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Chen WL, Cheng MF, Tseng FC, Wu PC, Huang IF, Chen YW, Chiou YH, Chen YS, Lee SSJ, Hung WY, Wang JL, Hung CH. Geographic distribution of the major clone of extended-spectrum beta-lactamase-producing Escherichia coli infection in a pediatric community in southern Taiwan. J Infect Public Health 2023; 16:853-858. [PMID: 37030038 DOI: 10.1016/j.jiph.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The geographic distribution of the major clone of sequence type 131 (ST131) in extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) infections is not known. We analyzed the clinical features, resistance mechanisms, and geographic distribution of ESBL-producing E. coli clones in 120 children. METHODS We studied the 120 ESBL-producing E. coli strains from children younger than 18 years. A VITEK 2 automated system was used to determine bacterial identification and ESBL production. Sequence type was determined by multi-locus sequence typing (MLST). The genetic relationship of the ESBL-producing strains was studied using pulsed-field gel electrophoresis (PFGE). Phylogenetic group and blaCTX-M group was performed using polymerase chain reaction (PCR). Multiplex PCR for detecting the common group 9 variant, CTX-M-14, and group 1 variant, CTX-M-15, was also performed. The addresses of the 120 children were collected, and plotted on the Taiwan map. RESULTS The groups in the center of Kaohsiung City lived mainly in urban areas with a population density of over 10,000 people per square kilometer, and the majority of the Kaohsiung groups on the outskirts of the city center lived in suburban areas with a population density of under 6000 people per square kilometer. There was no statistically significant difference between the city center and outskirt groups in terms of clinical presentation, laboratory, and imaging data. However, more ST131 clones, major pulsotype groups, and phylogenetic group B2 strains were found in the center of Kaohsiung than on the outskirts. CONCLUSION ESBL-producing E. coli clones may be more challenging to treat clinically. Most infections were community-acquired, and there appeared to be major pulsotype clones, mainly in urban areas. This reinforces the necessity of environmental surveillance and sanitary procedures for ESBL-producing E. coli.
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Affiliation(s)
- Wan-Ling Chen
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan; Division of Pediatric Infectious Diseases, Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Ming-Fang Cheng
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan; Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Fooyin University, Kaohsiung, Taiwan
| | - Fan-Chen Tseng
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Pin-Chien Wu
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan; Department of Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Fei Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yun-Wen Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Fooyin University, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wan-Yu Hung
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jiun-Ling Wang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chih-Hsin Hung
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan.
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Zhang J, Shu B, Gao Y, Gui X, He L, Zhang K. Multicolor fluorescence digital mapping of rare-earth ion-labeled porous silica nanoprobes for the recognition of various antibiotic residues in milk. CHINESE JOURNAL OF ANALYTICAL CHEMISTRY 2022. [DOI: 10.1016/j.cjac.2022.100181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nourollahpour Shiadeh M, Sepidarkish M, Mollalo A, As'adi N, Khani S, Shahhosseini Z, Danesh M, Esfandyari S, Mokdad AH, Rostami A. Worldwide prevalence of maternal methicillin-resistant Staphylococcus aureus colonization: A systematic review and meta-analysis. Microb Pathog 2022; 171:105743. [PMID: 36044936 DOI: 10.1016/j.micpath.2022.105743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection during pregnancy can adversely influence the well-being of pregnant women, fetuses, and neonates. To our knowledge, there is no global data on the maternal prevalence of MRSA colonization. We conducted a systematic review and meta-analysis to estimate the global and regional prevalence rates of MRSA colonization among pregnant women. We searched international databases (i.e., MEDLINE/PubMed, EMBASE, Scopus, Web of Science collection, and SciELO) for studies published from inception to March 10, 2022. Observational population-based studies reporting MRSA colonization among pregnant women were eligible to be included. We utilized the random-effects meta-analyses to compute the pooled prevalence estimates of maternal colonization across studies at 95% confidence intervals (CIs). The heterogeneity was assessed by I2 statistic and the Cochran's Q test. Subgroup and meta-regression analyses were used to adjust for potential sources of heterogeneity. The data source regarding maternal MRSA colonization included 55 studies from 24 countries and 110,654 pregnant women. The worldwide pooled prevalence for maternal MRSA colonization was 3.23% (95% CI, 2.40-4.17%), with the highest and lowest colonization rates for Africa (9.13%, 4.36-15.34%) and Europe (0.79%, 0.28-1.51%), respectively. We estimated that nearly 4.5 million pregnant women are colonized with MRSA worldwide. MRSA colonization rates were higher among black ethnicity, multiparous women, pregnant women with prior MRSA infection, women with lower personal hygiene, and those living in lower-income and human development indices countries or regions. MRSA colonizes substantial numbers of pregnant women worldwide, with varying prevalence rates in different regions; however, further investigations are needed to recognize regional differences. Our findings emphasized the need for prevention efforts against MRSA to reduce the health risks among women and newborns.
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Affiliation(s)
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
| | - Nayereh As'adi
- Department of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmonir Danesh
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sahar Esfandyari
- Department of Urology, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Arzilli G, Scardina G, Casigliani V, Petri D, Porretta A, Moi M, Lucenteforte E, Rello J, Lopalco P, Baggiani A, Privitera GP, Tavoschi L. Screening for Antimicrobial-Resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review. J Infect 2021; 84:119-130. [PMID: 34793762 DOI: 10.1016/j.jinf.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/26/2021] [Accepted: 11/10/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transmission of antimicrobial-resistant Gram-negative bacteria (AMR-GNB) among hospitalised patients can lead to new cases of carriage, infection and outbreaks, hence the need for early carrier identification. We aim to explore two key elements that may guide control policies for colonisation/infection in hospital settings: screening practices on admission to hospital wards and risk of developing infection from colonisation. METHODS We searched on PubMed, Scopus and Cochrane databases for studies published from 2010 up to 2021 reporting on adult patients hospitalised in high-income countries. RESULTS The search retrieved 11853 articles. After screening, 100 studies were included. Combining target patient groups and setting type, we identified six screening approaches. The most reported approach was all admitted patients to high-risk (HR) wards (49.4%). The overall prevalence of AMR-GNB was 13.8% (95%CI 9.3-19.0) with significant differences across regions and time. Risk of progression to infection among colonised patients was 11.0% (95%CI 8.0-14.3) and varied according to setting and pathogens' group (p value<0.0001), with higher values reported for Klebsiella species (18.1%; 95%CI 8.9-29.3). CONCLUSIONS While providing a comprehensive overview of the screening approaches, our study underlines the considerable burden of AMR-GNB colonisation and risk of progression to infection in hospitals by pathogen, setting and time.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Virginia Casigliani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Davide Petri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy.
| | - Marco Moi
- Department of Surgical Sciences, University of Cagliari, Cagliari 09124, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56123, Italy
| | - Jordi Rello
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/epidemiology In Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Clinical Research, CHU Nîmes, Nîmes, France
| | - Pierluigi Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
| | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Gaetano Pierpaolo Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy; University Hospital of Pisa, Pisa 56123, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56123, Italy
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Ogura J, Inayama Y, Sasamoto N, Hirayama T, Ohara T, Sakai M, Suzuki H, Yasumoto K, Suginami K, Yamanoi K. Vertical transmission of methicillin-resistant Staphylococcus aureus at delivery and its clinical impact: An observational, prospective cohort study. Acta Obstet Gynecol Scand 2021; 100:1986-1994. [PMID: 34435346 DOI: 10.1111/aogs.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) infection has a significant clinical impact on both pregnant women and neonates. The aim of this study was to assess accurately the vertical transmission rate of MRSA and its clinical impacts on both pregnant mothers and neonates. MATERIAL AND METHODS We conducted a prospective observational cohort study of 898 pregnant women who were admitted to our department and 905 neonates from August 2016 to December 2017. MRSA was cultured from nasal and vaginal samples taken from the mothers at enrollment and from nasal and umbilical surface swabs taken from neonates at the time of delivery. We examined the vertical transmission rate of MRSA in mother-neonate pairs. We used multivariable logistic regression to identify risk factors for maternal MRSA colonization and maternal/neonatal adverse outcomes associated with maternal MRSA colonization. RESULTS The prevalence of maternal MRSA colonization was 6.1% (55 of 898) at enrollment. The independent risk factors were multiparity and occupation (healthcare provider) (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.25-4.42 and OR 2.58, 95% CI 1.39-4.79, respectively). The prevalence of neonatal MRSA colonization at birth was 12.7% (7 of 55 mother-neonate pairs) in the maternal MRSA-positive group, whereas it was only 0.12% (one of 843 pairs) in the maternal MRSA-negative group (OR 121, 95% CI 14.6-1000). When maternal vaginal samples were MRSA-positive, vertical transmission was observed in four of nine cases (44.4%) in this study. Skin and soft tissue infections developed more frequently in neonates in the maternal MRSA-positive group than in the MRSA-negative group (OR 7.47, 95% CI 2.50-22.3). CONCLUSIONS The prevalence of MRSA in pregnant women was approximately 6%. Vertical transmission caused by maternal vaginal MRSA colonization was observed in four of nine cases (44.4%). Although our study includes a limited number of maternal MRSA positive cases, the vertical transmission of MRSA may occur in up to 44% of neonates of mothers with vaginal MRSA colonization. Maternal MRSA colonization may be associated with increased development of skin and soft tissue infections in neonates via vertical transmission.
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Affiliation(s)
- Jumpei Ogura
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Yoshihide Inayama
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Takahiro Hirayama
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Tsutomu Ohara
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Mie Sakai
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Haruka Suzuki
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Koji Yasumoto
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Koh Suginami
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
| | - Koji Yamanoi
- Department of Obstetrics and Gynecology, Toyooka Public Hospital, Hyogo, Japan
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A systematic review and meta-analysis on the prevalence of Escherichia coli and extended-spectrum β-lactamase-producing Escherichia coli in pregnant women. Arch Gynecol Obstet 2021; 303:363-379. [PMID: 33386957 DOI: 10.1007/s00404-020-05903-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023]
Abstract
PROPOSE The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic review and meta-analysis study. METHODS We searched important databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of ESBL E. coli in pregnant women that published from January 1990 to June 2020. RESULTS The pooled prevalence of E. coli in pregnant women with and without symptoms of UTI after combining 82 studies with a sample size of 33,118 was 29% (29%; %95 CI 23, 36%). The prevalence based on urine, Feacal, and vagina samples was 26% (% 95 CI 19-34%), 77% (% 95 CI 22-98%), and 32% (% 95 CI 17-48%), respectively. Also, 19 studies with a sample size of 9,200 reported ESBL E. coli prevalence in pregnant women. After combining the results of these studies, the pooled prevalence of ESBL E. coli in pregnant women was 34% (34%; %95 CI 24, 43%). The pooled prevalence of E. coli in pregnant women with HIV was 9%(9%; %95 CI 7, 11%). CONCLUSION According to the results of this study, the prevalence of E. coli and ESBL E. coli is high in pregnant women. Also, the overuse of antibiotics was higher in European and Asian pregnant women than other continents.
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Heigl K, Zamfir M, Adler AC, Dammeyer A, Schomacher L, Karlin B, Franitza M, Hörmansdorfer S, Tuschak C, Valenza G, Ochmann U, Herr C, Heinze S. Prevalence of methicillin-sensitive, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing Escherichia coli in newborns: a cross-sectional study. J Matern Fetal Neonatal Med 2020; 35:4243-4249. [PMID: 33207996 DOI: 10.1080/14767058.2020.1849100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The prevalence of antimicrobial-resistant bacteria and methicillin-sensitive Staphylococcus aureus (MSSA) in healthy newborns and the role of maternal transmission are scarcely discussed. OBJECTIVES The objective of this study was to evaluate the prevalence of MSSA, MRSA, and ESBL among healthy newborns. Additionally, mother-to-newborn transmission rates were investigated as well as antibiotic susceptibility of MSSA, MRSA, and ESBL isolates. METHODS Swabs of 658 newborns and their mothers were collected to investigate the presence of MSSA, MRSA, and ESBL. Swabs were taken from the nose and umbilicus immediately after birth. Additional swabs were taken from the nose, perianal area, and umbilicus 3 days after birth. Samples were screened and further characterized using culture and molecular methods. RESULTS Prevalence of MSSA, MRSA, and ESBL colonization was 10.9, 0.5, and 2.6%, respectively. There was no association between the colonization status of the newborn and infections at any time point. Mother-to-newborn transmission rates (confirmed by PFGE) were 53.6% for MSSA/MRSA and 100% for ESBL. Maternal carriage of MSSA, MRSA, or ESBL was a risk factor for colonization of the newborn. Some isolates were resistant to the antibiotics recommended for therapy, including clindamycin and daptomycin for MSSA/MRSA isolates and ertapenem, fosfomycin, and tigecyclin for ESBL isolates. CONCLUSION No association between infections and the newborns' colonization status could be detected. Maternal colonization played an important role in newborn colonization, but not every case of colonization could be explained by mother-to-newborn transmission. General screening of pregnant women and healthy newborns in the absence of other risk factors is not necessary. To prevent the possibility of transmission in the healthcare setting, professionals, pregnant women, parents, hospital visitors, and obstetricians should receive regular training on appropriate hygiene measures. With regard to the emergence of resistance to recommended antibiotics, an antibiogram should be conducted before treating MSSA/MRSA/ESBL infections to ensure the efficacy of the antibiotics.
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Affiliation(s)
- Katharina Heigl
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Mihai Zamfir
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Alexandra C Adler
- Bavarian State Ministry of Public Health and Care Services, Munich, Germany
| | - Antchen Dammeyer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Lasse Schomacher
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Barbara Karlin
- Rotkreuzklinikum München, Women's Clinic, Munich, Germany
| | | | - Stefan Hörmansdorfer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Christian Tuschak
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Giuseppe Valenza
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - Uta Ochmann
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - Caroline Herr
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - Stefanie Heinze
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
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Abstract
Antibiotic-resistant bacteria are an increasing problem in the NICU. Ineffective empiric antibiotic therapy is associated with increased risk for morbidity and mortality. Organisms that are resistant to multiple antimicrobial agents (multidrug-resistant organisms) are particularly problematic. These organisms may be transmitted to infants if infection control practices are not adhered to, or they may be created by antibiotic exposure. Therefore, meticulous infection prevention-including hand hygiene, surveillance cultures, contact precautions, and selective decolonization-and antibiotic stewardship are important strategies to minimize drug resistance in the NICU.
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Affiliation(s)
| | - Joseph B Cantey
- Division of Neonatology and.,Division of Allergy, Immunology, and Infectious Diseases, Department of Pediatrics, University of Texas Health San Antonio, San Antonio, TX
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Dammeyer AH, Heinze S, Adler AC, Nasri L, Schomacher L, Zamfir M, Heigl K, Karlin B, Franitza M, Hörmansdorfer S, Tuschak C, Valenza G, Ochmann U, Herr C. Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy. Arch Gynecol Obstet 2019; 300:1303-1316. [PMID: 31531777 DOI: 10.1007/s00404-019-05287-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated. METHODS From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included. RESULTS Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection. CONCLUSION Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.
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Affiliation(s)
- A H Dammeyer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.
| | - S Heinze
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - A C Adler
- Bavarian State Ministry of Public Health and Care Services, Munich, Germany
| | - L Nasri
- Klinikum Augsburg, Women's Clinic, Augsburg, Germany
| | - L Schomacher
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - M Zamfir
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - K Heigl
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - B Karlin
- Rotkreuzklinikum München, Women's Clinic, Munich, Germany
| | - M Franitza
- Klinikum Augsburg, Women's Clinic, Augsburg, Germany
| | - S Hörmansdorfer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - C Tuschak
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - G Valenza
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - U Ochmann
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - C Herr
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
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10
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Jalilian N, Kooshkiforooshani M, Ahmadi S, Nankali A. Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae in pregnant/post-partum women: Systematic review and meta-analysis. J Glob Antimicrob Resist 2019; 19:338-347. [PMID: 31212106 DOI: 10.1016/j.jgar.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Maternal colonisation with extended-spectrum β-lactamase (ESBL)-producing micro-organisms can lead to transmission of such pathogens to neonates, resulting in considerable morbidity. The aim of this study was to determine the global prevalence of maternal colonisation with ESBL-producing Enterobacteriaceae (ESBL-E). METHODS A systematic review of PubMed, Embase, Scopus, Web of Science and ProQuest databases as well as the grey literature was performed. Studies reporting the prevalence of ESBL-E colonisation during pregnancy or postpartum period were included. Prevalence data were grouped by geographic region. The pooled prevalence and 95% confidence interval (CI) was estimated by meta-analysis using a random-effects model. RESULTS Nineteen studies with reports from 16 countries (seven studies from Africa, one study from South America, two studies from Asia and nine studies from Europe) reporting data for 7352 pregnant/postpartum women were included. The pooled prevalence of ESBL-E colonisation was 8% (95% CI 5-10%). Prevalence estimates were 15% (95% CI 5-24%) in Africa, 6% (95% CI 4-10%) in South America, 5% (95% CI 4-6%) in Asia and 4% (95% CI 2-5%) in Europe. The pooled prevalence was higher in studies with low risk of bias (10%; 95% CI 7-13%) compared with those with high risk of bias (3%; 95% CI 2-3%). CONCLUSION There was heterogeneity regarding ESBL-E colonisation rates in different continents. The pooled prevalence rate was higher in Africa compared with other areas. Given that the highest rate was observed in Africa, implementing screening efforts for ESBL-E colonisation during pregnancy may be justified.
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Affiliation(s)
- Nasrin Jalilian
- Fertility and Infertility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shooba Ahmadi
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Anisodowleh Nankali
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Nanayakkara D, Liyanapathirana V, Kandauda C, Gihan C, Ekanayake A, Adasooriya D. Maternal vaginal colonization with selected potential pathogens of neonatal sepsis in the era of antimicrobial resistance, a single center experience from Sri Lanka. BMC Infect Dis 2018; 18:351. [PMID: 30055584 PMCID: PMC6064104 DOI: 10.1186/s12879-018-3262-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Maternal vaginal colonization with antibiotic resistant organisms is a growing concern in countries with high antibiotic resistance rates. METHODS A low vaginal swab was collected from mothers on admission, on discharge and a peri-rectal swab was collected from the neonates born to these mothers on discharge. Routine microbiological methods were used to identify the colonization rates for Escherichia coli, Klebsiella spp. and Streptococcus agalactiae. RESULTS The pre-delivery colonization rate among the 250 participants for total Enterobacteriaceae was 18.8%. The colonization rates for Klebsiella spp., E. coli and S. agalactiae were, 12.4, 5.6 and 14.8% respectively. Two Klebsiella spp. and two E. coli isolates were confirmed to be exentend spectrum β lactamase (ESBL) producers with the commonest resistant determinant being blaCTX-M. Post-delivery swabs were collected from 130 participants and the colonization rates were 41.5% for Enterobacteriaceae, 25.4% for Klebsiella spp., 10.8% for E. coli, and 10.8% for S. agalacteiae. Three Klebsiella isolates and one E. coli isolate were confirmed to be ESBL producers with the commonest resistant determinant being blaCTX-M. Considering the 130 participants with both samples, there was a significant increase in the colonization with any Enterobacteriaceae and Klebsiella spp. (p < 0.05). Peri-rectal swabs were collected from neonates in 159 instances. The isolation rates for Enterobacteriaceae was 34%. The genus specific isolation rate for Klebsiella was 21.4% while the rates for E. coli and S.agalactiae were 10.1 and 5.7% respectively. Two of the E. coli were confirmed to be ESBL producers while none of the klebsiellae were identified to be so. Considering these 159 instances where both the mother and baby were sampled, random amplification of polymorphic DNA (RAPD) analysis revealed that Enterbacteriaceae with same strain type was present in 6.9% of the instances, indicating possible transfer between the mother and neonate. The transfer rate for ESBL producers were 0.6%. CONCLUSIONS The lower level of antimicrobial resistance among these potentially community acquired isolates is encouraging. However, in view of the increasing level of resistance reported elsewhere in the region, regular monitoring is warranted.
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Affiliation(s)
- Dulmini Nanayakkara
- Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Veranja Liyanapathirana
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Chaminda Kandauda
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Champika Gihan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Asela Ekanayake
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dinuka Adasooriya
- Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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