1
|
Irusan D, Akshay SD, Shetty VP, Karunasagar I, Deekshit VK, Rohit A. Analysis of mcr family of colistin resistance genes in Gram-negative isolates from a tertiary care hospital in India. J Appl Microbiol 2024; 135:lxae172. [PMID: 38986507 DOI: 10.1093/jambio/lxae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/25/2024] [Accepted: 07/09/2024] [Indexed: 07/12/2024]
Abstract
AIM Colistin serves as the drug of last resort for combating numerous multidrug-resistant (MDR) Gram-negative infections. Its efficacy is hampered by the prevalent issue of colistin resistance, which severely limits treatment options for critically ill patients. Identifying resistance genes is crucial for controlling resistance spread, with horizontal gene transfer being the primary mechanism among bacteria. This study aimed to assess the prevalence of plasmid-mediated mcr genes associated with colistin resistance in Gram-negative bacteria, utilizing both genotypic and phenotypic tests. METHODS AND RESULTS The clinical isolates (n = 913) were obtained from a tertiary care center in Chennai, India. Colistin resistance was seen among Gram-negative isolates. These strains underwent screening for mcr-1, mcr-3, mcr-4, and mcr-5 genes via conventional PCR. Additionally, mcr-positive isolates were confirmed through Sanger sequencing and phenotypic testing. The bacterial isolates predominantly comprised Klebsiella pneumoniae (62.43%), Escherichia coli (19.71%), Pseudomonas aeruginosa (10.73%), and Acinetobacter baumannii (4.81%), along with other species. All isolates exhibited multidrug resistance to three or more antibiotic classes. Colistin resistance, determined via broth microdilution (BMD) using CLSI guidelines, was observed in 13.08% of the isolates studied. Notably, mcr-5 was detected in K. pneumoniae in PCR, despite its absence in Sanger sequencing and phenotypic tests (including the combined-disk test, colistin MIC in the presence of EDTA, and Zeta potential assays). This finding underscores the importance of employing multiple diagnostic approaches to accurately identify colistin resistance mechanisms.
Collapse
Affiliation(s)
- Dhinakaran Irusan
- Department of Microbiology, The Madras Medical Mission, 4-A, Mogappair, Chennai, Tamil Nadu 600037, India
| | - Sadanand Dangari Akshay
- Department of Bio & Nano Technology, Nitte (Deemed to be University), Nitte University Centre for Science Education and Research, Paneer Campus, Deralakatte, Mangaluru 575018, India
| | - Varsha Prakash Shetty
- Department of Infectious Diseases & Microbial Genomics, Nitte (Deemed to be University), Nitte University Centre for Science Education and Research, Paneer Campus, Deralakatte, Mangaluru 575018, India
| | - Iddya Karunasagar
- Nitte (Deemed to be University), Medical Sciences Complex, Mangaluru 575018, India
| | - Vijaya Kumar Deekshit
- Department of Infectious Diseases & Microbial Genomics, Nitte (Deemed to be University), Nitte University Centre for Science Education and Research, Paneer Campus, Deralakatte, Mangaluru 575018, India
| | - Anusha Rohit
- Department of Microbiology, The Madras Medical Mission, 4-A, Mogappair, Chennai, Tamil Nadu 600037, India
- Nitte (Deemed to be University), Medical Sciences Complex, Mangaluru 575018, India
| |
Collapse
|
2
|
Gómez-Zorrilla S, Becerra-Aparicio F, Sendra E, Zamorano L, Grau I, Pintado V, Padilla B, Benito N, Boix-Palop L, Fariñas MC, Peñaranda M, Gamallo MR, Martinez JA, Morte-Romea E, Del Pozo JL, Montesinos IL, Durán-Jordà X, Ponz R, Cotarelo M, Cantón R, Oliver A, Ruiz-Garbajosa P, Horcajada JP, Siverio A, Montesinos IL, Gijón D, Merino I, López de Gopegui E, López-Causapé C, Sabé N, Shaw E, Berbel D, Quintano FT, Carrillo CS, Cercenado E, Rubio V, Rivera A, Calvo E, Badía C, Xercavins M, de Malet A, Canoura-Fernández L, Salvo S, Paño-Pardo JR, Carmona-Torre F. Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteremic urinary tract infections: a post-hoc analysis of a multicenter prospective cohort in Spain. J Hosp Infect 2024:S0195-6701(24)00219-6. [PMID: 38945399 DOI: 10.1016/j.jhin.2024.05.020] [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: 03/31/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION The global burden associated with antimicrobial resistance is of increasing concern. The aim of this study was to evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated (HCA) bacteremic urinary tract infections (BUTI). METHODS This is a post-hoc analysis a prospective multicenter study of patients with HCA-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. RESULTS 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (OR 3.13, 95% CI 2.11-4.69, p<0.001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa etiology (OR 7.84, 95% CI 2.37-25.95; p=0.001). MDR was independently associated with prior use of fluoroquinolones (aOR 2.43; 95% CI 1.25-4.69), cephalosporins (aOR 2.14; 95% CI 1.35-3.41) and imipenem or meropenem (aOR 2.08; 95% CI 1.03-4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but with longer hospital stay. CONCLUSIONS MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although was independently associated with longer duration of hospital stay.
Collapse
Affiliation(s)
- Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute. Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Federico Becerra-Aparicio
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid, Spain
| | - Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute. Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Zamorano
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Service, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Inmaculada Grau
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Vicente Pintado
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Padilla
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Natividad Benito
- Infectious Diseases Service, Hospital de la Santa Creui Sant Pau - Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Service, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Maria Carmen Fariñas
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Universitario Marqués de Valdecilla, Santander
| | - María Peñaranda
- Infectious Diseases Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Maria Rocío Gamallo
- Infectious Diseases Service, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Jose Antonio Martinez
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Hospital Clinic, Barcelona, Spain
| | - Elena Morte-Romea
- Infectious Diseases Service, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain
| | - Jose Luis Del Pozo
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Inmaculada López Montesinos
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute. Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Durán-Jordà
- Methodology and Biostatistics Support Unit, Hospital del Mar Research Institute, Barcelona, Spain
| | | | | | - Rafael Cantón
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid, Spain
| | - Antonio Oliver
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Service, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Patricia Ruiz-Garbajosa
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute. Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain; Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Ana Siverio
- Microbiology Service, Hospital del Mar Research Hospital, Barcelona, Spain
| | | | - Desiré Gijón
- Microbiology Service, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain
| | - Irene Merino
- Microbiology Service, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - Carla López-Causapé
- Microbiology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Nuria Sabé
- Infectious Diseases Service, Hospital Universitario de Bellvitge- Institut d'Investigacio Biomedica de Bellvitge, Barcelona, Spain
| | - Evelyn Shaw
- Infectious Diseases Service, Hospital Universitario de Bellvitge- Institut d'Investigacio Biomedica de Bellvitge, Barcelona, Spain
| | - Dámaris Berbel
- Microbiology Service, Hospital Universitario de Bellvitge- Institut d'Investigacio Biomedica de Bellvitge, Barcelona, Spain
| | - Fe Tubau Quintano
- Microbiology Service, Hospital Universitario de Bellvitge- Institut d'Investigacio Biomedica de Bellvitge, Barcelona, Spain
| | | | | | - Verónica Rubio
- Infectious Diseases Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Microbiology Service, Hospital de la Santa Creu i Sant Pau- Institut d'Investigació Biomèdica Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Calvo
- Infectious Diseases Service, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Cristina Badía
- Infectious Diseases Service, Hospital Mutua de Terrassa, Barcelona, Spain
| | | | - Ana de Malet
- Microbiology Service, Hospital Marqués de Valdecilla, Santander
| | | | - Soledad Salvo
- Microbiology Service, Hospital Clínico Lozano Blesa, Zaragoza
| | | | | |
Collapse
|
4
|
Leone M, Duclos G, Lakbar I, Martin-Loeches I, Einav S. Antimicrobial resistance and outcome in the critically ill patient: An opinion paper. J Crit Care 2023; 77:154352. [PMID: 37302284 DOI: 10.1016/j.jcrc.2023.154352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
Antimicrobial resistance (AMR) is associated with increased mortality and resources consumption in critically ill patients. However, the causality of AMR in this mortality remains unclear. This opinion paper aims to overview the effects of multidrug resistant (MDR) pathogens on the outcomes of critically ill patients, considering different variables as appropriateness of empirical antimicrobial therapy, severity of sepsis, comorbid conditions and frailty. Large studies based on national database associated MDR and increased mortality in critically ill patients. However, the patients carrying MDR pathogens, as compared with those carrying non-MDR pathogens, are those with co-morbid conditions, high risk of frailty and invasive procedures. In addition, inappropriate empirical antibiotics are more often used in these patients as well as withholding and withdrawing of life-sustained therapy. Future studies on AMR should report the rate of appropriateness of empirical antimicrobial therapy, withholding and withdrawing of life-sustained therapy.
Collapse
Affiliation(s)
- Marc Leone
- Department of Anaesthesiology and Intensive Care Unit, North Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France; Centre for Nutrition and Cardiovascular Disease (C2VN), INSERM, INRAE, Aix Marseille University, 13005 Marseille, France.
| | - Gary Duclos
- Department of Anaesthesiology and Intensive Care Unit, North Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Ines Lakbar
- Department of Anaesthesiology and Intensive Care Unit, North Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France; CEReSS, Health Service Research and Quality of Life Centre, School of Medicine, La Timone, Aix-Marseille University, Marseille, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland
| | - Sharon Einav
- Hebrew University Faculty of Medicine, Jerusalem 23456, Israel; Intensive Care Unit of the Shaare Zedek Medical Center, Jerusalem Y56L5, Israel
| |
Collapse
|