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López-Luis BA, Sifuentes-Osornio J, Lambraño-Castillo D, Ortiz-Brizuela E, Ramírez-Fontes A, Tovar-Calderón YE, Leal-Vega FJ, Bobadilla-Del-Valle M, Ponce-de-León A. Risk factors and outcomes associated with vancomycin-resistant Enterococcus faecium and ampicillin-resistant Enterococcus faecalis bacteraemia: A 10-year study in a tertiary-care centre in Mexico City. J Glob Antimicrob Resist 2020; 24:198-204. [PMID: 33359937 DOI: 10.1016/j.jgar.2020.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/31/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We sought to identify risk factors associated with vancomycin-resistant Enterococcus faecium (VRE) and ampicillin-resistant Enterococcus faecalis (ARE) bacteraemia, predictors of 30-day mortality, and 90-day recurrence-free survival according to resistance. METHODS We evaluated clinical records of patients with E. faecalis and E. faecium bacteraemia (2007-2017). We performed bivariate and multivariate logistic regression analyses to identify factors associated with VRE and ARE bacteraemia and predictors of 30-day mortality. A Kaplan-Meier estimate of 90-day recurrence-free survival was done. RESULTS We identified 192 and 147 E. faecium and E. faecalis bacteraemia episodes, respectively, of which 55.7% of E. faecium were VRE (94% vanA) and 12.2% of E. faecalis were ARE. Factors related to VRE bacteraemia were previous hospitalisation (aOR, 80.18, 95% CI 1.81-634), history of central venous catheter (aOR, 11.15, 95% CI 2.48-50.2) and endotracheal cannula use (aOR, 17.91, 95% CI 1.22-262.82). There was higher attributable mortality to VRE (28%, 95% CI 14-68%; P < 0.001) and ARE (10%, 95% CI 0.1-36%; P = 0.58) compared with their susceptible counterparts. APACHE II (aOR, 1.45, 95% CI 1.26-1.66) and history of chemotherapy (aOR, 3.52, 95% CI 1.09-11.39) were predictors of E. faecium bacteraemia 30-day mortality. We could not recognise any factor related to ARE bacteraemia or E. faecalis 30-day mortality. CONCLUSION History of hospitalisation and invasive device use were related to VRE bacteraemia. APACHE II and history of chemotherapy were predictors of mortality. We could not identify factors related to ARE or predictors of mortality.
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Affiliation(s)
- Bruno Ali López-Luis
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Darwin Lambraño-Castillo
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Edgar Ortiz-Brizuela
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Andrea Ramírez-Fontes
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Yanet Estrella Tovar-Calderón
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Francisco Javier Leal-Vega
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Miriam Bobadilla-Del-Valle
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Laboratory of Clinical Microbiology, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, Mexico.
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Stratmann JA, Lacko R, Ballo O, Shaid S, Gleiber W, Vehreschild MJGT, Wichelhaus T, Reinheimer C, Göttig S, Kempf VAJ, Kleine P, Stera S, Brandts C, Sebastian M, Koschade S. Colonization with multi-drug-resistant organisms negatively impacts survival in patients with non-small cell lung cancer. PLoS One 2020; 15:e0242544. [PMID: 33237921 PMCID: PMC7688109 DOI: 10.1371/journal.pone.0242544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/05/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives Multidrug-resistant organisms (MDRO) are considered an emerging threat worldwide. Data covering the clinical impact of MDRO colonization in patients with solid malignancies, however, is widely missing. We sought to determine the impact of MDRO colonization in patients who have been diagnosed with Non-small cell lung cancer (NSCLC) who are at known high-risk for invasive infections. Materials and methods Patients who were screened for MDRO colonization within a 90-day period after NSCLC diagnosis of all stages were included in this single-center retrospective study. Results Two hundred and ninety-five patients were included of whom 24 patients (8.1%) were screened positive for MDRO colonization (MDROpos) at first diagnosis. Enterobacterales were by far the most frequent MDRO detected with a proportion of 79.2% (19/24). MDRO colonization was present across all disease stages and more present in patients with concomitant diabetes mellitus. Median overall survival was significantly inferior in the MDROpos study group with a median OS of 7.8 months (95% CI, 0.0–19.9 months) compared to a median OS of 23.9 months (95% CI, 17.6–30.1 months) in the MDROneg group in univariate (p = 0.036) and multivariate analysis (P = 0.02). Exploratory analyses suggest a higher rate of non-cancer-related-mortality in MDROpos patients compared to MDROneg patients (p = 0.002) with an increased rate of fatal infections in MDROpos patients (p = 0.0002). Conclusions MDRO colonization is an independent risk factor for inferior OS in patients diagnosed with NSCLC due to a higher rate of fatal infections. Empirical antibiotic treatment approaches should cover formerly detected MDR commensals in cases of (suspected) invasive infections.
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Affiliation(s)
- Jan A. Stratmann
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- * E-mail:
| | - Raphael Lacko
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Olivier Ballo
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Shabnam Shaid
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Wolfgang Gleiber
- Department of Internal Medicine, Pneumology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Maria J. G. T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
- University Center for Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Thomas Wichelhaus
- University Center for Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Institute of Medical Microbiology and Infection Control, Goethe University, Frankfurt, Frankfurt am Main, Germany
- University Center of Competence for Infection Control, Frankfurt, State of Hesse, Germany
| | - Claudia Reinheimer
- University Center for Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Institute of Medical Microbiology and Infection Control, Goethe University, Frankfurt, Frankfurt am Main, Germany
- University Center of Competence for Infection Control, Frankfurt, State of Hesse, Germany
| | - Stephan Göttig
- University Center for Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Institute of Medical Microbiology and Infection Control, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A. J. Kempf
- University Center for Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Institute of Medical Microbiology and Infection Control, Goethe University, Frankfurt, Frankfurt am Main, Germany
- University Center of Competence for Infection Control, Frankfurt, State of Hesse, Germany
| | - Peter Kleine
- Department of Cardiothoracic Surgery, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Susanne Stera
- Department of Radiation Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Christian Brandts
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- University Cancer Center Frankfurt (UCT), Goethe University, Frankfurt, Germany
| | - Martin Sebastian
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Koschade
- Department of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
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Prevalence of vancomycin-resistant enterococcus in Africa in one health approach: a systematic review and meta-analysis. Sci Rep 2020; 10:20542. [PMID: 33239734 PMCID: PMC7688635 DOI: 10.1038/s41598-020-77696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/02/2020] [Indexed: 11/08/2022] Open
Abstract
Vancomycin-resistant enterococci are a global challenge currently as reported by the World Health Organization. It is also important to recognize that combating antimicrobial resistance needs to recognize the interconnections between people, animals, plants and their shared environment in creating public health, the so-called One Health approach. Although the presence of VRE has been described in many regions of the world, there is a lack of comprehensive data indicating their prevalence of in Africa. Therefore, this study aimed to aggregate the result of studies describing VRE reported across multiple regions in Africa. A literature search was conducted on PubMed, Google scholar, and Hinari with the term “Vancomycin resistance enterococcus in Africa” on August 1–3, 2019. All available articles were downloaded to “Endnote version 7.1” then to Microsoft Word 2013. Articles determined to meet our criteria for the review was extracted to Microsoft Excel 2013. Those articles that reported the prevalence of vancomycin resistance Enterococcus obtained from all sample types and published from 2010 to 2019 in the English language were included for the review. A meta-analysis was conducted with OpenMetaAnalyst version R.3.1.0 software. The effect size was determined using a binary random effect model and statically significant considered when p < 0.05. Heterogeneity determined with the inconsistency index. A leave one out analysis used to perform the sensitivity analysis. There were 151 articles identified from the database searches; of this, 36 articles included after extensive review with two independent authors. Out of 4073 samples collected, 1488 isolates identified with an overall pooled prevalence of VRE 26.8% (95% CI; 10.7–43.0%) in Africa with a one-health perspective. The analysis showed that considerable heterogeneity among the studies (I2 = 99.97%; p < 0.001). Subgroup analysis in-country, African region, laboratory method, year of publication, and sample source showed that a high prevalence was identified from South Africa (74.8%), South African regions (74.8%), PCR (959.2%), 2010–2015 years (30.3%) and environmental (52.2%), respectively. This meta-analysis indicates that there was a high-pooled prevalence of vancomycin-resistant enterococci in African. A lot should be done to prevent and control the transmission of vancomycin resistance enterococci to a human being from the environment in the continent.
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Correa-Martínez CL, Becker F, Schwierzeck V, Mellmann A, Brockmann JG, Kampmeier S. Donor-derived vancomycin-resistant enterococci transmission and bloodstream infection after intestinal transplantation. Antimicrob Resist Infect Control 2020; 9:180. [PMID: 33160394 PMCID: PMC7648953 DOI: 10.1186/s13756-020-00845-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transplant recipients are at high risk for infections. However, donor-recipient transmission of multidrug-resistant organisms (MDROs) remains mostly unaddressed in the protocols of pre-transplant infection and colonization screening. Vancomycin-resistant enterococci (VRE) are MDROs that colonize the gastrointestinal tract and are associated with a significant burden of disease. Besides the high mortality of invasive VRE infections, chronic colonization leads to costly isolation measures in the hospital setting. Whereas most post-transplantation VRE infections are endogenous and thus preceded by colonization of the recipient, conclusive evidence of VRE transmission via allograft in the context of intestinal transplantation is lacking. CASE PRESENTATION We describe a donor-derived VRE infection after intestinal transplantation including small bowel and right hemicolon. The recipient, a 54-year old male with history of mesenteric ischemia and small bowel perforation due to generalized atherosclerosis and chronic stenosis of the celiac trunk and the superior mesenteric artery, developed an intra-abdominal infection and bloodstream infection after transplantation. VRE isolates recovered from the patient as well as from the allograft prior to transplantation were analyzed via whole genome sequencing. Isolates showed to be genetically identical, thus confirming the transmission from donor to recipient. CONCLUSIONS This case underlines the relevance of donor-recipient VRE transmission and invasive infection in the context of intestinal transplantation, highlighting the need for preoperative MDRO screening that facilitates the prompt and effective treatment of possible infections as well as the timely establishment of contact precautions to prevent further spread.
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Affiliation(s)
- Carlos L Correa-Martínez
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany.
| | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Vera Schwierzeck
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany
| | - Alexander Mellmann
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany
| | - Jens G Brockmann
- Department of General, Visceral and Transplant Surgery, University Hospital Münster, Waldeyerstraße 1, 48149, Münster, Germany
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149, Münster, Germany.,Institute of Medical Microbiology, University Hospital Münster, Domgakstraße 10, 48149, Münster, Germany
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55
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Kirkizlar TA, Akalin H, Kirkizlar O, Ozkalemkas F, Ozkocaman V, Kazak E, Ozakin C, Bulbul EN, Ozboz ES, Ali R. Vancomycin-resistant enterococci infection and predisposing factors for infection and mortality in patients with acute leukaemia and febrile neutropenia. Leuk Res 2020; 99:106463. [PMID: 33130331 DOI: 10.1016/j.leukres.2020.106463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality. PATIENTS-METHODS We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files. RESULTS There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival. CONCLUSION Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.
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Affiliation(s)
- Tugcan Alp Kirkizlar
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Halis Akalin
- Uludag University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Onur Kirkizlar
- Trakya University Medical Faculty, Department of Haematology, 22030, Edirne, Turkey.
| | - Fahir Ozkalemkas
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Vildan Ozkocaman
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
| | - Esra Kazak
- Uludag University Medical Faculty, Department of Infectious Diseases and Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Cuneyt Ozakin
- Uludag University Medical Faculty, Department of Clinical Microbiology, 16059, Gorukle, Bursa, Turkey.
| | - Esra Nur Bulbul
- Uludag University Medical Faculty, Department of Internal Medicine, 16059, Gorukle, Bursa, Turkey.
| | - Ezgi Sezen Ozboz
- Uludag University Medical Faculty, Department of Internal Medicine, 16059, Gorukle, Bursa, Turkey.
| | - Rıdvan Ali
- Uludag University Medical Faculty, Department of Haematology, 16059, Gorukle, Bursa, Turkey.
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Bright M, Parfitt EC, Pasquill K, Steele L, Laupland KB. Occurrence and determinants of enterococcal bloodstream infections: a population-based study. Infect Dis (Lond) 2020; 52:638-643. [PMID: 32516011 DOI: 10.1080/23744235.2020.1774074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Although enterococci are common causes of bloodstream infections (BSIs), few studies have examined their epidemiology in non-selected populations.Objective: To examine the incidence and risk factors for development of enterococcal BSI.Methods: Surveillance for incident enterococcal BSI was conducted among all residents of the western interior of British Columbia, Canada during 2011-2018.Results: The overall annual incidence was 10.0 per 100,000 and was 6.6 and 2.7 per 100,000 for E. faecalis and E. faecium, respectively. Among the overall cohort of 145 incident cases of enterococcal BSI, 22 (15.2%) were community-associated, 63 (43.5%) were healthcare associated and 60 (41.4%) were hospital-onset. Enterococcal BSI was predominantly a disease of older adults with rare cases occurring among those aged less than 40 years. Males showed significantly increased risk compared to females (14.3 vs. 5.6 per 100,000; incidence rate ratio; IRR; 2.6; 95% confidence interval; CI; 1.8-3.8; p < .0001) and this was most pronounced with advanced age. Several co-morbid illnesses were associated with increased risk (IRR; 95% CI) for development of enterococcal BSI most importantly cancer (8.8; 6.0-12.9; p < .0001), congestive heart failure (5.7; 3.1-9.7; p < .0001), diabetes mellitus (4.4; 3.0-6.3; p < .0001) and stroke (3.7; 1.9-6.5; .0001). As compared to patients with E. faecalis, patients with E. faecium BSI were more likely to be of hospital-onset, more likely to have an intra-abdominal/pelvic focus, and trended towards higher 30-day case-fatality rate.Conclusions: Enterococci are relatively common causes of BSI. Although E faecalis and E faecium share commonalities they are epidemiologically distinguishable on several criteria.
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Affiliation(s)
- M Bright
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - E C Parfitt
- Department of Medicine, Royal Inland Hospital, Kamloops, Canada
| | - K Pasquill
- Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, Canada
| | - L Steele
- Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, Canada
| | - K B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Australia.,Department of Medicine, Royal Inland Hospital, Kamloops, Canada.,Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, Canada.,Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Endogenous Vancomycin-Resistant Enterococcus gallinarum Endophthalmitis in Hematologic Malignancy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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58
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Goić-Barišić I, Radić M, Novak A, Rubić Ž, Boban N, Lukšić B, Tonkić M. Vancomycin-resistant Enterococcus faecium COLONIZATION and Clostridium difficile infection in a HEMATOLOGIC patient. Acta Clin Croat 2020; 59:523-528. [PMID: 34177063 PMCID: PMC8212656 DOI: 10.20471/acc.2020.59.03.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. The patient received prolonged broad-spectrum antimicrobial therapy. During hospital stay, the patient developed Clostridium difficile infection (CDI) and was found to be colonized with a strain of Enterococcus faecium resistant to vancomycin during therapy for CDI. This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory.
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Affiliation(s)
| | - Marina Radić
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
| | - Anita Novak
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
| | - Žana Rubić
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
| | - Nataša Boban
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
| | - Boris Lukšić
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
| | - Marija Tonkić
- 1Department of Clinical Microbiology, Split University Hospital Centre, Split, Croatia;2University of Split School of Medicine, Split, Croatia; 3Department of Clinical Epidemiology, Split University Hospital Centre, Split, Croatia; 4Department of Infectious Diseases, Split University Hospital Centre, Split, Croatia
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Abbo L, Shukla BS, Giles A, Aragon L, Jimenez A, Camargo JF, Simkins J, Sposato K, Tran TT, Diaz L, Reyes J, Rios R, Carvajal LP, Cardozo J, Ruiz M, Rosello G, Cardona AP, Martinez O, Guerra G, Beduschi T, Vianna R, Arias CA. Linezolid- and Vancomycin-resistant Enterococcus faecium in Solid Organ Transplant Recipients: Infection Control and Antimicrobial Stewardship Using Whole Genome Sequencing. Clin Infect Dis 2020; 69:259-265. [PMID: 30339217 DOI: 10.1093/cid/ciy903] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Vancomycin-resistant enterococci are an important cause of healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Linezolid is the only drug currently approved by the US Food and Drug Administration to treat vancomycin-resistant enterococci; however, resistance to this antibiotic appears to be increasing. Although outbreaks of linezolid- and vancomycin-resistant Enterococcus faecium (LR-VRE) in solid organ transplant recipients remain uncommon, they represent a major challenge for infection control and hospital epidemiology. METHODS We describe a cluster of 4 LR-VRE infections among a group of liver and multivisceral transplant recipients in a single intensive care unit. Failure of treatment with linezolid in 2 cases led to a review of standard clinical laboratory methods for susceptibility determination. Testing by alternative methods including whole genome sequencing (WGS) and a comprehensive outbreak investigation including sampling of staff members and surfaces was performed. RESULTS Review of laboratory testing methods revealed a limitation in the VITEK 2 system with regard to reporting resistance to linezolid. Linezolid resistance in all cases was confirmed by E-test method. The use of WGS identified a resistant subpopulation with the G2376C mutation in the 23S ribosomal RNA. Sampling of staff members' dominant hands as well as sampling of surfaces in the unit identified no contaminated sources for transmission. CONCLUSIONS This cluster of LR-VRE in transplant recipients highlights the possible shortcomings of standard microbiology laboratory methods and underscores the importance of WGS to identify resistance mechanisms that can inform patient care, as well as infection control and antibiotic stewardship measures.
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Affiliation(s)
- Lilian Abbo
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida.,Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South Carolina
| | - Bhavarth S Shukla
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Amber Giles
- Department of Pharmacy Practice, School of Pharmacy, Presbyterian College, Clinton, South Carolina
| | - Laura Aragon
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Adriana Jimenez
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Jacques Simkins
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Florida
| | - Kathleen Sposato
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Truc T Tran
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia
| | - Lorena Diaz
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Jinnethe Reyes
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Lina P Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Javier Cardozo
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Maribel Ruiz
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Gemma Rosello
- Department of Infection Control and Prevention and Antimicrobial Stewardship Program, Jackson Memorial Hospital, Miami, Florida
| | - Armando Perez Cardona
- Department of Pathology and Laboratory Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Octavio Martinez
- Department of Pathology and Laboratory Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Thiago Beduschi
- Division of Liver and Gastrointestinal Transplant Surgery, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Rodrigo Vianna
- Division of Liver and Gastrointestinal Transplant Surgery, Department of Surgery, University of Miami Miller School of Medicine, Florida
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston, Bogota, Colombia.,Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Center for Infectious Diseases, University of Texas Health Science Center School of Public Health, Houston, Texas
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60
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Jacopin E, Lehtinen S, Débarre F, Blanquart F. Factors favouring the evolution of multidrug resistance in bacteria. J R Soc Interface 2020. [PMCID: PMC7423433 DOI: 10.1098/rsif.2020.0105] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The evolution of multidrug antibiotic resistance in commensal bacteria is an important public health concern. Commensal bacteria such as Escherichia coli, Streptococcus pneumoniae or Staphylococcus aureus, are also opportunistic pathogens causing a large fraction of the community-acquired and hospital-acquired bacterial infections. Multidrug resistance (MDR) makes these infections harder to treat with antibiotics and may thus cause substantial additional morbidity and mortality. Here, we develop an evolutionary epidemiology model to identify the factors favouring the evolution of MDR in commensal bacteria. The model describes the evolution of antibiotic resistance in a commensal bacterial species evolving in a host population subjected to multiple antibiotic treatments. We combine statistical analysis of a large number of simulations and mathematical analysis to understand the model behaviour. We find that MDR evolves more readily when it is less costly than expected from the combinations of single resistances (positive epistasis). MDR frequently evolves when bacteria are in contact with multiple drugs prescribed in the host population, even if individual hosts are only treated with a single drug at a time. MDR is favoured when the host population is structured in different classes that vary in their rates of antibiotic treatment. However, under most circumstances, recombination between loci involved in resistance does not meaningfully affect the equilibrium frequency of MDR. Together, these results suggest that MDR is a frequent evolutionary outcome in commensal bacteria that encounter the variety of antibiotics prescribed in the host population. A better characterization of the variability in antibiotic use across the host population (e.g. across age classes or geographical location) would help predict which MDR genotypes will most readily evolve.
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Affiliation(s)
- Eliott Jacopin
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France
- AgroParisTech, Université Paris-Saclay, Paris, France
| | - Sonja Lehtinen
- The Oxford Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Institute of Integrative Biology, Department of Environmental Systems Science, ETH Zurich, Zurich, Switzerland
| | - Florence Débarre
- Sorbonne Université, CNRS, Université Paris Est Créteil, Université de Paris, INRAE, IRD, Institute of Ecology and Environmental sciences of Paris, iEES-Paris (UMR 7618), 75005 Paris, France
| | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France
- Infection Antimicrobials Modelling Evolution, UMR 1137, INSERM, Université de Paris, Paris, France
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61
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Impact of vanA-Positive Enterococcus faecium Exhibiting Diverse Susceptibility Phenotypes to Glycopeptides on 30-Day Mortality of Patients with a Bloodstream Infection. Antimicrob Agents Chemother 2020; 64:AAC.02180-19. [PMID: 32340989 DOI: 10.1128/aac.02180-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/22/2020] [Indexed: 11/20/2022] Open
Abstract
This study was performed to evaluate the impacts of vanA positivity of Enterococcus faecium exhibiting diverse susceptibility phenotypes to glycopeptides on clinical outcomes in patients with a bloodstream infection (BSI) through a prospective, multicenter, observational study. A total of 509 patients with E. faecium BSI from eight sentinel hospitals in South Korea during a 2-year period were enrolled in this study. Risk factors of the hosts and causative E. faecium isolates were assessed to determine associations with the 30-day mortality of E. faecium BSI patients via multivariable logistic regression analyses. The vanA gene was detected in 35.2% (179/509) of E. faecium isolates; 131 E. faecium isolates exhibited typical VanA phenotypes (group vanA-VanA), while the remaining 48 E. faecium isolates exhibited atypical phenotypes (group vanA-atypical), which included VanD (n = 43) and vancomycin-variable phenotypes (n = 5). A multivariable logistic regression indicated that vanA positivity of causative pathogens was independently associated with the increased 30-day mortality rate in the patients with E. faecium BSI; however, there was no significant difference in survival rates between the patients of the vanA-VanA and vanA-atypical groups (log rank test, P = 0.904). A high 30-day mortality rate was observed in patients with vanA-positive E. faecium BSIs, and vanA positivity of causative E. faecium isolates was an independent risk factor for early mortality irrespective of the susceptibility phenotypes to glycopeptides; thus, intensified antimicrobial stewardship is needed to improve the clinical outcomes of patients with vanA-positive E. faecium BSI.
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62
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Shi C, Jin W, Xie Y, Zhou D, Xu S, Li Q, Lin N. Efficacy and safety of daptomycin versus linezolid treatment in patients with vancomycin-resistant enterococcal bacteraemia: An updated systematic review and meta-analysis. J Glob Antimicrob Resist 2020; 21:235-245. [DOI: 10.1016/j.jgar.2019.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
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63
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Impact of Daptomycin Minimum Inhibitory Concentration on Clinical Cure Rates for Vancomycin-Resistant Enterococcus Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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64
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Boudrioua A, Li Y, Hartke A, Giraud C. Opposite effect of vancomycin and D-Cycloserine combination in both vancomycin resistant Staphylococcus aureus and enterococci. FEMS Microbiol Lett 2020; 367:5819017. [DOI: 10.1093/femsle/fnaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT
The increasing spread of antibiotic resistant bacteria is a major human health concern. The challenging development of new effective antibiotics has led to focus on seeking synergistic antibiotic combinations. Vancomycin (VAN) is a glycopeptide antibiotic used to treat Staphylococcus aureus and enterococci infections. It is targeting D-Alanyl-D-Alanine dimers during peptidoglycan biosynthesis. D-cycloserine (DCS) is a D-Alanine analogue that targets peptidoglycan biosynthesis by inhibiting D-Alanine:D-Alanine ligase (Ddl). The VAN-DCS combination was found to be synergistic in VAN resistant S. aureus strains lacking van genes cluster. We hypothesize that this combination leads to opposite effects in S. aureus and enterococci strains harboring van genes cluster where VAN resistance is conferred by the synthesis of modified peptidoglycan precursors ending in D-Alanyl-D-Lactate. The calculated Fractional Inhibitory Concentration of VAN-DCS combination in a van- vancomycin-intermediate, VanA type, and VanB type strains were 0.5, 5 and 3, respectively. As a result, VAN-DCS combination leads to synergism in van-lacking strains, and to antagonism in strains harboring van genes cluster. The VAN-DCS antagonism is due to a mechanism that we named van-mediated Ddl inhibition bypass. Our results show that antibiotic combinations can lead to opposite effects depending on the genetic backgrounds.
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Affiliation(s)
| | - Yanyan Li
- Laboratory Molecules of Communication and Adaptation of Microorganisms (MCAM, UMR 7245 CNRS-MNHN), National Museum of Natural History (MNHN), CNRS, CP 54, 57 rue Cuvier 75005, Paris, France
| | - Axel Hartke
- Normandie Univ, UNICAEN, U2RM, 14000, Caen, France
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65
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Sterling AJ, Snelling WJ, Naughton PJ, Ternan NG, Dooley JSG. Competent but complex communication: The phenomena of pheromone-responsive plasmids. PLoS Pathog 2020; 16:e1008310. [PMID: 32240270 PMCID: PMC7117660 DOI: 10.1371/journal.ppat.1008310] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Enterococci are robust gram-positive bacteria that are found in a variety of surroundings and that cause a significant number of healthcare-associated infections. The genus possesses a high-efficiency pheromone-responsive plasmid (PRP) transfer system for genetic exchange that allows antimicrobial-resistance determinants to spread within bacterial populations. The pCF10 plasmid system is the best characterised, and although other PRP systems are structurally similar, they lack exact functional homologues of pCF10-encoded genes. In this review, we provide an overview of the enterococcal PRP systems, incorporating functional details for the less-well-defined systems. We catalogue the virulence-associated elements of the PRPs that have been identified to date, and we argue that this reinforces the requirement for elucidation of the less studied systems.
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Affiliation(s)
- Amy J. Sterling
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Londonderry, Northern Ireland
- * E-mail:
| | - William J. Snelling
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Londonderry, Northern Ireland
| | - Patrick J. Naughton
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Londonderry, Northern Ireland
| | - Nigel G. Ternan
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Londonderry, Northern Ireland
| | - James S. G. Dooley
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University, Coleraine, Londonderry, Northern Ireland
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Enterococcal Bacteremia in Children With Malignancies and Following Hematopoietic Stem Cell Transplantation: A 15-Year Single-Center Experience. Pediatr Infect Dis J 2020; 39:318-324. [PMID: 31990889 DOI: 10.1097/inf.0000000000002579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Data on enterococcal bacteremia (EB) in immunocompromised children are scarce. We aimed to describe EB in children with hematologic malignancies (HM), solid tumors and/or following allogeneic hematopoietic stem cell transplantation (HSCT) and analyze their ampicillin and vancomycin resistance. METHODS We conducted an observational retrospective study in the tertiary-care Hadassah University Medical Center (2001-2015). We collected demographic, clinical and laboratory data on EB and compared ampicillin and vancomycin sensitive with resistant episodes. RESULTS Fifty-six of 1123 children developed 74 episodes of EB; 62.1% Enterococcus faecium, 36.5% Enterococcus faecalis; and 1.4% Enterococcus gallinarum. EB developed in 12.1% of HSCT patients, 5.1% of HM, 6.3% of neuroblastoma and 1.0% of other solid tumors patients. Of these episodes, 85.1% were nosocomial, and 71.6% developed while on antibiotic therapy. Resistance rates were: to ampicillin, 57.6%; to vancomycin (vancomycin-resistant enterococci), 21.6%; and higher rates among E. faecium. Among vancomycin-resistant enterococci, 1 of 16 was linezolid and 2 of 10 daptomycin resistant. Overall 7- and 30-day mortality rates were 2.7% and 5.4%, respectively. Thirty-day mortality was 18.2% in recurrent episodes and 0% in the first-time EB episodes (P = 0.006). In multivariate analysis, high treatment intensity was associated with ampicillin resistance [odds ratio (OR) = 3.18, 95% confidence interval (CI): 1.31-9.12], prior penicillin exposure (OR = 7.50, 95% CI: 1.41-39.81) and breakthrough on vancomycin (OR = 18.83, 95% CI: 3.31-101.14) with vancomycin resistance. CONCLUSIONS EB occurs mainly as a nosocomial infection in children receiving high-intensity chemotherapy, especially in those with neuroblastoma, HM and following HSCT. Antibiotic resistance is common. Vancomycin resistance can occur regardless of previous vancomycin use. Prognosis in immunocompromised children with EB is better than previously reported. Recurrent EB is associated with increased mortality.
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67
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Xie O, Slavin MA, Teh BW, Bajel A, Douglas AP, Worth LJ. Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting. BMC Infect Dis 2020; 20:228. [PMID: 32188401 PMCID: PMC7079500 DOI: 10.1186/s12879-020-04952-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients. Methods A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008–2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission. Results Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days. Conclusions VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.
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Affiliation(s)
- Ouli Xie
- Victorian Infectious Disease Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.
| | - Monica A Slavin
- Victorian Infectious Disease Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3050, Australia.,Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Benjamin W Teh
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Ashish Bajel
- Department of Haematology, The Royal Melbourne Hospital, Parkville, Australia.,Department of Haematology, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Abby P Douglas
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
| | - Leon J Worth
- Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Parkville, Australia.,National Centre for Infections in Cancer, Melbourne, Australia
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68
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Birgand G, Mutters NT, Ahmad R, Tacconelli E, Lucet JC, Holmes A. Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study. Antimicrob Resist Infect Control 2020; 9:33. [PMID: 32059746 PMCID: PMC7023755 DOI: 10.1186/s13756-020-0695-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients. Methods In this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics. Results Between January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception. Conclusions The perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors.
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Affiliation(s)
- Gabriel Birgand
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK. .,European Committee on Infection Control (EUCIC), European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.
| | - Nico T Mutters
- European Committee on Infection Control (EUCIC), European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.,Medical Center - University of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Breisacher Straße 115B, 79106, Freiburg, Germany
| | - Raheelah Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.,Division of Health Sciences, University of London, London, UK
| | - Evelina Tacconelli
- European Committee on Infection Control (EUCIC), European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.,Department for Internal Medicine I, Division Infectious Diseases, Tübingen University, Otfried-Müller-Straße 10, 72076, Tübingen, Germany.,Department of Diagnostic and Public Health, Division Infectious Diseases, Verona University, Piazzale Luduvico Antonio Scuro 10, 37134, Verona, Italy
| | - Jean-Christophe Lucet
- European Committee on Infection Control (EUCIC), European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.,Universite de Paris, Infection, Antimicrobiens, Modelisation, Evolution (IAME), Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France.,AP-HP, Hôpital Bichat - Claude Bernard, Infection Control Unit, F-75018, Paris, France
| | - Alison Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK.,European Committee on Infection Control (EUCIC), European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland
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Melese A, Genet C, Andualem T. Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:124. [PMID: 32046668 PMCID: PMC7014939 DOI: 10.1186/s12879-020-4833-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022] Open
Abstract
Background The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia. Methods Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I2 tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test. Results Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I2 = 74.05%; P < 0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%). Conclusion The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.
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Affiliation(s)
- Addisu Melese
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Chalachew Genet
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tesfaye Andualem
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Baryakova TH, Ritter SC, Tresnak DT, Hackel BJ. Computationally Aided Discovery of LysEFm5 Variants with Improved Catalytic Activity and Stability. Appl Environ Microbiol 2020; 86:e02051-19. [PMID: 31811034 PMCID: PMC6997734 DOI: 10.1128/aem.02051-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/30/2019] [Indexed: 01/21/2023] Open
Abstract
Bacteriophage-derived lysin proteins are potentially effective antimicrobials that would benefit from engineered improvements to their bioavailability and specific activity. Here, the catalytic domain of LysEFm5, a lysin with activity against vancomycin-resistant Enterococcus faecium (VRE), was subjected to site-saturation mutagenesis at positions whose selection was guided by sequence and structural information from homologous proteins. A second-order Potts model with parameters inferred from large sets of homologous sequence information was used to predict the average change in the statistical fitness for mutant libraries with diversity at pairs of sites within the secondary catalytic shell. Guided by the statistical fitness, nine double mutant saturation libraries were created and plated on agar containing autoclaved VRE to quickly identify and segregate catalytically active (halo-forming) and inactive (non-halo-forming) variants. High-throughput DNA sequencing of 873 unique variants showed that the statistical fitness was predictive of the retention or loss of catalytic activity (area under the curve [AUC], 0.840 to 0.894), with the inclusion of more diverse sequences in the starting multiple-sequence alignment improving the classification accuracy when pairwise amino acid couplings (epistasis) were considered. Of eight random halo-forming variants selected for more sensitive testing, one showed a 1.8 (±0.4)-fold improvement in specific activity and an 11.5 ± 0.8°C increase in melting temperature compared to those of the wild type. Our results demonstrate that a computationally informed approach employing homologous protein information coupled with a mid-throughput screening assay allows for the expedited discovery of lysin variants with improved properties.IMPORTANCE Broad-spectrum antibiotics can indiscriminately kill most bacteria, including commensal species that are a part of the normal human flora. This can potentially lead to the proliferation of drug-resistant bacteria upon elimination of competing species and to unwanted autoimmune effects in patients. Bacteriophage-derived lysin proteins are an alternative to conventional antibiotics that have coevolved alongside specific bacterial hosts. Lysins are capable of targeting conserved substrates in the bacterial cell wall essential for its viability. To engineer these proteins to exhibit improved therapeutically relevant properties, homology-guided statistical approaches can be used to identify compelling sites for mutation and to quantify the functional constraints acting on these sites to direct mutagenic library creation. The platform described herein couples this informed approach with a visual plate assay that can be used to simultaneously screen hundreds of mutants for catalytic activity, allowing for the streamlined identification of improved lysin variants.
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Affiliation(s)
- Tsvetelina H Baryakova
- Department of Chemical Engineering and Materials Science, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Seth C Ritter
- Department of Chemical Engineering and Materials Science, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Daniel T Tresnak
- Department of Chemical Engineering and Materials Science, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Benjamin J Hackel
- Department of Chemical Engineering and Materials Science, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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Youssef A, Hafez H, Madney Y, Elanany M, Hassanain O, Lehmann LE, El Haddad A. Incidence, risk factors, and outcome of blood stream infections during the first 100 days post-pediatric allogeneic and autologous hematopoietic stem cell transplantations. Pediatr Transplant 2020; 24:e13610. [PMID: 31682054 DOI: 10.1111/petr.13610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/06/2019] [Accepted: 09/30/2019] [Indexed: 12/14/2022]
Abstract
Bloodstream infections (BSI) are a frequently observed complication after hematopoietic stem cell transplant (HSCT). Retrospective analysis of clinical and microbiological data during the first 100 days from 302 consecutive pediatric patients who underwent HSCT for a malignant disease at our institute between January 2013 and June 2017. A total of 164 patients underwent autologous and 138 allogeneic HSCT. The overall incidence of BSI was 37% with 92% of infectious episodes occurring during the pre-engraftment phase. Gram-positive bacteria (GPB) accounted for 54.6% of the isolated pathogens, gram-negative bacteria (GNB) for 43.9%, and fungi for 1.4%. Coagulase-negative staphylococci and Escherichia coli were the most commonly isolated GPB and GNB, respectively. Forty-five percent of GNB were extended-spectrum beta-lactamase producers and 21% were multidrug-resistant organisms. Fluoroquinolone resistance was 92% and 68%, among GPB and GNB, respectively. Risk factors for BSI in univariate analysis were allogeneic HSCT, delayed time to engraftment more than 12 days, previous BSI before HSCT, and alternative donor. In multivariate analysis, only HSCT type (allogeneic vs autologous P = .03) and previous BSI within 6 months before HSCT (P = .016) were significant. Overall survival at day 100 was 98% and did not differ significantly between patients with and without BSI (P = .76). BSI is common in children undergoing HSCT for malignant diseases. Allogeneic HSCT recipients and previous BSI within 6 months before HSCT are associated with increased risk of post-transplant BSI. With current supportive measures, BSI does not seem to confer an increased risk for 100-day mortality.
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Affiliation(s)
- Ahmed Youssef
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| | - Hanafy Hafez
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt.,Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Youssef Madney
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt.,Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Mervat Elanany
- Microbiology Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt.,Clinical Pathology Department, Cairo University, Cairo, Egypt
| | - Omneya Hassanain
- Biostatistics and Epidemiology Unit, Research Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| | - Leslie E Lehmann
- Pediatric Hematology-Oncology and Stem Cell Transplantation Unit, Dana Farber/Children's Hospital Cancer Care Center, Boston, MA, USA
| | - Alaa El Haddad
- Pediatric Oncology Department and Pediatric Stem Cell Transplantation Unit, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt.,Pediatric Oncology Department and Hematopoietic Stem Cell Transplantation, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
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72
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Correa-Martinez CL, Tönnies H, Froböse NJ, Mellmann A, Kampmeier S. Transmission of Vancomycin-Resistant Enterococci in the Hospital Setting: Uncovering the Patient-Environment Interplay. Microorganisms 2020; 8:microorganisms8020203. [PMID: 32024001 PMCID: PMC7074967 DOI: 10.3390/microorganisms8020203] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) are relevant nosocomial pathogens with an increasing incidence in the last decades. Their transmission is optimal in the hospital setting, as it offers two potential, large reservoirs that are closely related: susceptible patients and their environment. Here we investigate the role of the hospital environment in the nosocomial transmission of VRE by establishing concrete links between contaminated surfaces and colonized/infected patients in outbreak and non-outbreak settings. Environmental and patient VRE isolates were collected between 2013 and 2019 and analyzed by whole-genome sequencing (WGS), subsequent multilocus sequence typing (MLST), and core genome (cg) MLST. Pairs of isolates differing in <3 alleles were rated as closely related, making a transmission likely. Fifty-three environmental VRE isolates were analyzed. MLST sequence types (ST) ST203 (50.0%), ST192 (21.3%), ST117 (17.3%), ST721 (8.8%), ST80 (2%), and ST1489 (0.7%) were detected, carrying the resistance determinants vanA (72.7%), vanB (24%), or both (3.3%). Of the 53 environmental isolates, 51 were found to form five clusters with genetically related patient isolates (n = 97 isolates). WGS confirms the role of the environment in the transmission dynamics of VRE in both the outbreak and non-outbreak settings, highlighting the importance of prevention and control of VRE spread.
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Affiliation(s)
- Carlos L. Correa-Martinez
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany; (C.L.C.-M.); (H.T.); (A.M.)
| | - Hauke Tönnies
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany; (C.L.C.-M.); (H.T.); (A.M.)
| | - Neele J. Froböse
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149 Münster, Germany;
| | - Alexander Mellmann
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany; (C.L.C.-M.); (H.T.); (A.M.)
| | - Stefanie Kampmeier
- Institute of Hygiene, University Hospital Münster, Robert-Koch-Straße 41, 48149 Münster, Germany; (C.L.C.-M.); (H.T.); (A.M.)
- Correspondence: ; Tel.: +49-25-1835-2316
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73
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Dubler S, Lenz M, Zimmermann S, Richter DC, Weiss KH, Mehrabi A, Mieth M, Bruckner T, Weigand MA, Brenner T, Heininger A. Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study. Antimicrob Resist Infect Control 2020; 9:22. [PMID: 32005223 PMCID: PMC6995054 DOI: 10.1186/s13756-020-0683-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT). METHODS The outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycin-susceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days. RESULTS Mortality was similar between VRE- (n = 39) and VSE- (n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFANon-GCS score during the 7-day-period before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14-1.53; and HR 1.18; CI 1.08-1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders. CONCLUSION Vancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population. TRIAL REGISTRATION This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).
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Affiliation(s)
- S Dubler
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.
| | - M Lenz
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany.,Department of Anaesthesiology, Intensive Care and Emergency Medicine, Asklepios Clinics Hamburg, AK Wandsbek, Hamburg, Germany
| | - S Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Division Bacteriology, Heidelberg University Hospital, Heidelberg, Germany
| | - D C Richter
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - K H Weiss
- Department of Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - A Mehrabi
- Department of Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - M Mieth
- Department of Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - M A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - T Brenner
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, D-69120, Heidelberg, Germany
| | - A Heininger
- Division Hospital and Environmental Hygiene Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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Ndagi U, Falaki AA, Abdullahi M, Lawal MM, Soliman ME. Antibiotic resistance: bioinformatics-based understanding as a functional strategy for drug design. RSC Adv 2020; 10:18451-18468. [PMID: 35685616 PMCID: PMC9122625 DOI: 10.1039/d0ra01484b] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022] Open
Abstract
The use of antibiotics to manage infectious diseases dates back to ancient civilization, but the lack of a clear distinction between the therapeutic and toxic dose has been a major challenge. This precipitates the notion that antibiotic resistance was from time immemorial, principally because of a lack of adequate knowledge of therapeutic doses and continuous exposure of these bacteria to suboptimal plasma concentration of antibiotics. With the discovery of penicillin by Alexander Fleming in 1924, a milestone in bacterial infections' treatment was achieved. This forms the foundation for the modern era of antibiotic drugs. Antibiotics such as penicillins, cephalosporins, quinolones, tetracycline, macrolides, sulphonamides, aminoglycosides and glycopeptides are the mainstay in managing severe bacterial infections, but resistant strains of bacteria have emerged and hampered the progress of research in this field. Recently, new approaches to research involving bacteria resistance to antibiotics have appeared; these involve combining the molecular understanding of bacteria systems with the knowledge of bioinformatics. Consequently, many molecules have been developed to curb resistance associated with different bacterial infections. However, because of increased emphasis on the clinical relevance of antibiotics, the synergy between in silico study and in vivo study is well cemented and this facilitates the discovery of potent antibiotics. In this review, we seek to give an overview of earlier reviews and molecular and structural understanding of bacteria resistance to antibiotics, while focusing on the recent bioinformatics approach to antibacterial drug discovery. Understanding the evolution of antibiotic resistance at the molecular level as a functional tool for bioinformatic-based drug design.![]()
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Affiliation(s)
- Umar Ndagi
- Centre for Trans-Sahara Disease, Vaccine and Drug Research
- Ibrahim Badamasi Babangida University
- Lapai
- Nigeria
| | - Abubakar A. Falaki
- Department of Microbiology
- School of Agriculture and Applied Sciences
- University of KwaZulu-Natal
- Durban 4001
- South Africa
| | - Maryam Abdullahi
- Faculty of Pharmaceutical Sciences
- Ahmadu Bello University Zaria
- Nigeria
| | - Monsurat M. Lawal
- School of Laboratory Medicine and Medical Sciences
- University of KwaZulu-Natal
- Durban 4001
- South Africa
| | - Mahmoud E. Soliman
- Molecular Modeling and Drug Design Research Group
- School of Health Sciences
- University of KwaZulu Natal
- Durban 4001
- South Africa
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75
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Qi C, Xu S, Wu M, Zhu S, Liu Y, Huang H, Zhang G, Li J, Huang X. Pharmacodynamics Of Linezolid-Plus-Fosfomycin Against Vancomycin-Susceptible And -Resistant Enterococci In Vitro And In Vivo Of A Galleria mellonella Larval Infection Model. Infect Drug Resist 2019; 12:3497-3505. [PMID: 31814738 PMCID: PMC6858807 DOI: 10.2147/idr.s219117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/02/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives To explore the in vitro and in vivo antibacterial activity of linezolid/fosfomycin combination against vancomycin-susceptible and -resistant enterococci (VSE and VRE), and provide a theoretical basis for the treatment of VRE. Methods The checkerboard method and time-kill curve study were used to evaluate the efficacy of linezolid combined with fosfomycin against VSE and VRE. The transmission electron microscopy (TEM) was employed to observe the cell morphology of bacteria treated with each drug alone or in combination, which further elucidate the mechanism of action of antibiotic combination therapy. The Galleria mellonella infection model was constructed to demonstrate the in vivo efficacy of linezolid plus fosfomycin for VSE and VRE infection. Results The fractional inhibitory concentration index (FICI) values of all strains suggested that linezolid showed synergy or additivity in combination with fosfomycin against five of the six strains. Time-kill experiments demonstrated that the combination of linezolid-fosfomycin at 1×MIC or 2×MIC led to higher degree of bacterial killing without regrowth for all isolates tested than each monotherapy. TEM images showed that the combination treatment damaged the bacterial cell morphology more obviously than each drug alone. In the Galleria mellonella infection model, the enhanced survival rate of the combination treatment compared with linezolid monotherapy (P<0.05) was revealed. Conclusion Our data manifested that the combination of linezolid and fosfomycin was a potential therapeutic regimen for VRE infection. The combination displayed excellent bacterial killing and inhibited amplification of fosfomycin-resistant subpopulations.
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Affiliation(s)
- Caifen Qi
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China.,Department of Pharmacy, The Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui, People's Republic of China
| | - Shuangli Xu
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Maomao Wu
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Shuo Zhu
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Yanyan Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Hong Huang
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Guijun Zhang
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Xiaohui Huang
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, People's Republic of China
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76
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Cherkaoui A, Renzi G, Charretier Y, Blanc DS, Vuilleumier N, Schrenzel J. Automated Incubation and Digital Image Analysis of Chromogenic Media Using Copan WASPLab Enables Rapid Detection of Vancomycin-Resistant Enterococcus. Front Cell Infect Microbiol 2019; 9:379. [PMID: 31781516 PMCID: PMC6851235 DOI: 10.3389/fcimb.2019.00379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: The aim of the present study was to assess whether the WASPLab automation enables faster detection of vancomycin-resistant Enterococcus (VRE) on chromogenic VRE-specific plates by shortening the incubation time. Methods: Ninety different VRE culture negative rectal ESwab specimens were spiked with various concentrations (ranging from 3 × 102 to 3 × 107 CFU/ml) of 10 Enterococcus faecium strains (vancomycin MICs ranging from 32 to >256 mg/l), 3 E. faecium VanB strains (vancomycin MICs: 4, 8, and 16 mg/l), and 2 E. faecium VanB strains displaying vancomycin heteroresistance (vancomycin MICs: 64 and 96 mg/l). Results: Besides the two strains exhibiting vancomycin heteroresistance, all the other 13 VRE strains included in this study were detected as early as 24 h on the WASPLab even if the inoculum was low (3 × 103 CFU/ml). When the vancomycin MICs were high, all strains were detected as early as at 18 h. However, 30 h was a conservative time point for finalizing the analysis of chromogenic cultures. Conclusion: These results suggested that the WASPLab automated incubation could allow decreasing the initial incubation time to 18 h, followed by an intermediate time at 24 h and a final incubation period of 30 h for VRE culture screening, to deliver rapid results without affecting the analytical sensitivity.
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Affiliation(s)
- Abdessalam Cherkaoui
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Gesuele Renzi
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Yannick Charretier
- Genomic Research Laboratory, Division of Infectious Diseases, Department of Medical Specialities, Faculty of Medicine, Geneva, Switzerland
| | - Dominique S Blanc
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), Fribourg, Switzerland
| | - Nicolas Vuilleumier
- Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland.,Division of Laboratory Medicine, Department of Medical Specialities, Faculty of Medicine, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland.,Genomic Research Laboratory, Division of Infectious Diseases, Department of Medical Specialities, Faculty of Medicine, Geneva, Switzerland
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Zheng C, Cai J, Liu H, Zhang S, Zhong L, Xuan N, Zhou H, Zhang K, Wang Y, Zhang X, Tian B, Zhang Z, Wang C, Cui W, Zhang G. Clinical Characteristics And Risk Factors In Mixed-Enterococcal Bloodstream Infections. Infect Drug Resist 2019; 12:3397-3407. [PMID: 31802919 PMCID: PMC6827512 DOI: 10.2147/idr.s217905] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/02/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Although the enterococcal bloodstream infections (EBSI) are often observed in clinic, the mixed-EBSI are few reported. The aim of this study was to investigate the clinical characteristics and risk factors of mixed-EBSI in comparison with monomicrobial EBSI (mono-EBSI). Methods A single-center retrospective observational study was performed between Jan 1, 2013 and Dec 31, 2018 in a tertiary hospital. All patients with EBSI were enrolled, and their data were collected by reviewing electronic medical records. Results A total of 451 patients with EBSI were enrolled including 157 cases (34.8%) with mixed-EBSI. The most common co-pathogens were Coagulase-negative Staphylococcus (26.86%), followed by Acinetobacter baumannii (23.43%) and Klebsiella pneumoniae (8.57%). In multivariable analysis, burn injury (adjusted odds ratio [aOR], 7.39; 95% confidence interval [CI], 2.69-20.28), and length of prior hospital stay (aOR, 1.01; 95% CI, 1.00-1.02) were associated with mixed-EBSI. Patients with mixed-EBSI developed with more proportion of septic shock (19% vs. 31.8%, p=0.002), prolonged length of intensive care unit (ICU) stay [9(0,25) vs. 15(2.5,36), p<0.001] and hospital stay [29(16,49) vs. 33(18.5,63), p=0.031]. The mortality was not significantly different between mixed-EBSI and mono-EBSI (p=0.219). Conclusion A high rate of mixed-EBSI is among EBSI, and Acinetobacter baumannii is the second predominant co-existed species, except for Coagulase-negative Staphylococcus. Burn injury and length of prior hospital stay are independent risk factors for mixed-EBSI. Although the mortality is not different, patients with mixed-EBSI might have poor outcomes in comparison with mono-EBSI, which merits more attention by physicians in the future.
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Affiliation(s)
- Cheng Zheng
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China.,Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People's Republic of China
| | - Jiachang Cai
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Haizhou Liu
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China.,Department of Critical Care Medicine, Zhejiang Rehabilitation Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Shufang Zhang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, People's Republic of China
| | - Li Zhong
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China.,Department of Critical Care Medicine, Huzhou First People's Hospital, Huzhou, Zhejiang, People's Republic of China
| | - Nanxia Xuan
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Hongwei Zhou
- Clinical Microbiology Laboratory, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Kai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Yesong Wang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Xijiang Zhang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People's Republic of China
| | - Baoping Tian
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Zhaocai Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Changming Wang
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, People's Republic of China
| | - Wei Cui
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
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Lee RS, Gonçalves da Silva A, Baines SL, Strachan J, Ballard S, Carter GP, Kwong JC, Schultz MB, Bulach DM, Seemann T, Stinear TP, Howden BP. The changing landscape of vancomycin-resistant Enterococcus faecium in Australia: a population-level genomic study. J Antimicrob Chemother 2019; 73:3268-3278. [PMID: 30189014 DOI: 10.1093/jac/dky331] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background Vancomycin-resistant Enterococcus faecium (VREfm) represent a major source of nosocomial infection worldwide. In Australia, there has been a recent concerning increase in bacteraemia associated with the vanA genotype, prompting investigation into the genomic epidemiology of VREfm. Methods A population-level study of VREfm (10 November-9 December 2015) was conducted. A total of 321 VREfm isolates (from 286 patients) across Victoria State were collected and sequenced with Illumina NextSeq. SNPs were used to assess relatedness. STs and genes associated with resistance and virulence were identified. The vanA-harbouring plasmid from an isolate from each ST was assembled using long-read data. Illumina reads from remaining isolates were then mapped to these assemblies to identify their probable vanA-harbouring plasmid. Results vanA-VREfm comprised 17.8% of isolates. ST203, ST80 and a pstS(-) clade, ST1421, predominated (30.5%, 30.5% and 37.2%, respectively). Most vanB-VREfm were ST796 (77.7%). vanA-VREfm were more closely related within hospitals versus between them [core SNPs 10 (IQR 1-357) versus 356 (179-416), respectively], suggesting discrete introductions of vanA-VREfm, with subsequent intra-hospital transmission. In contrast, vanB-VREfm had similar core SNP distributions within versus between hospitals, due to widespread dissemination of ST796. Different vanA-harbouring plasmids were found across STs. With the exception of ST78 and ST796, Tn1546 transposons also varied. Phylogenetic analysis revealed Australian strains were often interspersed with those from other countries, suggesting ongoing cross-continental transmission. Conclusions Emerging vanA-VREfm in Australia is polyclonal, indicating repeat introductions of vanA-VREfm into hospitals and subsequent dissemination. The close relationship to global strains reinforces the need for ongoing screening and control of VREfm in Australia and abroad.
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Affiliation(s)
- Robyn S Lee
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia.,Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Level 5, Boston, MA, USA
| | - Anders Gonçalves da Silva
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Sarah L Baines
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Janet Strachan
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Susan Ballard
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Glen P Carter
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Jason C Kwong
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Mark B Schultz
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Dieter M Bulach
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Torsten Seemann
- Melbourne Bioinformatics Group, Lab-14, 700 Swanston Street, Carlton, Victoria, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- The Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Level 1, Melbourne, Victoria, Australia.,Infectious Diseases Department, Austin Health, Studley Rd, Heidelberg, Victoria, Australia
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Kim YJ, Jun YH, Choi HJ, You YK, Kim DG, Choi JY, Yoon SK, Kim SI. Impact of Enterococcal Bacteremia in Liver Transplant Recipients. Transplant Proc 2019; 51:2766-2770. [DOI: 10.1016/j.transproceed.2019.02.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/06/2019] [Indexed: 02/09/2023]
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80
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Blanquart F, Lehtinen S, Lipsitch M, Fraser C. The evolution of antibiotic resistance in a structured host population. J R Soc Interface 2019; 15:rsif.2018.0040. [PMID: 29925579 PMCID: PMC6030642 DOI: 10.1098/rsif.2018.0040] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/29/2018] [Indexed: 11/12/2022] Open
Abstract
The evolution of antibiotic resistance in opportunistic pathogens such as Streptococcus pneumoniae, Escherichia coli or Staphylococcus aureus is a major public health problem, as infection with resistant strains leads to prolonged hospital stay and increased risk of death. Here, we develop a new model of the evolution of antibiotic resistance in a commensal bacterial population adapting to a heterogeneous host population composed of untreated and treated hosts, and structured in different host classes with different antibiotic use. Examples of host classes include age groups and geographic locations. Explicitly modelling the antibiotic treatment reveals that the emergence of a resistant strain is favoured by more frequent but shorter antibiotic courses, and by higher transmission rates. In addition, in a structured host population, localized transmission in host classes promotes both local adaptation of the bacterial population and the global maintenance of coexistence between sensitive and resistant strains. When transmission rates are heterogeneous across host classes, resistant strains evolve more readily in core groups of transmission. These findings have implications for the better management of antibiotic resistance: reducing the rate at which individuals receive antibiotics is more effective to reduce resistance than reducing the duration of treatment. Reducing the rate of treatment in a targeted class of the host population allows greater reduction in resistance, but determining which class to target is difficult in practice.
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Affiliation(s)
- François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France .,IAME, UMR 1137, INSERM, Université Paris Diderot, Site Xavier Bichat, Paris, France.,Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Sonja Lehtinen
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christophe Fraser
- Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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81
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Jabbari Shiadeh SM, Pormohammad A, Hashemi A, Lak P. Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis. Infect Drug Resist 2019; 12:2713-2725. [PMID: 31564921 PMCID: PMC6731464 DOI: 10.2147/idr.s206084] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION One of the global concerns is the increasing trend toward antimicrobial resistance and the consequent lack of efficient antimicrobials. Nosocomial infections present a big threat for patients all over the world and treatment with broad-spectrum antibiotics leads to outgrowth of hospital-associated resistant Enterococci clones that are very important in bloodstream infections. We surveyed the frequency and time trend of antibiotic resistance in Enterococci blood isolates from hospitalized patients in different regions of the world. METHODS Literature from January 1, 2000 to May 20, 2018 was searched systematically using Medline (via PubMed), Embase, and Cochrane Library and all original publications on the antibiotic resistance prevalence in blood-isolated Enterococci strains with standard laboratory tests were included. Quality of the included studies was assessed with the modified Critical Appraisal Checklist recommended by the Joanna Briggs Institute. Depending on the heterogeneity test, we used either random or fixed effect models to assess the appropriateness of the pooled prevalence of drug resistance. RESULTS A total of 291 studies were enrolled in the meta-analysis. Between all antibiotics, based on the WHO original offices, American countries showed the lowest prevalence of resistance for linezolid in Enterococcus faecalis. Regarding the prevalence of vancomycin resistance, Western Pacific, European, and American countries had the lowest level of resistance and South-East Asia and Eastern Mediterranean countries showed the highest level of resistance. Moreover, our findings for Enterococcus faecium indicated that America and South-East Asia had the lowest and the highest levels of resistance for linezolid, respectively. CONCLUSION Based on our findings, the prevalence of vancomycin-resistant E. faecium in bloodstream infections is significantly high, especially in Eastern Mediterranean countries, which is a massive warning signal for resistance to this broad-spectrum antibiotic. Therefore, the establishment of appropriate antibiotic usage guidelines should be essential in these countries.
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Affiliation(s)
| | - Ali Pormohammad
- Student Research Committee, Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnian Lak
- Department of Cell and Tissue Biology, University of California San Francisco, San Francisco, CA, USA
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82
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Echeverria-Esnal D, Sorli L, Prim N, Conde-Estévez D, Mateu-De Antonio J, Martin-Ontiyuelo C, Horcajada JP, Grau S. Linezolid vs glycopeptides in the treatment of glycopeptide-susceptible Enterococcus faecium bacteraemia: A propensity score matched comparative study. Int J Antimicrob Agents 2019; 54:572-578. [PMID: 31476435 DOI: 10.1016/j.ijantimicag.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 08/19/2019] [Accepted: 08/24/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND The incidence of ampicillin-resistant Enterococcus faecium bacteraemia is increasing. Vancomycin remains the first-line treatment in areas with a high prevalence of glycopeptide-susceptible isolates, but data comparing its clinical outcomes with other treatments are lacking. The objective of this study was to compare the effectiveness and safety of linezolid and glycopeptides for the treatment of glycopeptide-susceptible E. faecium bloodstream infection (GSEF-BSI). METHODS This retrospective observational cohort study was conducted from January 2006 to May 2018 at the Hospital del Mar, Barcelona, Spain, and compared the clinical outcomes and safety of linezolid and glycopeptides in adult patients with GSEF-BSI. The main outcomes included clinical cure at the end of therapy, 30-day mortality, microbiological eradication and attributable length of stay (LOS). Propensity score matching was performed to reduce potential confounders among groups. RESULTS In total, 105 patients with GSEF-BSI were included (linezolid, n=38; glycopeptides, n=67). After propensity score matched analysis, 56 (53.3%) patients, 28 in each cohort, entered the final analysis. No differences were observed in any of the main clinical outcomes among patients treated with linezolid or glycopeptides: clinical cure [16/28 (57.1%) vs 13/28 (46.4%), P=0.593], 30-day mortality [8/28 (28.6%) vs 12/28 (42.9%), P=0.403], microbiological eradication [22/28 (78.6%) vs 20/28 (71.4%), P=0.758] and median attributable LOS (18.0 vs 17.0 days, P=0.924). Adverse events were similar in both groups. CONCLUSIONS Linezolid and glycopeptides showed similar clinical effectiveness and safety in the treatment of GSEF-BSI. Linezolid could be an alternative to glycopeptides in the treatment of GSEF-BSI.
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Affiliation(s)
- D Echeverria-Esnal
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Sorli
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Prim
- Service of Microbiology, Laboratori de Referència de Catalunya, Barcelona, Spain
| | - D Conde-Estévez
- Service of Pharmacy, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - J P Horcajada
- Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Grau
- Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain.
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83
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Zhang X, Bi W, Chen L, Zhang Y, Fang R, Cao J, Zhou T. Molecular mechanisms and epidemiology of fosfomycin resistance in enterococci isolated from patients at a teaching hospital in China, 2013-2016. J Glob Antimicrob Resist 2019; 20:191-196. [PMID: 31422238 DOI: 10.1016/j.jgar.2019.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/04/2019] [Accepted: 08/08/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the mechanisms of fosfomycin resistance and epidemiological characteristics in fosfomycin-resistant enterococci in China. METHODS A collection of 761 enterococcal clinical isolates from a teaching hospital in Wenzhou, China were studied. The fosfomycin susceptibility of the isolates was investigated by the agar dilution method. The isolates were also analysed for mechanisms of re fosfomycin resistance by PCR and quantitative real-time PCR. Furthermore, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed to analyse the molecular epidemiological characteristics of the fosfomycin-resistant isolates. RESULTS In this study, 0.3% (1/372) of Enterococcus faecalis and 4.9% (19/389) of Enterococcus faecium clinical isolates were found to be resistant to fosfomycin. Among the 20 fosfomycin-resistant isolates, 5 harboured the fosB gene, 10 carried multiple amino acid substitutions in MurA, and 6 showed high-level expression of the fosX gene; of note, 1 isolate simultaneously carried fosB and amino acid mutation in MurA. Furthermore, a high degree of homology in the fosfomycin-resistant enterococci was confirmed using MLST and PFGE. CONCLUSION These finding demonstrate that the fosB gene, mutations in the fosfomycin target enzyme MurA, and a high expression level of fosX were the resistance mechanisms in these fosfomycin-resistant enterococci.
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Affiliation(s)
- Xiucai Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wenzi Bi
- Department of Clinical Laboratory, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yizhi Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Renchi Fang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jianming Cao
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
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84
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Schuetz AN. Laboratory Antimicrobial Stewardship During an Outbreak of Linezolid- and Vancomycin-resistant Enterococcus faecium Bacteremia. Clin Infect Dis 2019; 69:266-267. [PMID: 30576431 DOI: 10.1093/cid/ciy1023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/29/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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85
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Ryu BH, Hong J, Jung J, Kim MJ, Sung H, Kim MN, Chong YP, Kim SH, Lee SO, Kim YS, Woo JH, Choi SH. Clinical characteristics and treatment outcomes of Enterococcus durans bacteremia: a 20-year experience in a tertiary care hospital. Eur J Clin Microbiol Infect Dis 2019; 38:1743-1751. [PMID: 31243595 DOI: 10.1007/s10096-019-03605-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/28/2019] [Indexed: 11/25/2022]
Abstract
While the clinical characteristics and treatment outcomes of Enterococcus faecalis and E. faecium bacteremia are well known, those of E. durans bacteremia are still largely unclear. We retrospectively identified 80 adult E. durans bacteremia cases treated at our 2700-bed tertiary care hospital between January 1997 and December 2016. We compared the clinical characteristics and treatment outcomes of the adult patients with E. durans bacteremia (case group) with those of E. faecalis and E. faecium bacteremia cases (two control groups). The case and control groups were matched for sex, age, and date of onset of bacteremia. E. durans was responsible for 1.2% of all enterococcal bacteremia cases at our hospital. Of 80 cases, 39 (48.8%) had biliary tract infection and 18 (22.5%) had urinary tract infection. Community-onset bacteremia was more frequent in the case group than in the control groups (56.2% vs. 35.0% vs. 21.2%, p < 0.01). Infective endocarditis tended to be more common in the E. durans group (7.5% vs. 1.2% vs. 1.2%, p = 0.05). The majority of E. durans isolates were susceptible to penicillin (66/76, 86.8%), ampicillin (67/76, 88.2%), and vancomycin (75/76, 98.7%). The case group had significantly lower all-cause mortality (20.0% vs. 31.2% vs. 42.5%, p < 0.01) and bacteremia-related mortality (2.5% vs. 16.2% vs. 18.8%, p < 0.01) than the control groups. E. durans bacteremia mainly originates from the biliary or urinary tract and is associated with a lower risk of mortality.
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Affiliation(s)
- Byung-Han Ryu
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jeongmin Hong
- Department of Infectious Diseases, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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86
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Fosfomycin for treatment of multidrug-resistant pathogens causing urinary tract infection: A real-world perspective and review of the literature. Diagn Microbiol Infect Dis 2019; 95:114856. [PMID: 31307867 DOI: 10.1016/j.diagmicrobio.2019.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/23/2022]
Abstract
Among 47 patients with urinary tract infections (UTIs) due to multidrug-resistant (MDR) bacteria, treatment with fosfomycin resulted in clinical cure rates of 87% and 94% at 48 hours and 14 days, respectively. Response rates did not vary across pathogens. Our retrospective, observational findings support fosfomycin treatment against MDR pathogens causing UTIs.
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87
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Prospective Observational Study of the Clinical Prognoses of Patients with Bloodstream Infections Caused by Ampicillin-Susceptible but Penicillin-Resistant Enterococcus faecalis. Antimicrob Agents Chemother 2019; 63:AAC.00291-19. [PMID: 31010856 DOI: 10.1128/aac.00291-19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate the clinical impacts of ampicillin-susceptible but penicillin-resistant (ASPR) phenotypes of Enterococcus faecalis on clinical outcomes in patients with bloodstream infection (BSI). A total of 295 patients with an E. faecalis BSI from six sentinel hospitals during a 2-year period (from May 2016 to April 2018) were enrolled in this study. Putative risk factors, including host-, treatment-, and pathogen-related variables, were assessed to determine the associations with the 30-day mortality rate of patients with an E. faecalis BSI. The proportion of ASPR E. faecalis isolates was 22.7% (67/295). ASPR isolates (adjusted odds ratio, 2.27; 95% confidence interval, 1.01 to 5.02) exhibited a significant association with an increased 30-day mortality rate, and a significant difference in survival was identified in a group of patients treated with ampicillin- and/or piperacillin-based regimens who were stratified according to the penicillin susceptibility of the causative pathogen (P = 0.011 by a log rank test). ASPR E. faecalis BSIs resulted in a >2-fold-higher 30-day mortality rate (26.9%; 18/67) than for the BSIs caused by penicillin-susceptible strains (12.3%; 28/228). The differences in mortality rates of patients stratified by penicillin susceptibility were likely due to the treatment failures of ampicillin and/or piperacillin in patients with an ASPR E. faecalis BSI.
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88
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Expansion of Vancomycin-Resistant Enterococcus faecium in an Academic Tertiary Hospital in Southwest Germany: a Large-Scale Whole-Genome-Based Outbreak Investigation. Antimicrob Agents Chemother 2019; 63:AAC.01978-18. [PMID: 30782988 DOI: 10.1128/aac.01978-18] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/13/2019] [Indexed: 12/11/2022] Open
Abstract
Vancomycin-resistant Enterococcus faecium (VREfm) is a frequent cause of nosocomial outbreaks. In the second half of 2015, a sharp increase in the incidence of VREfm was observed at our university medical center. Next-generation sequencing (NGS) was used to analyze the first isolates of VREfm recovered from patients between 2010 and 2016 (n = 773) in order to decipher epidemiological change, outbreak dynamics, and possible transmission routes. VREfm isolates were analyzed using whole-genome sequencing followed by sequence type extraction and phylogenetic analysis. We examined epidemiological data, room occupancy data, and patient transferals and calculated an intensity score for patient-to-patient contact. Phylogenetic analysis revealed the presence of 38 NGS clusters and 110 single clones. The increase of VREfm was caused mainly by the expansion of two newly introduced NGS clusters, comprising VanB-type strains determined by multilocus sequence typing (MLST) as sequence type 80 (ST80) and ST117. By combining phylogenetic information with epidemiological data, intrahospital transmission could be demonstrated, however to a lesser extent than initially expected based solely on epidemiological data. The outbreak clones were continuously imported from other hospitals, suggesting a change in the epidemiological situation at a regional scale. By tracking intrahospital patient transferals, two major axes could be identified that contributed to the spread of VREfm within the hospital. NGS-based outbreak analysis revealed a dramatic change in the local and regional epidemiology of VREfm, emphasizing the role of health care networks in the spread of VREfm.
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89
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Babiker A, Mustapha MM, Pacey MP, Shutt KA, Ezeonwuka CD, Ohm SL, Cooper VS, Marsh JW, Doi Y, Harrison LH. Use of online tools for antimicrobial resistance prediction by whole-genome sequencing in methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). J Glob Antimicrob Resist 2019; 19:136-143. [PMID: 31005733 DOI: 10.1016/j.jgar.2019.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/31/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The antimicrobial resistance (AMR) crisis represents a serious threat to public health and has resulted in concentrated efforts to accelerate development of rapid molecular diagnostics for AMR. In combination with publicly available web-based AMR databases, whole-genome sequencing (WGS) offers the capacity for rapid detection of AMR genes. Here we studied the concordance between WGS-based resistance prediction and phenotypic susceptibility test results for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) clinical isolates using publicly available tools and databases. METHODS Clinical isolates prospectively collected at the University of Pittsburgh Medical Center between December 2016 and December 2017 underwent WGS. The AMR gene content was assessed from assembled genomes by BLASTn search of online databases. Concordance between the WGS-predicted resistance profile and phenotypic susceptibility as well as the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each antibiotic/organism combination, using the phenotypic results as gold standard. RESULTS Phenotypic susceptibility testing and WGS results were available for 1242 isolate/antibiotic combinations. Overall concordance was 99.3%, with a sensitivity, specificity, PPV and NPV of 98.7% (95% CI 97.2-99.5%), 99.6% (95% CI 98.8-99.9%), 99.3% (95% CI 98.0-99.8%) and 99.2% (95% CI 98.3-99.7%), respectively. Additional identification of point mutations in housekeeping genes increased the concordance to 99.4%, sensitivity to 99.3% (95% CI 98.2-99.8%) and NPV to 99.4% (95% CI 98.4-99.8%). CONCLUSION WGS can be used as a reliable predicator of phenotypic resistance both for MRSA and VRE using readily available online tools.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Mustapha M Mustapha
- Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marissa P Pacey
- Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen A Shutt
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chinelo D Ezeonwuka
- Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sara L Ohm
- Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vaughn S Cooper
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jane W Marsh
- Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lee H Harrison
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Microbial Genomic Epidemiology Laboratory, Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA
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90
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Impact of Healthcare-Associated Infections on Length of Stay: A Study in 68 Hospitals in China. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2590563. [PMID: 31119159 PMCID: PMC6500696 DOI: 10.1155/2019/2590563] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/11/2019] [Indexed: 12/21/2022]
Abstract
Healthcare-associated infections (HAIs) not only bring additional medical cost to the patients but also prolong the length of stay (LOS). 2119 HAI case-patients and 2119 matched control-patients were identified in 68 hospitals in 14 primary sampling provinces of 7 major regions of China. The HAI caused an increase in stay of 10.4 days. The LOS due to HAI increased from 9.7 to 10.9 days in different levels of hospitals. There was no statistically significant difference in the increased LOS between different hospital levels. The increased LOS due to HAI in different regions was 8.2 to 12.6 days. Comparing between regions, we found that the increased LOS due to HAI in South China is longer than other regions except the Northeast. The gastrointestinal infection (GI) caused the shortest extra LOS of 6.7 days while the BSI caused the longest extra LOS of 12.8 days. The increased LOS for GI was significantly shorter than that of other sites. Among 2119 case-patients, the non-multidrug-resistant pathogens were detected in 365 cases. The average increased LOS due to these bacterial infections was 12.2 days. E. coli infection caused significantly shorter LOS. The studied MDROs, namely, MRSA, VRE, ESBLs-E. coli, ESBLs-KP, CR-E. coli, CR-KP, CR-AB, and CR-PA were detected in 381 cases (18.0%). The average increased LOS due to these MDRO infections was 14 days. Comparing between different MDRO infections, we found that the increased LOS due to HAI caused by CR-PA (26.5 days) is longer than other MDRO infections (shorter than 19.8 days).
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91
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Abdelbary MHH, Senn L, Greub G, Chaillou G, Moulin E, Blanc DS. Whole-genome sequencing revealed independent emergence of vancomycin-resistant Enterococcus faecium causing sequential outbreaks over 3 years in a tertiary care hospital. Eur J Clin Microbiol Infect Dis 2019; 38:1163-1170. [PMID: 30888549 DOI: 10.1007/s10096-019-03524-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/27/2019] [Indexed: 02/03/2023]
Abstract
Vancomycin-resistant Enterococcus faecium (VREfm) emerged as an important cause of nosocomial infections worldwide. Previous studies based on molecular typing revealed that VREfm outbreaks are mainly associated with a particular genetic lineage, namely clonal complex 17 (CC17), which harbours either vanA or vanB gene cluster. The University Hospital of Lausanne faced several VREfm episodes of transmissions between 2014 and 2017. In this study, we used whole-genome sequencing (WGS) to investigate the relatedness of 183 VREfm isolates collected from 156 patients. Sequence types (ST) 17, ST80 and ST117 were the most predominant clones. Based on epidemiological data, 10 outbreaks were identified, which were caused by at least 13 distinct genotypes. The majority of isolates involved in outbreaks (91%) differed by only 0 to 3 SNPs. Four outbreaks involved more than one genotype and half of the cases considered as sporadic were possibly linked to an outbreak. By sequencing all isolates, we were able to better understand our local epidemiology of VREfm. The polyclonal structure observed between the different outbreaks strains, the high level of recombination detected in isolates, the time elapsed between admission and the first VREfm detection and the negative screening at admission support the hypothesis of the emergence of new VREfm clones within the hospitalised population.
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Affiliation(s)
- Mohamed H H Abdelbary
- Service of hospital preventive medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Division of Oral Microbiology and Immunology, Department of Operative and Preventive Dentistry and Periodontology, RWTH Aachen University Hospital, Aachen, Germany
| | - Laurence Senn
- Service of hospital preventive medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Gregory Chaillou
- Service of hospital preventive medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Estelle Moulin
- Service of hospital preventive medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Dominique S Blanc
- Service of hospital preventive medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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92
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Chanderraj R, Millar JA, Patel TS, Read AF, Washer L, Kaye KS, Woods RJ. Vancomycin-Resistant Enterococcus Acquisition in a Tertiary Care Hospital: Testing the Roles of Antibiotic Use, Proton Pump Inhibitor Use, and Colonization Pressure. Open Forum Infect Dis 2019; 6:ofz139. [PMID: 31024976 PMCID: PMC6475592 DOI: 10.1093/ofid/ofz139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/12/2019] [Indexed: 02/07/2023] Open
Abstract
Background Vancomycin-resistant Enterococcus (VRE) is a leading cause of healthcare-associated infections, and asymptomatic colonization precedes infection. VRE continues to spread despite widespread application of pathogen-specific control guidelines. A better understanding of the risk factors for transmission is needed. Methods A retrospective matched case-control study was performed from June 2013 through December 2016 in a single institution. Patients in 6 intensive care units, 1 hematology and oncology unit, and 1 bone marrow transplant unit were screened by means of rectal swab sampling on admission and weekly thereafter. Case patients had a negative swab sample followed by a positive sample >3 days after admission. Controls were closely matched to case patients based on time from admission to the second swab sample, unit in which the second sample was obtained, and date of admission. Comorbidity data, procedures, healthcare settings and exposures, culture data, and duration of antibiotic and proton pump inhibitor (PPI) therapy were abstracted from the electronic medical record. A multivariable risk factor model for conversion was generated using purposeful selection. Results A total of 551 case patients were matched with controls. The largest modifiable effects on VRE acquisition were ≥1 day of vancomycin therapy (odd ratio, 1.98; P < .001), ≥1 day of aerobic antibiotic therapy (1.90; P < .001), and a dose-dependent effect of PPI therapy (odds ratio per day of therapy, 1.09; P < .001). Colonization pressures from patients identified to be carriers and placed in contact precautions did not confer increased risk. Conclusions Decreasing PPI use and preventing the inappropriate initiation of antibiotic therapy are modifiable targets to decrease VRE transmission in the hospital.
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93
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Pfaller MA, Cormican M, Flamm RK, Mendes RE, Jones RN. Temporal and Geographic Variation in Antimicrobial Susceptibility and Resistance Patterns of Enterococci: Results From the SENTRY Antimicrobial Surveillance Program, 1997-2016. Open Forum Infect Dis 2019; 6:S54-S62. [PMID: 30895215 PMCID: PMC6419914 DOI: 10.1093/ofid/ofy344] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background The SENTRY Antimicrobial Surveillance Program was established in 1997 and presently encompasses more than 750 000 bacterial isolates from over 400 medical centers worldwide. Among these pathogens, enterococci represents a prominent cause of bloodstream (BSIs), intra-abdominal (IAIs), skin and skin structure, and urinary tract infections (UTIs). In the present study, we reviewed geographic and temporal trends in Enterococcus species and resistant phenotypes identified throughout the SENTRY Program. Methods From 1997 to 2016, a total of 49 491 clinically significant enterococci isolates (15 species) were submitted from 298 medical centers representing the Asia-Pacific (APAC), European, Latin American (LATAM), and North American (NA) regions. Bacteria were identified by standard algorithms and matrix-assisted laser desorption ionization–time of flight mass spectrometry. Susceptibility (S) testing was performed by reference broth microdilution methods and interpreted using Clinical and Laboratory Standards Institute/US Food and Drug Administration and European Committee on Antimicrobial Susceptibility Testing criteria. Results The most common Enterococcus species in all 4 regions were Enterococcus faecalis (64.7%) and E. faecium (EFM; 29.0%). Enterococci accounted for 10.7% of BSIs in NA and was most prominent as a cause of IAIs (24.0%) in APAC and of UTIs (19.8%) in LATAM. A steady decrease in the susceptibility to ampicillin and vancomycin was observed in all regions over the 20-year interval. Vancomycin-resistant enterococci (VRE) accounted for more than 8% of enterococcal isolates in all regions and was most common in NA (21.6%). Among the 7615 VRE isolates detected, 89.1% were the VanA phenotype (91.0% EFM) and 10.9% were VanB. Several newer antimicrobial agents demonstrated promising activity against VRE, including daptomycin (99.6–100.0% S), linezolid (98.0%–99.6% S), oritavancin (92.2%–98.3% S), tedizolid (99.5%–100.0% S), and tigecycline (99.4%–100.0% S). Conclusions Enterococci remained a prominent gram-positive pathogen in the SENTRY Program from 1997 through 2016. The overall frequency of VRE was 15.4% and increased over time in all monitored regions. Newly released agents with novel mechanisms of action show promising activity against VRE.
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94
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Blanquart F. Evolutionary epidemiology models to predict the dynamics of antibiotic resistance. Evol Appl 2019; 12:365-383. [PMID: 30828361 PMCID: PMC6383707 DOI: 10.1111/eva.12753] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022] Open
Abstract
The evolution of resistance to antibiotics is a major public health problem and an example of rapid adaptation under natural selection by antibiotics. The dynamics of antibiotic resistance within and between hosts can be understood in the light of mathematical models that describe the epidemiology and evolution of the bacterial population. "Between-host" models describe the spread of resistance in the host community, and in more specific settings such as hospitalized hosts (treated by antibiotics at a high rate), or farm animals. These models make predictions on the best strategies to limit the spread of resistance, such as reducing transmission or adapting the prescription of several antibiotics. Models can be fitted to epidemiological data in the context of intensive care units or hospitals to predict the impact of interventions on resistance. It has proven harder to explain the dynamics of resistance in the community at large, in particular because models often do not reproduce the observed coexistence of drug-sensitive and drug-resistant strains. "Within-host" models describe the evolution of resistance within the treated host. They show that the risk of resistance emergence is maximal at an intermediate antibiotic dose, and some models successfully explain experimental data. New models that include the complex host population structure, the interaction between resistance-determining loci and other loci, or integrating the within- and between-host levels will allow better interpretation of epidemiological and genomic data from common pathogens and better prediction of the evolution of resistance.
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Affiliation(s)
- François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERMPSL Research UniversityParisFrance
- IAME, UMR 1137, INSERMUniversité Paris DiderotParisFrance
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95
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Lui SL, Yap D, Cheng V, Chan TM, Yuen KY. Clinical practice guidelines for the provision of renal service in Hong Kong: Infection Control in Renal Service. Nephrology (Carlton) 2019; 24 Suppl 1:98-129. [PMID: 30900339 PMCID: PMC7167703 DOI: 10.1111/nep.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | - Desmond Yap
- Department of MedicineThe University of Hong KongHong Kong
| | - Vincent Cheng
- Department of MicrobiologyQueen Mary HospitalHong Kong
| | - Tak Mao Chan
- Department of MedicineThe University of Hong KongHong Kong
| | - Kwok Yung Yuen
- Department of MicrobiologyThe University of Hong KongHong Kong
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96
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A retrospective cohort study of antibiotic exposure and vancomycin-resistant Enterococcus recolonization. Infect Control Hosp Epidemiol 2019; 40:414-419. [PMID: 30729903 DOI: 10.1017/ice.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed "decolonized," defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, "recolonized"), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics. METHODS In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients. RESULTS In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx-) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively. CONCLUSION Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.
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97
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Elstrøm P, Astrup E, Hegstad K, Samuelsen Ø, Enger H, Kacelnik O. The fight to keep resistance at bay, epidemiology of carbapenemase producing organisms (CPOs), vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) in Norway, 2006 - 2017. PLoS One 2019; 14:e0211741. [PMID: 30716133 PMCID: PMC6361454 DOI: 10.1371/journal.pone.0211741] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/18/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Scandinavian countries have traditionally had a low prevalence of resistant organisms, but have in recent years experienced a change in their epidemiology. We aim to describe the epidemiology of carbapenemase-producing organisms (CPOs), vancomycin-resistant enterococci (VRE) and methicillin-resistant S. aureus (MRSA) in Norway, measure the importance of infections contracted abroad, and assess the morbidity and mortality associated with these resistant bacteria in Norway. METHODS AND MATERIALS We used data from the Norwegian surveillance system for communicable diseases covering all findings of the selected resistant bacteria including both infections and colonisation, in the period 2006-2017. Annual trends were assessed using negative binomial regression. For MRSA, we were able to calculate the Morisita-Horn index and transmission numbers following importation in order to assess the effect this had on further domestic transmission. RESULTS The incidence rates (per 100,000 personyears) of the three groups of resistant bacteria have increased during the period. In 2017 the incidence rates were 0.82 for CPOs, 7.09 for VRE and 43.8 for MRSA. 81% of CPO cases were diagnosed in hospitals, but 73% were infected abroad. Most VRE cases were infected in Norwegian hospitals, 85% were associated with hospitals outbreaks. MRSA was predominantly diagnosed in the community, only 21% were diagnosed in hospitals. Of all MRSA cases, 35% were infected in other countries. Most MRSA spa-types were not identified again after introduction, resulting in a transmission of MRSA equivalent to a mean of 0.30 persons infected from each spa-type identified (range: 0-22). The proportion of infections among all notified cases within each diagnose was 44% for MRSA, 9% for VRE and 45% for CPOs. Among persons notified with bacteraemia, the 30 days all-cause mortality were 20%, 16% and 50% for MRSA, VRE and CPOs respectively. DISCUSSION The incidence rates of CPOs, VRE and MRSA in Norway are low, but increasing. The continuing increase of notified resistant bacteria highlights the need for a revision of existing infection prevention and control guidelines.
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Affiliation(s)
- Petter Elstrøm
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Astrup
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Hegstad
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Research Group of Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Ørjan Samuelsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Microbial Pharmacology and Population Dynamics Research Group, Department of Pharmacy, Faculty of Health Sciences, University of Tromsø –The Artic University of Norway, Tromsø, Norway
| | - Hege Enger
- Norwegian Reference Laboratory for MRSA, St. Olavs University Hospital, Trondheim, Norway
| | - Oliver Kacelnik
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
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98
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Weber S, Hogardt M, Reinheimer C, Wichelhaus TA, Kempf VAJ, Kessel J, Wolf S, Serve H, Steffen B, Scheich S. Bloodstream infections with vancomycin-resistant enterococci are associated with a decreased survival in patients with hematological diseases. Ann Hematol 2019; 98:763-773. [PMID: 30666433 DOI: 10.1007/s00277-019-03607-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.
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Affiliation(s)
- Sarah Weber
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany. .,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Michael Hogardt
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center of Competence for Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Johanna Kessel
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Medicine, Infectious Diseases Unit, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Wolf
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Hubert Serve
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Björn Steffen
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Scheich
- Department of Hematology and Oncology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
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Remschmidt C, Schneider S, Meyer E, Schroeren-Boersch B, Gastmeier P, Schwab F. Surveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI). DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:858-865. [PMID: 29271345 DOI: 10.3238/arztebl.2017.0858] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 01/20/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The project entitled Surveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI) was initiated in Germany in 2000. In this article, we describe developments in antibiotic use and resistance rates in the participating intensive care units over the years 2001-2015. METHODS The intensive care units supplied monthly figures on patient days, antibiotic use (in defined daily doses, DDD), and resistance data for 13 pathogens. The density of antibiotic use per 1000 patient days was calculated on the basis of antibiotic use, DDD, and patient days, and the resistance density per 1000 patient days was calculated from the number of resistant pathogens. RESULTS In the years 2001-2015, data on 2 920 068 patient days were collected in 77 intensive care units. The average overall antibiotic use rose by 19% over this period, with a marked increase in the density of carbapenem use (from 76 to 250 DDD per 1000 patient days, +230%) and piperacillin-tazobactam use (from 42 to 146 DDD per 1000 patient days, +247%). The proportion of Escherichia coli and Klebsiella pneumoniae isolates that were resistant to third-generation cephalosporins increased markedly initially, then remained stable over the remainder of the observation period. The proportion of methicillin-resistant Staphylococcus aureus was stable over the entire period. The rates of vancomycin resistance among Enterococcus faecium isolates and imipenem resistance among gram-negative pathogens increased from 2.3% to 13.3% and from 0.1% to 0.3%, respectively. CONCLUSION The resistance density of gram-negative multiresistant pathogens in the participating intensive care units increased markedly. The rise in imipenem-resistant pathogens arouses particular concern. The increased use of broad-spectrum/reserve antibiotics may well have contributed to this development. Efforts to use antibiotics rationally, e.g., with the support of multidisciplinary "antibiotic stewardship" teams, are therefore vitally important. As participation in SARI is voluntary, these surveillance data cannot be considered representative of Germany as a whole.
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Affiliation(s)
- Cornelius Remschmidt
- Institute of Hygiene and Environmental Medicine, Charitέ - Universitätsmedizin Berlin; Institute for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg
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100
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Kramer TS, Remschmidt C, Werner S, Behnke M, Schwab F, Werner G, Gastmeier P, Leistner R. The importance of adjusting for enterococcus species when assessing the burden of vancomycin resistance: a cohort study including over 1000 cases of enterococcal bloodstream infections. Antimicrob Resist Infect Control 2018; 7:133. [PMID: 30459945 PMCID: PMC6234683 DOI: 10.1186/s13756-018-0419-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/11/2018] [Indexed: 01/27/2023] Open
Abstract
Background Infections caused by vancomycin-resistant enterococci (VRE) are on the rise worldwide. Few studies have tried to estimate the mortality burden as well as the financial burden of those infections and found that VRE are associated with increased mortality and higher hospital costs. However, it is unclear whether these worse outcomes are attributable to vancomycin resistance only or whether the enterococcal species (Enterococcus faecium or Enterococcus faecalis) play an important role. We therefore aimed to determine the burden of enterococci infections attributable to vancomycin resistance and pathogen species (E. faecium and E. faecalis) in cases of bloodstream infection (BSI). Methods We conducted a retrospective cohort study on patients with BSI caused by Enterococcus faecium or Enterococcus faecalis between 2008 and 2015 in three tertiary care hospitals. Data was collected on true hospital costs (in €), length of stay (LOS), basic demographic parameters, and underlying diseases including the results of the Charlson comorbidity index (CCI). We used univariate and multivariable regression analyses to compare risk factors for in-hospital mortality and length of stay (i) between vancomycin-susceptible E. faecium- (VSEm) and vancomycin-susceptible E. faecalis- (VSEf) cases and (ii) between vancomycin-susceptible E. faecium- (VSEm) and vancomycin-resistant E. faecium-cases (VREm). We calculated total hospital costs for VSEm, VSEf and VREm. Results Overall, we identified 1160 consecutive cases of BSI caused by enterococci: 596 (51.4%) cases of E. faecium BSI and 564 (48.6%) cases of E. faecalis BSI. 103 cases of E. faecium BSI (17.3%) and 1 case of E. faecalis BSI (0.2%) were infected by vancomycin-resistant isolates. Multivariable analyses revealed (i) that in addition to different underlying diseases E. faecium was an independent risk factor for in-hospital mortality and prolonged hospital stay and (ii) that vancomycin-resistance did not further increase the risk for the described outcomes among E. faecium-isolates. However, the overall hospital costs were significantly higher in VREm-BSI cases as compared to VSEm- and VSEf-BSI cases (80,465€ vs. 51,365€ vs. 31,122€ p < 0.001). Conclusion Our data indicates that in-hospital mortality and infection-attributed hospital stay in enterococci BSI might rather be influenced by Enterococcus species and underlying diseases than by vancomycin resistance. Therefore, future studies should consider adjusting for Enterococcus species in addition to vancomycin resistance in order to provide a conservative estimate for the burden of VRE infections. Electronic supplementary material The online version of this article (10.1186/s13756-018-0419-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Siegfried Kramer
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Cornelius Remschmidt
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Sven Werner
- 3Department of Medical and Financial Controlling, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Behnke
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Frank Schwab
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Guido Werner
- 4Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany.,National Reference Centre for Staphylococci and Enterococci, Berlin, Germany
| | - Petra Gastmeier
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - Rasmus Leistner
- 1Charité Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
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