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Davido B, Watson AR, de Truchis P, Galazzo G, Dinh A, Batista R, Terveer EM, Lawrence C, Michelon H, Jobard M, Saleh-Mghir A, Kuijper EJ, Caballero S. Bacterial diversity and specific taxa are associated with decolonization of carbapenemase-producing enterobacterales after fecal microbiota transplantation. J Infect 2024; 89:106216. [PMID: 38964511 DOI: 10.1016/j.jinf.2024.106216] [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: 01/01/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES We evaluated the effect of fecal microbiota transplantation (FMT) on the clearance of carbapenemase-producing Enterobacterales (CPE) carriage. METHODS We performed a prospective, multi-center study, conducted among patients who received a single dose of FMT from one of four healthy donors. The primary endpoint was complete clearance of CPE carriage two weeks after FMT with a secondary endpoint at three months. Shotgun metagenomic sequencing was performed to assess gut microbiota composition of donors and recipients before and after FMT. RESULTS Twenty CPE-colonized patients were included in the study, where post-FMT 20% (n = 4/20) of patients met the primary endpoint and 40% (n = 8/20) of patients met the secondary endpoint. Kaplan-Meier curves between patients with FMT intervention and the control group (n = 82) revealed a similar rate of decolonization between groups. Microbiota composition analyses revealed that response to FMT was not donor-dependent. Responders had a significantly lower relative abundance of CPE species pre-FMT than non-responders, and 14 days post-FMT responders had significantly higher bacterial species richness and alpha diversity compared to non-responders (p < 0.05). Responder fecal samples were also enriched in specific species, with significantly higher relative abundances of Faecalibacterium prausnitzii, Parabacteroides distasonis, Collinsella aerofaciens, Alistipes finegoldii and Blautia_A sp900066335 (q<0.01) compared to non-responders. CONCLUSION FMT administration using the proposed regimen did not achieve statistical significance for complete CPE decolonization but was correlated with the relative abundance of specific bacterial taxa, including CPE species.
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Affiliation(s)
- Benjamin Davido
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France; FHU PaCeMM, Hôpital Saint-Antoine, AP-HP Université Paris Centre, 75571 Paris Cedex 12, France.
| | | | - Pierre de Truchis
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France
| | | | - Aurelien Dinh
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France; FHU PaCeMM, Hôpital Saint-Antoine, AP-HP Université Paris Centre, 75571 Paris Cedex 12, France
| | - Rui Batista
- Pharmacie Hospitalière, Hôpital Universitaire Cochin, AP-HP, 75014 Paris, France
| | - Elisabeth M Terveer
- Department of Medical Microbiology, Netherlands Donor Feces Bank (NDFB) at Leiden University Medical Center, Leiden, the Netherlands
| | - Christine Lawrence
- Laboratoire de Microbiologie, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France
| | - Hugues Michelon
- Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France
| | - Marion Jobard
- Pharmacie Hospitalière, Hôpital Universitaire Cochin, AP-HP, 75014 Paris, France
| | - Azzam Saleh-Mghir
- Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP Université Paris Saclay, 92380 Garches, France; UMR1173, Université Versailles Saint-Quentin, 78000 Versailles, France
| | - Ed J Kuijper
- Department of Medical Microbiology, Netherlands Donor Feces Bank (NDFB) at Leiden University Medical Center, Leiden, the Netherlands
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Burgaya J, Marin J, Royer G, Condamine B, Gachet B, Clermont O, Jaureguy F, Burdet C, Lefort A, de Lastours V, Denamur E, Galardini M, Blanquart F. The bacterial genetic determinants of Escherichia coli capacity to cause bloodstream infections in humans. PLoS Genet 2023; 19:e1010842. [PMID: 37531401 PMCID: PMC10395866 DOI: 10.1371/journal.pgen.1010842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023] Open
Abstract
Escherichia coli is both a highly prevalent commensal and a major opportunistic pathogen causing bloodstream infections (BSI). A systematic analysis characterizing the genomic determinants of extra-intestinal pathogenic vs. commensal isolates in human populations, which could inform mechanisms of pathogenesis, diagnostic, prevention and treatment is still lacking. We used a collection of 912 BSI and 370 commensal E. coli isolates collected in France over a 17-year period (2000-2017). We compared their pangenomes, genetic backgrounds (phylogroups, STs, O groups), presence of virulence-associated genes (VAGs) and antimicrobial resistance genes, finding significant differences in all comparisons between commensal and BSI isolates. A machine learning linear model trained on all the genetic variants derived from the pangenome and controlling for population structure reveals similar differences in VAGs, discovers new variants associated with pathogenicity (capacity to cause BSI), and accurately classifies BSI vs. commensal strains. Pathogenicity is a highly heritable trait, with up to 69% of the variance explained by bacterial genetic variants. Lastly, complementing our commensal collection with an older collection from 1980, we predict that pathogenicity continuously increased through 1980, 2000, to 2010. Together our findings imply that E. coli exhibit substantial genetic variation contributing to the transition between commensalism and pathogenicity and that this species evolved towards higher pathogenicity.
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Affiliation(s)
- Judit Burgaya
- Institute for Molecular Bacteriology, TWINCORE Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School (MHH), Hannover, Germany
| | - Julie Marin
- Université Sorbonne Paris Nord, INSERM, IAME, Bobigny, France
| | - Guilhem Royer
- Université Paris Cité, INSERM, IAME, Paris, France
- Département de Prévention, Diagnostic et Traitement des Infections, Hôpital Henri Mondor, Créteil, France
- Unité Ecologie et Evolution de la Résistance aux Antibiotiques, Institut Pasteur, UMR CNRS 6047, Université Paris-Cité, Paris, France
| | | | | | | | | | | | - Agnès Lefort
- Université Paris Cité, INSERM, IAME, Paris, France
| | | | - Erick Denamur
- Université Paris Cité, INSERM, IAME, Paris, France
- Laboratoire de Génétique Moléculaire, Hôpital Bichat, AP-HP, Paris, France
| | - Marco Galardini
- Institute for Molecular Bacteriology, TWINCORE Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School (MHH), Hannover, Germany
| | - François Blanquart
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR7241 / INSERM U1050, PSL Research University, Paris, France
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MacNair CR, Tsai CN, Rutherford ST, Tan MW. Returning to Nature for the Next Generation of Antimicrobial Therapeutics. Antibiotics (Basel) 2023; 12:1267. [PMID: 37627687 PMCID: PMC10451936 DOI: 10.3390/antibiotics12081267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
Antibiotics found in and inspired by nature are life-saving cures for bacterial infections and have enabled modern medicine. However, the rise in resistance necessitates the discovery and development of novel antibiotics and alternative treatment strategies to prevent the return to a pre-antibiotic era. Once again, nature can serve as a source for new therapies in the form of natural product antibiotics and microbiota-based therapies. Screening of soil bacteria, particularly actinomycetes, identified most of the antibiotics used in the clinic today, but the rediscovery of existing molecules prompted a shift away from natural product discovery. Next-generation sequencing technologies and bioinformatics advances have revealed the untapped metabolic potential harbored within the genomes of environmental microbes. In this review, we first highlight current strategies for mining this untapped chemical space, including approaches to activate silent biosynthetic gene clusters and in situ culturing methods. Next, we describe how using live microbes in microbiota-based therapies can simultaneously leverage many of the diverse antimicrobial mechanisms found in nature to treat disease and the impressive efficacy of fecal microbiome transplantation and bacterial consortia on infection. Nature-provided antibiotics are some of the most important drugs in human history, and new technologies and approaches show that nature will continue to offer valuable inspiration for the next generation of antibacterial therapeutics.
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Affiliation(s)
- Craig R. MacNair
- Department of Infectious Diseases, Genentech Inc., South San Francisco, CA 94080, USA;
| | - Caressa N. Tsai
- School of Law, University of California, Berkeley, Berkeley, CA 94704, USA;
| | - Steven T. Rutherford
- Department of Infectious Diseases, Genentech Inc., South San Francisco, CA 94080, USA;
| | - Man-Wah Tan
- Department of Infectious Diseases, Genentech Inc., South San Francisco, CA 94080, USA;
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Ahn ST, Lee HS, Han DE, Lee DH, Kim JW, Park MG, Park HS, Moon DG, Oh MM. What are the risk factors for recurrent UTI with repeated ESBL-producing Enterobacteriaceae? A retrospective cohort study. J Infect Chemother 2022; 29:72-77. [PMID: 36195248 DOI: 10.1016/j.jiac.2022.09.020] [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: 02/03/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A previous study has shown that two-thirds of patients with urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae experience recurrence with the same bacteria on subsequent UTI episodes. However, little is known about which patients suffer from UTI due to ESBL-producing Enterobacteriaceae repeatedly. This study aimed to investigate the risk factors for recurrent UTI due to repeated ESBL-producing organism infections. METHODS This retrospective, single-center, observational cohort study screened all patients with UTI caused by ESBL-producing strains between January 2012 and April 2019. Among the patients who were followed up, patients who experienced UTI recurrence were enrolled and divided into two groups: ESBL recurrence group and non-ESBL recurrence group. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between patient characteristics and the development of recurrent UTI caused by ESBL-producing Enterobacteriaceae. RESULTS A total of 330 patients were followed up after the diagnosis of UTI caused by ESBL-producing organisms. Among the patients, 115 (34.8%) experienced UTI recurrence, and 71 (61.7%) of them experienced subsequent recurrent UTI due to ESBL-producing organisms. Patient's age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.04; P = 0.046) and recurrent UTI history (HR, 1.69; 95% CI, 1.05-2.72; P = 0.031) were significantly associated with an increased risk of recurrence with ESBL-producing Enterobacteriaceae. CONCLUSION These findings showed that a history of previous frequent UTI recurrence is the risk factor for recurrence of UTI due to repeated ESBL producing Enterobacteriaceae infections.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Hyun Soo Lee
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Da Eun Han
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Dong Hyun Lee
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Min Gu Park
- Department of Urology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Mareunnae-ro 9, Jung-gu, Seoul, South Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Masui T, Nakano R, Nakano A, Saito K, Suzuki Y, Kakuta N, Horiuchi S, Tsubaki K, Kitahara T, Yano H. Predominance of CTX-M-9 Group Among ESBL-Producing Escherichia coli Isolated from Healthy Individuals in Japan. Microb Drug Resist 2022; 28:355-360. [PMID: 34990283 DOI: 10.1089/mdr.2021.0062] [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: 11/13/2022] Open
Abstract
The detection rate of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, microorganisms associated with health care settings, has significantly increased worldwide. Moreover, their community incidence has increased in several countries. In this study, we investigated the prevalence and genetic diversity of ESBL-producing Escherichia coli isolated from 547 nonduplicated stool specimens from healthy Japanese individuals, between 2015 and 2019. E. coli were isolated on deoxycholate-hydrogen sulfide-lactose (DHL) agar and identified by MALDI-TOF MS, ESBL were screened through disk diffusion method (cefotaxime with or without clavulanate), and genetic detection and genotyping were performed by PCR and DNA sequencing. Clonal similarities between ESBL-producing and nonproducing isolates were assessed by multilocus sequence typing (MLST). The prevalence of ESBL-producing E. coli was 9.7% (53/547). These bacteria harbored CTX-M genes, from which CTX-M-9 (31/53, 58.5%) and CTX-M-1 (13/53, 24.5%) groups were the predominant. The MLST analysis revealed that ST131 genotype prevailed within ESBL-producing E. coli (15/53), whereas ST95 (10/53) and ST73 (8/53) prevailed among non-ESBL producers, with ST131 being present in only four isolates. Overall, a high prevalence rate of CTX-M-type ESBL-producing E. coli was detected. CTX-M-9 group-producing ST131 predominated among healthy Japanese individuals, similar to that observed in hospital isolates. CTX-M-type ESBL may disseminate clonally among hospital patients and subsequently, within the community.
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Affiliation(s)
- Takashi Masui
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan.,Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Ryuichi Nakano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Akiyo Nakano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Kai Saito
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Yuki Suzuki
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Naoki Kakuta
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Saori Horiuchi
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Kousuke Tsubaki
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
| | - Tadashi Kitahara
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Japan
| | - Hisakazu Yano
- Department of Microbiology and Infectious Diseases, Nara Medical University, Kashihara, Japan
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Ugbo E, Anyamene C, Moses I, Iroha I, Babalola O, Ukpai E, Chukwunwejim C, Egbule C, Emioye A, Okata-Nwali O, Igwe O, Ugadu I. Prevalence of blaTEM, blaSHV, and blaCTX-M genes among extended spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae of clinical origin. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Thamlikitkul V, Tangkoskul T, Seenama C. Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae as a Proxy Composite Indicator of Antimicrobial Resistance in a Community in Thailand. Open Forum Infect Dis 2019; 6:ofz425. [PMID: 31660378 PMCID: PMC6809879 DOI: 10.1093/ofid/ofz425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Increasing awareness of and understanding about antimicrobial resistance (AMR), promoting changes in behavior, and monitoring of AMR in the community are challenging, as AMR is associated with many contributing factors that are difficult to assess individually. This study aimed to determine the effectiveness of a community-based AMR campaign for improving awareness, understanding, and behavior relating to antibiotic use and AMR in Thailand and to assess if fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae could be a proxy composite indicator of AMR in the community. METHODS This study was conducted in 4 communities that are home to approximately 400 000 people. A self-administered questionnaire on awareness, understanding, and behavior relating to antibiotic use and AMR was responded to by 20 521 and 19 634 adults before and immediately after the AMR campaign, respectively, at the household level. Fecal samples were collected from 534 adults before the AMR campaign and from 709 adults at 18 months after the AMR campaign to determine presence of ESBL-producing Enterobacteriaceae. RESULTS Awareness, understanding, and behavior relating to antibiotic use and AMR, as assessed by a self-administered questionnaire, were significantly improved after the AMR campaign. The fecal carriage rate of ESBL-producing Enterobacteriaceae decreased from 66.5% before to 44.6% after the AMR campaign (P < .01). CONCLUSIONS Our AMR campaign was effective for improving awareness, understanding, and behavior relating to antibiotic use and AMR among people in the community at the household level, and the prevalence of fecal carriage of ESBL-producing Enterobacteriaceae seemed to be decreased after the AMR campaign. Fecal carriage rate of ESBL-producing Enterobacteriaceae may be a proxy composite indicator of AMR in the community.
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Affiliation(s)
- Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Teerawit Tangkoskul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chakkraphong Seenama
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ahn ST, Kim SW, Kim JW, Park HS, Moon DG, Oh MM. Does urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli show same antibiotic resistance when it recurs? J Infect Chemother 2019; 25:498-502. [PMID: 30852104 DOI: 10.1016/j.jiac.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/22/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Abstract
This study was performed to evaluate what percentage of urinary tract infections (UTIs) caused by extended spectrum β-lactamase (ESBL)-producing strains recurs with ESBL-producing strains during follow up and to assess the risk factors for recurrence with ESBL-producing Escherichia coli strains on subsequent first recurrence episode. We enrolled female patients with UTIs caused by ESBL-producing E. coli between May 2012 and December 2015, who were longitudinally followed up for at least 24 months. Among the 206 patients with ESBL positive UTI, 180 completed the study. 60 (60/180, 33.3%) of patient with first episode of UTI caused by ESBL-producing E. coli experienced recurrent UTIs during follow up. Of 60 patients, 43 (43/60, 71.7%) recurred with ESBL-producing E. coli on the first UTI recurrence episode. On multivariate analysis, the time to recurrence and history of cephalosporin usage in the last 6 months were identified as risk factors for recurrence with ESBL-producing E. coli per se (odds ratio [OR] = 0.9, 95% confidence interval [CI] 0.8-1.0, p = 0.030 and OR = 27.0, 95% CI 2.4-299.8, p = 0.007, respectively). These findings show that high proportion of patient with UTI caused by ESBL-producing E. coli recurs with ESBL-producing E. coli on subsequent recurrence episode. While result of antibiotic susceptibility cannot be identified on the visit day empirical treatment should be referred to the antecedent antibiotic resistance profile in patients whose previous UTIs were due to ESBL-producing strains.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Sang Woo Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea.
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Isolation of Extended-Spectrum β-lactamase- (ESBL-) Producing Escherichia coli and Klebsiella pneumoniae from Patients with Community-Onset Urinary Tract Infections in Jimma University Specialized Hospital, Southwest Ethiopia. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2018; 2018:4846159. [PMID: 30651898 PMCID: PMC6311771 DOI: 10.1155/2018/4846159] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/24/2018] [Accepted: 11/25/2018] [Indexed: 11/18/2022]
Abstract
Background Klebsiella pneumoniae and Escherichia coli are the major extended-spectrum β-lactamase- (ESBL-) producing organisms increasingly isolated as causes of complicated urinary tract infections and remain an important cause of failure of therapy with cephalosporins and have serious infection control consequence. Objective To assess the prevalence and antibiotics resistance patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae from community-onset urinary tract infections in Jimma University Specialized hospital, Southwest Ethiopia, 2016. Methodology A hospital-based cross-sectional study was conducted, and a total of 342 urine samples were cultured on MacConkey agar for the detection of etiologic agents. Double-disk synergy (DDS) methods were used for detection of ESBL-producing strains. A disc of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of the Mueller–Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm (center to center) from the amoxicillin + clavulanic acid disc. Enhanced inhibition zone of any of the cephalosporin discs on the side facing amoxicillin + clavulanic acid was considered as ESBL producer. Results In the current study, ESBL-producing phenotypes were detected in 23% (n = 17) of urinary isolates, of which Escherichia coli accounts for 76.5% (n = 13) and K. pneumoniae for 23.5% (n = 4). ESBL-producing phenotypes showed high resistance to cefotaxime (100%), ceftriaxone (100%), and ceftazidime (70.6%), while both ESBL-producing and non-ESBL-producing isolates showed low resistance to amikacin (9.5%), and no resistance was seen with imipenem. In the risk factors analysis, previous antibiotic use more than two cycles in the previous year (odds ratio (OR), 6.238; 95% confidence interval (CI), 1.257–30.957; p = 0.025) and recurrent UTI more than two cycles in the last 6 months or more than three cycles in the last year (OR, 7.356; 95% CI, 1.429–37.867; p = 0.017) were found to be significantly associated with the ESBL-producing groups. Conclusion Extended-spectrum β-lactamases- (ESBL-)producing strain was detected in urinary tract isolates. The occurrence of multidrug resistance to the third-generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines is more common among ESBL producers. Thus, detecting and reporting of ESBL-producing organisms have paramount importance in the clinical decision-making.
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Singh R, de Groot PF, Geerlings SE, Hodiamont CJ, Belzer C, Berge IJMT, de Vos WM, Bemelman FJ, Nieuwdorp M. Fecal microbiota transplantation against intestinal colonization by extended spectrum beta-lactamase producing Enterobacteriaceae: a proof of principle study. BMC Res Notes 2018; 11:190. [PMID: 29566738 PMCID: PMC5863815 DOI: 10.1186/s13104-018-3293-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/13/2018] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Infections with multidrug-resistant microorganisms are associated with increased hospitalization, medication costs and mortality. Based on our fecal microbiota transplantation (FMT) experience for Clostridium difficile infection, we treated 15 patients carrying ESBL-producing Enterobacteriaceae (ESBL-EB) with FMT. Seven patients underwent a second FMT after 4 weeks when ESBL-EB remained, amounting to a total number of 22 transplants. The objective was decolonization of ESBL-EB. RESULTS Three out of fifteen (20%) patients were ESBL-negative at 1, 2 and 4 weeks after the first transplant, while six out of 15 (40%) were negative after the second transplant. Comparison of fecal microbiota at baseline and 4 weeks after FMT revealed restoration of microbial diversity after FMT and a microbial shift towards donor composition. Finally, we suggest several possible factors of response to therapy, such as donor-recipient microbiota match and number of FMTs. Therefore, FMT can be an effective treatment in patients carrying ESBL-EB. Response may be determined by microbiota composition and number of FMT procedures. Trial registration ISRCTN ISRCTN48328635 Registered 11 October 2017, retrospectively registered.
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Affiliation(s)
- Ramandeep Singh
- Renal Transplant Unit, Division of Nephrology, Academic Medical Centre, Room A3-273, PO box 22660, 1100 DD Amsterdam, The Netherlands
- Division of Infectious Diseases, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands
| | - Pieter F. de Groot
- Division of Vascular Medicine, Academic Medical Centre, Room F4-256, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Suzanne E. Geerlings
- Division of Infectious Diseases, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands
| | - Caspar J. Hodiamont
- Department of Medical Microbiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Clara Belzer
- Department of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Ineke J. M. ten Berge
- Renal Transplant Unit, Division of Nephrology, Academic Medical Centre, Room A3-273, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Willem M. de Vos
- Department of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Frederike J. Bemelman
- Renal Transplant Unit, Division of Nephrology, Academic Medical Centre, Room A3-273, PO box 22660, 1100 DD Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Division of Vascular Medicine, Academic Medical Centre, Room F4-256, PO box 22660, 1100 DD Amsterdam, The Netherlands
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands
- Wallenberg Laboratory, Sahlgrenska Hospital, University of Gothenburg, Gothenburg, Sweden
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Extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis. Int J Antimicrob Agents 2017; 50:649-656. [PMID: 28782707 DOI: 10.1016/j.ijantimicag.2017.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/08/2017] [Accepted: 08/01/2017] [Indexed: 11/23/2022]
Abstract
The objectives of this study were to estimate the colonisation rate by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) among residents of long-term care facilities (LTCFs) and to identify pertinent risk factors. A systematic search of PubMed and EMBASE databases for studies published up to May 2016 that provided raw data for gastrointestinal colonisation by ESBL-PE among LTCF residents was performed. Twenty-three studies reporting data on 9775 screened subjects met the inclusion criteria. The pooled prevalence of ESBL-PE among LTCF residents was 18% [95% confidence interval (CI) 12-24%]. Risk factors for colonisation included recent antibiotic use (within 6 months) [odds ratio (OR) = 2.06, 95% CI 1.78-2.38], previous hospitalisation (within 2.5 years) (OR = 1.50, 95% CI 1.04-2.15), history of invasive procedures (within 2 years) (OR = 2.79, 95% CI 1.66-4.70), previous ESBL-PE colonisation or infection (OR = 6.77, 95% CI 1.33-34.62), history of urinary tract infection (OR = 2.66, 95% CI 1.76-4.01) and urinary catheter use (OR = 2.55, 95% CI 1.29-5.04). In conclusion, almost one in five LTCF residents is colonised with ESBL-PE, and colonised residents are more likely to have a history of recent antibiotic use or healthcare facility utilisation. Strict adherence to antimicrobial stewardship in LTCFs is needed to address these high resistance rates.
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Yamamoto A, Yamasaki K. [Evaluation of antibiotic treatments for urinary tract infections in the elderly, especially regarding the effect on extended spectrum β-lactamase producing (ESBL-) Escherichia coli: A comparison between meropenem and alternatives]. Nihon Ronen Igakkai Zasshi 2016; 52:153-61. [PMID: 25994987 DOI: 10.3143/geriatrics.52.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An increasing incidence of extended-spectrum β-lactamase (ESBL-) producing Escherihia Coli poses a difficult problem for clinicians to establish an optimal strategy for the effective antibiotic treatment of urinary tract infections (UTI). METHODS (1) Fosfomycin/minocycline (FOM/MINO) or rifampicin/sulfamethoxazole-trimethoprim (RFP/ST) combinations and (2) levofloxacin (LVFX) alone were used as an internal medication, and (3) cefoperazone/sulbactam (CPZ/SBT) and (4) meropenem (MEPM) were administered through intravenous injection. The selection of antibiotics was done empirically, according to the history and severity of illness and urinary findings, and the presence of comobidities. The efficacy of the treatment was determined by the absence of any pathogenic bacteria from a urinary culture after treatment. RESULTS ESBL-producing and LVFX resistant non-ESBL producing E. coli were detected by an initial urinary culture in 33 and 10%, respectively, of the specimens before treatment. All the ESBL-producing E. Coli colonies were resistant against LVFX. The efficacy of the treatment was 9/11 (82%) in the FOM/MINO-RFP/ST group, 9/14 (64%) in the LVFX group, 9/16 (56%) in the CPZ/SBT group, and 19/27 (70%) in the MEPM group. In the FOM/MINO・RFP/ST group, ESBL-producing E. Coli were detected in the urine before treatment in 5 out of 16 patients and those E. coli disappeared after treatment in all 5 patients. In the LVFX group, the drug was changed to MEPM in 6 out of 15 patients soon after the presence of ESBL-producing/LVFX resistant E. Coli was identified by a urinary culture. In the CPZ/SBT group, ESBL-producing and/or LVFX-resistant E. coli disappeared in 4 out of 6 cases, while they were newly found in post-treatment urine cultures in 2 patients. In the MEPM group, 15 out of 28 patients initially had ESBL-producing/LVFX resistant E. Coli and those drug-resistant E. Coli disappeared from their urine after treatment in all patients. The drug susceptibility test of the urinary culture from all the patients with UTI showed CPZ/SBT-resistant colonies to be found in 19 out of 32 specimens, while AMPC/CVA-resistant ones were found in 9 out of 32 of ESBL-producing E. Coli. CONCLUSIONS Our present study demonstrates that FOM/MINO or ST combinations were effective in the treatment of ESBL-producing E. Coli in mild cases of UTI and MEPM in severe cases. When using β-lactam/β-lactamase inhibitor combinations, the effect should be ascertained by examining post-treatment urinary specimens, because of the presence of ESBL-producing E. Coli strains which are resistant to those antibiotics.
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Affiliation(s)
- Akira Yamamoto
- Blueberry, Amagasaki Health Care Facilities for the Elderly
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Community spread of extended-spectrum β-lactamase-producing bacteria detected in social insurance hospitals throughout Japan. J Infect Chemother 2016; 22:395-9. [PMID: 27066881 DOI: 10.1016/j.jiac.2016.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/10/2015] [Accepted: 03/02/2016] [Indexed: 11/20/2022]
Abstract
We surveyed the status of community-acquired infections involving four extended-spectrum β-lactamase (ESBL)-producing bacteria (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) isolated from clinical specimens from 11 social insurance hospitals in Japan in 2012. These are member hospitals of the Japan Community Healthcare Organization, an independent administrative hospital organization. The isolation rates for E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis were 14.0% (165/1176), 3.3% (16/480), 3.1% (4/130), and 15.9% (17/107), respectively. The CTX-M-9 group, the most frequently detected genotype, was found in 77.0% (127/165) of E. coli and 43.8% (7/16) of K. pneumoniae isolates. Among K. oxytoca isolates, 75% (3/4) were the CTX-M-1 group, and all 17 P. mirabilis strains were the CTX-M-2 group. ESBL-producing bacteria isolation rates in each hospital ranged from 5.8% to 21.5% (median 9.5%), and the proportion of community-acquired infections among ESBL-producing bacteria isolates ranged from 1.6% to 30.8% (median 11.4%) in each hospital. Overall, the rates of ESBL-producing bacterial infection in all community-acquired infections and in all hospital infections were 10.6% (115/1081) and 10.7% (87/812), respectively. The ESBL-producing bacteria are not limited to certain regions or hospitals but are spreading in communities throughout Japan.
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Lohiya A, Kant S, Kapil A, Gupta SK, Misra P, Rai SK. Pattern of Antibiotic Resistance Among Community Derived Isolates of Enterobacteriaceae Using Urine Sample: A Study From Northern India. J Clin Diagn Res 2015; 9:LC15-9. [PMID: 26393150 DOI: 10.7860/jcdr/2015/14230.6254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/10/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite world-wide evidence of increased antibiotic resistance, there is scarce data on antibiotic resistance in community settings. One of the reason being difficulty in collection of biological specimen (traditionally stool) in community from apparently healthy individuals. Hence, finding an alternative specimen that is easier to obtain in a community setting or in large scale surveys for the purpose, is crucial. We conducted this study to explore the feasibility of using urine samples for deriving community based estimates of antibiotic resistance and to estimate the magnitude of resistance among urinary isolates of Escherichia coli and Klebsiella pneumonia against multiple antibiotics in apparently healthy individuals residing in a rural community of Haryana, North India. MATERIALS AND METHODS Eligible individuals were apparently healthy, aged 18 years or older. Using the health management information system (HMIS) of Ballabgarh Health Demographic Surveillance System (HDSS), sampling frame was prepared. Potential individuals were identified using simple random sampling. Random urine sample was collected in a sterile container and transported to laboratory under ambient condition. Species identification and antibiotic susceptibility testing for Enterobacteriaceae was done using Clinical Laboratory and Standards Institute (CLSI) 2012 guidelines. Multi-drug resistant (MDR) Enterobacteriaceae, Extended Spectrum Beta Lactamase (ESBL) producing Enterobacteriaceae, and Carbapenem producing Enterobacteriaceae (CRE) were identified from the urine samples. RESULTS A total of 433 individuals participated in the study (non-response rate - 13.4%), out of which 58 (13.4%) were positive for Enterobacteriaceae, 8.1% for E. coli and 5.3% for K. pneumoniae. Resistance against penicillin (amoxicillin/ampicillin) for E. coli and K. pneumoniae was 62.8% and 100.0% respectively. Isolates resistant to co-trimoxazole were 5.7% and 0.0% respectively. None of the isolates were resistant to imipenem, and meropenem. CONCLUSION AND RECOMMENDATIONS It is feasible to use urine sample to study magnitude of antibiotic resistance in population based surveys. At community level, resistance to amoxicillin was considerable, negligible for co-trimoxazole, and to higher antibiotics including carbapenems.
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Affiliation(s)
- Ayush Lohiya
- Junior Resident, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India
| | - Shashi Kant
- Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India
| | - Arti Kapil
- Professor, Department of Microbiology, All India Institute of Medical Sciences , New Delhi, India
| | - Sanjeev Kumar Gupta
- Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India
| | - Puneet Misra
- Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India
| | - Sanjay K Rai
- Professor, Centre for Community Medicine, All India Institute of Medical Sciences , New Delhi, India
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Ben Sallem R, Ben Slama K, Estepa V, Cheikhna EO, Mohamed AM, Chairat S, Ruiz-Larrea F, Boudabous A, Torres C. Detection of CTX-M-15-producing Escherichia coli isolates of lineages ST410-A, ST617-A and ST354-D in faecal samples of hospitalized patients in a Mauritanian hospital. J Chemother 2014; 27:114-6. [PMID: 24548094 DOI: 10.1179/1973947814y.0000000172] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dierikx CM, van der Goot JA, Smith HE, Kant A, Mevius DJ. Presence of ESBL/AmpC-producing Escherichia coli in the broiler production pyramid: a descriptive study. PLoS One 2013; 8:e79005. [PMID: 24244401 PMCID: PMC3820706 DOI: 10.1371/journal.pone.0079005] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/20/2013] [Indexed: 12/03/2022] Open
Abstract
Broilers and broiler meat products are highly contaminated with extended spectrum beta-lactamase (ESBL) or plasmid-mediated AmpC beta-lactamase producing Escherichia coli and are considered to be a source for human infections. Both horizontal and vertical transmission might play a role in the presence of these strains in broilers. As not much is known about the presence of these strains in the whole production pyramid, the epidemiology of ESBL/AmpC-producing E. coli in the Dutch broiler production pyramid was examined. Cloacal swabs of Grandparent stock (GPS) birds (one−/two-days (breed A and B), 18 and 31 weeks old (breed A)), one-day old Parent stock birds (breed A and B) and broiler chickens of increasing age (breed A) were selectively cultured to detect ESBL/AmpC-producing isolates. ESBL/AmpC-producing isolates were found at all levels in the broiler production pyramid in both broiler breeds examined. Prevalence was already relatively high at the top of the broiler production pyramid. At broiler farms ESBL/AmpC producing E. coli were still present in the environment of the poultry house after cleaning and disinfection. Feed samples taken in the poultry house also became contaminated with ESBL/AmpC producing E. coli after one or more production weeks. The prevalence of ESBL/AmpC-positive birds at broiler farms increased within the first week from 0–24% to 96–100% independent of the use of antibiotics and stayed 100% until slaughter. In GPS breed A, prevalence at 2 days, 18 weeks and 31 weeks stayed below 50% except when beta-lactam antibiotics were administered. In that case prevalence increased to 100%. Interventions minimizing ESBL/AmpC contamination in broilers should focus on preventing horizontal and vertical spread, especially in relation to broiler production farms.
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Affiliation(s)
- Cindy M. Dierikx
- Department of Bacteriology and TSEs, Central Veterinary Institute (CVI), part of Wageningen UR, Lelystad, The Netherlands
- * E-mail:
| | - Jeanet A. van der Goot
- Department of Epidemiology Crisis Organization and Diagnostics, Central Veterinary Institute (CVI), part of Wageningen UR, Lelystad, The Netherlands
| | - Hilde E. Smith
- Department of Infection Biology, Central Veterinary Institute (CVI), part of Wageningen UR, Lelystad, The Netherlands
| | - Arie Kant
- Department of Bacteriology and TSEs, Central Veterinary Institute (CVI), part of Wageningen UR, Lelystad, The Netherlands
| | - Dik J. Mevius
- Department of Bacteriology and TSEs, Central Veterinary Institute (CVI), part of Wageningen UR, Lelystad, The Netherlands
- Utrecht University, Faculty of Veterinary Medicine, Utrecht, The Netherlands
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Extended spectrum beta-lactamase-producing Enterobacteriaceae in international travelers and non-travelers in New York City. PLoS One 2012; 7:e45141. [PMID: 23028808 PMCID: PMC3447858 DOI: 10.1371/journal.pone.0045141] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 08/13/2012] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We performed this study 1) to determine the prevalence of community-associated extended spectrum beta-lactamase producing Enterobacteriaceae (ESBLPE) colonization and infection in New York City (NYC); 2) to determine the prevalence of newly-acquired ESBLPE during travel; 3) to look for similarities in contemporaneous hospital-associated bloodstream ESBLPE and travel-associated ESBLPE. METHODS Subjects were recruited from a travel medicine practice and consented to submit pre- and post-travel stools, which were assessed for the presence of ESBLPE. Pre-travel stools and stools submitted for culture were used to estimate the prevalence of community-associated ESBLPE. The prevalence of ESBLPE-associated urinary tract infections was calculated from available retrospective data. Hospital-associated ESBLPE were acquired from saved bloodstream isolates. All ESBLPE underwent multilocus sequence typing (MLST) and ESBL characterization. RESULTS One of 60 (1.7%) pre- or non-travel associated stool was colonized with ESBLPE. Among community-associated urine specimens, 1.3% of Escherichia coli and 1.4% of Klebsiella pneumoniae were identified as ESBLPE. Seven of 28 travelers (25.0%) acquired a new ESBLPE during travel. No similarities were found between travel-associated ESBLPE and hospital-associated ESBLPE. A range of imported ESBL genes were found, including CTX-M-14 and CTX-15. CONCLUSION ESBL colonization and infection were relatively low during the study period in NYC. A significant minority of travelers acquired new ESBLPE during travel.
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Luvsansharav UO, Hirai I, Nakata A, Imura K, Yamauchi K, Niki M, Komalamisra C, Kusolsuk T, Yamamoto Y. Prevalence of and risk factors associated with faecal carriage of CTX-M -lactamase-producing Enterobacteriaceae in rural Thai communities. J Antimicrob Chemother 2012; 67:1769-74. [DOI: 10.1093/jac/dks118] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Yamamoto A. [Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is frequently detected as a pathogen of urinary tract infection in nursing home residents]. Nihon Ronen Igakkai Zasshi 2011; 48:530-538. [PMID: 22323032 DOI: 10.3143/geriatrics.48.530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To assess the prevalence of the fecal carriage of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli among nursing home residents and to demonstrate the relationship between fecal carriage and urinary tract infections (UTIs) in elderly patients. METHODS Data were collected for 12 months on aerobic bacteria obtained from the urine of elderly patients with UTI. Feces were analyzed for the bla(CTX-M) gene at the Department of Bioinformatics, Osaka University Graduate School of Medicine. RESULTS Among 56 strains of aerobic bacteria obtained from 40 patients with UTIs, there were 24 strains of Escherichia coli, 14 (58.3%) of which were ESBL-producing. All of these ESBL strains were also resistant to levofloxacin (LVFX). Fecal ESBL-carriage was detected in 21.5% of the residents, with similar ratios in men and women. Statistical analysis of the backgrounds of residents showed that the carriage rate was markedly high in those elderly patients who came from hospitals after the treatment of infectious/purulent diseases. Among the 145 residents, whose feces were analyzed for ESBL, UTIs developed in 10 patients, only 1 of whom was a man; urinary examination did not detect ESBL-producing Escherichia coli as a pathogen in this patient. In 9 female patients, ESBL-producing Escherichia coli was isolated from the urine of 8 women. While the combination of fosfomycin and minomycin was useful in the treatment of the UTIs in these cases, it did not completely remove the ESBL-producing bacteria from feces. CONCLUSIONS Fecal carriage of ESBL-producing Escherichia coli is prevalent in our facilities and is related to a high incidence of UTIs in elderly women, presenting treatment challenges.
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Affiliation(s)
- Akira Yamamoto
- Blueberry, Amagasaki Health Care Facilities for the Elderly
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