1
|
Su PY, Cheng WH, Ho CH. Molecular characterization of multidrug-resistant non-typeable Haemophilus influenzae with high-level resistance to cefuroxime, levofloxacin, and trimethoprim-sulfamethoxazole. BMC Microbiol 2023; 23:178. [PMID: 37407940 DOI: 10.1186/s12866-023-02926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Non-typeable Haemophilus influenzae (NTHi) has become the major cause of invasive H. influenzae diseases in the post-H. influenzae type b vaccine era. The emergence of multidrug-resistant (MDR) NTHi is a growing public health problem. Herein, we investigated the molecular basis of MDR in NTHi. The isolated NTHi were subjected to antimicrobial susceptibility testing for 12 agents. Whole genome and plasmid sequencing were conducted and analyzed to identify significant genetic variations and plasmid-encoded genes conferred antibiotic resistance. RESULTS Thirteen (50%) MDR NTHi isolates were obtained; of these, 92.3% were non-susceptible to ampicillin, 30.8% to amoxicillin-clavulanate, 61.5% to cefuroxime, 61.5% to ciprofloxacin/levofloxacin, 92.3% to trimethoprim-sulfamethoxazole, 30.8% to tetracycline, and 7.7% to azithromycin. Eight ampicillin-resistant isolates were β-lactamase positive; of these, 6 carried blaTEM-1 and 2 carried blaROB-1, whereas 4 were β-lactamase negative. Genetic variations in mrdA, mepA, and pbpG were correlated with amoxicillin-clavulanate non-susceptibility, whereas variations in ftsI and lpoA conferred cefuroxime resistance. Five variations in gyrA, 2 in gyrB, 3 in parC, 1 in parE, and 1 in the parC-parE intergenic region were associated with levofloxacin/ciprofloxacin non-susceptibility. Among these genes, 8 variations were linked to high-level levofloxacin resistance. Six variations in folA were associated with trimethoprim-sulfamethoxazole resistance. Plasmid-bearing tet(B) and mef(A) genes were responsible for tetracycline and azithromycin resistance in 4 and 1 MDR isolates, respectively. CONCLUSIONS This study clarified the molecular epidemiology of MDR in NTHi. This can benefit the monitoring of drug resistance trends in NTHi and the adequate medical management of patients with NTHi infection.
Collapse
Affiliation(s)
- Pei-Yi Su
- Department of Laboratory Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Wei-Hung Cheng
- Department of Parasitology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Hsun Ho
- Department of Medical Laboratory Science, College of Medical Science and Technology, I-Shou University, No.8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan.
| |
Collapse
|
2
|
Bahy R, Fatyan E, Saafan AE, El-Gebaly EAEA. Preparation and evaluation of a new combined conjugated vaccine against Klebsiella pneumonia and Pseudomonas aeruginosa. J Appl Microbiol 2022; 133:1543-1554. [PMID: 35652238 DOI: 10.1111/jam.15646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
AIMS Lower respiratory tract infections (LRTIs) have been identified by the WHO as the most deadly infectious diseases and a pervasive public health problem, causing increased hospital admissions, mortality, and antibiotic use. This study aims to determine the most common and resistant bacteria that cause LRTIs and prepare an appropriate vaccine to reduce and prevent potential future infections. METHODS AND RESULTS Our survey was conducted by collecting respiratory exudate specimens. The most predominant and resistant types were Klebsiella pneumonia and Pseudomonas aeruginosa. The lipopolysaccharides (LPS) were extracted using a modified hot phenol method to prepare the vaccine. The LPS were then activated and conjugated. The immunogenicity of the prepared singles and combined vaccines was determined through an in- vivo assay using BALB/c mice. The prepared vaccine provided high protection against the lethal dose of both bacteria in mice. The combined vaccine shows a significant value in achieving high immunization. CONCLUSION These findings demonstrate the potential of the bacterial LPS molecules to be used as effective vaccines. SIGNIFICANCE AND IMPACT OF STUDY developing an effective single and combined vaccine against Pseudomonas aeruginosa and Klebsiella pneumonia can protect and reduce LRTI incidence.
Collapse
Affiliation(s)
- Rehab Bahy
- Faculty of Pharmacy, Microbiology and Immunology Department, Fayoum University, Fayoum, Egypt
| | - Eman Fatyan
- National Organization of Drug Control and Research, Microbiology and Immunology Department, Giza, Egypt
| | - Amal E Saafan
- Faculty of pharmacy, Microbiology and Immunology Department, Menoufia University, Shibin Elkoum, Egypt
| | - Eman Abd El Aziz El-Gebaly
- Faculty of pharmacy, Microbiology and Immunology Department, Beni- Suef University, Beni- Suef, Egypt.,Microbiology and Immunology Department, faculty of pharmacy, 6 Oct University, Giza, Egypt
| |
Collapse
|
3
|
Dong Q, Shi W, Cheng X, Chen C, Meng Q, Yao K, Qian S. Widespread of non-typeable Haemophilus influenzae with high genetic diversity after two decades use of Hib vaccine in China. J Clin Lab Anal 2019; 34:e23145. [PMID: 31846125 PMCID: PMC7171301 DOI: 10.1002/jcla.23145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The aim of this study was to analyze the microbiological characteristics of nasopharyngeal carriage Haemophilus influenzae isolates collected from children with respiratory infections in Beijing hospital and Youyang Hospital of China. METHODS The serotypes of all isolates were determined using latex agglutinated antisera (a-f). The minimum inhibitory concentrations (MICs) of 11 antibiotics were determined using E-test strips. For the beta-lactamase-negative ampicillin-resistant (BLNAR) isolates, ftsI gene was sequenced based on fragments amplified by PCR. STs of H influenzae isolates were determined by multi-locus sequence typing. RESULTS The overall carriage rate of H influenzae in the study population was 9.1% (362/3984). One hundred and ninety H influenzae isolates which were selected in our study were non-typeable (NTHi) and 44 (23.2%) of them were positive for β-lactamase. All isolates were susceptible to ceftriaxone and levofloxacin. Susceptibility rates to erythromycin and sulfamethoxazole-trimethoprim in Beijing were significantly higher than Youyang (P < .05). Thirty-six BLNAR isolates were identified. The MLST analysis showed 108 STs in 190 isolates, the most common of which were ST408 (11, 5.8%), ST914 (10, 5.3%), ST57 (9, 4.7%), and ST834 (6, 3.2%). Twelve STs were detected in both of the study sites, which covered 63 isolates. CONCLUSIONS All isolates in the present study were NTHi, which suggested widespread of this type in China. The BLNAR isolates were detected more frequently than before. Because high genetic diversity of NTHi isolates of H influenzae exists worldwide, it is important to continuously monitor these bacteria in the future.
Collapse
Affiliation(s)
- Qiaoli Dong
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China.,Department of Pediatrics, Affiliated Hospital of Hebei University, Baoding, China
| | - Wei Shi
- Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoping Cheng
- Youyang Hospital, People's Hospital of Chongqing Youyang County, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changhui Chen
- Youyang Hospital, People's Hospital of Chongqing Youyang County, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghong Meng
- Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, National Key Discipline of Pediatrics (Capital Medical University), National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Zhou G, Liu H, He M, Yue M, Gong P, Wu F, Li X, Pang Y, Yang X, Ma J, Liu M, Li J, Zhang X. Smoking, leisure-time exercise and frequency of self-reported common cold among the general population in northeastern China: a cross-sectional study. BMC Public Health 2018; 18:294. [PMID: 29486739 PMCID: PMC6389261 DOI: 10.1186/s12889-018-5203-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity (PA) and smoking have been reported to be associated with the duration and severity of common cold symptoms. However, few studies have addressed the associations between the frequency of leisure-time exercise, cigarette smoking status and the frequency of the common cold in a cold area. This study was designed to investigate these issues in northeastern China. Methods This cross-sectional study included individuals who participated in a regular health examination conducted in Jilin Province, China. Information on episodes of the common cold, the frequency of leisure-time exercise and cigarette smoking status in the past year were collected by self-administered health questionnaires. Ordinal logistic regression models were used to analyse the associations between the frequency of leisure-time exercise, cigarette smoking status and the retrospective frequency of common cold. Results A total of 1413 employees participated in the study, with an average age of 38.92 ± 9.04 years and 44.4% of them were male. Of all participants, 80.8% reported having experienced the common cold in the past year. After adjustment, the risk of suffering from the common cold more than once (odds ratios (ORs), 1.59; 95% confidence interval (CI), 1.27–1.99) in passive smokers was 1.59 times as high as that in non-smokers. Nevertheless, the results of the adjusted analysis showed no statistically significant relation between current smoking and the frequency of the common cold. A high frequency of leisure-time exercise (≥3 days/week) was associated with a 26% reduced risk of having at least one episode of the common cold (OR, 0.74; 95% CI, 0.55–0.98) compared with a low frequency group (< 4 days/month). For current and passive smokers, the protective effect of a high frequency of leisure-time exercise appears not to be obvious (current smokers: OR, 0.68; 95% CI, 0.33–1.43; passive smokers: OR, 1.15; 95% CI, 0.69–1.93). Conclusion Passive smoking was associated with a higher risk of having self-reported common cold at least once, while a high frequency of leisure-time exercise was related to a lower risk of reporting more than one episode of the disease in Chinese.
Collapse
Affiliation(s)
- Ge Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Hongjian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Minfu He
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Mengjia Yue
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Ping Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Fangyuan Wu
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Xuanxuan Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Yingxin Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Xiaodi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Juan Ma
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Meitian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Jinghua Li
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Xiumin Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China.
| |
Collapse
|
5
|
How do hospital respiratory clinicians perceive antimicrobial stewardship (AMS)? A qualitative study highlighting barriers to AMS in respiratory medicine. J Hosp Infect 2017. [PMID: 28622980 DOI: 10.1016/j.jhin.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suboptimal antibiotic use in respiratory infections is widespread in hospital medicine and primary care. Antimicrobial stewardship (AMS) teams within hospitals, commonly led by infectious diseases physicians, are frequently charged with optimizing the use of respiratory antibiotics, but there is limited information on what drives antibiotic use in this area of clinical medicine, or on how AMS is perceived. AIM To explore the perceptions of hospital respiratory clinicians on AMS in respiratory medicine. METHODS In-depth interviews were conducted with 28 clinicians (13 doctors and 15 nurses) from two hospitals in Australia. Data were analysed thematically using the framework approach. FINDINGS Four key barriers to the integration of AMS processes within respiratory medicine, from the participants' perspectives, were identified: CONCLUSIONS: AMS processes are introduced in hospitals with established social structures and knowledge bases. This study found that AMS in respiratory medicine challenges and conflicts with many of these dynamics. If the influence of these dynamics is not considered, AMS processes may not be effective in containing antibiotic use in hospital respiratory medicine.
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW The increase in drug-resistant community-acquired pneumonia (CAP) is an important problem all over the world. This article explores the current state of antimicrobial resistance of different bacteria that cause CAP and also assesses risk factors to identify those pathogens. RECENT FINDINGS In the last two decades, it has been documented that there is a significant increase in drug-resistant Streptococcus pneumoniae and other bacteria causing CAP. The most important risk factors are overuse of antibiotics, prior hospitalization, and lung comorbidities. The direct consequences can be severe, including prolonged stays in hospital, increased costs, and morbi-mortality. However, drug-resistant CAP declined after the introduction of the pneumococcal conjugate vaccine. This review found an increase in resistance to the antibiotics used in CAP, and the risk factor can be used for identifying patients with drug-resistant CAP and initiate appropriate treatment. Judicious use of antibiotics and the development of effective new vaccines are needed.
Collapse
Affiliation(s)
- Francisco Arancibia
- Servicio de Medicina Respiratoria, Instituto Nacional Del Tórax and Unidad de Enfermedades Respiratorias, Facultad de Medicina Oriente, Universidad de Chile, J.M.Infante 717, Providencia, Santiago of Chile, Chile.
| | - Mauricio Ruiz
- Departamento de Medicina, Hospital Clínico U. de Chile, Universidad de Chile, Av. Independencia 1027, Independencia, Providencia, Santiago of Chile, Chile
| |
Collapse
|
7
|
Martínez-Reséndez MF, González-Chávez JM, Garza-González E, Castro-Fuentes LN, Gutiérrez-Ferman JL, Echániz-Aviles G, Camacho-Ortíz A, Carnalla-Barajas MN, Soto-Noguerón A, Maldonado-Garza HJ, Hernández-Balboa CL, Llaca-Díaz JM, Flores-Treviño S. Non-typeable Haemophilus influenzae biofilm production and severity in lower respiratory tract infections in a tertiary hospital in Mexico. J Med Microbiol 2016; 65:1385-1391. [DOI: 10.1099/jmm.0.000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Michel Fernando Martínez-Reséndez
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Juan Manuel González-Chávez
- Departamento de Medicina Interna, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Elvira Garza-González
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
- Departamento de Patología Clínica, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Lorena Nefertiti Castro-Fuentes
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Jessica Lizzeth Gutiérrez-Ferman
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Gabriela Echániz-Aviles
- Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico
| | - Adrián Camacho-Ortíz
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - María Noemí Carnalla-Barajas
- Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico
| | - Araceli Soto-Noguerón
- Departamento de Evaluación de Vacunas, Instituto Nacional de Salud Pública. Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera C.P. 62100. Cuernavaca, Morelos, Mexico
| | - Héctor Jesús Maldonado-Garza
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Cristina Liliana Hernández-Balboa
- Servicio de Infectología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Jorge M. Llaca-Díaz
- Departamento de Patología Clínica, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| | - Samantha Flores-Treviño
- Servicio de Gastroenterología, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Av. Francisco I. Madero Pte. S/N y Av. Gonzalitos, Col. Mitras Centro, 64460 Monterrey, Nuevo León, Mexico
| |
Collapse
|
8
|
Novel broad-spectrum and long-acting parenteral cephalosporins having an acyl cyanamide moiety at the C-3 terminal: Synthesis and structure-activity relationships. Eur J Med Chem 2016; 124:698-712. [PMID: 27639362 DOI: 10.1016/j.ejmech.2016.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/09/2016] [Accepted: 09/03/2016] [Indexed: 11/23/2022]
Abstract
A series of novel 7β-[2-(2-aminothiazole-4-yl)-2-(Z)-(alkoxyimino)acetamido]-cephalosporins having pyridinium-linked acyl cyanamide at the C-3 position were prepared and their antibacterial activities and pharmacokinetics profiles were evaluated. Most of the compounds exhibited potent antibacterial activities against penicillin-resistant Streptococcus pneumoniae (PRSP) and β-lactamase non-producing penicillin-resistant Haemophilus influenzae (BLNAR). Introduction of a propenyl group between the cephalospoin core and the side chains at the C-3 position improved the pharmacokinetics profile. Among these compounds, 7β-[2-(2-aminothiazole-4-yl)-2-(Z)- (alkoxyimino)acetamido]-3-(pyridin-1-ium-1-yl)prop-1-en-1-yl)cephalosporins (32j) showed well-balanced antibacterial activity against S. pneumoniae and H. influenzae which included resistant strains and also other Gram-positive or Gram-negative pathogens. Furthermore, 32j showed a long half-life comparable to that of Ceftriaxone in mice and monkeys.
Collapse
|
9
|
Lavi E, Breuer O. The Impact of Prior Antibiotic Therapy on Outcomes in Children Hospitalized for Community-Acquired Pneumonia. Curr Infect Dis Rep 2015; 18:3. [PMID: 26715113 DOI: 10.1007/s11908-015-0509-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Here, we review current available literature regarding the effect of prior antibiotic treatment on outcomes of children hospitalized for community-acquired pneumonia (CAP). To date, no prospective trial has reported information regarding morbidity or mortality in this group of patients. Retrospective studies have provided evidence for the advantage of treatment with broad-spectrum antibiotics in children who failed prior antibiotic therapy. We discuss the changing epidemiology of CAP in the post PCV13 and Hib vaccines era and its relevance to the outcome of pediatric patients hospitalized for CAP. Current studies still report Streptococcus pneumoniae as the most common typical bacterial causative agent in pediatric CAP. However, in children who fail to respond to guideline directed antibiotic therapy, a non-pneumococcal, possibly one of several β-lactam resistant causative bacterial agents should be considered thus clarifying the advantage for broad-spectrum empirical antibiotic treatment in this group of patients.
Collapse
Affiliation(s)
- Eran Lavi
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Breuer
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
- Pediatric Pulmonology Unit, Hadassah-Hebrew University Medical Center, 91120, Jerusalem, Israel.
| |
Collapse
|
10
|
Yayan J, Ghebremedhin B, Rasche K. No development of ciprofloxacin resistance in the Haemophilus species associated with pneumonia over a 10-year study. BMC Infect Dis 2015; 15:514. [PMID: 26567094 PMCID: PMC4644324 DOI: 10.1186/s12879-015-1267-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 11/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background The widespread overuse of antibiotics promotes the development of antibiotic resistance in bacteria, which can cause severe illness and constitutes a major public health concern. Haemophilus species are a common cause of community- and nosocomial-acquired pneumonia. The antibiotic resistance of these Gram-negative bacteria can be prevented through the reduction of unnecessary antibiotic prescriptions, the correct use of antibiotics, and good hygiene and infection control. This article examines, retrospectively, antibiotic resistance in patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species. Methods The demographic, clinical, and laboratory data of all patients with community- and nosocomial-acquired pneumonia caused by Haemophilus species were collected from the hospital charts at the HELIOS Clinic, Witten/Herdecke University, Wuppertal, Germany, within a study period from 2004 to 2014. Antimicrobial susceptibility testing was performed for the different antibiotics that have been consistently used in the treatment of patients with pneumonia caused by Haemophilus species. Results During the study period of January 1, 2004, to August 12, 2014, 82 patients were identified with community- and nosocomial-acquired pneumonia affected by Haemophilus species. These patients had a mean age of 63.8 ± 15.5 (60 [73.2 %, 95 % CI 63.6 %–82.8 %] males and 22 [26.8 %, 95 % CI 17.2 %–36.4 %] females). Haemophilus species had a high resistance rate to erythromycin (38.3 %), ampicillin (24.4 %), piperacillin (20.8 %), cefuroxime (8.5 %), ampicillin-sulbactam (7.3 %), piperacillin-sulbactam (4.3 %), piperacillin-tazobactam (2.5 %), cefotaxime (2.5 %), and levofloxacin (1.6 %). In contrast, they were not resistant to ciprofloxacin in patients with pneumonia (P = 0.016). Conclusion Haemophilus species were resistant to many of the typically used antibiotics. Resistance toward ciprofloxacin was not detected in patients with pneumonia caused by Haemophilus species.
Collapse
Affiliation(s)
- Josef Yayan
- Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Beniam Ghebremedhin
- Witten/Herdecke University, Witten, Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research, HELIOS Clinic Wuppertal, Wuppertal, Germany.
| | - Kurt Rasche
- Witten/Herdecke University, Witten, Department of Internal Medicine, Division of Pulmonary, Allergy, and Sleep Medicine, HELIOS Clinic Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Germany.
| |
Collapse
|
11
|
Obolski U, Stein GY, Hadany L. Antibiotic Restriction Might Facilitate the Emergence of Multi-drug Resistance. PLoS Comput Biol 2015; 11:e1004340. [PMID: 26110266 PMCID: PMC4481510 DOI: 10.1371/journal.pcbi.1004340] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/13/2015] [Indexed: 01/21/2023] Open
Abstract
High antibiotic resistance frequencies have become a major public health issue. The decrease in new antibiotics' production, combined with increasing frequencies of multi-drug resistant (MDR) bacteria, cause substantial limitations in treatment options for some bacterial infections. To diminish overall resistance, and especially the occurrence of bacteria that are resistant to all antibiotics, certain drugs are deliberately scarcely used—mainly when other options are exhausted. We use a mathematical model to explore the efficiency of such antibiotic restrictions. We assume two commonly used drugs and one restricted drug. The model is examined for the mixing strategy of antibiotic prescription, in which one of the drugs is randomly assigned to each incoming patient. Data obtained from Rabin medical center, Israel, is used to estimate realistic single and double antibiotic resistance frequencies in incoming patients. We find that broad usage of the hitherto restricted drug can reduce the number of incorrectly treated patients, and reduce the spread of bacteria resistant to both common antibiotics. Such double resistant infections are often eventually treated with the restricted drug, and therefore are prone to become resistant to all three antibiotics. Thus, counterintuitively, a broader usage of a formerly restricted drug can sometimes lead to a decrease in the emergence of bacteria resistant to all drugs. We recommend re-examining restriction of specific drugs, when multiple resistance to the relevant alternative drugs already exists. Methods for minimizing antibiotic resistance are becoming more important as antibiotic resistance frequencies are rising, coupled with low discovery rates of new antibiotics. In this work we examined the practice of restricting specific drugs to be used only as 'last resort'. The goal of such restrictions is to maintain low resistance levels to certain drugs, and prevent the creation of bacteria resistant to all available treatment options. We used a mathematical model to study the impact of such restrictions, when some resistance to the unrestricted drugs is already present. We estimated the resistance frequencies of common bacteria from hospital data. We find that restricting drugs leads to increased rates of incorrect treatment, and might simultaneously lead to increased emergence of multidrug resistant bacteria. We conclude that restricting specific antibiotics should be done with caution. In some cases lifting restrictions might even delay MDR emergence.
Collapse
Affiliation(s)
- Uri Obolski
- Department of Molecular Biology and Ecology of Plants, Tel-Aviv University, Tel Aviv, Israel
| | - Gideon Y. Stein
- Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Lilach Hadany
- Department of Molecular Biology and Ecology of Plants, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
| |
Collapse
|
12
|
Zhu H, Wang A, Tong J, Yuan L, Gao W, Shi W, Yu S, Yao K, Yang Y. Nasopharyngeal carriage and antimicrobial susceptibility of Haemophilus influenzae among children younger than 5 years of age in Beijing, China. BMC Microbiol 2015; 15:6. [PMID: 25648185 PMCID: PMC4332420 DOI: 10.1186/s12866-015-0350-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 01/16/2015] [Indexed: 11/12/2022] Open
Abstract
Background Haemophilus influenzae is one of the main pathogens that cause community-acquired respiratory infections in children. Our previous study showed that H. influenzae is the second most common pathogen causing pneumonia and accounts for 30–50% of bacterial meningitis among Chinese children. H. influenzae carriage in children and its resistance to commonly used antimicrobials varies widely both geographically and over time. Results Surveys of the nasopharyngeal carriage of H. influenzae in children younger than 5 years of age with acute respiratory tract infection (ARI) were conducted in Beijing Children’s Hospital, China in 2000, 2002, 2010, and 2012. The overall annual carriage rates of H. influenzae among children younger than 5 years of age with ARI were 35.5%, 20.6%, 14.4%, and 18.7%, and the percentages of H. influenzae isolates producing β-lactamase were 4%, 13%, 27.1%, and 31%, respectively. The percentages of susceptibility to ampicillin progressively decreased from 96% (2000) to 87% (2002) to 63% (2010) to 61% (2012). All of the ampicillin-resistant isolates were found to be beta-lactamase producers. The susceptibility to tetracycline increased from 54% (2000) to 60% (2002) to 91.5% (2010) to 94.5% (2012). No statistically significant differences were observed in the susceptibility to cefaclor, cefuroxime, sulfamethoxazole, and chloramphenicol. Amoxicillin/clavulanic acid and ceftriaxone were the most effective antimicrobials for the isolates of H. influenzae across the 10-year period. Conclusions This report on the H. influenzae carriage rates in children and the susceptibility of these bacteria to commonly used antibiotics showed that H. influenzae carriage decreased from 2000 to 2012. Additionally, the percentage of β-lactamase-producing isolates increased while their susceptibility to ampicillin progressively decreased during this time. These results indicate that the appropriate empirical antimicrobial therapy should be changed for pediatric patients in China.
Collapse
Affiliation(s)
- Hongbin Zhu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China. .,Department of Pediatrics, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing, 100020, China.
| | - Aihua Wang
- Department of Pediatrics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China.
| | - Jingjing Tong
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Lin Yuan
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Wei Gao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Wei Shi
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Sangjie Yu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| | - Yonghong Yang
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Nan Li Shi Road 56, Beijing, 100045, China.
| |
Collapse
|
13
|
Van Eldere J, Slack MPE, Ladhani S, Cripps AW. Non-typeable Haemophilus influenzae, an under-recognised pathogen. THE LANCET. INFECTIOUS DISEASES 2014; 14:1281-92. [PMID: 25012226 DOI: 10.1016/s1473-3099(14)70734-0] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Non-typeable Haemophilus influenzae (NTHi) is a major cause of mucosal infections such as otitis media, sinusitis, conjunctivitis, and exacerbations of chronic obstructive pulmonary disease. In some regions, a strong causal relation links this pathogen with infections of the lower respiratory tract. In the past 20 years, a steady but constant increase has occurred in invasive NTHi worldwide, with perinatal infants, young children, and elderly people most at risk. Individuals with underlying comorbidities are most susceptible and infection is associated with high mortality. β-lactamase production is the predominant mechanism of resistance. However, the emergence and spread of β-lactamase-negative ampicillin-resistant strains in many regions of the world is of substantial concern, potentially necessitating changes to antibiotic treatment guidelines for community-acquired infections of the upper and lower respiratory tract and potentially increasing morbidity associated with invasive NTHi infections. Standardised surveillance protocols and typing methodologies to monitor this emerging pathogen should be implemented. International scientific organisations need to raise the profile of NTHi and to document the pathobiology of this microbe.
Collapse
Affiliation(s)
- Johan Van Eldere
- Department of Microbiology and Immunology, Catholic University Leuven, Belgium; Clinical Department of Laboratory Medicine, University Hospital Leuven, Belgium.
| | - Mary P E Slack
- WHO Collaborating Centre for Haemophilus influenzae, Respiratory and Vaccine Preventable Bacteria Reference Unit, Microbiology Services, Public Health England, Colindale, London, UK
| | - Shamez Ladhani
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Services, Public Health England, Colindale, London, UK
| | - Allan W Cripps
- School of Medicine, Griffith Health Institute, Griffith University, Gold Coast, QLD, Australia
| |
Collapse
|
14
|
Antimicrobial resistance trends among community-acquired respiratory tract pathogens in Greece, 2009-2012. ScientificWorldJournal 2014; 2014:941564. [PMID: 24592201 PMCID: PMC3925540 DOI: 10.1155/2014/941564] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of the present study was to determine the antimicrobial resistance trends of respiratory tract pathogens isolated from patients with community-acquired respiratory tract infections (CARTIs) in Crete, Greece, over a 4-year period (2009-2012). A total of 588 community-acquired respiratory pathogens were isolated during the study period. Streptococcus pneumoniae was the most common organism responsible for 44.4% of CARTIs, followed by Haemophilus influenzae (44.2%) and Moraxella catarrhalis (11.4%). Among S. pneumoniae, the prevalence of isolates with intermediate- and high-level resistance to penicillin was 27.2% and 12.3%, respectively. Macrolide resistance slightly decreased from 29.4% over the period 2009-2010 to 28.8% over the period 2011-2012. Multiresistance was observed among 56 (54.4%) penicillin nonsusceptible isolates. A nonsignificant increase in resistance of H. influenzae isolates was noted for β -lactams, cotrimoxazole, and tetracycline. Among the 67 M. catarrhalis tested, 32 produced beta-lactamase and were resistant to ampicillin. Macrolide resistance decreased over the study period. All isolates were susceptible to amoxicillin + clavulanic acid, chloramphenicol, rifampicin, and the fluoroquinolones. Although a decreasing trend in the prevalence of resistance of the three most common pathogens involved in CARTIs was noted, continuous surveillance of antimicrobial susceptibility at the local and national level remains important, in order to guide appropriate empirical antimicrobial therapy.
Collapse
|
15
|
Bacterial profile, antibiotic sensitivity and resistance of lower respiratory tract infections in upper egypt. Mediterr J Hematol Infect Dis 2013; 5:e2013056. [PMID: 24106606 PMCID: PMC3787711 DOI: 10.4084/mjhid.2013.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/02/2013] [Indexed: 11/16/2022] Open
Abstract
Background Lower respiratory tract infections (LRTI) account for a considerable proportion of morbidity and antibiotic use. We aimed to identify the causative bacteria, antibiotic sensitivity and resistance of hospitalized adult patients due to LRTI in Upper Egypt. Methods A multicentre prospective study was performed at 3 University Hospitals for 3 years. Samples included sputum or bronchoalveolar lavage (BAL) for staining and culture, and serum for serology. Samples were cultured on 3 bacteriological media (Nutrient, Chocolate, MacConkey's agars). Colonies were identified via MicroScan WalkAway-96. Pneumoslide IgM kit was used for detection of atypical pathogens via indirect immunofluorescent assay. Results The predominant isolates in 360 patients with CAP were S. pneumoniae (36%), C. pneumoniae (18%), and M. pneumoniae (12%). A higher sensitivity was recorded for moxifloxacin, levofloxacin, macrolides, and cefepime. A higher of resistance was recorded for doxycycline, cephalosporins, and β-lactam-β-lactamase inhibitors. The predominant isolates in 318 patients with HAP were, methicillin-resistant Staphylococcus aureus; MRSA (23%), K. pneumoniae (14%), and polymicrobial in 12%. A higher sensitivity was recorded for vancomycin, ciprofloxacin, and moxifloxacin. Very high resistance was recorded for β-lactam-β-lactamase inhibitors and cephalosporins. The predominant organisms in 376 patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD) were H. influnzae (30%), S. pneumoniae (25%), and M. catarrhalis (18%). A higher sensitivity was recorded for moxifloxacin, macrolides and cefepime. A higher rate of resistance was recorded for aminoglycosides and cephalosporins. Conclusions The most predominant bacteria for CAP in Upper Egypt are S. pneumoniae and atypical organisms, while that for HAP are MRSA and Gram negative bacteria. For acute exacerbation of COPD, H. influnzae was the commonest organism. Respiratory quinolones, macrolides, and cefepime are the most efficient antibiotics in treatment of LRTI in our locality.
Collapse
|
16
|
Geelen TH, Stassen FR, Hoogkamp-Korstanje JAA, Bruggeman CA, Stobberingh EE. Antimicrobial resistance among respiratory Haemophilus influenzae isolates from pulmonology services over a six-year period. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2013; 45:606-611. [PMID: 23746341 DOI: 10.3109/00365548.2013.796088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Respiratory tract infections (RTI) are frequently caused by Haemophilus influenzae. Widespread antibacterial resistance among respiratory microorganisms complicates empirical RTI treatment. Therefore, national data on antibiotic resistance for H. influenzae are important for guiding optimal antibiotic choice. METHODS The antibiotic susceptibility of H. influenzae strains isolated from respiratory specimens of patients admitted to the pulmonology services between 2005 and 2010 was assessed. Isolates were collected annually from 13 hospitals in the Netherlands as part of the national intramural antimicrobial resistance surveillance performed by the Dutch Working Group on Antibiotic Policy (SWAB). Breakpoints for resistance were in accordance with the criteria of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Trend analysis was performed using logistic regression analysis. RESULTS In total, 1606 H. influenzae strains were analyzed. The prevalence of antibiotic resistance to amoxicillin, co-amoxiclav, doxycycline, co-trimoxazole, and clarithromycin was stable over the 6-y period, and there was a trend towards a decrease in the prevalence of beta-lactamase-producing isolates. Regarding prevalences, no significant trends were observed. CONCLUSIONS Our study showed no significant changes in antibiotic resistance for H. influenzae isolated at different hospitals in the Netherlands over a 6-y period. Regular surveillance remains important in controlling the prevalence of resistance, since actual resistance data should be taken into account when the choice of an empiric antibiotic is made.
Collapse
Affiliation(s)
- Tanja H Geelen
- Department of Medical Microbiology, Research Institute NUTRIM, Maastricht University Medical Centre, the Netherlands
| | | | | | | | | |
Collapse
|
17
|
Metzler K, Drlica K, Blondeau JM. Minimal inhibitory and mutant prevention concentrations of azithromycin, clarithromycin and erythromycin for clinical isolates of Streptococcus pneumoniae. J Antimicrob Chemother 2012; 68:631-5. [PMID: 23169894 DOI: 10.1093/jac/dks461] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous work showed a higher prevalence of macrolide/azalide resistance in provinces of Canada where azithromycin was the major treatment for Streptococcus pneumoniae as compared with regions where clarithromycin was the dominant treatment. These data provided a way to test the mutant selection window hypothesis, which predicts that the serum drug concentration (AUC(24)) relative to the mutant prevention concentration (MPC) would be higher for clarithromycin than for azithromycin. METHODS The MIC and MPC were determined for 191 penicillin/macrolide-susceptible clinical isolates of S. pneumoniae with azithromycin, clarithromycin and erythromycin using agar plate assays. RESULTS The MIC(50/90) (mg/L) and MPC(50/90) (mg/L), respectively, were as follows: azithromycin 0.13/0.25 and 1/4; clarithromycin 0.031/0.063 and 0.13/0.5; erythromycin 0.063/0.13 and 0.25/2. We calculated from published pharmacokinetic values that the AUC(24)/MPC(90) for azithromycin was 0.85; for clarithromycin it was 96, and for erythromycin base and estolate it was 4 and 10, respectively. Thus the AUC(24)/MPC(90) was about 50 times higher for clarithromycin than for azithromycin. CONCLUSIONS The elevated prevalence of azithromycin resistance may derive in part from a low value of AUC(24)/MPC(90) and/or time above MPC, since previous work indicates that the number of prescriptions per person was similar in the geographical regions examined.
Collapse
Affiliation(s)
- Kelli Metzler
- Department of Pathology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | |
Collapse
|
18
|
Marchese A, Esposito S, Barbieri R, Bassetti M, Debbia E. Does the adoption of EUCAST susceptibility breakpoints affect the selection of antimicrobials to treat acute community-acquired respiratory tract infections? BMC Infect Dis 2012; 12:181. [PMID: 22866984 PMCID: PMC3449191 DOI: 10.1186/1471-2334-12-181] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 07/27/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In several European Countries, by the end of 2012, CLSI guidelines will be replaced by EUCAST. We compared antimicrobial susceptibility results of a large number of respiratory pathogens using both EUCAST and previously adopted CLSI criteria to evaluate the impact on susceptibility patterns and the possible consequences that could occur in clinical practice due to this replacement.For S. pyogenes and S. aureus, the interpretation of susceptibility data using the EUCAST criteria did not produce relevant changes in comparison to CLSI.Against S. pneumoniae, more restrictive EUCAST breakpoints could lead to increased benzylpenicillin and/or amoxicillin-clavulanate resistance rates, which in turn could translate in increased dosages of these antibiotics or usage of alternative agents for respiratory tract infections.Against S. pneumoniae, M. catarrhalis and H. influenzae, cefuroxime-axetil and cefaclor produced the most divergent results depending on the breakpoints adopted and these striking differences could lead to the revision of those guidelines suggesting these two cephalosporins as alternatives in the management of upper respiratory tract infections. DISCUSSION Many differences exist between CLSI and EUCAST breakpoints. However, only in a few cases do these differences translate in major interpretive category discrepancies. In countries adopting more restrictive EUCAST breakpoints, clinicians should be aware of these discrepancies and that they could be faced with antibiotic-resistant respiratory pathogens more frequently than before. SUMMARY The interpretive discrepancies between EUCAST and CLSI suggest that the discussion on the management of community-acquired respiratory tract infections is still open and further studies are desirable to better define the role of some antibiotics.
Collapse
Affiliation(s)
- Anna Marchese
- Microbiology Unit, DISC Department, University of Genoa, R. Benzi 10, 16132, Genoa, Italy
| | - Susanna Esposito
- Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ramona Barbieri
- Microbiology Unit, DISC Department, University of Genoa, R. Benzi 10, 16132, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Eugenio Debbia
- Microbiology Unit, DISC Department, University of Genoa, R. Benzi 10, 16132, Genoa, Italy
| |
Collapse
|
19
|
Luo C, Xia Y, Liu Q, Chu L, Fu X, Jing C, Chen D, Liu L, Shi Y. Antibiotic resistance and molecular epidemiology of the beta-lactamase-producing Haemophilus influenzae isolated in Chongqing, China. APMIS 2012; 120:926-34. [PMID: 23009117 DOI: 10.1111/j.1600-0463.2012.02921.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 04/15/2012] [Indexed: 11/30/2022]
Abstract
This study aimed to determine the antibiotic resistance and molecular epidemiology of Haemophilus influenzae isolated from children with acute respiratory infection in Chongqing, China. To this end, 1967 H. influenzae isolates from 2006 to 2009 were analysed regarding β-lactamase production and antibiotic resistance. Ninety-nine β-lactamase-producing H. influenzae isolates from 2010 were analysed for antibiotic resistance and promoter regions of bla(TEM) (-1) . β-lactamase production was found in 35.8% (705/1967) of the strains. All ninety-nine β-lactamase-producing strains from 2010 were of the TEM-1 type as determined by PCR but did not produce the predicted 1075 bp product. According to PCR-SSCP and DNA sequencing, the promoter regions of bla(TEM) (-1) were categorized into 6 genotypes as SSCP1 (Pdel), SSCP2 (Pa/Pb), SSCP3 (P4), SSCP4 (Prpt.b), SSCP5 (2Prpt) and SSCP6 (P3.b). The Pdel, Pa/Pb and Prpt.b were common promoters of bla(TEM) (-1) for H. influenzae isolated from children in Chongqing. Strains with Prpt.b were more resistant to ampicillin (AMP) than strains with Pdel, Pa/Pb and P4 (p < 0.05). Therefore, bla(TEM-1) β-lactamase is the main mechanism for resistance of H. influenzae to ampicillin in Chongqing. Furthermore, the Prpt.b promoters may be related to the high resistance of H. influenzae to AMP.
Collapse
Affiliation(s)
- Chong Luo
- Department of Kidney and Immunology, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Hasan S, Sulieman H, Chapman C, Stewart K, Kong DCM. Community pharmacy in the United Arab Emirates: characteristics and workforce issues. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2011; 19:392-9. [PMID: 22060234 DOI: 10.1111/j.2042-7174.2011.00134.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the characteristics and workforce issues of community pharmacy practice in the United Arab Emirates (UAE). METHODS Data collection was by anonymous cross-sectional survey. Questionnaires were distributed by hand to 700 community pharmacies to collect information about the participating pharmacists, pharmacy characteristics, the types of products and professional pharmacy services available to patients, and the barriers to offering professional services. KEY FINDINGS A total of 344 pharmacists (49%) responded. Most were male (64%), had been in practice for less than 10 years (mean = 9.3, 95% confidence interval (CI) = 8.4-10.0) and were trained in India (35%) or Egypt (15%). The pharmacies were open for business 7 days/week (mean = 6.8, 95% CI = 6.7-8.8) with an average working day of 13 h (mean = 12.9, 95% CI = 12.7-13.2) and were mostly owned by independent non-pharmacists (70%). The pharmacies employed on average 2.6 full-time-equivalent (FTE) pharmacists (95% CI = 2.3-2.8) with 74% employing 1.8 FTE pharmacy assistants (95% CI = 1.7-2.0) and 47% employing trainee pharmacists (mean = 1.8 FTE, 95% CI = 1.6-2.0). Around three-quarters of the pharmacies dispensed fewer than 100 prescriptions (75%) and responded to fewer than 100 requests for over-the-counter medicines (69%) per day. Most pharmacists encountered limited immediate access to up-to-date resources. CONCLUSIONS This is the first study to explore the characteristics of community pharmacy practice in the UAE. The study provides baseline data which are critical to inform the development of strategies to improve the quality of community pharmacy services in the UAE.
Collapse
Affiliation(s)
- Sanah Hasan
- College of Pharmacy, Sharjah University, Sharjah, United Arab Emirates
| | | | | | | | | |
Collapse
|
21
|
Blasi F, Concia E, Mazzei T, Moretti AM, Nicoletti G, Novelli A, Tempera G. Etiology issues and problems of antibiotic resistance. J Chemother 2010; 22 Suppl 1:8-13. [PMID: 21097388 DOI: 10.1179/joc.2010.22.supplement-1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
22
|
Zhang X, Pan B, Yang K, Zhang D, Hou J. Adsorption of sulfamethoxazole on different types of carbon nanotubes in comparison to other natural adsorbents. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2010; 45:1625-1634. [PMID: 20730655 DOI: 10.1080/10934529.2010.506127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The environmental risks of wide application and occurrence of antibiotics have attracted great concern but their environmental behaviors are still unclear. The fast development of nanotechnology also arise environmental concerns, one of which is that the discharge of nanomaterials into the environment may alter the environmental behavior and risks of various contaminants. This study conducted batch adsorption experiments of sulfamethoxazole (SMX), a widely studied antibiotic, on various carbon nanotubes (CNTs) and sediment particles. The SMX adsorption data on other natural adsorbents were also collected from literature. The surface area of CNTs is an important parameter controlling their adsorption to SMX. Other properties, including diameters and surface functional groups, were also observed to be important in regulating SMX adsorption. Inorganic mineral particles have comparable adsorption coefficients with other natural sorbents including soils, sediments and sludges, suggesting the contribution of inorganic fractions to SMX adsorption could not be ignored and the normalization of adsorption coefficient by organic carbon content should be avoided. The adsorption coefficients of SMX on CNTs were generally two orders of magnitude higher than other natural sorbents. The presence of CNTs in the environment, especially in waste water and solid waste of water treatment plant, could greatly alter SMX behavior as well as its risks.
Collapse
Affiliation(s)
- Xin Zhang
- Faculty of Environmental Science & Engineering, Kunming University of Science & Technology, Kunming, Yunnan, China
| | | | | | | | | |
Collapse
|
23
|
Vanhoof R, Camps K, Carpentier M, De Craeye S, Frans J, Glupczynski Y, Goffinet P, Gordts B, Govaerts D, Ide L, Lefèvre P, Lontie M, Cartuyvels R, Meunier F, Mulongo B, Philippart I, Surmont I, Van Bossuyt E, Van Eldere J, Verhaegen J. 10th Survey of antimicrobial resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2007–2008. ACTA ACUST UNITED AC 2010; 58:147-51. [DOI: 10.1016/j.patbio.2009.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
|
24
|
Bae S, Lee J, Kim E, Lee J, Yu J, Kang Y. Serotype distribution and beta-lactam resistance in Haemophilus influenzae isolated from patients with respiratory infections in Korea. J Microbiol 2010; 48:84-8. [PMID: 20221734 DOI: 10.1007/s12275-009-0212-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 07/27/2009] [Indexed: 11/29/2022]
Abstract
Haemophilus influenzae is a frequent causative bacterial pathogen of respiratory tract infections. Resistance to beta-lactam antibiotics has been a significant clinical problem in treatment for H. influenzae respiratory infections. This study describes the serotype, antibiotic resistance and distribution of TEM-1 or ROB-1 beta-lactamase in H. influenzae isolates from local private hospitals from 2002 to 2004. Among the 100 H. influenzae respiratory isolates, only 7% were identified as serotypes a, b, e, and f, with the remaining 93% being nontypeable. Resistance to ampicillin, cefaclor, and tetracycline was 57%, 46%, and 16%, respectively. All strains were susceptible to azithromycin and ciprofloxacin, whereas amoxicillin/clavulanate, cefotaxime, and imipenem exhibited reduced susceptibilities of 99%, 99%, and 91%, respectively. All 57 ampicillin-resistant strains (minimum inhibitory concentration, MIC>or=4 microg/ml) were beta-lactamase-positive and possessed the TEM-1 type beta-lactamase. One beta-lactamase-positive amoxicillin/clavulanate-resistant isolate that was resistant to ampicillin (MIC>128 microg/ml) had the TEM-1 type beta-lactamase and not susceptible to cefaclor and cefotaxime. Analysis of penicillin binding protein 3 revealed six residues (Asp-350, Met-377, Ala-502, Asn-526, Val-547, and Asn-569) that were substituted by Asn, Ile, Val, Lys, Ile, and Ser, respectively.
Collapse
Affiliation(s)
- Songmee Bae
- Division of Bacterial Respiratory Infections, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Seoul, Republic of Korea,
| | | | | | | | | | | |
Collapse
|
25
|
Antimicrobial resistance in Haemophilus influenzae respiratory tract isolates in Korea: results of a nationwide acute respiratory infections surveillance. Antimicrob Agents Chemother 2009; 54:65-71. [PMID: 19884366 DOI: 10.1128/aac.00966-09] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial susceptibility patterns and beta-lactam resistance mechanisms of 544 Haemophilus influenzae isolates through the nationwide Acute Respiratory Infections Surveillance (ARIS) network in Korea during 2005 and 2006 were determined. Resistance to ampicillin was 58.5%, followed by resistance to cefuroxime (23.3%), clarithromycin (18.7%), cefaclor (17.0%), amoxicillin-clavulanate (10.4%), and chloramphenicol (8.1%). Levofloxacin and cefotaxime were the most active agents tested in this study. beta-Lactamase production (52.4%) was the main mechanism of ampicillin resistance, affecting 96.1% of TEM-1-type beta-lactamase. According to their beta-lactam resistance mechanisms, all isolates were classified into the following groups: beta-lactamase-negative, ampicillin-sensitive (BLNAS) strains (n = 224; 41.5%); beta-lactamase-positive, ampicillin-resistant (BLPAR) strains (n = 255; 47.2%); beta-lactamase-negative, ampicillin-resistant (BLNAR) strains (n = 33; 6.1%); and beta-lactamase-positive, amoxicillin-clavulanate-resistant (BLPACR) strains (n = 28; 5.2%). Among the BLNAR and BLPACR strains, there were various patterns of multiple-amino-acid substitutions in penicillin-binding protein 3. Particularly, among BLNAR, group III isolates, which had three simultaneous substitutions (Met377Ile, Ser385Thr, and Leu389Phe), were identified for the first time in Korea. Three group III strains displayed the highest MIC of cefotaxime (1 to 2 mug/ml). The results indicate the importance of monitoring a changing situation pertaining to the increase and spread of BLNAR and BLPACR strains of H. influenzae for appropriate antibiotic therapy for patients with respiratory tract infections in Korea.
Collapse
|
26
|
Stefani S, Mezzatesta ML, Fadda G, Mattina R, Palù G, Rossano F, Tufano MA, Schito GC, Nicoletti G. Antibacterial activity of cefditoren against major community-acquired respiratory pathogens recently isolated in Italy. J Chemother 2009; 20:561-9. [PMID: 19028617 DOI: 10.1179/joc.2008.20.5.561] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
In this study we evaluated the in vitro activities of cefditoren--a broad-spectrum oral cephalosporin--and other comparator agents against 2,396 fresh isolates from community-acquired respiratory tract infections, collected from 6 clinical Italian microbiology laboratories. On penicillin-susceptible pneumococci and Streptococcus pyogenes, cefditoren demonstrated to be the most active antibiotic (MIC(90)values of 0.03 and 0.06 mg/L respectively), showing only a slight decrease in potency on penicillin-intermediate and resistant pneumococci (MIC(90)value 0.5 mg/L, 1.0 mg/L respectively). All the other comparators displayed MIC(90 )values of 4 - 8 mg/L for penicillins and of 4 to >64 mg/L for the oral cephalosporins. Cefditoren and levofloxacin were the most active against MSSA (MIC(90)0.5 mg/mL). Cefditoren displayed a uniformly potent inhibitory activity (MIC(90)of 0.03 mg/L) against all strains of Haemophilus influenzae, regardless of their ampicillin resistance (mediated or not by beta-lactamase production), while against Moraxella catarrhalis MIC(90)values were higher against beta-lactamase-positive (0.25 mg/L). Cefditoren was active also against Klebsiella pneumoniae and Escherichia coli : in this case its activity was comparable with that of levofloxacin. In conclusion, cefditoren, due to its potent activity, is a new effective therapeutic option for the treatment of respiratory tract infections.
Collapse
Affiliation(s)
- S Stefani
- Department of Microbiological and Gynecological Sciences, University of Catania, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Morrissey I, Maher K, Williams L, Shackcloth J, Felmingham D, Reynolds R. Non-susceptibility trends among Haemophilus influenzae and Moraxella catarrhalis from community-acquired respiratory tract infections in the UK and Ireland, 1999-2007. J Antimicrob Chemother 2008; 62 Suppl 2:ii97-103. [DOI: 10.1093/jac/dkn356] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Alonso JM. [Immunity and pathophysiology of respiratory tract infections]. Med Mal Infect 2008; 38:433-7. [PMID: 18692336 DOI: 10.1016/j.medmal.2008.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 06/17/2008] [Indexed: 10/21/2022]
Abstract
The respiratory tract is permanently exposed to infections that may remain localized (bronchitis, pneumonias) or become potentially invasive (bacteremia and meningitis). It can be considered as an immunologic organ the upper part of which, the tracheobronchial tree, has the same secretory epithelium as the naso-oropharynx and shares bronchial associated lymphoid tissue (BALT). In this tissue, secretory IgA are more abundant than IgG. It is colonized by a commensal bacterial flora, including some potentially pathogenic species (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis). The pulmonary compartment includes the bronchioles and the alveoli, the wall of which is made of pneumocytes, resident macrophages, plasmocytoid dendritic cells and T cells. This wall is protected by a film that contains microbicidal agents, such as surfactant and phospholipase A2. Immune defenses of the respiratory tract involve mechanical factors, mucociliary escalator, receptor and effector molecules of the innate immune system and, by the proximity of lymph and blood vessels, humoral and cellular effectors of adaptative immunity. However, this sophisticated respiratory tract immune system can be bypassed in the non immunized host by infections due to primary pathogens (tuberculosis, plague, whooping cough, influenza) and may be impaired by endogenous factors (genetic defects, iatrogenic disorders) or exogenous factors (chemical pollutants, respiratory viruses) making the host susceptible to occasional pathogens, including commensal organisms.
Collapse
Affiliation(s)
- J-M Alonso
- Unité Neisseria, Institut Pasteur, 28, rue du Dr-Roux, 75724 Paris, France.
| |
Collapse
|
29
|
Wang A, Yu S, Yao K, Zhang W, Yuan L, Wang Y, Wei J, Shen X, Yang Y. Antimicrobial susceptibility of Haemophilus influenzae strains and antibiotics usage patterns in pediatric outpatients: results from a children's hospital in China (2000-2004). Pediatr Pulmonol 2008; 43:457-62. [PMID: 18360841 DOI: 10.1002/ppul.20789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the nasopharyngeal carriage and antimicrobial susceptibility of H. influenzae among children younger than 5 years old and to assess antibiotics usage patterns in the outpatient department of Beijing Children's Hospital from 2000 to 2004. MATERIALS AND METHODS From 2000 to 2004, At least 100 strains of H. influenzae were isolated from the pediatric patients who were younger than 5 years and who presented with symptoms of acute upper respiratory tract infections during February to May in each of the study years. Antimicrobial susceptibilities were determined; and antibiotics usage was expressed as defined daily dose (DDD)/100 patient days. RESULTS The overall nasopharyngeal carriage rate of H. influenzae is 26.3% (562/2,137) in children younger than 5 years old with acute upper respiratory tract infection. The percentage of ampicillin-resistant isolates ranges from 4.0% (4/100) to 14.3% (17/119) from 2000 to 2004. All the ampicillin-resistant isolates are beta-lactamase producers. More than 80% of the isolates are susceptible to amoxicillin, cefaclor, and chloramphenicol; whereas, almost all (99-100%) of the isolates are sensitive to amoxicillin/clavulanic acid, ceftriaxone, and cefuroxime. For antibiotics utilization, macrolides are the predominantly used antibiotics, followed by cephalosporins and penicillins among pediatric patients in the outpatient department during the study period. CONCLUSION All amoxicillin-resistant isolates of H. influenzae are producing beta-Lactamase; and the rates of amoxicillin-resistant isolates are increasing over time. Amoxicillin/clavulanic acid and cephalosporins are highly sensitive to H. influenzae isolated from Chinese pediatric patients. Macrolides are the most used antibiotics in the outpatient department during the study period.
Collapse
Affiliation(s)
- Aihua Wang
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | | | | | | | | | | | | | | | | |
Collapse
|