transferred to the other bacterial species through horizontal gene transfer [
49]. Furthermore, some
L. garvieae strains carry these antimicrobial resistance genes on transferable R plasmids [
35]. The acquisition and transfer of antimicrobial resistance genes have been considered to be responsible for the spread and distribution of antimicrobial resistance [
16]. Previous studies indicate a high prevalence of antimicrobial resistance genes in
Lactococcus spp. isolates from
Oncorhynchus mykiss [
13,
16,
35]. There is no description of the detection of resistance genes in
Lactococcus spp. strains from Brazilian fishes. However, given the higher percentage of multi-resistant isolates, future studies should be conducted to identify resistance genes, particularly those encoding antimicrobial resistance, using genomic tools.
In Brazil, only florfenicol and oxytetracycline are approved antimicrobial agents for use in aquaculture [
50]. Both antimicrobials act against Gram-negative and Gram-positive bacteria; they are bacteriostatic drugs that work by binding to bacterial ribosomal subunits and inhibiting protein synthesis [
49]. However, neither of these antimicrobials has been evaluated for their therapeutic efficacy in fish either naturally or experimentally infected with
Lactococcus spp. in Brazil. Nevertheless, the administration of oxytetracycline in
Oncorhynchus mykiss in Greece was reported to be unsatisfactory in both prophylactic and therapeutic treatments [
51]. The circulation of florfenicol- and oxytetracycline-resistant strains in Brazilian fish farms could become a significant health issue when producing native species. The oral administration of amoxicillin, erythromycin and flumequine did not yield significant results in the treatment of
Oncorhynchus mykiss and
Dicentrarchus labrax with lactococcosis [
6,
51]. However, based on the antimicrobial susceptibility tests from our study, amoxicillin and neomycin could be tested for their therapeutic efficacy against piscine lactococcosis in Brazil.
Author Contributions
Conceptualization: AECR, ACCB, HCM, HCPF and GCT; Methodology: AECR, ACCB, HCM, CRMSM, JMT, HCPF and GCT; Formal analysis: AECR, ACCB and HCM; Investigation: AECR, ACCB, HCM, CRMSM, LFFN, FP, SUG, CAGL, HCPF and GCT; Resources: FP, SUG, CAGL, HCPF and GCT; Data curation: LFFN and GCT; Writing—original draft preparation, AECR and GCT; Writing—review and editing, AECR, ACCB, HCM, CRMSM, JMT, LFFN, FP, SUG, CAGL, HCPF and GCT; Visualization: GCT; Supervision: SUG, HCPF and GCT; Project administration: GCT; Funding acquisition: HCPF and GCT. All authors have read and agreed to the published version of the manuscript.