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Abban MK, Ayerakwa EA, Mosi L, Isawumi A. The burden of hospital acquired infections and antimicrobial resistance. Heliyon 2023; 9:e20561. [PMID: 37818001 PMCID: PMC10560788 DOI: 10.1016/j.heliyon.2023.e20561] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/21/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
The burden of Hospital care-associated infections (HCAIs) is becoming a global concern. This is compounded by the emergence of virulent and high-risk bacterial strains such as "ESKAPE" pathogens - (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species), especially within Intensive care units (ICUs) that house high-risk and immunocompromised patients. In this review, we discuss the contributions of AMR pathogens to the increasing burden of HCAIs and provide insights into AMR mechanisms, with a particular focus on last-resort antibiotics like polymyxins. We extensively discuss how structural modifications of surface-membrane lipopolysaccharides and cationic interactions influence and inform AMR, and subsequent severity of HCAIs. We highlight some bacterial phenotypic survival mechanisms against polymyxins. Lastly, we discuss the emergence of plasmid-mediated resistance as a phenomenon making mitigation of AMR difficult, especially within the ICUs. This review provides a balanced perspective on the burden of HCAIs, associated pathogens, implication of AMR and factors influencing emerging AMR mechanisms.
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Affiliation(s)
- Molly Kukua Abban
- West African Centre for Cell Biology of Infectious Pathogens, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
| | - Eunice Ampadubea Ayerakwa
- West African Centre for Cell Biology of Infectious Pathogens, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
| | - Lydia Mosi
- West African Centre for Cell Biology of Infectious Pathogens, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
| | - Abiola Isawumi
- West African Centre for Cell Biology of Infectious Pathogens, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, College of Basic and Applied Sciences, P.O. Box LG 54, Volta Road, University of Ghana, Legon, Accra, Ghana
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Qiao J, Chen Y, Ge H, Xu H, Guo X, Liu R, Li C, Chen R, Gou J, Chen M, Zheng B. Coexistence of blaIMP-4, blaNDM-1 and blaOXA-1 in blaKPC-2-producing Citrobacter freundii of clinical origin in China. Front Microbiol 2023; 14:1074612. [PMID: 37378293 PMCID: PMC10291173 DOI: 10.3389/fmicb.2023.1074612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose To explore the genetic characteristics of the IMP-4, NDM-1, OXA-1, and KPC-2 co-producing multidrug-resistant (MDR) clinical isolate, Citrobacter freundii wang9. Methods MALDI-TOF MS was used for species identification. PCR and Sanger sequencing analysis were used to identify resistance genes. In addition to agar dilution, broth microdilution was used for antimicrobial susceptibility testing (AST). We performed whole genome sequencing (WGS) of the strains and analyzed the resulting data for drug resistance genes and plasmids. Phylogenetic trees were constructed with maximum likelihood, plotted using MAGA X, and decorated by iTOL. Results Citrobacter freundii carrying blaKPC-2, blaIMP-4, blaOXA-1, and blaNDM-1 are resistant to most antibiotics, intermediate to tigecycline, and only sensitive to polymyxin B, amikacin, and fosfomycin. The blaIMP-4 coexists with the blaNDM-1 and the blaOXA-1 on a novel transferable plasmid variant pwang9-1, located on the integron In1337, transposon TnAS3, and integron In2054, respectively. The gene cassette sequence of integron In1337 is IntI1-blaIMP-4-qacG2-aacA4'-catB3Δ, while the gene cassette sequence of In2054 is IntI1-aacA4cr-blaOXA-1-catB3-arr3-qacEΔ1-sul1. The blaNDM-1 is located on the transposon TnAS3, and its sequence is IS91-sul-ISAba14-aph (3')-VI-IS30-blaNDM-1-ble-trpF-dsbD-IS91. The blaKPC-2 is located on the transposon Tn2 of plasmid pwang9-1, and its sequence is klcA-korC-ISkpn6-blaKPC-2-ISkpn27-tnpR-tnpA. Phylogenetic analysis showed that most of the 34\u00B0C. freundii isolates from China were divided into three clusters. Among them, wang1 and wang9 belong to the same cluster as two strains of C. freundii from environmental samples from Zhejiang. Conclusion We found C. freundii carrying blaIMP-4, blaNDM-1, blaOXA-1, and blaKPC-2 for the first time, and conducted in-depth research on its drug resistance mechanism, molecular transfer mechanism and epidemiology. In particular, we found that blaIMP-4, blaOXA-1, and blaNDM-1 coexisted on a new transferable hybrid plasmid that carried many drug resistance genes and insertion sequences. The plasmid may capture more resistance genes, raising our concern about the emergence of new resistance strains.
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Affiliation(s)
- Jie Qiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Chen
- Department of Neurosurgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Haoyu Ge
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaobing Guo
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruishan Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chenyu Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruyan Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianjun Gou
- Department of Laboratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mantao Chen
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Beiwen Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Structure and Morphology, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, China
- Research Units of Infectious Diseases and Microecology, Chinese Academy of Medical Sciences, Beijing, China
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Liu L, Zhang L, Zhou H, Yuan M, Hu D, Wang Y, Sun H, Xu J, Lan R. Antimicrobial Resistance and Molecular Characterization of Citrobacter spp. Causing Extraintestinal Infections. Front Cell Infect Microbiol 2021; 11:737636. [PMID: 34513738 PMCID: PMC8429604 DOI: 10.3389/fcimb.2021.737636] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives This prospective study was carried out to investigate molecular characteristics and antimicrobial susceptibility patterns of Citrobacter spp. from extraintestinal infections. Methods Forty-six clinical Citrobacter spp. isolates were isolated from hospital patients with extraintestinal infections and analyzed by multilocus sequence typing (MLST) using seven housekeeping genes. Antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Adhesion and cytotoxicity to HEp-2 cells were assessed. Results The 46 clinical Citrobacter spp. isolates were typed into 38 sequence types (STs), 9 of which belonged to four clonal complexes (CCs). None of the isolates shared the same ST or CCs with isolates from other countries or from other parts of China. Over half of the isolates were multidrug-resistant (MDR), with 17/26 C. freundii, 5/6 C. braakii, and 3/14 C. koseri isolates being MDR. Moreover, four isolates were carbapenem resistant with resistance to imipenem or meropenem. Among eight quinolone resistant C. freundii, all had a mutation in codon 59 (Thr59Ile) in quinolone resistance determining region of the gyrA gene. Only a small proportion of the isolates were found to be highly cytotoxic and adhesive with no correlation to sample sources. Conclusions There was a diverse range of Citrobacter isolates causing extraintestinal infections and a high prevalence of MDR.
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Affiliation(s)
- Liyun Liu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Zhang
- Microbiology Department, Maanshan Center for Clinical Laboratory, Ma'anshan, China
| | - Haijian Zhou
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Min Yuan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Dalong Hu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Yonglu Wang
- Microbiology Department, Maanshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Hui Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Jianguo Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Research Units of Discovery of Unknown Bacteria and Function (2018RU010), Chinese Academy of Medical Sciences, Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia
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Hu Y, Li D, Xu L, Hu Y, Sang Y, Zhang G, Dai H. Epidemiology and outcomes of bloodstream infections in severe burn patients: a six-year retrospective study. Antimicrob Resist Infect Control 2021; 10:98. [PMID: 34193300 PMCID: PMC8243830 DOI: 10.1186/s13756-021-00969-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Infection is the leading cause of morbidity and mortality among burn patients, and bloodstream infection (BSI) is the most serious. This study aimed to evaluate the epidemiology and clinical outcomes of BSI in severe burn patients. Methods Clinical variables of all patients admitted with severe burns (≥ 20% total body surface area, %TBSA) were analyzed retrospectively from January 2013 to December 2018 at a teaching hospital. The Kaplan–Meier method was utilized for plotting survival curves. Multivariate logistic regression and Cox regression model were also performed. Results A total of 495 patients were evaluated, of whom 136 (27.5%) had a BSI. The median time from the patients being burned to BSI was 8 days. For BSI onset in these patients, 47.8% (65/136) occurred in the first week. The most frequently isolated causative organism was A. baumannii (22.7%), followed by methicillin-resistant Staphylococcus aureus (18.7%) and K. pneumoniae (18.2%), in patients with BSI. Multivariate logistic regression analysis showed that %TBSA (p = 0.023), mechanical ventilation (p = 0.019), central venous catheter (CVC) (p < 0.001) and hospital length of stay (27d vs 50d, p < 0.001) were independent risk factors associated with BSI. Cox regression model showed that acute kidney injury (HR, 12.26; 95% CI 2.31–64.98; p = 0.003) and septic shock (HR, 4.36; 95% CI 1.16–16.34; p = 0.031) were identified as independent predictors of 30-day mortality of BSI in burn patients. Conclusions Multidrug resistant gram-negative bacteria were the main pathogens of BSI in severe burn patients. Accurate evaluation of risk factors for BSI and the mortality of BSI in severe burn patients may improve early appropriate management.
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Affiliation(s)
- Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Danyang Li
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Lingcheng Xu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuping Hu
- Department of Pharmacy, Hangzhou Third People's Hospital, Hangzhou, 310009, China
| | - Yiwen Sang
- Department of Laboratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Chen CM, Wang M, Li XP, Li PL, Tian JJ, Zhang K, Luo C. Homology analysis between clinically isolated extraintestinal and enteral Klebsiella pneumoniae among neonates. BMC Microbiol 2021; 21:25. [PMID: 33430787 PMCID: PMC7802202 DOI: 10.1186/s12866-020-02073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023] Open
Abstract
Background Klebsiella pneumoniae is a leading cause of hospital-associated (HA) infections. It has been reported that gastrointestinal colonization (GI) is likely to be a common and significant reservoir for the transmission and infections of K. pneumoniae in both adults and neonates. However, the homologous relationship between clinically isolated extraintestinal and enteral K. pneumoniae in neonates hasn’t been characterized yet. Results Forty-three isolates from 21 neonatal patients were collected in this study. The proportion of carbapenem resistance was 62.8%. There were 12 patients (12/21, 57.4%) whose antibiotic resistance phenotypes, genotypes, and ST types (STs) were concordant. Six sequence types were detected using MLST, with ST37 and ST54 being the dominant types. The results of MLST were consist with the results of PFGE. Conclusions These data showed that there might be a close homologous relationship between extraintestinal K. pneumoniae (EXKP) and enteral K. pneumoniae (EKP) in neonates, indicating that the K. pneumoniae from the GI tract is possibly to be a significant reservoir for causing extraintestinal infections. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-020-02073-2.
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Affiliation(s)
- Chun-Mei Chen
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Min Wang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
| | - Xian-Ping Li
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Peng-Ling Li
- Department of Laboratory Medicine, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Jing-Jing Tian
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Kan Zhang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Can Luo
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
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Peng Q, Chen L, Zhou S, Li H, Long J, Yao F, Zhuang Y, Zhang Z, Huang Y, Duan K. Co-existence of Citrobacter freundii exacerbated Pseudomonas aeruginosa infection in vivo. Int J Med Microbiol 2020; 310:151379. [PMID: 31759864 DOI: 10.1016/j.ijmm.2019.151379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/11/2019] [Accepted: 11/10/2019] [Indexed: 02/05/2023] Open
Abstract
The presence of bacterial species other than the pathogen at infection site can affect the progression of a bacterial infection. Based on the fact that Citrobacter freundii can coexist during Pseudomonas aeruginosa infection, this study aims to investigate the impact of the co-existing C. freundii on the pathogenesis of P. aeruginosa infection. A murine peritonitis model was used to compare the mortality rates and histopathology of P. aeruginosaPAO1 infection in the presence and absence of a C. freundii clinical isolate C9. We also investigated the intercellular interaction between PAO1 and C9 by examining pyocyanin production and comparing gene expression levels. The results demonstrate that co-infection with C9 significantly increased the mortality rate and tissue damages in PAO1 infected mice. At an inoculum of 106 CFU, no mortality was observed in the C9 infected group at three days post-infection, whereas the mortality rate in the PAO1-C9 co-infection group was 64%, compared with 24% in the PAO1 infected group. Pyocyanin production in P. aeruginosa PAO1 increased 8 folds approximately in the presence of C. freundii C9, and operons associated with phenazine synthesis, phzA1 and phzA2, were also upregulated. Disruption of the phzA1 and phzA2 eliminated the exacerbated pathogenicity in the co-infection group, indicating that the elevated pyocyanin production was the main contributing factor. The results suggest that co-existing C. freundii during P. aeruginosa infection can exacerbate the pathogenicity, which may have significant implications in patients infected with these bacteria.
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Affiliation(s)
- Qing Peng
- Department of Hepatobiliary Surgery II, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China; Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada
| | - Lin Chen
- Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada; Faculty of Life Sciences, Northwest University, 229 Taibai Rd. North, Xi'an, Shaanxi, China
| | - Shuqin Zhou
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haiyan Li
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Jun Long
- Department of Clinical Laboratory, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Fen Yao
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Yijing Zhuang
- Department of Clinical Laboratory, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zijie Zhang
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanchun Huang
- Department of Clinical Laboratory, the first affiliated hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Kangmin Duan
- Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada.
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Li M, Li F, Mi Z, Zhao Y, Zhang X, Jiang Z, Pei G, Zhou L, Tong Y, Zhao B. Comparative genomics analysis of pTEM-2262, an MDR plasmid from Citrobacter freundii, harboring two unclassified replicons. Future Microbiol 2018; 13:1657-1668. [PMID: 30499345 DOI: 10.2217/fmb-2018-0243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To genetically characterize the multidrug-resistance (MDR) plasmid pTEM-2262 that could not be classified into any known incompatibility group from the clinical Citrobacter freundii isolate 2262. MATERIALS & METHODS The repA or repB deletion mutants of pTEM-2262 were constructed using the scarless Cas9-assisted recombineering system. Comparative genomic analysis of pTEM-2262 and the other four previously sequenced plasmids belonging to the same incompatibility group were performed. RESULTS pTEM-2262, a conjugative plasmid, harbored two unclassified replicons, repA and repB, while repB was not essential for pTEM-2262 replication. In five analyzed plasmids, their conserved backbones primarily integrated massive accessory modules at two 'hotspots' that were located between orf597 and orf504, and between orf393 and orf405. All the antibiotic resistance genes of pTEM-2262 were clustered in the MDR region with a complex mosaic structure. CONCLUSION This study thoroughly investigates the detailed structure and genomic comparison of this unknown incompatibility group for the first time.
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Affiliation(s)
- Manli Li
- College of Life Science, Hebei Normal University, Shijiazhuang, Hebei 050024, PR China.,State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Fei Li
- Clinical Laboratory, Taian City Central Hospital, Taian 271000, PR China
| | - Zhiqiang Mi
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Yachao Zhao
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Xianglilan Zhang
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Zhaofang Jiang
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Guangqian Pei
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Lijun Zhou
- Central Laboratory, Navy General Hospital, Beijing 100048, PR China
| | - Yigang Tong
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, PR China
| | - Baohua Zhao
- College of Life Science, Hebei Normal University, Shijiazhuang, Hebei 050024, PR China
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Parathon H, Kuntaman K, Widiastoety TH, Muliawan BT, Karuniawati A, Qibtiyah M, Djanun Z, Tawilah JF, Aditama T, Thamlikitkul V, Vong S. Progress towards antimicrobial resistance containment and control in Indonesia. BMJ 2017; 358:j3808. [PMID: 28874346 PMCID: PMC5598291 DOI: 10.1136/bmj.j3808] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Harry Parathon
- Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
- Antimicrobial Resistance Control Committee, Ministry of Health, Jakarta, Indonesia
| | - Kuntaman Kuntaman
- Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
- Antimicrobial Resistance Control Committee, Ministry of Health, Jakarta, Indonesia
| | | | - Bayu T Muliawan
- Directorate of Pharmaceutical Services, Ministry of Health, Jakarta, Indonesia
| | - Anis Karuniawati
- Medical Faculty Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
- Antimicrobial Resistance Control Committee, Ministry of Health, Jakarta, Indonesia
| | - Mariyatul Qibtiyah
- Faculty of Medicine Universitas Airlangga, Dr Soetomo Hospital, Surabaya, Indonesia
| | - Zunilda Djanun
- Medical Faculty Universitas Indonesia, Jakarta, Indonesia
- Antimicrobial Resistance Control Committee, Ministry of Health, Jakarta, Indonesia
| | - Jihane F Tawilah
- World Health Organization, Country Office for Indonesia, Jakarta, Indonesia
| | - Tjandra Aditama
- World Health Organization, Regional Office of South-East Asia, New Delhi
| | - Visanu Thamlikitkul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirenda Vong
- World Health Organization, Regional Office of South East Asia, New Delhi, India
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Wan YK, Sang W, Chen B, Yang YG, Zhang LQ, Sun AN, Liu YJ, Xu Y, Cai YP, Wang CB, Shen YF, Jiang YW, Zhang XY, Xu W, Hong M, Chen T, Xu RR, Li F, Xu YL, Xue Y, Lu YL, He ZM, Dong WM, Chen Z, Ji MH, Yang YY, Zhai LJ, Zhao Y, Wu GQ, Ding JH, Cheng J, Cai WB, Sun YM, Ouyang J. [Distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015: results from a multicenter, retrospective study]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:602-606. [PMID: 28810329 PMCID: PMC7342276 DOI: 10.3760/cma.j.issn.0253-2727.2017.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Indexed: 11/05/2022]
Abstract
Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions: Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.
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Affiliation(s)
- Y K Wan
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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Liu LH, Wang NY, Wu AYJ, Lin CC, Lee CM, Liu CP. Citrobacter freundii bacteremia: Risk factors of mortality and prevalence of resistance genes. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:565-572. [PMID: 28711438 DOI: 10.1016/j.jmii.2016.08.016] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Multidrug-resistant strains of Citrobacter have emerged, which carry Amp-C β-lactamase (Amp-C), broad-spectrum β-lactamase, extended-spectrum β-lactamase (ESBL), and other resistance mechanisms. These strains are associated with a higher rate of in-hospital mortality. The object of this study is to determine the mortality risk factors, susceptibility pattern to antibiotics, and prevalence of resistance genes in patients with Citrobacter freundii bacteremia. METHODS From January 2009 to December 2014, blood isolates of C. freundii were collected in MacKay Memorial Hospital, Taipei, Taiwan. PCR technique and sequencing were performed for resistance genes. Pulsed-field gel electrophoresis (PFGE) was done using XbaI restriction enzyme. The clinical characteristics and risk factors for mortality are demonstrated. RESULTS The 36 blood isolates of C. freundii belonged to 32 different PFGE pulsotypes, and 15 isolates (41.7%) were polymicrobial. The most common source of infection was intra-abdominal origin (61.1%), followed by unknown sources (22.2%), the urinary tract (8.3%), intravascular catheter (5.6%), and soft tissue (2.8%). High degree of antibiotic resistance was noted for cefazolin (100%), cefoxitin (97.2%), and cefuroxime (66.7%). The blaTEM-1 resistance gene was present in 16.7% isolates. 72.2% isolates carried blaAmpC and 5.6% isolates carried ESBL genes (blaSHV-12 or blaCTX-M-15). Multivariate analysis indicated that the independent risk factor for 28-day mortality was carrying the blaTEM-1 resistance gene. CONCLUSION For patients with C. freundii bacteremia, carrying the blaTEM-1 resistance gene was an independent risk factor for 28-day mortality. Carbapenems, fourth-generation cephalosporins, amikacin, and quinolones are still reliable agents for drug-resistant strains.
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Affiliation(s)
- Li-Hsiang Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nai-Yu Wang
- Section of Microbiology, Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Alice Ying-Jung Wu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Chen Lin
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chun-Ming Lee
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Section of Microbiology, Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, Taipei, Taiwan.
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Dabiri H, Tarashi S, Heidary M, Nasiri M. Prevalence of drug-resistant Pseudomonas aeruginosain Iranian burned patients: A meta-analysis. ARCHIVES OF TRAUMA RESEARCH 2017. [DOI: 10.4103/atr.atr_22_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Praharaj AK, Khajuria A, Kumar M, Grover N. Phenotypic detection and molecular characterization of beta-lactamase genes among Citrobacter species in a tertiary care hospital. Avicenna J Med 2016; 6:17-27. [PMID: 26952135 PMCID: PMC4759968 DOI: 10.4103/2231-0770.173578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To examine the distribution, emergence, and spread of genes encoding beta-lactamase resistance in Citrobacter species isolated from hospitalized patients in a tertiary care hospital. Methods: A prospective study was conducted in a 1000-bed tertiary care center in Pune, India from October 2010 to October 2013. A total of 221 Citrobacter spp. isolates were recovered from clinical specimens from different patients (one isolate per patient) admitted to the surgical ward, medical ward and medical and surgical Intensive Care Units. Polymerase chain reaction (PCR) assays and sequencing were used to determine the presence of beta-lactamase encoding genes. Conjugation experiments were performed to determine their transferability. Isolate relatedness were determined by repetitive element based-PCR, enterobacterial repetitive intergenic consensus-PCR and randomly amplified polymorphic DNA. Results: Among 221 tested isolates of Citrobacter spp. recovered from various clinical specimens, 179 (80.9%) isolates showed minimum inhibitory concentration (MIC) >4 μg/ml against meropenem and imipenem. One hundred and forty-five isolates with increased MICs value against carbapenems were further processed for molecular characterization of beta-lactamase genes. Susceptibility profiling of the isolates indicated that 100% retained susceptibility to colistin. Conjugation experiments indicated that blaNDM-1 was transferable via a plasmid. Conclusion: The ease of NDM-1 plasmid transmissibility may help their dissemination among the Citrobacter species as well as to others in Enterobacteriaceae. Early detection, antimicrobial stewardship and adequate infection control measures will help in limiting the spread of these organisms.
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Affiliation(s)
| | - Atul Khajuria
- Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Mahadevan Kumar
- Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Naveen Grover
- Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India
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13
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Vaez H, Beigi F. Antibiotic susceptibility patterns of aerobic bacterial strains isolated from patients with burn wound infections. Germs 2016; 6:34-6. [PMID: 27019830 DOI: 10.11599/germs.2016.1087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 11/23/2022]
Affiliation(s)
- Hamid Vaez
- PhD, Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Iran
| | - Fahimeh Beigi
- PhD, School of Medicine, Yazd University of Medical Sciences, Iran
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14
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Zhao X, Huang S, Zhao J, He X, Li E, Li H, Liu W, Zou D, Wei X, Wang X, Dong D, Yang Z, Yan X, Shen Z, Yuan J. Characterization of phiCFP-1, a virulent bacteriophage specific for Citrobacter freundii. J Med Virol 2015; 88:895-905. [PMID: 26455439 DOI: 10.1002/jmv.24401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/14/2022]
Abstract
Citrobacter freundii, a Gram-negative bacterium, causes many opportunistic infections. Bacteriophage phiCFP-1 was isolated and characterized by its ability to lyse the multidrug-resistant clinical C. freundii strain P10159. Transmission electron microscopy showed that the phage has an icosahedral head and a short tail, making it a Podoviridae family member. In a single-step growth experiment, phiCFP-1 exhibited an eclipse period of 20 min and a burst size of 100 particles per cell. Its genome assembled as a circular molecule when genomic sequencing was completed. However, based on genome content and organization, it was categorized as a classic T7-related phage, and such phages are known to have linear genomes with direct terminal repeats. With the quick and simple method established herein, the 38,625-bp linear double-stranded DNA with 229-bp direct terminal repeats was accurately identified. The genome contained 43 putative open reading frames and no tRNA genes. Using a proteomics-based approach, seven viral and two host proteins from purified phiCFP-1 particles were identified. Comparative genomics and recombination analyzes revealed close genetic relatedness among phiCFP-1, phiYeO3-12/vB_YenP_AP5 (from Yersinia enterocolitica O3), and phiSG-JL2 (from Salmonella enterica).
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Affiliation(s)
- Xiangna Zhao
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Simo Huang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Jiangtao Zhao
- Emergency Department, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoming He
- College of Food Science and Engineering, Northwest A and F University, Yangling, China
| | - Erna Li
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Huan Li
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Wei Liu
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Dayang Zou
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Xiao Wei
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Xuesong Wang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Derong Dong
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Zhan Yang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Xiabei Yan
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Zhiqiang Shen
- Tianjin Institute of Health and Environmental Medicine, Key Laboratory of Risk Assessment and Control for Environment and Food Safety, Tianjin, China
| | - Jing Yuan
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
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15
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Salehifar E, Rafati MR. Extended-Interval Dosing of Aminoglycosides in Pediatrics: A Narrative Review. JOURNAL OF PEDIATRICS REVIEW 2015. [DOI: 10.17795/jpr-2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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16
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Xu Y, Gu B, Huang M, Liu H, Xu T, Xia W, Wang T. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia. J Thorac Dis 2015; 7:376-85. [PMID: 25922715 DOI: 10.3978/j.issn.2072-1439.2014.12.33] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/13/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Over the past decade, the worldwide emergence of carbapenem resistance in Enterobacteriaceae has become a severe public health issue. This meta-analysis aims to describe the epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during the years of 2000-2012 in Asian area. METHODS PubMed and Embase databases were searched to identify the qualified papers. Random or fixed-effect model was used to deal with the data. RESULTS Over all the 49 Asian countries (or regions), only 37.5% [19] of them contributed epidemiology data of CRE, and the rest ones provided either only case reports or no information at all. In Asia, the prevalence of CRE was still low during the study period with average resistance rates of 0.6% (95% CI, 0.6-0.8%, imipenem) and 0.9% (95% CI, 0.7-1.2%, meropenem). Resistance rates to imipenem and meropenem in Enterobacteriaceae exhibited stably escalating trend. Similar trend can also be observed among each Enterobacteriaceae genus, such as E. coli, Klebsiella spp. and Enterobacer spp. Klebsiella spp. accounted for the largest proportion among the isolates resistant to imipenem, and then followed by E. coli and Serratia. The rank order of resistance rates to imipenem among Enterobacteriaceae genus during the period of 2000-2012 was as follows: Serratia spp. (1.8%) > Proteus spp. (1.6%) > Klebsiella spp. (0.8%) = Citrobacter spp. (0.8%) > Enterobacer spp. (0.7%) > E. coli (0.2%). CONCLUSIONS Given the fact that the prevalence of CRE was increasing during the past decade, it is urgent for us to establish regional surveillance worldwide, carry out more effective antibiotic stewardship and infection control measures to prevent further spread of carbapenem resistance in Enterobacteriaceae.
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Affiliation(s)
- Yanling Xu
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Bing Gu
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Mao Huang
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Haiyan Liu
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Ting Xu
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Wenying Xia
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
| | - Tong Wang
- 1 Department of General Medicine, 2 Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China ; 3 National Key Clinical Department of Laboratory Medicine, Nanjing 210029, China
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Öncül O, Öksüz S, Acar A, Ülkür E, Turhan V, Uygur F, Ulçay A, Erdem H, Özyurt M, Görenek L. Nosocomial infection characteristics in a burn intensive care unit: Analysis of an eleven-year active surveillance. Burns 2014; 40:835-41. [DOI: 10.1016/j.burns.2013.11.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 10/31/2013] [Accepted: 11/06/2013] [Indexed: 12/14/2022]
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18
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Azzopardi EA, Azzopardi E, Camilleri L, Villapalos J, Boyce DE, Dziewulski P, Dickson WA, Whitaker IS. Gram negative wound infection in hospitalised adult burn patients--systematic review and metanalysis-. PLoS One 2014; 9:e95042. [PMID: 24751699 PMCID: PMC3994014 DOI: 10.1371/journal.pone.0095042] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/22/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gram negative infection is a major determinant of morbidity and survival. Traditional teaching suggests that burn wound infections in different centres are caused by differing sets of causative organisms. This study established whether Gram-negative burn wound isolates associated to clinical wound infection differ between burn centres. METHODS Studies investigating adult hospitalised patients (2000-2010) were critically appraised and qualified to a levels of evidence hierarchy. The contribution of bacterial pathogen type, and burn centre to the variance in standardised incidence of Gram-negative burn wound infection was analysed using two-way analysis of variance. PRIMARY FINDINGS Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumanni, Enterobacter spp., Proteus spp. and Escherichia coli emerged as the commonest Gram-negative burn wound pathogens. Individual pathogens' incidence did not differ significantly between burn centres (F (4, 20) = 1.1, p = 0.3797; r2 = 9.84). INTERPRETATION Gram-negative infections predominate in burn surgery. This study is the first to establish that burn wound infections do not differ significantly between burn centres. It is the first study to report the pathogens responsible for the majority of Gram-negative infections in these patients. Whilst burn wound infection is not exclusive to these bacteria, it is hoped that reporting the presence of this group of common Gram-negative "target organisms" facilitate clinical practice and target research towards a defined clinical demand.
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Affiliation(s)
- Ernest A. Azzopardi
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Elayne Azzopardi
- Research Institute for Health and Social Change, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, United Kingdom
| | - Liberato Camilleri
- Department of Statistics and Operations, Tal-Qroqq Campus, University of Malta, Msida, Malta
| | - Jorge Villapalos
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital NHS Trust, London, United Kingdom
| | - Dean E. Boyce
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Peter Dziewulski
- St. Andrews Centre for Burns and Plastic Surgery, Chelmsford, United Kingdom
| | - William A. Dickson
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
| | - Iain S. Whitaker
- Institute of Life Science, Swansea University College of Medicine, Singleton Park, Swansea, United Kingodm
- The Welsh Centre for Burns and Plastic Surgery, Moriston Hospital, Swansea, United Kingdom
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Patel BM, Paratz JD, Mallet A, Lipman J, Rudd M, Muller MJ, Paterson DL, Roberts JA. Characteristics of bloodstream infections in burn patients: An 11-year retrospective study. Burns 2012; 38:685-90. [DOI: 10.1016/j.burns.2011.12.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 11/24/2011] [Accepted: 12/21/2011] [Indexed: 11/30/2022]
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Fadeyibi IO, Raji MA, Ibrahim NA, Ugburo AO, Ademiluyi S. Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria. Burns 2012; 39:168-73. [PMID: 22386976 DOI: 10.1016/j.burns.2012.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/24/2012] [Accepted: 02/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment. PATIENTS AND METHODS Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed. RESULTS A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations. CONCLUSION Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.
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Affiliation(s)
- Idowu Olusegun Fadeyibi
- Burns and Plastic Surgery Unit, Department of Surgery, College of Medicine, Lagos State University (LASUCOM)/Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria.
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Abstract
For 2008, approximately 1200 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns). As in the previous year's review, articles were divided into the following topic areas: epidemiology, wound characterisation, critical care physiology, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain management, rehabilitation, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.
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Affiliation(s)
- Steven E Wolf
- Department of Surgery, University of Texas Health Science Center - San Antonio and United States Army Institute of Surgical Research, 7703 Floyd Curl, San Antonio, TX 78229-3600, United States.
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Ullah F, Malik SA, Ahmed J. Antimicrobial susceptibility and ESBL prevalence in Pseudomonas aeruginosa isolated from burn patients in the North West of Pakistan. Burns 2009; 35:1020-5. [PMID: 19501980 DOI: 10.1016/j.burns.2009.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 01/15/2009] [Indexed: 10/20/2022]
Abstract
Pseudomonas aeruginosa is one of the most prevalent pathogen in burn infections. Infections with P. aeruginosa are associated with higher mortality rate and antibiotic costs in hospitalized patients. These bacteria also produce enzymes called Expanded Spectrum Beta-Lactamases (ESBL) which render penicillins and cephalosporins inactive. The aim of this study was to assess the antimicrobial susceptibility pattern and prevalence of ESBL in P. aeruginosa in Peshawar, North West of Pakistan. During 2005-2006, one hundred and six P. aeruginosa isolates were collected from burn patients at a tertiary care hospital. Antibiotic susceptibility testing and ESBL detection were carried out according to Clinical Laboratory and Standards Institute (CLSI) criteria. Eighteen antibiotics were tested in this study. A total of 38 (35.85%) isolates were found to be ESBL producers. Thirty one (29.24%) isolates were resistant to 3 or more antibiotics (multidrug resistance). Meropenem and imipenem showed high potency with 99% and 96% isolates being susceptible respectively. Susceptibility to amikacin was 70%; gentamicin 25%; ciprofloxacin 49%; enoxacin 47%; gatifloxacin 42%; doxycycline 21% and to co-trimoxazole only 16%. This study reveals that P. aeruginosa isolated from burns in this region are multidrug resistant and produce ESBL in large proportions.
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Affiliation(s)
- Farhat Ullah
- Department of Biochemistry/Molecular Biology, Quaid-i-Azam University, Islamabad, Pakistan.
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