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Blank M, Wilson RC, Wan Y, Peters J, Davies F, Tyszczuk L, Pichon B, Riezk A, Demirjian A, Brown CS, Gilchrist M, Holmes AH, Rawson TM. Exploring real-world vancomycin target attainment in neonatal intensive care in the context of Staphylococcal infections: a retrospective observational cohort study. J Infect 2024; 89:106191. [PMID: 38848967 DOI: 10.1016/j.jinf.2024.106191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Michael Blank
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom.
| | - Richard C Wilson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom; David Price Evans Infectious Diseases & Global Health Group, The University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Yu Wan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, UK Health Security Agency (UKHSA), 61 Colindale Avenue London NW9 5EQ, United Kingdom
| | - Joanna Peters
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom
| | - Frances Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom
| | - Lidia Tyszczuk
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom
| | - Bruno Pichon
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, UK Health Security Agency (UKHSA), 61 Colindale Avenue London NW9 5EQ, United Kingdom
| | - Alaa Riezk
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - Alicia Demirjian
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, UK Health Security Agency (UKHSA), 61 Colindale Avenue London NW9 5EQ, United Kingdom; Department of Paediatric Infectious Disease & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, Kings College London, London, UK; Faculty of Medicine, Imperial College London, London, UK
| | - Colin Stewart Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) & Sepsis Division, UK Health Security Agency (UKHSA), 61 Colindale Avenue London NW9 5EQ, United Kingdom
| | - Mark Gilchrist
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS. United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom; David Price Evans Infectious Diseases & Global Health Group, The University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Timothy Miles Rawson
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department for Infectious Disease, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN. United Kingdom; Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0NN, United Kingdom; David Price Evans Infectious Diseases & Global Health Group, The University of Liverpool, Liverpool L7 8TX, United Kingdom
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Gashaw M, Ali S, Berhane M, Tesfaw G, Eshetu B, Workneh N, Seeholzer T, Froeschl G, Kroidl A, Wieser A, Gudina EK. Neonatal Sepsis Due to Multidrug-resistant Bacteria at a Tertiary Teaching Hospital in Ethiopia. Pediatr Infect Dis J 2024; 43:687-693. [PMID: 38656939 PMCID: PMC11191060 DOI: 10.1097/inf.0000000000004364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia. METHODS An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH). RESULTS A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens. CONCLUSIONS The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.
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Affiliation(s)
- Mulatu Gashaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Solomon Ali
- Department of Medical Microbiology, Parasitology, and Immunology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Melkamu Berhane
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- From the School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Netsanet Workneh
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Thomas Seeholzer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Guenter Froeschl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Arne Kroidl
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
| | - Andreas Wieser
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU)
- Max von Pettenkofer-Institute (Medical Microbiology), LMU, Munich, Germany
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Channon-Wells S, Elmes J, Muller-Pebody B, McGarrity O, Chappell F, Drysdale SB, Ashiru-Oredope D, Patel S, Demirjian A. National point-prevalence survey of healthcare-associated infections and antimicrobial use: UK-PAS/UKHSA joint call to action for all paediatric services. J Antimicrob Chemother 2023; 78:2392-2394. [PMID: 37611224 PMCID: PMC10805576 DOI: 10.1093/jac/dkad265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
The negative impact of high antimicrobial use (AMU), antimicrobial resistance and healthcare-associated infections (HCAIs) on children is concerning. However, a lack of available paediatric data makes it challenging to design and implement interventions that would improve health outcomes in this population, and impedes efforts to secure additional resources. The upcoming 2023 national point-prevalence survey of HCAIs and AMU in hospitals, led by the UK Health Security Agency, is an opportunity to collect valuable information, which will enable healthcare providers and policy makers to optimize antimicrobial stewardship and infection prevention practices in all populations, including children. These data will facilitate benchmarking and sharing of best practice, internally, nationally and internationally. This is a joint call to action asking all healthcare professionals-particularly in paediatrics-to nominate a lead for their institution and participate in this survey, to ensure appropriate paediatric representation, and help protect children from these growing threats.
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Affiliation(s)
- Samuel Channon-Wells
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, UK
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
| | - Jocelyn Elmes
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Orlagh McGarrity
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Pharmacy, Great Ormond Street Hospital, London, UK
| | - Faye Chappell
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
| | - Simon B Drysdale
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Centre for Paediatric and Neonatal Infection, St George’s, University of London, London, UK
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Sanjay Patel
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Alicia Demirjian
- UK Paediatric Antimicrobial Stewardship Network, Birmingham, UK
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU) and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Felgate H, Sethi D, Faust K, Kiy C, Härtel C, Rupp J, Clifford R, Dean R, Tremlett C, Wain J, Langridge G, Clarke P, Page AJ, Webber MA. Characterisation of neonatal Staphylococcus capitis NRCS-A isolates compared with non NRCS-A Staphylococcus capitis from neonates and adults. Microb Genom 2023; 9:001106. [PMID: 37791541 PMCID: PMC10634448 DOI: 10.1099/mgen.0.001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Staphylococcus capitis is a frequent cause of late-onset sepsis in neonates admitted to Neonatal Intensive Care Units (NICU). One clone of S. capitis, NRCS-A has been isolated from NICUs globally although the reasons for the global success of this clone are not well understood.We analysed a collection of S. capitis colonising babies admitted to two NICUs, one in the UK and one in Germany as well as corresponding pathological clinical isolates. Genome analysis identified a population structure of three groups; non-NRCS-A isolates, NRCS-A isolates, and a group of 'proto NRCS-A' - isolates closely related to NRCS-A but not associated with neonatal infection. All bloodstream isolates belonged to the NRCS-A group and were indistinguishable from strains carried on the skin or in the gut. NRCS-A isolates showed increased tolerance to chlorhexidine and antibiotics relative to the other S. capitis as well as enhanced ability to grow at higher pH values. Analysis of the pangenome of 138 isolates identified characteristic nsr and tarJ genes in both the NRCS-A and proto groups. A CRISPR-cas system was only seen in NRCS-A isolates which also showed enrichment of genes for metal acquisition and transport.We found evidence for transmission of S. capitis NRCS-A within NICU, with related isolates shared between babies and multiple acquisitions by some babies. Our data show NRCS-A strains commonly colonise uninfected babies in NICU representing a potential reservoir for potential infection. This work provides more evidence that adaptation to survive in the gut and on skin facilitates spread of NRCS-A, and that metal acquisition and tolerance may be important to the biology of NRCS-A. Understanding how NRCS-A survives in NICUs can help develop infection control procedures against this clone.
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Affiliation(s)
- Heather Felgate
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Dheeraj Sethi
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Kirsten Faust
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Cemsid Kiy
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Rebecca Clifford
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Rachael Dean
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | | | - John Wain
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Gemma Langridge
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
| | - Paul Clarke
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
- Norfolk and Norwich University Hospital (NNUH), NR4 7UY, Norwich, UK
| | - Andrew J. Page
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
| | - Mark A. Webber
- Quadram Institute Bioscience, Norwich Research Park, NR4 7UQ, Norwich, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, UK
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