51
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Yu WL, Winokur PL, Von Stein DL, Pfaller MA, Wang JH, Jones RN. First description of Klebsiella pneumoniae harboring CTX-M beta-lactamases (CTX-M-14 and CTX-M-3) in Taiwan. Antimicrob Agents Chemother 2002; 46:1098-100. [PMID: 11897596 PMCID: PMC127095 DOI: 10.1128/aac.46.4.1098-1100.2002] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Klebsiella pneumoniae isolates from Taiwan medical centers (50 strains; 1998 to 2000) with a CTX-M resistance phenotype (ceftazidime susceptible and ceftriaxone or cefotaxime nonsusceptible) were selected for initial isoelectric focusing analysis. beta-Lactamases with pIs of 7.9 (n = 22) and 8.4 (n = 28) in addition to 5.4 and/or 7.6 were detected. DNA gene sequencing identified the beta-lactamases with pIs of 7.9 and 8.4 as CTX-M-14 and CTX-M-3, respectively. Molecular typing suggested inter- and intrahospital clonal dissemination of these Taiwanese CTX-M-producing Klebsiella strains.
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Affiliation(s)
- Wen Liang Yu
- University of Iowa College of Medicine, Iowa City, USA.
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52
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Chanawong A, M'Zali FH, Heritage J, Xiong JH, Hawkey PM. Three cefotaximases, CTX-M-9, CTX-M-13, and CTX-M-14, among Enterobacteriaceae in the People's Republic of China. Antimicrob Agents Chemother 2002; 46:630-7. [PMID: 11850241 PMCID: PMC127467 DOI: 10.1128/aac.46.3.630-637.2002] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Of 15 extended-spectrum beta-lactamase (ESBL)-producing isolates of the family Enterobacteriaceae collected from the First Municipal People's Hospital of Guangzhou, in the southern part of the People's Republic of China, 9 were found to produce CTX-M ESBLs, 3 produced SHV-12, and 3 produced both CTX-M and SHV-12. Eleven isolates produced either TEM-1B or SHV-11, in addition to an ESBL. Nucleotide sequence analysis of the 12 isolates carrying bla(CTX-M) genes revealed that they harbored three different bla(CTX-M) genes, bla(CTX-M-9) (5 isolates), bla(CTX-M-13) (1 isolate), and bla(CTX-M-14) (6 isolates). These genes have 98% nucleotide homology with bla(Toho-2). The bla(CTX-M) genes were carried on plasmids that ranged in size from 35 to 150 kb. Plasmid fingerprints and pulsed-field gel electrophoresis showed the dissemination of the bla(CTX-M) genes through transfer of different antibiotic resistance plasmids to different bacteria, suggesting that these resistance determinants are highly mobile. Insertion sequence ISEcp1, found on the upstream region of these genes, may be involved in the translocation of the bla(CTX-M) genes. This is the first report of the occurrence of SHV-12 and CTX-M ESBLs in China. The presence of strains with these ESBLs shows both the evolution of bla(CTX-M) genes and their dissemination among at least three species of the family Enterobacteriaceae, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, isolated within a single hospital. The predominance of CTX-M type enzymes seen in this area of China appears to be similar to that seen in South America but is different from those seen in Europe and North America, suggesting different evolutionary routes and selective pressures. A more comprehensive survey of the ESBL types from China is urgently needed.
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53
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Abstract
While some trends in antimicrobial resistance rates are universal, others appear to be unique for specific regions. In Taiwan, the strikingly high prevalence of resistance to macrolides and streptogramin in clinical isolates of gram-positive bacteria correlates with the widespread use of these agents in the medical and farming communities, respectively. The relatively low rate of enterococci that are resistant to glycopeptide does not parallel the high use of glycopeptides and extended-spectrum beta-lactams in hospitals. The evolving problem of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates is substantial, and some unique enzymes have been found. Recently, some gram-negative bacteria (e.g., Pseudomonas aeruginosa and Acinetobacter baumannii) that are resistant to all available antimicrobial agents including carbapenems have emerged.
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Affiliation(s)
- Po-Ren Hsueh
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Liu
- Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Kwen-Tay Luh
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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54
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Wong-Beringer A, Hindler J, Loeloff M, Queenan AM, Lee N, Pegues DA, Quinn JP, Bush K. Molecular correlation for the treatment outcomes in bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae with reduced susceptibility to ceftazidime. Clin Infect Dis 2002; 34:135-46. [PMID: 11740699 DOI: 10.1086/324742] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2001] [Revised: 07/24/2001] [Indexed: 11/04/2022] Open
Abstract
Data are limited on outcomes of treatment with extended-spectrum cephalosporins (ESCs) for infections caused by Enterobacteriaceae that produce extended-spectrum beta-lactamases (ESBLs). This study describes the largest treatment experience of a nonoutbreak series of bloodstream infections caused by strains of Escherichia coli (23 episodes) and Klebsiella pneumoniae (13 episodes) with a ceftazidime minimal inhibitory concentration of > or =2 microg/mL. E. coli isolates produced a greater variety of beta-lactamase types than did K. pneumoniae isolates, among which ESBL production was predominant. Five ESBL types were identified: TEM-12, TEM-71, TEM-6, SHV-12, and SHV-5. Most patients were treated empirically with an ESC-based regimen. A favorable response to treatment with a nonceftazidime ESC was observed when the causative pathogen produced either TEM-6 or TEM-12; ceftazidime treatment was associated with failure of therapy in all patients. Despite the limited clinical success, ESCs are currently not recommended for the treatment of serious infections caused by ESBL-producing strains.
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Affiliation(s)
- Annie Wong-Beringer
- Western University of Health Sciences, College of Pharmacy, Pomona, CA 91766, USA.
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55
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Extended Spectrum Beta-lactamases in Gram-negative Sepsis. Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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56
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Hsueh PR, Chen ML, Sun CC, Chen WH, Pan HJ, Yang LS, Chang SC, Ho SW, Lee CY, Hsieh WC, Luh KT. Antimicrobial drug resistance in pathogens causing nosocomial infections at a university hospital in Taiwan, 1981-1999. Emerg Infect Dis 2002; 8:63-8. [PMID: 11749750 PMCID: PMC2730256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
To determine the distribution and antimicrobial drug resistance in bacterial pathogens causing nosocomial infections, surveillance data on nosocomial infections documented from 1981 to 1999 at National Taiwan University Hospital were analyzed. During this period, 35,580 bacterial pathogens causing nosocomial infections were identified. Candida species increased considerably, ranking first by 1999 in the incidence of pathogens causing all nosocomial infections, followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida species also increased in importance as bloodstream infection isolates, from 1.0% in 1981-1986 to 16.2% in 1999. The most frequent isolates from urinary tract infections were Candida species (23.6%), followed by Escherichia coli (18.6%) and P. aeruginosa (11.0%). P. aeruginosa remained the most frequent isolates for respiratory tract and surgical site infections in the past 13 years. A remarkable increase in incidence was found in methicillin-resistant S. aureus (from 4.3% in 1981-1986 to 58.9% in 1993-1998), cefotaxime-resistant E. coli (from 0% in 1981-1986 to 6.1% in 1993-1998), and cefotaxime-resistant Klebsiella pneumoniae (from 4.0% in 1981-1986 to 25.8% in 1993-1998). Etiologic shifts in nosocomial infections and an upsurge of antimicrobial resistance among these pathogens, particularly those isolated from intensive care units, are impressive and alarming.
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Affiliation(s)
- Po-Ren Hsueh
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Ling Chen
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Hui-Ju Pan
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Seh Yang
- National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Shen-Wu Ho
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yu Lee
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Kwen-Tay Luh
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
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57
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Hsueh PR, Chen ML, Sun CC, Chen WH, Pan HJ, Yang LS, Chang SC, Ho SW, Lee CY, Hsieh WC, Luh KT. [Hormonal contraception and epilepsy]. AKUSHERSTVO I GINEKOLOGIIA 2002; 42:18-21. [PMID: 11799750 PMCID: PMC2730256 DOI: 10.3201/eid0801.000454] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Attempts to optimize quality of life in woman with epilepsy should include a reliable method for birth control, including oral contraceptives (OC). One of these methods is hormonal oral contraception. The classic antiepileptic drugs (AEDs)--Phenytoin, Phenobarbital, Ethosuximide and Carbamazepine induce hepatic microsomal enzymes and decrease the production of estradiol and progesterone, that may be compromise the effects of OC. Recommendation for women taking OC include possible use of noninducing AEDs (Valproic acid), new AEDs--Lamotrigine, Gabapentin, Topiramate, Tiagabine or for patients taking inducing AEDs use of an OC containing > or = 50 micrograms. estrogen. Patients should be warned that midcycle bleeding indicates possible OC failure and that the absence of such bleeding is not an indication of OC effectiveness. Additional contraceptive methods are also advised. The authors report their own experience in 12 women taking AEDs and OC.
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Affiliation(s)
- Po-Ren Hsueh
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Ling Chen
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Hui-Ju Pan
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Seh Yang
- National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Shen-Wu Ho
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yu Lee
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Kwen-Tay Luh
- National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
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58
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Chang FY, Siu LK, Fung CP, Huang MH, Ho M. Diversity of SHV and TEM beta-lactamases in Klebsiella pneumoniae: gene evolution in Northern Taiwan and two novel beta-lactamases, SHV-25 and SHV-26. Antimicrob Agents Chemother 2001; 45:2407-13. [PMID: 11502506 PMCID: PMC90669 DOI: 10.1128/aac.45.9.2407-2413.2001] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 113 blood culture isolates of Klebsiella pneumoniae from 10 hospitals in northern Taiwan were studied for SHV and TEM beta-lactamase production. bla(SHV) was amplified from all isolates by PCR. TEM-type resistance, was found in 32 of the isolates and was of the TEM-1 type in all isolates. SHV-1, -2, -5, -11, and -12 and two novel enzymes were identified. These novel enzymes were designated SHV-25 and SHV-26 and had pIs of 7.5 and 7.6, respectively. Amino acid differences in comparison to the amino acid sequence of bla(SHV-1) were found at positions T18A (ThrACC-->AlaGCC), L35Q (LeuCTA-->GluCAA), and M129V (MetATG-->ValGTG) for SHV-25 and at position A187T (AlaGCC-->ThrACC) for SHV-26. The results of substrate profiles and MIC determinations showed that the novel enzymes did not hydrolyze extended-spectrum cephalosporins, rendering the isolates susceptible to these agents. Inhibition profiles revealed that the 50% inhibitory concentration for SHV-26 was higher than those for SHV-1 and SHV-25, resulting in an intermediate resistance to amoxicillin-clavulanic acid. Forty-nine ribotypes were identified, suggesting that major clonal spread had not occurred in any of the hospitals. According to the amino acid sequence, SHV beta-lactamases in Taiwan may basically be derived through stepwise mutation from SHV-1 or SHV-11 and further subdivided by four routes. The stepwise mutations initiated from SHV-1 or SHV-11 to SHV-2, SHV-5, and SHV-12 comprise the evolutionary change responsible for extended-spectrum beta-lactamase (ESBL) production in Taiwan. The stepwise mutations that lead to a non-ESBL (SHV-25) and the beta-lactamase (SHV-26) with reduced susceptibility to clavulanic acid are possibly derived from SHV-11 and SHV-1, respectively. The results suggest a stepwise evolution of SHV beta-lactamases in Taiwan.
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Affiliation(s)
- F Y Chang
- Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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59
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Paterson DL, Ko WC, Von Gottberg A, Casellas JM, Mulazimoglu L, Klugman KP, Bonomo RA, Rice LB, McCormack JG, Yu VL. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001; 39:2206-12. [PMID: 11376058 PMCID: PMC88112 DOI: 10.1128/jcm.39.6.2206-2212.2001] [Citation(s) in RCA: 378] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although extended-spectrum beta-lactamases (ESBLs) hydrolyze cephalosporin antibiotics, some ESBL-producing organisms are not resistant to all cephalosporins when tested in vitro. Some authors have suggested that screening klebsiellae or Escherichia coli for ESBL production is not clinically necessary, and when most recently surveyed the majority of American clinical microbiology laboratories did not make efforts to detect ESBLs. We performed a prospective, multinational study of Klebsiella pneumoniae bacteremia and identified 10 patients who were treated for ESBL-producing K. pneumoniae bacteremia with cephalosporins and whose infecting organisms were not resistant in vitro to the utilized cephalosporin. In addition, we reviewed 26 similar cases of severe infections which had previously been reported. Of these 36 patients, 4 had to be excluded from analysis. Of the remaining 32 patients, 100% (4 of 4) patients experienced clinical failure when MICs of the cephalosporin used for treatment were in the intermediate range and 54% (15 of 28) experienced failure when MICs of the cephalosporin used for treatment were in the susceptible range. Thus, it is clinically important to detect ESBL production by klebsiellae or E. coli even when cephalosporin MICs are in the susceptible range (<or = 8 microg/ml) and to report ESBL-producing organisms as resistant to aztreonam and all cephalosporins (with the exception of cephamycins).
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Affiliation(s)
- D L Paterson
- Infectious Disease Division, University of Pittsburgh VA Medical Center, University Dr. C, Pittsburgh, PA 15240, USA
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60
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Abstract
Infection caused by organisms resistant to conventional antimicrobial therapy is an emerging problem of global proportions. This article describes the epidemiology of infections caused by resistant organisms in chronically critically ill patients and explores factors and mechanisms that lead to the development of resistance. Specific organisms and strategies for the treatment and control of these resistance organisms are discussed.
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Affiliation(s)
- D D Poutsiaka
- Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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61
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Donnelly JP. Infection in the neutropenic and haematopoietic stem cell transplant recipient. Curr Opin Infect Dis 2000; 13:337-342. [PMID: 11964799 DOI: 10.1097/00001432-200008000-00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patterns of bacterial infection have remained fairly static with Gram-positive bacteria predominating, although this varies between institutions and between patient populations. Similarly, antimicrobial resistance rates differ widely and reflect antibiotic use and exposure. Hence, each institution should devote microbiological resources to maintain surveillance and employ vigilance so that antimicrobial treatment protocols can be adapted to meet any new challenges. Most changes are being seen in the diagnosis of fungal infections, particularly aspergillosis, and the way in which it is being incorporated into treatment strategies.
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Affiliation(s)
- J. Peter Donnelly
- Department of Haematology, University Medical Center, St Radboud, Nijmegen, The Netherlands
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