1
|
Lin J, Li Y, Fang T, Wang T, Liao K, Zhao Q, Wang D, Chen M, Zhu X, Chen Y, Chen H, Guo Y, Zhan L, Zhang J, Zhang T, Zeng P, Peng Y, Yang L, Cai C, Guo Z, He X. Substantial decline of organ preservation fluid contamination following adoption of ischemia-free liver transplantation: a post-hoc analysis. Int J Surg 2024; 110:2855-2864. [PMID: 38329144 PMCID: PMC11093427 DOI: 10.1097/js9.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Preservation fluid (PF) contaminations are common in conventional liver transplantation (CLT) and presumably originate from organ or PF exposures to the external environment in a non-strict sterile manner. Such exposures and PF contamination may be avoided in ischaemia-free liver transplantation (IFLT) because of the strict sterile surgical procedures. In this study, the authors evaluated the impact of IFLT on organ PF contamination. METHODS A post-hoc analysis using data from the first randomized controlled trial of IFLT was performed to compare the incidence, pathogenic spectrum of PF contamination, and incidence of early recipient infection between IFLT and CLT. Multivariable logistic regression was used to explore risk factors for PF contamination. RESULTS Of the 68 cases recruited in the trial, 64 were included in this post-hoc analysis. The incidence of culture-positive PF was 9.4% (3/32) in the IFLT group versus 78.1% (25/32) in the CLT group ( P <0.001). Three microorganisms were isolated from PF in the IFLT group, while 43 were isolated in the CLT group. The recipient infection rate within postoperative day 14 was 3.1% (1/32) in the IFLT group vs 15.6% (5/32) in the CLT group, although this difference did not reach statistical significance ( P =0.196). Multivariate analysis revealed that adopting IFLT is an independent protective factor for culture-positive PF. CONCLUSION PF contamination is substantially decreased in IFLT, and IFLT application is an independent protective factor for PF contamination. Using rigorous sterile measures and effective antibiotic therapy during IFLT may decrease PF contamination.
Collapse
|
2
|
Shahid M, Saeed NK, Ahmad N, Shadab M, Joji RM, Al-Mahmeed A, Bindayna KM, Tabbara KS, Ismaeel AY, Dar FK. Molecular Screening of Carbapenem-Resistant K. pneumoniae (CRKP) Clinical Isolates for Concomitant Occurrence of Beta-Lactam Genes (CTX-M, TEM, and SHV) in the Kingdom of Bahrain. J Clin Med 2023; 12:7522. [PMID: 38137591 PMCID: PMC10744081 DOI: 10.3390/jcm12247522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/05/2023] [Accepted: 11/14/2023] [Indexed: 12/24/2023] Open
Abstract
The emergence of extended-spectrum β-lactamase-producing Klebsiella pneumoniae, including CRKP infections, has resulted in significant morbidity and mortality worldwide. We aimed to explore the presence of bla genes (CTX-M, TEM, and SHV) in CRKP isolates. A total of 24 CRKP isolates were randomly selected from the Salmaniya Medical Complex Microbiology Laboratory. These isolates, which were positive for carbapenemases, were further explored for CTX-M, TEM, and SHV genes using PCR. All the CTX-M PCR amplicons were sent for sequencing. To determine genetic relatedness, molecular typing by ERIC-PCR was performed. The bla gene testing demonstrated that a significant proportion of these isolates harbored SHV, CTX-M, and TEM genes (100%, 91.6%, and 45.8%), respectively. Bioinformatic analyses confirmed CTX-M-15 in these isolates. ERIC-PCR analysis showed three clusters demonstrating genetic relatedness. The study findings reveal the concomitant carriage of the SHV and CTX-M-15 and a comparatively lower carriage of TEM genes in CRKP isolates. Our findings highlight the significance of routinely reporting the presence of antibiotic resistance genes along with regular antibiotic sensitivity reports, as this will aid clinicians in prescribing appropriate antibiotics.
Collapse
Affiliation(s)
- Mohammad Shahid
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Nermin Kamal Saeed
- Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Manama 435, Bahrain;
| | - Nayeem Ahmad
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Mohd Shadab
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Ronni Mol Joji
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Ali Al-Mahmeed
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Khalid M. Bindayna
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Khaled Saeed Tabbara
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Abdulrahman Y. Ismaeel
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| | - Fazal K. Dar
- Department of Microbiology, Immunology, and Infectious Diseases, College of Medicine & Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; (N.A.); (M.S.); (R.M.J.); (A.A.-M.); (K.M.B.); (K.S.T.); (A.Y.I.); (F.K.D.)
| |
Collapse
|
3
|
Eltahlawi RA, Jiman-Fatani A, Gad NM, Ahmed SH, Al-Rabia MW, Zakai S, Kharaba A, El-Hossary D. Detection of Carbapenem-resistance in CRE by Comparative Assessment of RAPIDEC ® CARBA NP and Xpert™Carba-R Assay. Infect Drug Resist 2023; 16:1123-1131. [PMID: 36855392 PMCID: PMC9968435 DOI: 10.2147/idr.s393739] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Carbapenem-resistant Enterobacteriaceae (CRE) infections resist nearly most available antimicrobials, resulting in poor clinical outcomes. Saudi Arabia has a relatively high CRE prevalence. This study aims to evaluate the sensitivity of Rapidec Carba NP test and GeneXpert Carba-R assay compared with conventional manners for detection of carbapenemase-producing Enterobacteriaceae. Methods This is a cross-sectional study including a total of 90 CRE isolates examined at two tertiary hospitals in KSA from October 2020 to December 2021. Gram-negative Enterobacteriaceae were identified by using Vitek 2 system and were furtherly tested for imipenem and meropenem susceptibility by E- test strips, followed by Rapidec Carba NP test and the Xpert™Carba-R assay. Results Carbapenem-resistant K. pneumoniae (78.9%) and carbapenem-resistant E. coli (14.4%) were the two most common isolates species. Colistin (98.9%) and tigecycline (88.9%) were the most effective antibiotics against CRE isolates, followed by amikacin (52.2%), gentamicin (33.3%), cotrimoxazole (15.6%), and ciprofloxacin (8.9%). blaOXA-48 was the predominant carbapenemase gene (44.4%), followed by blaNDM (32.2%). blaKPC gene was not detected. The Rapidec Carba NP and the Xpert™Carba-R demonstrated an overall sensitivity of 69.3% and 88%, respectively, in comparison to gold standard detection of meropenem and imipenem resistance by Vitek 2 system and E- test strips. Discussion RAPIDEC® CARBA NP may be a beneficial screening test for detecting CRE, but for confirmation of the results, Xpert Carba-R assay is more sensitive, significantly lowering the turnaround time compared to reference traditional methods. The information on carbapenemase genes may be used for epidemiologic purposes and outbreak management.
Collapse
Affiliation(s)
- Rehab A Eltahlawi
- Department of Microbiology, College of Medicine, Taibah University, Taibah, Saudi Arabia,Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Asif Jiman-Fatani
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Clinical and Molecular Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Niveen M Gad
- Clinical Microbiology Laboratory, King Fahd Hospital, Medina, Saudi Arabia,Medical Microbiology and Immunology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Shereen H Ahmed
- Medical Microbiology and Immunology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohammed W Al-Rabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Health Promotion Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shadi Zakai
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ayman Kharaba
- Intensive Care Unit, King Fahad Hospital, Madinah, Saudi Arabia
| | - Dalia El-Hossary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt,Correspondence: Dalia El-Hossary, Email
| |
Collapse
|
4
|
Alsultan A, Dasuqi SA, Aljamaan F, Omran RA, Syed SA, AlJaloud T, AlAhmadi A, Alqahtani S, Hamad MA. Pharmacokinetics of meropenem in critically ill patients in Saudi Arabia. Saudi Pharm J 2021; 29:1272-1277. [PMID: 34819789 PMCID: PMC8596159 DOI: 10.1016/j.jsps.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background Meropenem is commonly used in the ICU to treat gram-negative infections. Due to various pathophysiological changes, critically ill patients are at higher risk of having subtherapeutic concentrations and hence have a higher risk of treatment failure—especially in regions where gram-negative drug resistance is increasing, such as Saudi Arabia. No studies have evaluated the pharmacokinetics of meropenem in critically ill patients in Saudi Arabia. Our primary objective is to assess the percentage of patients achieving the therapeutic target for meropenem. Methods This prospective observational study was conducted in the ICUs of King Khalid University Hospital. Patient were included if >18 years-of-age and received meropenem for a clinically suspected or proven bacterial infection. The primary outcome was to assess the percentage of patients who achieved the pharmacokinetic/pharmacodynamic (PKPD) therapeutic target of a free trough concentration four times the MIC. The secondary outcome was to estimate the pharmacokinetics of meropenem. Pharmacokinetic analysis was performed using Monolix Suite 2020R1 (Lixoft, France). Results Trough concentrations were highly variable and ranged from <0.5 µg/mL to 39 µg/mL, with a mean ± SD trough concentration of 8.5 ± 8 µg/mL. Only 46% of patients achieved the therapeutic target. The only significant predictor of failing to achieve the PKPD target was augmented renal clearance. Conclusion In conclusion, more than half of our patients did not achieve the PKPD target. Thus, there is a need for better dosing strategies of meropenem in critically ill patients in Saudi Arabia such as extended and continuous infusion.
Collapse
Affiliation(s)
- Abdullah Alsultan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Clinical Pharmacokinetics and Pharmacodynamics Unit, King Saud University Medical City, Riyadh, Saudi Arabia
- Corresponding author at: Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
| | - Shereen A. Dasuqi
- Department of Pharmacy, King Khalid University Hospital, King Saudi University Medical City, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- Critical Care Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Rasha A. Omran
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, University of Jordan, Amman Jordan
| | - Saeed Ali Syed
- Department of Pharmaceutical; Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Turki AlJaloud
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah AlAhmadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Saeed Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Clinical Pharmacokinetics and Pharmacodynamics Unit, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammed A. Hamad
- Critical Care Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Al Musawi S, Ur Rahman J, Aljaroodi SA, AlShammari L, Itbaileh A, Mohammed H, Saeed N, Abdalhamid B, Alkharsah KR, Aljindan RY. mCIM test as a reliable assay for the detection of CRE in the Gulf region. J Med Microbiol 2021; 70. [PMID: 34232118 DOI: 10.1099/jmm.0.001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Carbapenem resistant Enterobacterales (CRE) are one of the leading causes of systemic and nosocomial infections and are multidrug-resistant organisms producing different carbapenemases. There are many genotypic and phenotypic methods for detecting the carbapenemases; however, there is a limitation for each. Modified carbapenem inactivation method (mCIM) assay is a recent phenotypic method which has been published by the Clinical and Laboratory Standards Institute.Hypothesis / Gap Statement. mCIM assay could provide a reliable method for the detection of carbapenemases in CRE.Aim. Evaluation of the mCIM assay performance for the detection of carbapenemases in Enterobacterales and the identification of the common carbapenemase genes at Eastern Province of Saudi Arabia and Kingdom of Bahrain.Methodology. A collection of 197 non-duplicate carbapenem resistant Enterobacterales clinical isolates, were evaluated with the mCIM test comparing its performance to multiplex PCR. The minimum inhibitory concentration susceptibility testing was done by the Etest method for imipenem, meropenem, and ertapenem.Results. The sensitivity of the mCIM assay was 94 % (95 % CI, (89.3-97.1)). In Saudi Arabia and Bahrain, OXA-48 was the most prevalent carbapenemase gene followed by NDM. Coexistence of multiple carbapenemase genes is reported in eleven cases.Conclusion. These findings indicate that the mCIM test is a reliable and simple assay for detecting the activity of carbapenemase in Enterobacterales, especially in resource-limited laboratories.
Collapse
Affiliation(s)
- Safiya Al Musawi
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Jawad Ur Rahman
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Salma Ali Aljaroodi
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Lateefah AlShammari
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Ahmed Itbaileh
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Hessa Mohammed
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Nermin Saeed
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Baha Abdalhamid
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Khaled R Alkharsah
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Reem Y Aljindan
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| |
Collapse
|
6
|
Alhifany AA, Alqurashi AF, Al-Agamy MH, Alkhushaym N, Alhomoud F, Alhomoud FK, Almangour TA. Employment of Mapping Technology in Antimicrobial Resistance Reporting in Saudi Arabia. GEOSPATIAL HEALTH 2020; 15. [PMID: 32575972 DOI: 10.4081/gh.2020.868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 06/11/2023]
Abstract
Although Antimicrobial Resistance (AMR) is a worldwide threat, local AMR databases do not exist. Unlike other health disasters, developing containment strategies for AMR cannot be started without a representative, local, updated AMR data. However, Geographical Information Systems (GIS) mapping technology is capable of visualizing AMR data integrated with geographical regions. Due to the absence of AMR databases in Saudi Arabia, we searched Medline and Embase databases from inception until May 28, 2018, including literature that reported AMR data on the most prevalent gram-negative bacterial strains in Saudi Arabia. These data were extracted into Microsoft Excel file and inserted into STATA software, version 13 and ArcMap 10.6 software platform for mapping. We found particularly high levels of AMR in Makkah (Mecca), possibly due to high antibiotic consumption because of the influx of pilgrims, with Pseudomonas aeruginosa isolates showing the highest resistance rate against amikacin, aztreonam, cefepime, ceftazidime, ciprolfloxacin, gentamicin, imipenem, meropenem and pipracillin/tazobactam, and Enterobacteriaceae isolates against cefuroxime, ciprofloxacin, ampicillin, imipenem and ertapenem. The cause is, however, multifactorial since Acinetobacter baumannii isolates showed a variable resistance rate throughout the country. The employment of mapping technology in displaying AMR data extracted from published literature is a practically useful approach, and advanced GIS analyses should help stakeholders create containment strategies and allocate resources to slow down the emergence of AMR.
Collapse
Affiliation(s)
- Abdullah A Alhifany
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah.
| | | | - Mohamed H Al-Agamy
- Microbiology and Immunology Department, College of Pharmacy, King Saud University, Riyadh.
| | - Nasser Alkhushaym
- Department of Clinical Pharmacy; Royal Commission Health Services Program; Jubail.
| | - Faten Alhomoud
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam.
| | - Farah K Alhomoud
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam.
| | - Thamer A Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh.
| |
Collapse
|
7
|
Pathogenic spectrum of blood stream infections and resistance pattern in Gram-negative bacteria from Aljouf region of Saudi Arabia. PLoS One 2020; 15:e0233704. [PMID: 32516308 PMCID: PMC7282660 DOI: 10.1371/journal.pone.0233704] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background The pathogenic spectrum of bloodstream infections (BSIs) varies across regions. Monitoring the pathogenic profile and antimicrobial resistance is a prerequisite for effective therapy, infection control and for strategies aimed to counter antimicrobial resistance. The pathogenic spectrum of BSIs in blood cultures was analysed, focusing on the resistance patterns of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae, in Aljouf region. Methods This descriptive cross-sectional study analysed the culture reports of all non-duplicate blood samples collected from January 1 to December 31, 2019. Antibiograms of A. baumannii, E. coli, and K. pneumoniae were analysed for antibiotic resistance. The frequency and percentages of multi-drug, extensively-drug, pan-drug and carbapenem resistance were calculated. Results Of the 222 bloodstream infections, 62.2% and 36.4% were caused by gram-negative and gram-positive bacteria, respectively. Most BSIs occurred in patients aged ≥60 years (59.5%). Among the 103 isolates of the studied Gram-negative bacteria (GNB), 47.6%, 38.8%, and 2.9% were multi-drug, extensively drug and pan-drug resistant respectively. 46% of K. pneumoniae isolates were carbapenemase producers. Resistance to gentamycin, 1st–4th generation cephalosporins, and carbapenems was observed for A. baumannii. More than 70% of E. coli isolates were resistant to 3rd- and 4th-generation cephalosporins. Klebsiella pneumoniae presented a resistance rate of >60% to imipenems. Conclusions Gram-negative bacteria dominate BSIs, with carbapenem-resistant K. pneumoniae most frequently detected in this region. Resistant GNB infections make it challenging to treat geriatric patients. Regional variations in antimicrobial resistance should be continually monitored.
Collapse
|
8
|
Aldrazi FA, Rabaan AA, Alsuliman SA, Aldrazi HA, Alabdalslam MJ, Alsadiq SA, Alhani HM, Bueid AS. ESBL expression and antibiotic resistance patterns in a hospital in Saudi Arabia: Do healthcare staff have the whole picture? J Infect Public Health 2020; 13:759-766. [DOI: 10.1016/j.jiph.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022] Open
|
9
|
El-Saed A, Balkhy HH, Alshamrani MM, Aljohani S, Alsaedi A, Al Nasser W, El Gammal A, Almohrij SA, Alyousef Z, Almunif S, Alzahrani M. High contribution and impact of resistant gram negative pathogens causing surgical site infections at a multi-hospital healthcare system in Saudi Arabia, 2007-2016. BMC Infect Dis 2020; 20:275. [PMID: 32264843 PMCID: PMC7140359 DOI: 10.1186/s12879-020-4939-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background Despite being largely preventable, surgical site infections (SSIs) are still one of the most frequent healthcare-associated infections. The presence of resistant pathogens can further augment their clinical and economic impacts. The objective was to estimate the distribution and resistance in SSI pathogens in Saudi Arabia and to compare them to the US National Healthcare Safety Network (NHSN) hospitals. Methods Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN. Results A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were Staphylococcus aureus (22.8%), Pseudomonas aeruginosa (20.1%), Klebsiella spp. (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus was methicillin-resistant (MRSA), 13.0% of Enterococcus spp. was vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter spp. (58.3%), Klebsiella spp. (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella spp., MDR Klebsiella spp., and MDR Escherichia coli were significantly more frequent in our hospitals compared with NHSN hospitals. Conclusion GNPs in a tertiary care setting in Saudi Arabia are responsible for more than 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support for caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.
Collapse
Affiliation(s)
- Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, 11426, Riaydh, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hanan H Balkhy
- Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, 11426, Riaydh, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riaydh, Saudi Arabia.
| | - Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, 11426, Riaydh, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sameera Aljohani
- Department of Pathology and Laboratory Medicine, KAMC, Riyadh, Saudi Arabia
| | - Asim Alsaedi
- Infection Prevention and Control Department, KAMC, MNGHA, Jeddah, Saudi Arabia
| | - Wafa Al Nasser
- Infection Prevention and Control Department, Imam Abdulrahman bin Faisal Hospital, MNGHA, Dammam, Saudi Arabia
| | - Ayman El Gammal
- Infection Prevention and Control Department, King Abdulaziz Hospital, MNGHA, Al hassa, Saudi Arabia
| | | | - Ziyad Alyousef
- Department of Surgery, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Sara Almunif
- Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, 11426, Riaydh, Kingdom of Saudi Arabia
| | | |
Collapse
|
10
|
Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007-2016. Antimicrob Resist Infect Control 2020; 9:21. [PMID: 32000850 PMCID: PMC6993320 DOI: 10.1186/s13756-020-0678-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/09/2020] [Indexed: 01/13/2023] Open
Abstract
Background Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. The objective was to describe ten-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Saudi Arabia and to compare such trends with those of US National Health Surveillance Network (NHSN). Methods Pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN. Consecutive NHSN reports were used for comparisons. Results A total 1544 pathogens causing 1531 HAI events were included. Gram negative pathogens (GNP) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp. and a decreasing trend in Acinetobacter. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN. Vancomycin-resistant Enterococci (VRE, 20.3%) were more than doubled during the study, closing the gap with NHSN. Carbapenem resistance was highest with Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest in Pseudomonas and Enterobacteriaceae, closing initial gaps with NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs were generally decreasing, mainly due to the decreasing resistance towards cephalosporins, fluoroquinolones, and aminoglycosides. Conclusion The findings showed increasing trends of carbapenem resistance and VRE, which may reflect heavy use of carbapenems and vancomycin. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance.
Collapse
|
11
|
Al-Qahtani SM, Baffoe-Bonnie H, El-Saed A, Alshamrani M, Algwizani A, Alaklabi A, AlJoudi K, Albaalharith N, Mohammed A, Hussain S, Balkhy HH. Appropriateness of antimicrobial use among septic patients managed by the critical care response team: an opportunity for improvement through de-escalation. Antimicrob Resist Infect Control 2019; 8:186. [PMID: 31832186 PMCID: PMC6869254 DOI: 10.1186/s13756-019-0609-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background Most septic patients managed by critical care response teams (CCRT) are prescribed antimicrobials. Nevertheless, data evaluating their appropriateness are lacking both locally and internationally. The objective was to assess antimicrobial use among septic and non-septic patients managed by CCRT. Setting Case-control design was used to compare septic (cases) and non-septic (controls) CCRT patients at tertiary care setting. The frequency of antimicrobial use was assessed before and after CCRT activation. The appropriateness of antimicrobial use was assessed at day four post-CCRT, based on standard recommendations, clinical assessment, and culture results. Main results A total of 157 cases and 158 controls were included. The average age was 61.1 ± 20.4 years, and 54.6% were males, with minor differences between groups. The use of any antimicrobial was 100.0% in cases and 87.3% in controls (p < 0.001). The use of meropenem (68.2% versus 34.8%, p < 0.001) and vancomycin (56.7% versus 25.9%, p < 0.001) were markedly higher in cases than controls. The overall appropriateness was significantly lower in cases than controls (50.7% versus 59.6%, p = 0.047). Individual appropriateness was lowest with meropenem (16.7%) and imipenem (25.0%), and highest with piperacillin/tazobactam (87.1%) and colistin (78.3%). Only 48.5% of antimicrobials prescribed by CCRT were de-escalated by a primary team within four days. Individual appropriateness and de-escalations were not different between groups. Conclusions Empiric use and inadequate de-escalation of broad-spectrum antimicrobials were major causes for inappropriate antimicrobial use in CCRT patients. Our findings highlight the necessity of urgent implementation of an antimicrobial stewardship program, including training and auditing of antimicrobial prescriptions.
Collapse
Affiliation(s)
- Saad M Al-Qahtani
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Henry Baffoe-Bonnie
- 3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aiman El-Saed
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Ali Alaklabi
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,5Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khuloud AlJoudi
- 6Pharmacy Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nahlah Albaalharith
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Azzam Mohammed
- 3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sajid Hussain
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,7King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Dandachi I, Chaddad A, Hanna J, Matta J, Daoud Z. Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach. Front Microbiol 2019; 10:1941. [PMID: 31507558 PMCID: PMC6716069 DOI: 10.3389/fmicb.2019.01941] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
In the last decade, extended-spectrum cephalosporin and carbapenem resistant Gram-negative bacilli (GNB) have been extensively reported in the literature as being disseminated in humans but also in animals and the environment. These resistant organisms often cause treatment challenges due to their wide spectrum of antibiotic resistance. With the emergence of colistin resistance in animals and its subsequent detection in humans, the situation has worsened. Several studies reported the transmission of resistant organisms from animals to humans. Studies from the middle east highlight the spread of resistant organisms in hospitals and to a lesser extent in livestock and the environment. In view of the recent socio-economical conflicts that these countries are facing in addition to the constant population mobilization; we attempt in this review to highlight the gaps of the prevalence of resistance, antibiotic consumption reports, infection control measures and other risk factors contributing in particular to the spread of resistance in these countries. In hospitals, carbapenemases producers appear to be dominant. In contrast, extended spectrum beta lactamases (ESBL) and colistin resistance are becoming a serious problem in animals. This is mainly due to the continuous use of colistin in veterinary medicine even though it is now abandoned in the human sphere. In the environment, despite the small number of reports, ESBL and carbapenemases producers were both detected. This highlights the importance of the latter as a bridge between humans and animals in the transmission chain. In this review, we note that in the majority of the Middle Eastern area, little is known about the level of antibiotic consumption especially in the community and animal farms. Furthermore, some countries are currently facing issues with immigrants, poverty and poor living conditions which has been imposed by the civil war crisis. This all greatly facilitates the dissemination of resistance in all environments. In the one health concept, this work re-emphasizes the need to have global intervention measures to avoid dissemination of antibiotic resistance in humans, animals and the environment in Middle Eastern countries.
Collapse
Affiliation(s)
- Iman Dandachi
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Amer Chaddad
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jason Hanna
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jessika Matta
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Ziad Daoud
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
- Division of Clinical Microbiology, Saint George Hospital University Medical Center, Beirut, Lebanon
| |
Collapse
|
13
|
Carbapenem-Resistant Enterobacteriaceae: An update narrative review from Saudi Arabia. J Infect Public Health 2019; 12:465-471. [PMID: 31060974 DOI: 10.1016/j.jiph.2019.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 03/23/2019] [Accepted: 03/31/2019] [Indexed: 11/21/2022] Open
Abstract
Carbapenem-Resistant Enterobacteriaceae (CRE) is a worldwide urgent public health problem. Similar to other countries, Saudi Arabia is facing the challenge of increasingly reported cases of CRE. The aim of this review is to bring and update on the prevalence, epidemiology and microbiological characteristics of CRE reported from Saudi Arabia.
Collapse
|
14
|
Saeed NK, Alkhawaja S, Azam NFAEM, Alaradi K, Al-Biltagi M. Epidemiology of carbapenem-resistant Enterobacteriaceae in a Tertiary Care Center in the Kingdom of Bahrain. J Lab Physicians 2019; 11:111-117. [PMID: 31160848 PMCID: PMC6543944 DOI: 10.4103/jlp.jlp_101_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of the study is to estimate the rate of infection with carbapenem-resistant Enterobacteriaceae (CRE) in the main governmental tertiary care hospital in Bahrain. MATERIALS AND METHODS All clinical samples with positive growth of CRE over 6-year period (January 2012-December 2017) were collected from the microbiology laboratory data. RESULTS The CRE incidence was high in the first half of study period (2012-2014) and then decreased between 2015 and 2017, after implementation of intensified CRE control measure bundle. About 49.4% of CRE-positive samples were isolated from the elderly age group (above 65 years old), most of them were admitted in the intensive care unit (ICU). The most common isolated organisms were Klebsiella pneumoniae (87.0%), followed by Escherichia coli (7.9%). Isolates from deep tracheal aspirate and midstream urine specimens were the most common source of CRE isolates (27.3%) and (26.3%), respectively. Bacteremia was documented in 21.2% of cases. CRE isolates in the study showed high rates of resistance to aminoglycosides (72.2% resistant to amikacin and 67.3% to gentamicin). Alternatively, most isolates retained their susceptibility to colistin and tigecycline with sensitivity of 83.9% and 85.7%, respectively. Combined resistance to both colistin and tigecycline was observed in 0.06% of total isolates. CONCLUSION Elderly population and ICU admission were important risk factors for CRE acquisition. Most of CRE isolates were sensitive to both colistin and tigecycline, which make them the best combination for empiric frontline therapy for suspected serious CRE infection in our facility. Implementing CRE-bundled infection control measures significantly reduced the incidence of CRE infection in our hospital.
Collapse
Affiliation(s)
- Nermin Kamal Saeed
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
- Address for correspondence: Dr. Nermin Kamal Saeed, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain. E-mail:
| | - Safaa Alkhawaja
- Department of Infection Control, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | | | - Khalil Alaradi
- Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatrics, Tanta University, Egypt and Arabian Gulf University, Bahrain, Kingdom of Bahrain
| |
Collapse
|
15
|
Balkhy HH, El-Saed A, El-Metwally A, Arabi YM, Aljohany SM, Al Zaibag M, Baharoon S, Alothman AF. Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study. Antimicrob Resist Infect Control 2018; 7:156. [PMID: 30598819 PMCID: PMC6302414 DOI: 10.1186/s13756-018-0451-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background Estimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption. Objectives To quantify service-specific antimicrobial consumption using different metrics. Methods A surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as defined daily dose (DDD), days of therapy (DOT) per 1000 patient days, and frequency of daily consumption. Results A total of 43,970 DDDs and 46,940 DOTs were monitored during 54,116 patient-days. For the most frequently consumed antimicrobials, the consumption of carbapenems, piperacillin/tazobactam, vancomycin, and colistin (respectively) in all ICUs combined were 255.9, 134.3, 98.2, and 13.6 DDDs per 1000 patient-days and 235.7, 145.9, 129.5, and 117.5 DOTs per 1000 patient-days. For the frequency of daily consumption, carbapenems were the most frequently consumed antimicrobial group in medical/surgical, burn, and step-down ICUs while piperacillin/tazobactam was the most frequently consumed antimicrobial in neuro-surgical and cardio-thoracic ICUs. Conclusion High consumption of broad-spectrum antimicrobial agents such as meropenem and piperacillin/tazobactam is observed in multiple ICUs in a tertiary care hospital. Meropenem consumption is considerably higher than similar ICUs internationally. Future studies focusing on concurrent monitoring of antimicrobial resistance and identifying patient and physician characteristics associated with specific prescription patterns may help in improving judicious antimicrobial consumption.
Collapse
Affiliation(s)
- Hanan H Balkhy
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,2Infectious Diseases, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia
| | - Aiman El-Saed
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia.,4Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf El-Metwally
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,2Infectious Diseases, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,Intensive Care Department, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Sameera M Aljohany
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Pathology and Laboratory Medicine Department, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Muayed Al Zaibag
- Cardiac Center & Cardiac Sciences, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Salim Baharoon
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Internal Medicine Department, Infectious Disease Division, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Adel F Alothman
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Internal Medicine Department, Infectious Disease Division, KAMC, MNGHA, Riyadh, Saudi Arabia
| |
Collapse
|
16
|
Alghamdi S, Shebl NA, Aslanpour Z, Shibl A, Berrou I. Hospital adoption of antimicrobial stewardship programmes in Gulf Cooperation Council countries: A review of existing evidence. J Glob Antimicrob Resist 2018; 15:196-209. [DOI: 10.1016/j.jgar.2018.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
|
17
|
Almohammed RA, Bird EL. Public knowledge and behaviours relating to antibiotic use in Gulf Cooperation Council countries: A systematic review. J Infect Public Health 2018; 12:159-166. [PMID: 30245158 DOI: 10.1016/j.jiph.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/13/2018] [Accepted: 09/01/2018] [Indexed: 10/28/2022] Open
Abstract
The aim of this review was to assess public knowledge and behaviours in relation to antibiotic use in GCC countries. A systematic review was performed using MEDLINE, EMBASE and other relevant databases. Cross-sectional studies published from January 2000 to June 2017 relating to public knowledge and behaviours towards antibiotic use were included. Overall nine studies met the inclusion criteria for this systematic review. Nearly half of general public respondents in the GCC region reported a lack of knowledge about antibiotic use and showed negative attitudes towards antibiotic utilisation. Penicillin was the most frequently misused antibiotic, particularly for self-medication. Most respondents declared that they obtained information on antibiotics from pharmacists. Pharmacies were the major source of antibiotics used for self-medication. A multi-disciplinary approach must be put in place to educate the public on appropriate antibiotic use, to improve policies regarding the rational prescription of antimicrobials and to increase regulation enforcement.
Collapse
Affiliation(s)
| | - Emma L Bird
- Department of Health and Social Sciences, Faculty of Health & Applied Sciences, University of the West of England, Bristol, United Kingdom
| |
Collapse
|
18
|
Al-Zahrani IA, Alsiri BA. The emergence of carbapenem-resistant Klebsiella pneumoniae isolates producing OXA-48 and NDM in the Southern (Asir) province, Saudi Arabia. Saudi Med J 2018; 39:23-30. [PMID: 29332105 PMCID: PMC5885116 DOI: 10.15537/smj.2018.1.21094] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and the most common types of cabapenemases among CRKP in the Southern (Asir) province hospitals, Saudi Arabia. Methods: The cross-sectional study was conducted between late April and September in 2015. A total of 54 Klebsiella pneumoniae (K. pneumoniae) isolates with reduced sensitivity to carbapenems were obtained from various clinical specimens of the 2 largest hospitals in the Southern province. Minimum inhibitory concentrations (MICs) of carbapenems were confirmed using E-test. Molecular detection of the most common carbapenemase genes (blaIMP, bla-carbapenem-hydrolyzing oxacillinase [OXA-48], blaVIM, bla-New Delhi metallo-ß-lactamas [NDM], and blaKPC) was performed using multiplex-polymerase chain reaction. Results: The current study found that increasing age and intensive care unit admission were associated with CRKP isolation. The major type of carbapenemases was OXA-48 with 81.5% (n=44) and it seems to reach an endemic level. New Delhi metallo-ß-lactamas (NDM) was the second most frequent carbapenemase by 7.4% (n=4) of isolates while Verona integron-encoded metallo-ß-lactamase (VIM) was reported only in one isolate. Conclusion: Saudi Arabia receives large numbers of visitors and migrant workers from OXA-48 and NDM endemic countries such as Turkey, India, and Pakistan every year.
Collapse
Affiliation(s)
- Ibrahim A Al-Zahrani
- Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
19
|
Hazen TH, Mettus R, McElheny CL, Bowler SL, Nagaraj S, Doi Y, Rasko DA. Diversity among bla KPC-containing plasmids in Escherichia coli and other bacterial species isolated from the same patients. Sci Rep 2018; 8:10291. [PMID: 29980699 PMCID: PMC6035167 DOI: 10.1038/s41598-018-28085-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/15/2018] [Indexed: 11/23/2022] Open
Abstract
Carbapenem resistant Enterobacteriaceae are a significant public health concern, and genes encoding the Klebsiella pneumoniae carbapenemase (KPC) have contributed to the global spread of carbapenem resistance. In the current study, we used whole-genome sequencing to investigate the diversity of blaKPC-containing plasmids and antimicrobial resistance mechanisms among 26 blaKPC-containing Escherichia coli, and 13 blaKPC-containing Enterobacter asburiae, Enterobacter hormaechei, K. pneumoniae, Klebsiella variicola, Klebsiella michiganensis, and Serratia marcescens strains, which were isolated from the same patients as the blaKPC-containing E. coli. A blaKPC-containing IncN and/or IncFIIK plasmid was identified in 77% (30/39) of the E. coli and other bacterial species analyzed. Complete genome sequencing and comparative analysis of a blaKPC-containing IncN plasmid from one of the E. coli strains demonstrated that this plasmid is present in the K. pneumoniae and S. marcescens strains from this patient, and is conserved among 13 of the E. coli and other bacterial species analyzed. Interestingly, while both IncFIIK and IncN plasmids were prevalent among the strains analyzed, the IncN plasmids were more often identified in multiple bacterial species from the same patients, demonstrating a contribution of this IncN plasmid to the inter-genera dissemination of the blaKPC genes between the E. coli and other bacterial species analyzed.
Collapse
Affiliation(s)
- Tracy H Hazen
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Roberta Mettus
- Division of Infectious Diseases and Center for Innovative Antimicrobial Therapy, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christi L McElheny
- Division of Infectious Diseases and Center for Innovative Antimicrobial Therapy, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah L Bowler
- Division of Infectious Diseases and Center for Innovative Antimicrobial Therapy, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sushma Nagaraj
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Yohei Doi
- Division of Infectious Diseases and Center for Innovative Antimicrobial Therapy, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Microbiology, Fujita Health University, Aichi, Japan.
| | - David A Rasko
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| |
Collapse
|
20
|
ElMahallawy HA, Zafer MM, Amin MA, Ragab MM, Al-Agamy MH. Spread of carbapenem resistant Enterobacteriaceae at tertiary care cancer hospital in Egypt. Infect Dis (Lond) 2018; 50:560-564. [PMID: 29373938 DOI: 10.1080/23744235.2018.1428824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Hadir A ElMahallawy
- a Department of Clinical Pathology , National Cancer Institute, Cairo University , Cairo , Egypt
| | - Mai M Zafer
- b Department of Microbiology and Immunology, Faculty of Pharmacy , Ahram Canadian University , 6th of October , Egypt
| | - Magdy A Amin
- c Department of Microbiology and Immunology, Faculty of Pharmacy , Cairo University , Cairo , Egypt
| | - Mai M Ragab
- c Department of Microbiology and Immunology, Faculty of Pharmacy , Cairo University , Cairo , Egypt
| | - Mohamed H Al-Agamy
- d Department of Pharmaceutics , College of Pharmacy,King Saud University , Riyadh , Saudi Arabia.,e Department of Microbiology and Immunology, Faculty of Pharmacy , Al-Azhar University , Cairo , Egypt
| |
Collapse
|
21
|
van Loon K, Voor In 't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e01730-17. [PMID: 29038269 PMCID: PMC5740327 DOI: 10.1128/aac.01730-17] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are major health care-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE infection prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized the environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in the random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that the use of medical devices generated the highest pooled estimate (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67), followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions, including the use of barrier/contact precautions for patients colonized or infected with CRE, are needed. In addition, it is necessary to optimize the therapeutic approach, which is an important message to infectious disease specialists, who need to be actively involved in a timely manner in the treatment of patients with known CRE infections or suspected carriers of CRE.
Collapse
Affiliation(s)
- Karlijn van Loon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
22
|
Emergence of carbapenem-resistant Enterobacteriaceae isolated from patients in a university hospital in Saudi Arabia. Epidemiology, clinical profiles and outcomes. J Infect Public Health 2017. [PMID: 28642140 PMCID: PMC7102805 DOI: 10.1016/j.jiph.2017.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbapenemase-producing Enterobacteriaceae have been steadily spreading worldwide during the last decade. Nine patients were identified prospectively and were followed during their hospitalization course to identify the epidemiology, clinical profiles and outcomes. These patients had one or more cultures positive for a CRE isolate, contributing to a total of eleven positive cultures from various sites without including duplicates of isolates obtained from the same site. Isolates from these patients included five Klebseilla pneumoniae, three Escherichia coli, and one Enterobacter aerogenes. Five isolates were grown from blood cultures, three from wound cultures, one from urine cultures, one from respiratory cultures and one from an abscess collection. Five survived the hospital course. The other five patients died due to severe sepsis, septic shock or multi-organ failure. Of the nine isolates of CRE identified for which molecular analysis were available, four K. pneumonia were confirmed as blaNDM and one as OXA-48. For the purpose of controlling the spread of CRE in our institution, we recommend considering active surveillance cultures and screening patients transferred from other hospitals or coming from highly endemic settings at admission for these organisms.
Collapse
|
23
|
Xu L, Sun X, Ma X. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob 2017; 16:18. [PMID: 28356109 PMCID: PMC5371217 DOI: 10.1186/s12941-017-0191-3] [Citation(s) in RCA: 321] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/15/2017] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Carbapenem resistant K. pneumoniae (CRKP) has aroused widespread attention owing to its very limited therapeutic options, and this strain has increased rapidly in recent years. Although it is accepted that drug resistance is associated with increased mortality in general, but some other studies found no such relationship. To estimate mortality of patients infected with CRKP in general and analyze factors for mortality of this infection, thus, we conducted this systematic review and meta-analysis. METHODS A systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP. RESULTS Pooled mortality was 42.14% among 2462 patients infected with CRKP versus 21.16% in those infected with carbapenem-susceptible K. pneumoniae (CSKP). The mortality of patients with bloodstream infection (BSI) or urinary tract infection was 54.30 and 13.52%, respectively, and 48.9 and 43.13% in patients admitted to the intensive care unit (ICU) or who underwent solid organ transplantation (SOT). Mortality was 47.66% in patients infected with K. pneumoniae carbapenemase-producing K. pneumoniae and 46.71% in those infected with VIM-producing K. pneumoniae. Geographically, mortality reported in studies from North America, South America, Europe, and Asia was 33.24, 46.71, 50.06, and 44.82%, respectively. CONCLUSIONS Our study suggests that patients infected with CRKP have higher mortality than those infected with CSKP, especially in association with BSI, ICU admission, or SOT. We also considered that patients' survival has a close relationship with their physical condition. Our results imply that attention should be paid to CRKP infection, and that strict infection control measures and new antibiotics are required to protect against CRKP infection.
Collapse
Affiliation(s)
- Liangfei Xu
- Department of Laboratory Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001 Anhui China
| | - Xiaoxi Sun
- Department of Laboratory Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001 Anhui China
| | - Xiaoling Ma
- Department of Laboratory Medicine, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001 Anhui China
| |
Collapse
|
24
|
French CE, Coope C, Conway L, Higgins JPT, McCulloch J, Okoli G, Patel BC, Oliver I. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect 2016; 95:3-45. [PMID: 27890334 DOI: 10.1016/j.jhin.2016.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been increasing globally and present a major public health challenge. AIM To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally; and (ii) to identify the control measures used during these outbreaks and report on their effectiveness. METHODS A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for 2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative synthesis of the evidence was conducted. FINDINGS Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the vast majority of outbreaks, multi-component infection control measures were used, commonly including: patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high for these studies. CONCLUSION The findings indicate that CPE outbreaks can be controlled using combinations of existing measures. However, the quality of the evidence base is weak and further high-quality research is needed, particularly on the effectiveness of individual infection control measures.
Collapse
Affiliation(s)
- C E French
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | - C Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK.
| | - L Conway
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| | - J P T Higgins
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | | | - G Okoli
- University of Bristol, Bristol, UK
| | | | - I Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| |
Collapse
|
25
|
The strategic plan for combating antimicrobial resistance in Gulf Cooperation Council States. J Infect Public Health 2016; 9:375-85. [DOI: 10.1016/j.jiph.2016.03.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
26
|
Infections due to Carbapenem Resistant Enterobacteriaceae among Saudi Arabian Hospitalized Patients: A Matched Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3961684. [PMID: 27144165 PMCID: PMC4837245 DOI: 10.1155/2016/3961684] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/13/2016] [Indexed: 11/18/2022]
Abstract
Background. We conducted this case-control study to determine the risk factors and treatment outcome of infections due to carbapenem resistant Enterobacteriaceae in our institution. Methods. This is a matched case-control study of patients with infection due to carbapenem resistant Enterobacteriaceae (CRE) and carbapenem susceptible Enterobacteriaceae (CSE), from Riyadh, Saudi Arabia, between March 2012 and December 2013. Results. During this period, 29 cases and 58 controls were studied. The mean ages of the cases (55.4 years) and controls (54.7 years) were similar (p = 0.065). Cases had higher mean Charlson comorbidity index (CCI) (3.1) than controls (1.9), p = 0.026. Several factors contributed to infection among the studied population. Prior uses of piperacillin-tazobactam, a carbapenem, a quinolone, and metronidazole were significantly associated with CRE infections. Nine of the cases died compared with 7 of the controls, p = 0.031. Mortality was associated with advanced age, the presence of comorbidities, ICU stay, and receipt of invasive procedures. Conclusions. Infections due to CRE resulted in a significantly increased mortality. Combination antibiotic therapy was associated with reduced mortality. Properly designed randomized controlled studies are required to better characterize these findings.
Collapse
|
27
|
Sonnevend Á, Ghazawi AA, Hashmey R, Jamal W, Rotimi VO, Shibl AM, Al-Jardani A, Al-Abri SS, Tariq WUZ, Weber S, Pál T. Characterization of Carbapenem-Resistant Enterobacteriaceae with High Rate of Autochthonous Transmission in the Arabian Peninsula. PLoS One 2015; 10:e0131372. [PMID: 26110660 PMCID: PMC4482506 DOI: 10.1371/journal.pone.0131372] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/31/2015] [Indexed: 12/18/2022] Open
Abstract
To establish the role of local transmission versus possible pathogen import due to previous foreign exposure in infections caused by carbapenem non-susceptible Enterobacteriaceae in the Arabian Peninsula, 200 independent isolates collected in 16 hospitals of Saudi Arabia, Kuwait, Oman and the United Arab Emirates were studied. All strains were multidrug resistant; 42.5% of them also qualified as extremely drug resistant. The frequency of various carbapenemases varied according to the participating countries, but in the collection, as a whole, blaNDM-1 was the most frequently encountered carbapenemase gene (46.5%) followed by blaOXA-48-like gene (32.5%). A comparatively high rate (8.9%) of multi-clonal strains carrying both blaNDM and blaOXA-48-like genes in the United Arab Emirates, representing the most resistant subgroup, was encountered. No KPC-expressing isolates were detected. Three major clones of blaNDM-1 carrying Klebsiella pneumoniae of ST152 (n = 22, Saudi Arabia), ST14 (n = 7, United Arab Emirates) and ST147 types (n = 9, Oman) were identified, the latter two clones carrying similar, but not identical HI1b incompatibility type plasmids of >170kb. While from 78.6% of the cases with documented foreign hospitalization blaNDM positive strains were isolated, these strains formed only 25.6% of all the isolates expressing this enzyme. In fact, 56.8% of the NDM, 75.7% of OXA-48-like and 90.9% of VIM positive strains were recovered from patients without documented foreign exposure, neither in the form of travel or prior hospitalization abroad, suggesting a high rate of autochthonous infections. This, considering the extensive links of these countries to the rest of the world, predicts that trends in the local epidemiology of carbapenem resistant strains may increasingly affect the spread of these pathogens on the global scale. These results call for improved surveillance of carbapenem resistant Enterobacteriaceae in the countries of the Arabian Peninsula.
Collapse
Affiliation(s)
- Ágnes Sonnevend
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Akela A. Ghazawi
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Rayhan Hashmey
- Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Wafaa Jamal
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Vincent O. Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Atef M. Shibl
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Pathology and Pharmacology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Amina Al-Jardani
- Central Public Health Laboratories, Ministry of Health, Muscat, Oman
| | - Seif S. Al-Abri
- Department of Medicine, Royal Hospital, Muscat, Sultanate of Oman
| | - Waheed U. Z. Tariq
- Department of Laboratory Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Stefan Weber
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Tibor Pál
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
| |
Collapse
|
28
|
Falagas ME, Tansarli GS, Karageorgopoulos DE, Vardakas KZ. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis 2015; 20:1170-5. [PMID: 24959688 PMCID: PMC4073868 DOI: 10.3201/eid2007.121004] [Citation(s) in RCA: 378] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 7 studies, rates ranged from 26% to 44%; in 2 studies, rates were −3% and −4%, respectively. We evaluated the number of deaths attributable to carbapenem-resistant Enterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case–control studies, 2 retrospective cohort studies, and 1 prospective cohort study. Klebsiella pneumoniae was the causative pathogen in 8 studies; bacteremia was the only infection in 5 studies. We calculated that 26%–44% of deaths in 7 studies were attributable to carbapenem resistance, and in 2 studies, which included bacteremia and other infections, −3% and −4% of deaths were attributable to carbapenem resistance. Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable.
Collapse
|
29
|
Hamzan NI, Yean CY, Rahman RA, Hasan H, Rahman ZA. Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia. EMERGING HEALTH THREATS JOURNAL 2015; 8:26011. [PMID: 25765342 PMCID: PMC4357264 DOI: 10.3402/ehtj.v8.26011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 02/03/2023]
Abstract
Background Antibiotic resistance among Enterobacteriaceae posts a great challenge to the health care service. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is attracting significant attention due to its rapid and global dissemination. The infection is associated with significant morbidity and mortality, thus creating challenges for infection control and managing teams to curb the infection. In Southeast Asia, there have been limited reports and subsequent research regarding CRKP infections. Thus, the study was conducted to characterize CRKP that has been isolated in our setting. Methods A total of 321 K. pneumoniae were included in the study. Each isolate went through an identification process using an automated identification system. Phenotypic characterization was determined using disk diffusion, modified Hodge test, Epsilometer test, and inhibitor combined disk test. Further detection of carbapenemase genes was carried out using polymerase chain reaction and confirmed by gene sequence analysis. Results All together, 13 isolates (4.05%) were CRKP and the majority of them were resistant to tested antibiotics except colistin and tigercycline. Among seven different carbapenemase genes studied (blaKPC, blaIMP, blaSME, blaNDM, blaIMI, blaVIM, and blaOXA), only two, blaIMP4 (1.87%) and blaNDM1 (2.18%), were detected in our setting. Conclusion Evidence suggests that the prevalence of CRKP in our setting is low, and knowledge of Carbapenem-resistant Enterobacteriaceae and CRKP has improved and become available among clinicians.
Collapse
Affiliation(s)
- Nurul Izzati Hamzan
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Chan Yean Yean
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Rosliza Abdul Rahman
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Habsah Hasan
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Zaidah Abdul Rahman
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia;
| |
Collapse
|
30
|
Yezli S, Shibl AM, Memish ZA. The molecular basis of β-lactamase production in Gram-negative bacteria from Saudi Arabia. J Med Microbiol 2014; 64:127-136. [PMID: 25418734 DOI: 10.1099/jmm.0.077834-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Resistance to β-lactams among Gram-negative bacteria is a worldwide issue. Increased prevalence of extended-spectrum β-lactamase (ESBL)-producers and the dissemination of carbapenem-resistance genes are particularly concerning. ESBL-producing strains are common in the Kingdom of Saudi Arabia, particularly among the Enterobacteriaceae, and carbapenem resistance is on the increase, especially among the non-fermenters. β-lactamase production is a major mechanism of resistance to these agents and although β-lactamase-producing strains have been documented in the Kingdom, relatively few reports characterized the molecular basis of this production. Nevertheless, available data suggest that CTX-M (CTX-M-15 in particular) is the predominant ESBL in the Enterobacteriaceae, with SHV also being prevalent in Klebsiella pneumoniae. Carbapenem resistance in the latter is mainly due to OXA-48 and NDM-1. In Pseudomonas aeruginosa, VEB-like enzymes are the most common ESBLs, and VIM is the prevalent metallo-β-lactamase. OXA-10 extended-spectrum enzymes are also frequent. PER and GES ESBLs have been reported in Acinetobacter baumannii, and oxacillinases (OXA-23 in particular) are the dominant carbapanamases in this species.
Collapse
Affiliation(s)
- Saber Yezli
- Saudi Ministry of Health, Riyadh, Saudi Arabia
| | | | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Ministry of Health, Riyadh, Saudi Arabia
| |
Collapse
|
31
|
Multi-drug carbapenem-resistant Klebsiella pneumoniae infection carrying the OXA-48 gene and showing variations in outer membrane protein 36 causing an outbreak in a tertiary care hospital in Riyadh, Saudi Arabia. Int J Infect Dis 2014; 28:186-92. [PMID: 25245001 DOI: 10.1016/j.ijid.2014.05.021] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the genes of antibiotic resistance among isolates from the first reported carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in a tertiary care hospital, Riyadh, Saudi Arabia. METHODS Antimicrobial susceptibility testing was performed on bacterial isolates using the Microscan Walkaway system (Siemens, Germany) and was confirmed by Etest (AB Biodisk, Sweden). bla-CTX-M, -SHV, -TEM, -OXA-48, OXA-A,B,C,D, -KPC, -NDM, -VIM, -IMP, integron 1, and outer membrane proteins(Omp)-35 and Omp-36 were investigated by PCR amplification and direct sequencing of PCR products. Isolates were sequence-typed by multilocus sequence typing (MLST). RESULTS All isolates were resistant to cefotaxime, ceftazidime, cefepime, ciprofloxacin, and piperacillin-tazobactam, and 91% (21 out of 23) were resistant to amikacin and gentamicin. All isolates except two from a single patient were resistant to one of the carbapenems. CTX-M and SHV genes were detected in all isolates, CTX-M-15 and SHV-1 types being predominant among these extended-spectrum beta-lactamases (ESBLs). TEM-1 was found in all except one isolate (isolate 3). Significantly, the OXA-48 gene was also found in all isolates. OXA-D-gene was found in three out of 23 isolates. KPC, NDM, OXA-A, -B, -C, VIM, and IMP genes were absent in all isolates. Disruption of the Omp-36 gene due to insertion of transposon IS903 and/or IS4 was detected in four out of 23 isolates, and some unique variations were also observed in this gene, including an insertion of two amino acids in the L3 region of Omp-36 in one isolate (isolate 3) and a mutation resulting in a premature stop codon in another isolate (isolate 25). MLST revealed ST29 to be the predominant sequence type (17 out of 23 isolates, 74%). Three were ST709 and one each was ST37 and ST111; one isolate had an unknown ST. CONCLUSIONS This is probably the first reported outbreak of multidrug/carbapenem-resistant Klebsiella infection involving the OXA-48 gene from Saudi Arabia. Although the presence of ESBLs such as OXA, CTX-M, TEM, and SHV are predictable reasons for resistance, variations in the Omp-36 gene might also have precipitated this phenomenon. Disruption of the Omp-36 sequence by large insertional elements, the insertion of two amino acids in a very crucial part of this protein, and the presence of a premature stop codon in one isolate might have rendered this protein incomplete and non-functional. The study also demonstrated that more than one type of clone was responsible for this reported apparent outbreak and that ST29, a clone not reported from this region before, was the major clone responsible.
Collapse
|
32
|
Yezli S, Shibl AM, Livermore DM, Memish ZA. Prevalence and antimicrobial resistance among Gram-negative pathogens in Saudi Arabia. J Chemother 2014; 26:257-72. [DOI: 10.1179/1973947814y.0000000185] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
33
|
Somily AM, Alsubaie SS, BinSaeed AA, Torchyan AA, Alzamil FA, Al-Aska AI, Al-Khattaf FS, Khalifa LA, Al-Thawadi SI, Alaidan AA, Al-Ahdal MN, Al-Qahtani AA, Murray TS. Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the neonatal intensive care unit: does vancomycin play a role? Am J Infect Control 2014; 42:277-82. [PMID: 24581016 DOI: 10.1016/j.ajic.2013.09.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU. METHODS A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection. RESULTS During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors. CONCLUSION Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting.
Collapse
Affiliation(s)
- Ali M Somily
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sarah S Alsubaie
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz A BinSaeed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Armen A Torchyan
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad A Alzamil
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - AbdulKarim I Al-Aska
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah S Al-Khattaf
- Department of Infection Control, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lyla A Khalifa
- Department of Infection Control, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sahar I Al-Thawadi
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alwaleed A Alaidan
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed N Al-Ahdal
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed A Al-Qahtani
- Department of Infection and Immunity, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Thomas S Murray
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
34
|
Dash N, Panigrahi D, Zarouni MA, Darwish D, Ghazawi A, Sonnevend A, Pal T, Yasin F, Hadi SA. High Incidence of New Delhi Metallo-Beta-Lactamase-ProducingKlebsiella pneumoniaeIsolates in Sharjah, United Arab Emirates. Microb Drug Resist 2014; 20:52-6. [DOI: 10.1089/mdr.2013.0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nihar Dash
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Debadatta Panigrahi
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mansour Al Zarouni
- Microbiology Laboratory, Al-Qassimi Hospital, Sharjah, United Arab Emirates
| | - Dania Darwish
- Department of Microbiology and Immunology, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Akela Ghazawi
- Department of Microbiology and Immunology, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Agnes Sonnevend
- Department of Microbiology and Immunology, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Tibor Pal
- Department of Microbiology and Immunology, College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Faten Yasin
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | |
Collapse
|
35
|
β-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula. Clin Microbiol Rev 2014; 26:361-80. [PMID: 23824364 DOI: 10.1128/cmr.00096-12] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY Infections due to Gram-negative bacilli (GNB) are a leading cause of morbidity and mortality worldwide. The extent of antibiotic resistance in GNB in countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Oman, and Bahrain, has not been previously reviewed. These countries share a high prevalence of extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing GNB, most of which are associated with nosocomial infections. Well-known and widespread β-lactamases genes (such as those for CTX-M-15, OXA-48, and NDM-1) have found their way into isolates from the GCC states. However, less common and unique enzymes have also been identified. These include PER-7, GES-11, and PME-1. Several potential risk factors unique to the GCC states may have contributed to the emergence and spread of β-lactamases, including the unnecessary use of antibiotics and the large population of migrant workers, particularly from the Indian subcontinent. It is clear that active surveillance of antimicrobial resistance in the GCC states is urgently needed to address regional interventions that can contain the antimicrobial resistance issue.
Collapse
|
36
|
Saidel-Odes L, Borer A. Limiting and controlling carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist 2013; 7:9-14. [PMID: 24353433 PMCID: PMC3862651 DOI: 10.2147/idr.s44358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, is associated with substantial morbidity and mortality, and poses a serious threat to public health. The ongoing worldwide spread of this pathogen emphasizes the need for immediate intervention. This article reviews the global spread and risk factors for CRKP colonization/infection, and provides an overview of the strategy to combat CRKP dissemination.
Collapse
Affiliation(s)
- Lisa Saidel-Odes
- Infection Control and Hospital Epidemiology Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Abraham Borer
- Infection Control and Hospital Epidemiology Unit, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|