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Logan LK, Gandra S, Mandal S, Klein EY, Levinson J, Weinstein RA, Laxminarayan R. Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012. J Pediatric Infect Dis Soc 2017; 6:352-359. [PMID: 27856730 PMCID: PMC5907855 DOI: 10.1093/jpids/piw064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a common cause of healthcare-associated infection. Multidrug-resistant (MDR) (>3 classes) and carbapenem-resistant (CR) P aeruginosa are significant threats globally. We used a large reference-laboratory database to study the epidemiology of P aeruginosa in children in the United States. METHODS Antimicrobial susceptibility data from the Surveillance Network were used to phenotypically identify MDR and CR P aeruginosa isolates in children aged 1 to 17 years between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of MDR and CR P aeruginosa. Isolates from infants (<1 year old) and patients with cystic fibrosis were excluded. RESULTS Among the isolates tested, the crude proportion of MDR P aeruginosa increased from 15.4% in 1999 to 26% in 2012, and the proportion of CR P aeruginosa increased from 9.4% in 1999 to 20% in 2012. The proportion of both MDR and CR P aeruginosa increased each year by 4% (odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03-1.04] and 1.04 [95% CI, 1.04-1.05], respectively). In multivariable analysis, both MDR and CR P aeruginosa were more common in the intensive care setting, among children aged 13 to 17 years, in respiratory specimens, and in the West North Central region. In addition, resistance to other antibiotic classes (aminoglycosides, fluoroquinolones, cephalosporins, and piperacillin-tazobactam) often used to treat P aeruginosa increased. CONCLUSIONS Rates of MDR and CR P aeruginosa infection in children are rising nationally. Aggressive prevention strategies, including instituting antimicrobial stewardship programs in pediatric settings, are essential for combating antimicrobial resistance.
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Affiliation(s)
- Latania K Logan
- Departments of Pediatrics
- Section of Pediatric Infectious Diseases, Rush Medical College, Rush University Medical Center, Chicago, Illinois
- Cook County Health and Hospitals System, Chicago, Illinois
| | - Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | | | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jordan Levinson
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Robert A Weinstein
- Internal Medicine, Division of Infectious Diseases
- Cook County Health and Hospitals System, Chicago, Illinois
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Public Health Foundation of India, New Delhi
- Princeton University, Princeton, New Jersey
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Pobiega M, Maciag J, Pomorska-Wesolowska M, Chmielarczyk A, Romaniszyn D, Ziolkowski G, Heczko PB, Wojkowska-Mach J, Bulanda M. Urinary tract infections caused by Pseudomonas aeruginosa among children in Southern Poland: Virulence factors and antibiotic resistance. J Pediatr Urol 2016; 12:36.e1-6. [PMID: 26320394 DOI: 10.1016/j.jpurol.2015.05.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to analyze antibiotic resistance and virulence patterns in Pseudomonas aeruginosa (PAR) isolates from urinary tract infections among children in Southern Poland. MATERIALS AND METHODS This study comprised consecutive, non-repetitive PAR isolates sent from two collaborative laboratories. The study group consisted of children aged up to 17 years from Southern Poland with culture-proven PAR UTIs. Relevant information about patients with UTIs, such as age, sex, and type of infection (polymicrobial or monomicrobial), was collected. Isolates were screened for major virulence factors found in uropathogenic PAR strains. Multidrug-resistant (MDR) strains were defined as strains not susceptible to one antimicrobial in at least three different antimicrobial classes. Extensively drug resistant (XDR) strains were defined as strains susceptible to no more than two antimicrobial classes. RESULTS The total prevalence of PAR UTIs was 2.1%, and in children <5 years of age it was 3.0%. A total of 26 isolates was tested: 21 from outpatients and five from inpatients. Most infections (80.8%) occurred in children ≤ 4 years of age. The most prevalent virulence gene was exoY (96.2%). The prevalence of other effector proteins was 88.5% for exoT, 92.3% for exoS, and 19.2% for exoU. The gene for LasB was present in 80.8% of isolates; the gene for AprA in 61.5%; the gene for PilA in 19.2%; and the gene for PilB was not detected. The PAR isolates were generally susceptible to beta-lactam and aminoglycoside antimicrobials. All isolates were also susceptible to colistin. A large proportion of isolates were resistant to carbapenems and fluoroquinolones (Fig. 1). No significant differences were found in antimicrobial resistance between males and females or inpatients and outpatients (p > 0.05 for all tested antimicrobials), or in antimicrobial resistance between younger (≤ 5 years old, n = 21) and older (> 5 years old, n = 5) children (p > 0.05 for all tested antimicrobials). Two isolates were classified as XDR and none as MDR. The EDTA test yielded one MBL-positive isolate (3.8%), from a 17-year-old patient in home care. No isolates with genes for the KPC, IMP, or VIM were identified. CONCLUSION As data on UTIs in children with Pseudomonas etiology are scarce, this paper provides useful information for clinicians and allows for comparison between Poland and other countries. Our findings have important implications for clinicians treating UTIs empirically, because the success of empiric treatment is based on knowledge of pathogen antimicrobial susceptibility patterns.
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Affiliation(s)
- M Pobiega
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland.
| | - J Maciag
- Institute of Dentistry, Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, Poland
| | - M Pomorska-Wesolowska
- Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska KORLAB NZOZ, Ruda Slaska, Poland
| | - A Chmielarczyk
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - D Romaniszyn
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - P B Heczko
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - J Wojkowska-Mach
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
| | - M Bulanda
- Department of Microbiology, Jagiellonian University Medical College, Krakow, Poland
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Moore SS, Bahat H, Rachmiel M, Ziv-Baran T, Youngster I, Goldman M. Guidelines for urinary tract infections and antenatal hydronephrosis should be gender specific. Acta Paediatr 2015; 104:e512-7. [PMID: 26173376 DOI: 10.1111/apa.13129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/19/2015] [Accepted: 07/09/2015] [Indexed: 01/10/2023]
Abstract
AIM Febrile urinary tract infections (UTIs) may be associated with long-term renal damage. Our goal was to identify risk factors for future UTIs in children who had voiding cystourethrography (VCUG) as a part of an antenatal hydronephrosis (ANH) assessment or after a febrile UTI. METHODS We conducted a cohort study based on the medical records of children aged 0-24 months who underwent a VCUG between January 2004 and December 2011 and had at least six months of follow-up. The incidence of future UTIs was assessed. RESULTS We included 285 children: 176 had a primary UTI and 109 had ANH. We recorded 28 UTIs during the follow-up period, and the risk was 12.5% after a primary UTI and 5.5% after an ANH (p = 0.049). Multivariate analysis showed no risk difference was found between the groups. Females had a greater risk of febrile UTIs (hazard ratio 3.3, 95% confidence interval 1.03-9.2, p = 0.04), but the UTI risk did not differ between children with or without VURs. CONCLUSION Female infants were at greater risk of febrile UTIs, regardless of the presence of VUR, VUR degree, ANH or a previous UTI. Clinical guidelines for UTI and ANH assessment should preferably be gender specific.
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Affiliation(s)
- Shiran S. Moore
- Department of Paediatrics; Meir Medical Centre; Kfar Saba Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Hilla Bahat
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Mariana Rachmiel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ilan Youngster
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Michael Goldman
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
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Zhang X, Niu S, Zhang L. Antimicrobial susceptibilities and clinical characterization of Pseudomonas aeruginosa isolates from urinary tract infections. Urol Int 2014; 93:464-9. [PMID: 24642393 DOI: 10.1159/000358493] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pseudomonas aeruginosa is a uropathogen that is mainly involved in nosocomial infection. The aim of this study was to analyze the antimicrobial susceptibilities and clinical characterization of P. aeruginosa isolates from urinary tract infections (UTIs). MATERIALS AND METHODS The study collected all P. aeruginosa UTI strains from a hospital in Chongqing, China, from January 1st, 2010 to December 31st, 2011. The antibiotic susceptibilities of the P. aeruginosa isolates were analyzed using the agar dilution method and the genotypes were assessed using random amplification of polymorphic DNA-PCR (RAPD-PCR). The clinical characteristics of the patients with UTIs were collected from the hospital information systems, and significance was analyzed using the proportion test. RESULTS A total of 2,778 episodes of culture-proven UTIs were used in the study. There were 198 infections (7.1%) caused by P. aeruginosa. P. aeruginosa strains were highly resistant to most drugs tested. The RAPD-PCR data revealed that the 198 P. aeruginosa infections had 82 different genotypes. Antibacterial use, previous UTI, urinary tract catheter and urinary tract operation were found to be risk factors for the development of UTIs. CONCLUSIONS P. aeruginosa is the second most common UTI pathogen in our hospital. We should closely monitor patients with risk factors for P. aeruginosa infection.
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Affiliation(s)
- Xiaobing Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Pseudomonas Aeruginosa Urinary Tract Infection in Children: Risk Factors and Outcomes. J Urol 2012; 187:260-4. [DOI: 10.1016/j.juro.2011.09.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Indexed: 11/17/2022]
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Abstract
Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines.
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Chen CH, Lan SK, Lin YH, Tsai YS. Community-acquired Pseudomonas aeruginosa Epididymo-orchitis With Abscess Formation in a Prepubertal Boy. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Current world literature. Curr Opin Pediatr 2009; 21:272-80. [PMID: 19307901 DOI: 10.1097/mop.0b013e32832ad5c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mena KD, Gerba CP. Risk assessment of Pseudomonas aeruginosa in water. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2009; 201:71-115. [PMID: 19484589 DOI: 10.1007/978-1-4419-0032-6_3] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
P. aeruginosa is part of a large group of free-living bacteria that are ubiquitous in the environment. This organism is often found in natural waters such as lakes and rivers in concentrations of 10/100 mL to >1,000/100 mL. However, it is not often found in drinking water. Usually it is found in 2% of samples, or less, and at concentrations up to 2,300 mL(-1) (Allen and Geldreich 1975) or more often at 3-4 CFU/mL. Its occurrence in drinking water is probably related more to its ability to colonize biofilms in plumbing fixtures (i.e., faucets, showerheads, etc.) than its presence in the distribution system or treated drinking water. P. aeruginosa can survive in deionized or distilled water (van der Jooij et al. 1982; Warburton et al. 1994). Hence, it may be found in low nutrient or oligotrophic environments, as well as in high nutrient environments such as in sewage and in the human body. P. aeruginosa can cause a wide range of infections, and is a leading cause of illness in immunocompromised individuals. In particular, it can be a serious pathogen in hospitals (Dembry et al. 1998). It can cause endocarditis, osteomyelitis, pneumonia, urinary tract infections, gastrointestinal infections, and meningitis, and is a leading cause of septicemia. P. aeruginosa is also a major cause of folliculitis and ear infections acquired by exposure to recreational waters containing the bacterium. In addition, it has been recognized as a serious cause of keratitis, especially in patients wearing contact lenses. P. aeruginosa is also a major pathogen in burn and cystic fibrosis (CF) patients and causes a high mortality rate in both populations (MOlina et al. 1991; Pollack 1995). P. aeruginosa is frequently found in whirlpools and hot tubs, sometimes in 94-100% of those tested at concenrations of <1 to 2,400 CFU/mL. The high concentrations found probably result from the relatively high temperatures of whirlpools, which favor the growth of P. aeruginosa, and the aeration which also enhances its growth. The organism is usually found in whirlpools when the chlorine concentrations are low, but it has been isolated even in the presence of 3.00 ppm residual free chlorine (Price and Ahearn 1988). Many outbreaks of folliculitis and ear infections have been reportedly associated with the use of whirlpools and hot tubs that contain P. aeruginosa (Ratnam et al. 1986). Outbreaks have also been reported from exposure to P. aeruginosa in swimming pools and water slides. Although P. aeruginosa has a reputation for being resistant to disinfection, most studies show that it does not exhibit any marked resistance to the disinfectants used to treat drinking water such as chlorine, chloramines, ozone, or iodine. One author, however, did find it to be slightly more resistant to UV disinfection than most other bacteria (Wolfe 1990). Although much has been written about biofilms in the drinking water industry, very little has been reported regarding the role of P. aeruginosa in biofilms. Tap water appears to be a significant route of transmission in hospitals, from colonization of plumbing fixtures. It is still not clear if the colonization results from the water in the distribution system, or personnel use within the hospital. Infections and colonization can be significantly reduced by placement of filters on the water taps. The oral dose of P. aeruginosa required to establish colonization in a healthy subject is high (George et al. 1989a). During dose-response studies, even when subjects (mice or humans) were colonized via ingestion, there was no evidence of disease. P. aeruginosa administered by the aerosol route at levels of 10(7) cells did cause disease symptoms in mice, and was lethal in aerosolized doses of 10(9) cells. Aerosol dose-response studies have not been undertaken with human subjects. Human health risks associated with exposure to P. aeruginosa via drinking water ingestion were estimated using a four-step risk assessment approach. The risk of colonization from ingesting P. aeruginosa in drinking water is low. The risk is slightly higher if the subject is taking an antibiotic resisted by P. aeruginosa. The fact that individuals on ampicillin are more susceptible to Pseudomonas gastrointestinal infection probably results from suppression of normal intestinal flora, which would allow Pseudomonas to colonize. The process of estimating risk was significantly constrained because of the absence of specific (quantitative) occurrence data for Pseudomonas. Sensitivity analysis shows that the greatest source of variability/uncertainty in the risk assessment is from the density distribution in the exposure rather than the dose-response or water consumption distributions. In summary, two routes appear to carry the greatest health risks from contacting water contaminated with P. aeruginosa (1) skin exposure in hot tubs and (2) lung exposure from inhaling aerosols.
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Affiliation(s)
- Kristina D Mena
- University of Texas-Houston School of Public Health, Houston, Texas, USA.
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Zhang J, Koh J, Lu J, Thiel S, Leong BSH, Sethi S, He CYX, Ho B, Ding JL. Local inflammation induces complement crosstalk which amplifies the antimicrobial response. PLoS Pathog 2009; 5:e1000282. [PMID: 19180241 PMCID: PMC2629585 DOI: 10.1371/journal.ppat.1000282] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 12/27/2008] [Indexed: 12/20/2022] Open
Abstract
By eliciting inflammatory responses, the human immunosurveillance system notably combats invading pathogens, during which acute phase proteins (CRP and cytokines) are elevated markedly. However, the Pseudomonas aeruginosa is a persistent opportunistic pathogen prevalent at the site of local inflammation, and its acquisition of multiple antibiotic-resistance factors poses grave challenges to patient healthcare management. Using blood samples from infected patients, we demonstrate that P. aeruginosa is effectively killed in the plasma under defined local infection-inflammation condition, where slight acidosis and reduced calcium levels (pH 6.5, 2 mM calcium) typically prevail. We showed that this powerful antimicrobial activity is provoked by crosstalk between two plasma proteins; CRPratioL-ficolin interaction led to communication between the complement classical and lectin pathways from which two amplification events emerged. Assays for C4 deposition, phagocytosis, and protein competition consistently proved the functional significance of the amplification pathways in boosting complement-mediated antimicrobial activity. The infection-inflammation condition induced a 100-fold increase in CRPratioL-ficolin interaction in a pH- and calcium-sensitive manner. We conclude that the infection-induced local inflammatory conditions trigger a strong interaction between CRPratioL-ficolin, eliciting complement-amplification pathways which are autonomous and which co-exist with and reinforce the classical and lectin pathways. Our findings provide new insights into the host immune response to P. aeruginosa infection under pathological conditions and the potential development of new therapeutic strategies against bacterial infection.
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Affiliation(s)
- Jing Zhang
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore
| | - Jingyun Koh
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Jinhua Lu
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Steffen Thiel
- Department of Medical Microbiology and Immunology, University of Aarhus, Aarhus, Denmark
| | | | - Sunil Sethi
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cynthia Y. X. He
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Bow Ho
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeak L. Ding
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
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