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Yeung GYC, Smalbrugge M, van Buul LW, Rutten JJS, van Houten P, Gerridzen IJ, de Bruijne MC, Joling KJ, Hertogh CMPM. Urinary Tract Infection Guideline Adherence in a Dutch Sentinel Nursing Home Surveillance Network. J Am Med Dir Assoc 2024; 25:105037. [PMID: 38796171 DOI: 10.1016/j.jamda.2024.105037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To investigate guideline adherence 3 years after the introduction of a national guideline on urinary tract infections (UTIs) in frail older adults. Appropriate use of urine dipstick tests, treatment decisions, and antibiotic drug choices in residents with (suspected) UTIs without a catheter were examined. DESIGN Observational prospective study. SETTING AND PARTICIPANTS Nineteen nursing homes participating in a Dutch Sentinel Nursing Home Surveillance Network. METHODS As of September 2021, for a 3-month period, medical practitioners recorded additional clinical information in the electronic health record in case of a (suspected) UTI. Based on this information, adherence to guideline recommendations was assessed. Nonadherence was classified into 2 categories: (1) "intentional nonadherence" as reported by practitioners and (2) "nonadherence otherwise" applied to all other cases where the recorded information was discordant with the guideline recommendations. RESULTS A total of 532 cases of (suspected) UTIs from 469 residents were analyzed. In 455 cases (86%), dipsticks were used. For the 231 cases where clinical signs and symptoms already indicated no UTI treatment according to the guideline, a dipstick was still inappropriately ordered in 196 cases (85%). The decision to prescribe or withhold antibiotics was in 69% of the cases adherent, in 6% intentionally nonadherent, and in 25% nonadherent otherwise. The type of prescribed antibiotic was adherent to the recommended antibiotics for cystitis in 88% and for UTIs with signs of tissue invasion in 48%. Overall, for 40% of suspected UTIs, adherence to all relevant recommendations could be established, and in 9% practitioners reported intentional nonadherence to the guideline. CONCLUSIONS AND IMPLICATIONS There is considerable room for improvement in all clinical stages of managing a suspected UTI in Dutch nursing homes, particularly with regard to the importance of patient's clinical signs and symptoms for appropriate dipstick use and antibiotic UTI treatments.
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Affiliation(s)
- Gary Y C Yeung
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Paul van Houten
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; ABR Zorgnetwerken Noord-Holland en Flevoland, Amsterdam, the Netherlands
| | - Ineke J Gerridzen
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Atlant, Korsakoff Centre of Expertise, Beekbergen, the Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Luo H, Chen X, Jiang Z, Yan Q. Prevalence of and risk factors for intestinal colonisation by multidrug-resistant Gram-negative bacteria in patients with haematological malignancies: A systematic review and meta-analysis. Int J Antimicrob Agents 2024; 63:107043. [PMID: 38040318 DOI: 10.1016/j.ijantimicag.2023.107043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Patients with haematological malignancies (HM patients) are at high risk of infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). MDR-GNB intestinal colonisation is associated with MDR-GNB infections. The aim of this systematic review and meta-analysis on HM patients was to pool the prevalence of and risk factors for intestinal colonisation by MDR-GNB, including carbapenem-resistant Enterobacterales (CRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, reported in previous studies. METHODS This study was conducted according to the protocol registered in PROSPERO (CRD42022374425). PubMed, Embase, Web of Science, Ovid MEDLINE(R) ALL and Cochrane Library were searched from inception to 25 October 2022. Observational studies reporting CRE and/or ESBL intestinal colonisation in HM patients were included. Subgroup analyses were conducted by study region. RESULTS A total of 21 402 HM patients from 32 studies were analysed. The pooled CRE and ESBL colonisation rates were 21.7% [95% confidence interval (95%CI) 18.7-24.8] and 19.2% (95%CI 13.9-24.5), respectively. Prior exposure to tigecycline [odds ratio (OR) 3.99, 95%CI 2.08-7.68], carbapenem (OR 1.84, 95%CI 1.13-2.97) or penicillin (OR 1.72, 95%CI 1.05-2.83), as well as chemotherapy (OR 2.45, 95%CI 1.05-5.73), neutropenia (OR 1.88, 95%CI 1.08-3.26) and acute myeloid leukaemia (AML; OR 1.86, 95%CI 1.33-2.61), were risk factors for CRE colonisation in HM patients. Prior antibiotic exposure was a risk factor for ESBL colonisation in HM patients (OR 4.90, 95%CI 2.76-8.70). CONCLUSIONS This study shows the high prevalence of MDR-GNB (CRE and ESBL) colonisation in HM patients and explains associated factors for the colonisation. The results provide evidence for MDR-GNB infection control in HM management.
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Affiliation(s)
- Huijuan Luo
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xia Chen
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiping Jiang
- Department of Haematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.; National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China..
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Abera D, Alemu A, Mihret A, Negash AA, Abegaz WE, Cadwell K. Colonization with extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae among hospitalized patients at the global level: A systematic review and meta-analysis. PLoS One 2023; 18:e0293528. [PMID: 38011148 PMCID: PMC10681255 DOI: 10.1371/journal.pone.0293528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Gut commensal bacteria can mediate resistance against pathogenic bacteria. However, exposure to antibiotics and hospitalization may facilitate the emergence of multidrug resistant bacteria. We aimed to conduct a systematic review and meta-analysis to provide comprehensive evidence about colonization rate of extended spectrum beta-lactamase and carbapenemases producing Enterobacteriaceae. METHOD We used PubMed, Google Scholar and Web of Science data bases to search studies from January 1, 2016 to August10, 2022 about colonization rate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae. Data were extracted from eligible studies and analyzed using Stata version 16 software. The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools, and publication bias was assessed using funnel plot and eggers test. RESULTS We identified 342 studies from the comprehensive data search and data were extracted from 20 studies. The pooled estimate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae were 45.6%(95%CI: 34.11-57-10) and 16.19% (95% CI: 5.46-26.91) respectively. The predominant extended spectrum beta-lactamase producers were E. coli,32.99% (95% CI: 23.28-42.69) and K. pneumoniae, 11.43% (95% CI:7.98-14.89). Prolonged hospitalization was linked to carbapenemase producing Enterobacteriaceae colonization with the odds of 14.77 (95% CI: -1.35-30.90) at admission and 45.63 (95% CI: 0.86-92.12) after ≥7 days of admission. CONCLUSION The pooled estimate of extended spectrum beta-lactamase and carbapenemase producing Enterobacteriaceae were high. This indicates the need for strong mitigation strategies to minimize the spread of multidrug-resistant bacteria at the healthcare facilities.
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Affiliation(s)
- Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopoia
| | - Adane Mihret
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abel Abera Negash
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Woldaregay Erku Abegaz
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ken Cadwell
- Department of Microbiology, New York University Grossman School of Medicine, New York, NY, United States of America
- Department of Medicine, Division of Gastroenterology and Hepatology, New York University Langone Health, New York, NY, United States of America
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Nitti MT, Sleghel F, Kaczor M, Aschbacher R, Moroder E, Di Pierro AM, Piscopiello F, Spalla M, Piazza A, Migliavacca R, Pagani E. Colonization of Residents and Staff of an Italian Long-Term Care Facility and an Adjacent Acute Care Hospital Geriatrics Unit by Multidrug-Resistant Bacteria. Microb Drug Resist 2023; 29:477-484. [PMID: 37389822 DOI: 10.1089/mdr.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
In 2022, we undertook a point prevalence screening study for Enterobacterales with extended-spectrum β-lactamases (ESBLs), high-level AmpC cephalosporinases and carbapenemases, and also methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in a long-term care facility (LTCF) and the associated acute-care hospital Geriatrics unit in Bolzano, Northern Italy. Urine samples and rectal, inguinal, oropharyngeal, and nasal swabs were plated on selective agar plates. Metadata of the patients, including demographic data, were collected, and risk factors for colonization were determined. ESBL, AmpC, carbapenemase, and quinolone resistance genes were investigated by the HybriSpot 12 PCR AUTO System. The following colonization percentages by multidrug-resistant (MDR) bacteria have been found in LTCF residents: all MDR organisms, 59.5%; ESBL producers, 46.0% (mainly CTX-M-type enzymes); carbapenemase producers, 1.1% (one Klebsiella pneumoniae with KPC-type); MRSA, 4.5%; VRE, 6.7%. Colonization by MDR bacteria was 18.9% for LTCF staff and 45.0% for Geriatrics unit patients. Peripheral vascular disease, the presence of any medical device, cancer, and a Katz Index of 0 were significant risk factors for colonization of LTCF residents by MDR bacteria in univariate and/or multivariate regression analysis. To conclude, the ongoing widespread diffusion of MDR bacteria in the LTCF suggests that efforts should be strengthened on MDR screening, implementation of infection control strategies, and antibiotic stewardship programs targeting the unique aspects of LTCFs. ClinicalTrials.gov ID: 0530250-BZ Reg01 30/08/2022.
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Affiliation(s)
| | - Ferisa Sleghel
- Reparto di Geriatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Malgorzata Kaczor
- Reparto di Geriatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Richard Aschbacher
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Elena Moroder
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Angela Maria Di Pierro
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Francesca Piscopiello
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Università degli Studi di Pavia, Pavia, Italy
| | - Melissa Spalla
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Università degli Studi di Pavia, Pavia, Italy
| | - Aurora Piazza
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Università degli Studi di Pavia, Pavia, Italy
| | - Roberta Migliavacca
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Università degli Studi di Pavia, Pavia, Italy
| | - Elisabetta Pagani
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
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Uhland FC, Li XZ, Mulvey MR, Reid-Smith R, Sherk LM, Ziraldo H, Jin G, Young KM, Reist M, Carson CA. Extended Spectrum β-Lactamase-Producing Enterobacterales of Shrimp and Salmon Available for Purchase by Consumers in Canada-A Risk Profile Using the Codex Framework. Antibiotics (Basel) 2023; 12:1412. [PMID: 37760708 PMCID: PMC10525137 DOI: 10.3390/antibiotics12091412] [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: 08/02/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
The extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) encompass several important human pathogens and are found on the World Health Organization (WHO) priority pathogens list of antibiotic-resistant bacteria. They are a group of organisms which demonstrate resistance to third-generation cephalosporins (3GC) and their presence has been documented worldwide, including in aquaculture and the aquatic environment. This risk profile was developed following the Codex Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance with the objectives of describing the current state of knowledge of ESBL-EB in relation to retail shrimp and salmon available to consumers in Canada, the primary aquacultured species consumed in Canada. The risk profile found that Enterobacterales and ESBL-EB have been found in multiple aquatic environments, as well as multiple host species and production levels. Although the information available did not permit the conclusion as to whether there is a human health risk related to ESBLs in Enterobacterales in salmon and shrimp available for consumption by Canadians, ESBL-EB in imported seafood available at the retail level in Canada have been found. Surveillance activities to detect ESBL-EB in seafood are needed; salmon and shrimp could be used in initial surveillance activities, representing domestic and imported products.
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Affiliation(s)
- F. Carl Uhland
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Xian-Zhi Li
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Richard Reid-Smith
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Lauren M. Sherk
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Hilary Ziraldo
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Grace Jin
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Kaitlin M. Young
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Mark Reist
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
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Mills JP, Mantey J, Cassone M, Kaye KS, Mody L. Epidemiology of resistant gram-negative bacteria in nursing homes. Infect Control Hosp Epidemiol 2023; 44:1423-1428. [PMID: 36916011 PMCID: PMC10507500 DOI: 10.1017/ice.2022.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Resistant gram-negative bacteria (R-GNB) colonization in nursing home patients can cause clinical infection and intrafacility transmission. Limited data exist on the roles of age and function on R-GNB colonization. METHODS A secondary data analysis was performed from a cohort study of 896 patients admitted to 6 Michigan nursing homes between November 2013 and May 2018. Swabs obtained upon enrollment, weekly for 1 month, then monthly until nursing home discharge from 5 anatomical sites were cultured for GNB. R-GNB were defined as resistant to ciprofloxacin, ceftazidime, or imipenem. Patients with growth of the same R-GNB as the initial positive visit, from any anatomical site at any subsequent visit, were considered persistently colonized. Demographic data, antibiotic use, device use, and physical self-maintenance scales (PSMSs) were obtained upon enrollment. Characteristics were compared between patients with R-GNB colonization versus those without, and those with persistent R-GNB colonization versus those with spontaneous decolonization. RESULTS Of 169 patients with a positive R-GNB culture and ≥2 subsequent study visits, 89 (53%) were transiently colonized and 80 (47%) were persistently colonized. Compared to uncolonized patients, persistent and transient R-GNB colonization were associated with higher PSMS score: 1.14 (95% confidence interval or CI, 1.05-1.23; P = .002) and 1.10 (95% CI, 1.01-1.19; P = .023), respectively. Persistent colonization was independently associated with longer duration of nursing home stay (1.02; 95% CI, 1.01-1.02; P < .001). Higher readmission rate among persistently colonized patients was observed on unadjusted analysis. CONCLUSIONS Persistent R-GNB colonization is associated with younger age, functional disability, and prolonged length of nursing home stay. In-depth longitudinal studies to understand new acquisition and transmission dynamics of R-GNB in nursing homes are needed.
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Affiliation(s)
- John P. Mills
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marco Cassone
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith S. Kaye
- Division of Infectious Diseases, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Gudra D, Silamikelis I, Pjalkovskis J, Danenberga I, Pupola D, Skenders G, Ustinova M, Megnis K, Leja M, Vangravs R, Fridmanis D. Abundance and prevalence of ESBL coding genes in patients undergoing first line eradication therapy for Helicobacter pylori. PLoS One 2023; 18:e0289879. [PMID: 37561723 PMCID: PMC10414638 DOI: 10.1371/journal.pone.0289879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
The spread of extended-spectrum beta-lactamases (ESBLs) in nosocomial and community-acquired enterobacteria is an important challenge for clinicians due to the limited therapeutic options for infections that are caused by these organisms. Here, we developed a panel of ESBL coding genes, evaluated the abundance and prevalence of ESBL encoding genes in patients undergoing H. pylori eradication therapy, and summarized the effects of eradication therapy on functional profiles of the gut microbiome. To assess the repertoire of known beta lactamase (BL) genes, they were divided into clusters according to their evolutionary relation. Primers were designed for amplification of cluster marker regions, and the efficiency of this amplification panel was assessed in 120 fecal samples acquired from 60 patients undergoing H. pylori eradication therapy. In addition, fecal samples from an additional 30 patients were used to validate the detection efficiency of the developed ESBL panel. The presence for majority of targeted clusters was confirmed by NGS of amplification products. Metagenomic sequencing revealed that the abundance of ESBL genes within the pool of microorganisms was very low. The global relative abundances of the ESBL-coding gene clusters did not differ significantly among treatment states. However, at the level of each cluster, classical ESBL producers such as Klebsiella sp. for blaOXY (p = 0.0076), Acinetobacter sp. for blaADC (p = 0.02297) and others, differed significantly with a tendency to decrease compared to the pre- and post-eradication states. Only 13 clusters were common across all three datasets, suggesting a patient-specific distribution profile of ESBL-coding genes. The number of AMR genes detected in the post-eradication state was higher than that in the pre-eradication state, which could be attributed, at least in part, to the therapy. This study demonstrated that the ESBL screening panel was effective in targeting ESBL-coding gene clusters from bacterial DNA and that minor differences exist in the abundance and prevalence of ESBL-coding gene levels before and after eradication therapy.
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Affiliation(s)
- Dita Gudra
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | | | | | | | - Darta Pupola
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Girts Skenders
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Maija Ustinova
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Kaspars Megnis
- Latvian Biomedical Research and Study Centre, Riga, Latvia
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Reinis Vangravs
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
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Azzini AM, Be G, Naso L, Lambertenghi L, Salerno ND, Coledan I, Bazaj A, Mirandola M, Miotti J, Mazzaferri F, Accordini S, Lo Cascio G, Tacconelli E. Risk factors for colonization with multidrug-resistant Gram-negative bacteria and Clostridioides difficile in Long Term Care Facilities (LTCFs) residents: the evidence from 27 facilities in a high endemic setting. Front Cell Infect Microbiol 2023; 13:1155320. [PMID: 37377644 PMCID: PMC10292821 DOI: 10.3389/fcimb.2023.1155320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Residency in LTCFs increases the likelihood of colonization with multidrug resistant Gram-negative bacteria (MDR-GNB). We assessed the prevalence and risk factors for enteric colonization by III-generation cephalosporins-resistant and carbapenem-resistant (CR) GNB in a large group of LTCFs in a high endemic setting. We also assessed the prevalence and risk factors for C. difficile colonization. Methods A point prevalence survey with rectal screening (RS) was conducted in 27 LTCFs in north Italy. Epidemiological and clinical variables on the survey day, history of hospitalization and surgery within one year, and antibiotics within three months, were collected. The presence of III-generation cephalosporin resistant and CR GNB was assessed using a selective culture on chromogenic medium and PCR for carbapenemase detection. The presence of C. difficile was assessed using ELISA for GDH and RT-PCR to identify toxigenic strains. Multi-variable analyses were performed using two-level logistic regression models. Results In the study period 1947 RSs were performed. The prevalence of colonization by at least one GNB resistant to III-generation cephalosporin was 51% (E. coli 65%, K. pneumoniae 14% of isolates). The prevalence of colonization by CR GNB was 6%. 6% of all isolates (1150 strains) resulted in a carbapenem-resistant K. pneumoniae, and 3% in a carbapenem-resistant E. coli. KPC was the most frequent carbapenemase (73%) identified by PCR, followed by VIM (23%). The prevalence of colonization by C. difficile was 11.7%. The presence of a medical device (OR 2.67) and previous antibiotic use (OR 1.48) were significantly associated with III-generation cephalosporin resistant GNB colonization. The presence of a medical device (OR 2.67) and previous hospitalization (OR 1.80) were significantly associated with CR GNB. The presence of a medical device (OR 2.30) was significantly associated with C. difficile colonization. Main previously used antibiotic classes were fluoroquinolones (32% of previously treated subjects), III-generation cephalosporins (21%), and penicillins (19%). Conclusion Antimicrobial stewardship in LTCFs is a critical issue, being previous antibiotic treatment a risk factor for colonization by MDR-GNB. The prevalence of colonization by III-generation cephalosporin and CR GNB among LTCF residents also underlines the importance to adhere to hand hygiene indications, infection prevention and control measures, and environmental hygiene protocols, more achievable than rigorous contact precautions in this type of social setting.
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Affiliation(s)
- Anna Maria Azzini
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giorgia Be
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Disease Unit, Mater Salutis Hospital - ULSS 9 Scaligera, Legnago, Italy
| | - Laura Naso
- Microbiology and Virology Unit, AOUI Verona, Verona, Italy
| | - Lorenza Lambertenghi
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nicola Duccio Salerno
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ilaria Coledan
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- SerT Suzzara, SC Ser.D. Mantova, ASST Mantova, Suzzara, Italy
| | - Alda Bazaj
- Microbiology Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jessica Miotti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuliana Lo Cascio
- Microbiology and Virology Unit, AOUI Verona, Verona, Italy
- Microbiology Unit, AUSL Piacenza, Piacenza, Italy
| | - Evelina Tacconelli
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Mbonyingingo D, Nzoyikorera N, Diawara I, Fdany K, Katfy K, Maaloum F, Nyandwi J, Chlilek A, Belabbes H, Elmdaghri N, Khalid Z. Faecal carriage of extended-spectrum beta-lactamase-producing Enterobacterales in a paediatric intensive care unit in Casablanca, Morocco. J Hosp Infect 2023; 133:109-110. [PMID: 36435310 DOI: 10.1016/j.jhin.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Affiliation(s)
- D Mbonyingingo
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Burundi Food and Medicines Regulatory Authority (ABREMA), Bujumbura, Burundi; Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - N Nzoyikorera
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Higher Institute of Biosciences and Biotechnology, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco; Laboratoire National de Référence, Institut National de Santé Publique, Bujumbura, Burundi.
| | - I Diawara
- Higher Institute of Biosciences and Biotechnology, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco; Laboratoire National de Référence, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - K Fdany
- Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - K Katfy
- Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - F Maaloum
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - J Nyandwi
- Faculté de Médecine, Université du Burundi, Bujumbura, Burundi; Ministère de la Santé Publique et de la Lutte contre le Sida, Institut National de Santé Publique de Bujumbura, Burundi; Unité de Néphrologie, Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi
| | - A Chlilek
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Resuscitation Department of the HAROUCHI Abderrahim Children's Hospital of Casablanca, Morocco
| | - H Belabbes
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - N Elmdaghri
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
| | - Z Khalid
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco; Bacteriology-Virology and Hospital Hygiene Laboratory, Ibn Rochd University Hospital Centre, Casablanca, Morocco
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Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers. Eur J Clin Microbiol Infect Dis 2023; 42:229-254. [PMID: 36680641 PMCID: PMC9899200 DOI: 10.1007/s10096-023-04548-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens-especially Escherichia coli and Klebsiella pneumoniae-may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.
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11
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Callejón Fernández M, Madueño Alonso A, Abreu Rodríguez R, Aguirre-Jaime A, Castro Hernández MB, Ramos-Real MJ, Pedroso-Fernández Y, Lecuona Fernández M. Risk factors for colonization by carbapenemase-producing bacteria in Spanish long-term care facilities: a multicentre point-prevalence study. Antimicrob Resist Infect Control 2022; 11:163. [PMID: 36536455 PMCID: PMC9763085 DOI: 10.1186/s13756-022-01200-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The emergence of carbapenemase-producing bacteria (CPB) has become a major public health concern. Long-term care facilities (LTCF) are potential reservoirs for multidrug-resistant micro-organisms (MDRO). However, data on CPB is limited. The study aims to determine the prevalence of MDRO and risk factors for CPB colonization among residents of LTCFs. METHODS A point-prevalence study was conducted at 14 LTCFs in Tenerife (Spain) between October 2020 and May 2021. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenemase-producing Enterobacterales, MDR Acinetobacter baumannii (MDR-Ab) and MDR Pseudomonas aeruginosa. Antimicrobial susceptibility testing and molecular detection of resistance genes were performed. Risk factors for colonization by carbapenemase-producing bacteria (CPB) were determined by univariate and multivariate analysis. RESULTS A total of 760 LTCF residents were recruited. The prevalence of colonization by CPB was 9.3% (n = 71) with the following distribution: 35 (49.3%) K. pneumoniae, 26 (36.6%) MDR-Ab, 17 (23.9%) E. coli, and 1 (1.4%) C. koseri. In addition, the prevalence of colonization by MRSA was 28.1% (n = 215) and only one case of VRE was isolated. Multivariate analysis identified male sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.86-3.11; P = 0.01), having a high health requirement (OR, 6.32; 95% CI, 1.91-20.92; P = 0.003) and previous hospitalization (OR, 3.60; 95% CI, 1.59-8.15 P = 0.002) as independent risk factors for CPB rectal carriage. CONCLUSIONS LTCFs are an important reservoir for MDRO, including CPB. We have identified some predictors of colonization by CPB, which enable a more targeted management of high-risk residents. Antimicrobial stewardship programmes and infection control preventive measures are needed to stop acquisition and transmission of MDRO.
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Affiliation(s)
- Manuel Callejón Fernández
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Ana Madueño Alonso
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Rossana Abreu Rodríguez
- grid.10041.340000000121060879Department of Preventive Medicine and Public Health, University of La Laguna, Tenerife, Spain
| | - Armando Aguirre-Jaime
- Institute of Care Research, Nurses Association of Santa Cruz de Tenerife, Tenerife, Spain
| | - María Beatriz Castro Hernández
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - María José Ramos-Real
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Yanet Pedroso-Fernández
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - María Lecuona Fernández
- grid.411220.40000 0000 9826 9219Microbiology and Infection Control Service, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
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12
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Sule IO, Mendelsohn A, Panas RM. The Causes and Control Measures of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae in Long-Term Care Facilities: A Systematic Review and Meta-Analysis. Health Serv Res Manag Epidemiol 2022; 9:23333928221131709. [PMID: 36277608 PMCID: PMC9580105 DOI: 10.1177/23333928221131709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), infections among residents are increasing in long-term care facilities (LTCFs), resulting in a high rate of morbidity and healthcare costs. A designated infection control team is unavailable to control the disease. Methods A systematic review and meta-analysis were conducted to characterize the causes of ESBL-PE and evaluate the infection control strategies within LTCFs. Multiple regression analysis (MRA) was included as supplementary statistical analysis to identify relationships between LTCFs, geographical locations, infection control measures (ICMs), and ESBL-PE. A systematic search was conducted for studies from January 2008 to December 2018. Twenty-two of the 3106 studies met the inclusion criteria. Results The pooled prevalence for ESBL-PE among LTCFs residents was a mean difference (MD) of 15.78 (95% CI: 0.04, 31.53). Risk factors included the influence of regional areas was a standardized mean difference (SMD) of 0.61(95% CI: 0.32, 0.91) in Europe, SMD was 14.92 (95% CI: 9.17, 20.68) in Asia, and SMD was 0.51(95% CI: 0.35, 0.67) in other regions (North America and Australia). Nine of 22 studies reported ICMs were MD of 13.59 (95% CI: 5.32, 21.86). Conclusions Meta-analysis and MRA revealed a statistically significant association between LTCF and ESBL-PE among residents (p = .05). Strict adherence to infection control measures in LTCFs is needed to address this ESBL-PE prevalence among residents. The potential positive social change is promoting knowledge about vulnerable residents in LTCFs and the community factors responsible for ESBL infection.
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Affiliation(s)
- Ismaila Olatunji Sule
- Microbiology Department, NHS Western Isles, Stornoway, Isle of Lewis, Scotland,Microbiology Department, Biomedical Science Consulting Service, IG4M, Belfast, United Kingdom,Ismaila Olatunji Sule, Biomedical Science Consulting Service, IG4M, 7 Moatview Crescent. Bt16 2bg Belfast, UK.
| | - Aaron Mendelsohn
- Senior Contributing Faculty, Public Health Department, College of Health Professions, Walden University, Minneapolis, USA
| | - Raymond M Panas
- Senior Contributing Faculty, Public Health Department, College of Health Professions, Walden University, Minneapolis, USA
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13
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No Crystal Ball? Using Risk Factors and Scoring Systems to Predict Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-E) and Carbapenem-Resistant Enterobacterales (CRE) Infections. Curr Infect Dis Rep 2022. [DOI: 10.1007/s11908-022-00785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Rostamian M, Kadivarian S, Kooti S, Dashtbin S, Abiri R, Alvandi A. Prevalence of Extended-Spectrum Beta-Lactamase in Gram Negative Bacteria Isolated from Kermanshah Medical Centers:
A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL MICROBIOLOGY 2022. [DOI: 10.30699/ijmm.16.6.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Prevalence of Multidrug-Resistant Diarrheagenic Escherichia coli in Asia: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11101333. [PMID: 36289991 PMCID: PMC9598397 DOI: 10.3390/antibiotics11101333] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Diarrhea is one of the leading causes of morbidity and mortality in developing countries. Diarrheagenic Escherichia coli (DEC) is an important bacterial agent for diarrhea in infants, children, and international travelers, and accounts for more than 30% of diarrheal cases in children less than 5 years old. However, the choices of antimicrobial agents are now being limited by the ineffectiveness of many first-line drugs, in relation to the emergence of antimicrobial-resistant E. coli strains. The aim of this systematic review and meta-analysis was to provide an updated prevalence of antimicrobial-resistant DEC in Asia. A comprehensive systematic search was conducted on three electronic databases (PubMed, ScienceDirect, and Scopus), where 40 eligible studies published between 2010 and 2022 were identified. Using meta-analysis of proportions and a random-effects model, the pooled prevalence of DEC in Asian diarrheal patients was 22.8% (95% CI: 16.5–29.2). The overall prevalence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing DEC strains was estimated to be 66.3% (95% CI: 58.9–73.7) and 48.6% (95% CI: 35.1–62.1), respectively. Considering antimicrobial drugs for DEC, the resistance prevalence was highest for the penicillin class of antibiotics, where 80.9% of the DEC isolates were resistant to amoxicillin and 73.5% were resistant to ampicillin. In contrast, resistance to carbapenems such as imipenem (0.1%), ertapenem (2.6%), and meropenem (7.9%) was the lowest. The relatively high prevalence estimation signifies that the multidrug-resistant DEC is a public health threat. Effective antibiotic treatment strategies, which may lead to better outcomes for the control of E. coli infections in Asia, are necessary.
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16
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Laupland KB. Preventing healthcare-related infections among older adults: a focus on cross-transmission of antibiotic-resistant bacteria. Expert Rev Anti Infect Ther 2022; 20:1171-1178. [PMID: 35793840 DOI: 10.1080/14787210.2022.2099375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Older individuals (i.e. age ≥65 years) are at increased risk for development of infections including those due to antimicrobial-resistant bacteria, and transmission may occur between institutional and community settings. AREAS COVERED This article reviews infections in older individuals with a specific focus on healthcare-related and antimicrobial resistant infections. A structured narrative review was performed to identify articles published in English since 2010. Themes included defining the scope of the problem, establishing characteristics of older individuals that impact the burden of resistant infections, and interventions aimed at minimizing their impact. EXPERT OPINION Older individuals suffer a high burden of illness related to antimicrobial resistant infections. Individuals with chronic illnesses, frailty, and residents of nursing homes are at highest risk. Clinical trials have shown that antimicrobial stewardship interventions may reduce antibiotic use in nursing homes without compromising safety. Antimicrobial resistant bacteria are prevalent among nursing home residents, and bundled infection prevention and control interventions can reduce their transmission. Transmission of antimicrobial resistant bacteria occurs among older adults across hospital and institutional settings, which may further spread to the community. The burden of infections in older adults is expected to increase in the coming years and represents a healthcare and research priority.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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17
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Grall-Zahar I, Rucly S, Billard-Pomares T, Gasnier-Besnardeau K, Al Mouft O, Zahar J, Zirnhelt I. Prevalence and risk factors for carriage of extended-spectrum β-lactamase-producing enterobacteriaceae in rehabilitation wards in France. Infect Dis Now 2022; 52:403-407. [DOI: 10.1016/j.idnow.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/22/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
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18
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Agud M, de Medrano I, Mendez-Echevarria A, Sainz T, Román F, Ruiz Carrascoso G, Escosa-Garcia L, Molina Amores C, Climent FJ, Rodríguez A, Garcia-Fernandez de Villalta M, Calvo C. Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions. Sci Rep 2022; 12:7223. [PMID: 35508685 PMCID: PMC9068800 DOI: 10.1038/s41598-022-11295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Abstract
To assess drug-resistant bacterial colonisation rates and associated risk factors in children with complex chronic conditions admitted to a national reference unit in Spain. Cross-sectional study that included all children admitted to our unit from September 2018 to July 2019. Rectal swabs were obtained to determine multidrug-resistant Gram-negative bacilli (MR-GNB) colonisation, and nasal swab to determine S. aureus and methicillin-resistant S. aureus (MRSA) colonisation. Medical records were reviewed. 100 children were included, with a median of four complex chronic conditions. Sixteen percent had S. aureus colonisation, including two MRSA. S. aureus colonisation was associated with technology-dependent children, while being on antibiotic prophylaxis or having undergone antibiotic therapy in the previous month were protective factors. The prevalence of MR-GNB colonisation was 27%, which was associated with immunosuppressive therapy (aOR 31; 2.02–47]; p = 0.01), antibiotic prophylaxis (aOR 4.56; 1.4–14.86; p = 0.012), previously treated skin-infections (aOR 2.9; 1.07–8.14; p = 0.03), surgery in the previous year (aOR 1.4; 1.06–1.8; p = 0.014), and hospital admission in the previous year (aOR 1.79; [1.26–2.56]; p = 0.001). The rate of S. aureus nasal colonisation in this series was not high despite the presence of chronic conditions, and few cases corresponded to MRSA. Antibiotic prophylaxis, immunosuppressive therapies, history of infections, previous surgeries, and length of admission in the previous year were risk factors for MR-GNB colonisation.
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Affiliation(s)
- Martin Agud
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Ines de Medrano
- Paediatric Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Mendez-Echevarria
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Talia Sainz
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Federico Román
- Nosocomial Infections Unit, CNM, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Guillermo Ruiz Carrascoso
- Department of Clinical Microbiology, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Luis Escosa-Garcia
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Clara Molina Amores
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Francisco José Climent
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Aroa Rodríguez
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Cristina Calvo
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
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Farfour E, Dortet L, Guillard T, Chatelain N, Poisson A, Mizrahi A, Fournier D, Bonnin RA, Degand N, Morand P, Janvier F, Fihman V, Corvec S, Broutin L, Le Brun C, Yin N, Héry-Arnaud G, Grillon A, Bille E, Jean-Pierre H, Amara M, Jaureguy F, Isnard C, Cattoir V, Diedrich T, Flevin E, Merens A, Jacquier H, Vasse M. Antimicrobial Resistance in Enterobacterales Recovered from Urinary Tract Infections in France. Pathogens 2022; 11:pathogens11030356. [PMID: 35335681 PMCID: PMC8949168 DOI: 10.3390/pathogens11030356] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022] Open
Abstract
In the context of increasing antimicrobial resistance in Enterobacterales, the management of these UTIs has become challenging. We retrospectively assess the prevalence of antimicrobial resistance in Enterobacterales isolates recovered from urinary tract samples in France, between 1 September 2017, to 31 August 2018. Twenty-six French clinical laboratories provided the susceptibility of 134,162 Enterobacterales isolates to 17 antimicrobials. The most frequent species were E. coli (72.0%), Klebsiella pneumoniae (9.7%), Proteus mirabilis (5.8%), and Enterobacter cloacae complex (2.9%). The overall rate of ESBL-producing Enterobacterales was 6.7%, and ranged from 1.0% in P. mirabilis to 19.5% in K. pneumoniae, and from 3.1% in outpatients to 13.6% in long-term care facilities. Overall, 4.1%, 9.3% and 10.5% of the isolates were resistant to cefoxitin, temocillin and pivmecillinam. Cotrimoxazole was the less active compound with 23.4% resistance. Conversely, 4.4%, 12.9%, and 14.3% of the strains were resistant to fosfomycin, nitrofurantoin, and ciprofloxacin. However, less than 1% of E. coli was resistant to fosfomycin and nitrofurantoin. We identified several trends in antibiotics resistances among Enterobacterales isolates recovered from the urinary tract samples in France. Carbapenem-sparing drugs, such as temocillin, mecillinam, fosfomycin, cefoxitin, and nitrofurantoin, remained highly active, including towards ESBL-E.
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Affiliation(s)
- Eric Farfour
- Service de Biologie Clinique, Hôpital Foch, 92150 Suresnes, France;
- Correspondence: ; Tel.: +33-1-46-25-75-51
| | - Laurent Dortet
- Team RESIST, Laboratoire de Bactériologie-Hygiène, Assistance Publique des Hôpitaux de Paris, Faculté de Médecine, CHU de Bicêtre, Université Paris-Saclay, UMR 1184, 95270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Thomas Guillard
- Inserm UMR-S 1250 P3Cell, SFR CAP-Santé, Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière-Parasitologie-Mycologie, Hôpital Robert Debré, CHU Reims, Université de Reims-Champagne-Ardenne, 51000 Reims, France;
| | | | | | - Assaf Mizrahi
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, 75015 Paris, France;
- Institut Micalis UMR 1319, Université Paris-Saclay, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, AgroParisTech, 92290 Châtenay Malabry, France
| | - Damien Fournier
- Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, 25000 Besançon, France;
| | - Rémy A. Bonnin
- Team RESIST, Laboratoire de Bactériologie-Hygiène, Assistance Publique des Hôpitaux de Paris, Faculté de Médecine, CHU de Bicêtre, Université Paris-Saclay, UMR 1184, 95270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Nicolas Degand
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nice, 06200 Nice, France;
| | - Philippe Morand
- Service de Bactériologie, AP-HP Centre-Université de Paris, Site Cochin, 75014 Paris, France;
| | | | - Vincent Fihman
- Bacteriology and Infection Control Unit, Department of Prevention, Diagnosis, and Treatment of Infections, AP-HP Centre, Henri-Mondor University Hospital, 94000 Creteil, France;
| | - Stéphane Corvec
- Inserm, Service de Bactériologie et des Contrôles Microbiolgoiques, CHU de Nantes, Université de Nantes, 44000 Nantes, France;
| | - Lauranne Broutin
- Service de Bactériologie et d’Hygiène Hospitalière, Unité de Microbiologie Moléculaire et Séquençage, CHU de Poitiers, 86000 Poitiers, France;
| | - Cécile Le Brun
- Service de Bactériologie, Virologie et Hygiène Hospitalière, CHU de Tours, 37000 Tours, France;
| | - Nicolas Yin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles—Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), 1000 Brussels, Belgium;
- Department of Microbiology, Institut Gustave Roussy, Université Paris-Saclay, 94800 Villejuif, France
| | - Geneviève Héry-Arnaud
- Inserm UMR 1078 GGB, Unité de Bactériologie, Hôpital La Cavale Blanche, CHRU de Brest, Université de Brest, CEDEX, 29609 Brest, France;
| | - Antoine Grillon
- Fédération de Médecine Translationnelle de Strasbourg, Institut de Bactériologie, Université de Strasbourg, VBP EA7290, 67000 Strasbourg, France;
| | - Emmanuelle Bille
- Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, AP-HP Centre-Université de Paris, 75015 Paris, France;
| | - Hélène Jean-Pierre
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34000 Montpellier, France;
- Maladies Infectieuses et Vecteurs—Écologie, Génétique, Évolution et Contrôle, Centre National pour la Recherche Scientifique, Institut de Recherche pour le Développement, Université de Montpellier, 34000 Montpellier, France
| | - Marlène Amara
- Service de Biologie, Unité de Microbiologie, CH de Versailles, 78150 Le Chesnay, France;
| | - Francoise Jaureguy
- Service de Microbiologie Clinique, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP Centre, CHU Avicenne, 93000 Bobigny, France;
| | - Christophe Isnard
- Department of Microbiology, CHU de Caen Normandie, Normandie University, UNICAEN, 14000 Caen, France;
| | - Vincent Cattoir
- Service de Bactériologie-Hygiène, CHU de Rennes, 35033 Rennes, France;
| | - Tristan Diedrich
- Service de Microbiologie, CH de Valenciennes, 59300 Valenciennes, France;
| | - Emilie Flevin
- Laboratoire de Biologie, CH de Dieppe, 76200 Dieppe, France;
| | - Audrey Merens
- SSA (French Military Health Service), Bégin Military Teaching Hospital, 94160 Saint-Mandé, France;
| | - Hervé Jacquier
- Service de Bactériologie-Virologie, AP-HP Centre, Hôpital Lariboisière, 75010 Paris, France;
| | - Marc Vasse
- Service de Biologie Clinique, Hôpital Foch, 92150 Suresnes, France;
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Epidemiology and molecular characterization of fecal carriage of third-generation cephalosporin-resistant enterobacterales among elderly residents in Japan. J Infect Chemother 2022; 28:569-575. [PMID: 35039227 DOI: 10.1016/j.jiac.2021.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The spread of third-generation cephalosporin-resistant Gram-negative bacteria is a serious concern in acute and post-acute care settings. This study aimed to understand the epidemiology and molecular background of fecal colonization of resistant Enterobacterales in elderly people. METHODS In December 2015-December 2017, stool or rectal swab samples were collected from 101 elderly patients receiving home care, using long-term care facilities (LTCF), and living in nursing homes repeatedly at 3-9-month intervals. Patient clinical background data were collected from medical records. After phenotypic screening for extended-spectrum β-lactamase (ESBL), AmpC-type β-lactamase or carbapenemase production, drug resistance genes of isolates were analyzed using polymerase chain reaction (PCR). ESBL-producing Escherichia coli isolates obtained from the same patients in repetitive screenings were analyzed using PCR-based ORF typing. Risk factors for persistent carriage of resistant Enterobacterales were analyzed using multivariate analysis. RESULTS Resistant Enterobacterales isolates were detected in 37 of 101 (36.6%) and 29 of 80 (36.3%) residents in first and second screenings, respectively. ESBL-producing E. coli accounted for 80% isolates, the most common being CTX-M-9-group β-lactamase producers. Molecular epidemiological analysis revealed probable transmissions of ESBL-producing E. coli; 58% of ESBL-producing E. coli colonizers were persistent colonizers at least after 3 -month intervals. Age > 87 years and LTCF residence were independent risk factors for persistent carriage of ESBL-producing E. coli. CONCLUSIONS We showed, for the first time, high persistent colonization rate of ESBL-producing E. coli among elderly people in post-acute care settings with probable horizontal transmission. We also identified significant risk factors for persistent colonization.
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21
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Comparison of the performance of a clinical classification tree versus clinical gestalt in predicting sepsis with extended-spectrum beta-lactamase–producing gram-negative rods. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e35. [PMID: 36310800 PMCID: PMC9614789 DOI: 10.1017/ash.2021.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
A clinical decision tree was developed using point-of-care characteristics to identify patients with culture-proven sepsis due to extended-spectrum β-lactamase–producing Enterobacterales (ESBL-PE). We compared its performance with the clinical gestalt of emergency department (ED) clinicians and hospital-based clinicians. The developed tree outperformed ED-based clinicians but was comparable to inpatient-based clinicians.
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22
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Singh SR, Teo AKJ, Prem K, Ong RTH, Ashley EA, van Doorn HR, Limmathurotsakul D, Turner P, Hsu LY. Epidemiology of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Enterobacterales in the Greater Mekong Subregion: A Systematic-Review and Meta-Analysis of Risk Factors Associated With Extended-Spectrum Beta-Lactamase and Carbapenemase Isolation. Front Microbiol 2021; 12:695027. [PMID: 34899618 PMCID: PMC8661499 DOI: 10.3389/fmicb.2021.695027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the rapid spread of extended-spectrum beta-lactamase (ESBL) producing-Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE), little is known about the extent of their prevalence in the Greater Mekong Subregion (GMS). In this systematic review, we aimed to determine the epidemiology of ESBL-E and CPE in clinically significant Enterobacterales: Escherichia coli and Klebsiella pneumoniae from the GMS (comprising of Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan province and Guangxi Zhuang region of China). Methods: Following a list of search terms adapted to subject headings, we systematically searched databases: Medline, EMBASE, Scopus and Web of Science for articles published on and before October 20th, 2020. The search string consisted of the bacterial names, methods involved in detecting drug-resistance phenotype and genotype, GMS countries, and ESBL and carbapenemase detection as the outcomes. Meta-analyses of the association between the isolation of ESBL from human clinical and non-clinical specimens were performed using the "METAN" function in STATA 14. Results: One hundred and thirty-nine studies were included from a total of 1,513 identified studies. Despite the heterogeneity in study methods, analyzing the prevalence proportions on log-linear model scale for ESBL producing-E. coli showed a trend that increased by 13.2% (95%CI: 6.1-20.2) in clinical blood specimens, 8.1% (95%CI: 1.7-14.4) in all clinical specimens and 17.7% (95%CI: 4.9-30.4) increase in carriage specimens. Under the log-linear model assumption, no significant trend over time was found for ESBL producing K. pneumoniae and ESBL-E specimens. CPE was reported in clinical studies and carriage studies past 2010, however a trend could not be determined because of the small dataset. Twelve studies were included in the meta-analysis of risk factors associated with isolation of ESBL. Recent antibiotic exposure was the most studied variable and showed a significant positive association with ESBL-E isolation (pooled OR: 2.9, 95%CI: 2.3-3.8) followed by chronic kidney disease (pooled OR: 4.7, 95%CI: 1.8-11.9), and other co-morbidities (pooled OR: 1.6, 95%CI: 1.2-2.9). Conclusion: Data from GMS is heterogeneous with significant data-gaps, especially in community settings from Laos, Myanmar, Cambodia and Yunnan and Guangxi provinces of China. Collaborative work standardizing the methodology of studies will aid in better monitoring, surveillance and evaluation of interventions across the GMS.
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Affiliation(s)
- Shweta R. Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Elizabeth A. Ashley
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Direk Limmathurotsakul
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul Turner
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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23
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Ae R, Sasahara T, Yoshimura A, Kosami K, Hatakeyama S, Sasaki K, Kimura Y, Akine D, Ogawa M, Hamabata K, Cui L. Prolonged carriage of ESBL-producing enterobacterales and potential cross-transmission among residents in geriatric long-term care facilities. Sci Rep 2021; 11:21607. [PMID: 34732819 PMCID: PMC8566574 DOI: 10.1038/s41598-021-01190-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. Most ESBL-E carriers are asymptomatic. The study tested the hypothesis that residents with ESBL-E carriage may accumulate inside geriatric LTCFs through potential cross-transmission after exposure to residents with prolonged ESBL-E carriage. 260 residents from four Japanese LTCFs underwent ESBL-E testing of fecal specimens and were divided into two cohorts: Cohort 1,75 patients with ≥ 2 months residence at study onset; Cohort 2, 185 patients with < 2 months residence at study onset or new admission during the study period. Three analyses were performed: (1) ESBL-E carriage statuses in Cohort 1 and Cohort 2; (2) changes in ESBL-E carriage statuses 3-12 months after the first testing and ≥ 12 months after the second testing; and (3) lengths of positive ESBL-E carriage statuses. Compared with the residents in Cohort 1, a significantly larger proportion of residents in Cohort 2 were positive for ESBL-E carriage (28.0% in Cohort 1 vs 40.0% in Cohort 2). In the subsequent testing results, 18.3% of residents who were negative in the first testing showed positive conversion to ESBL-E carriage in the second testing, while no patients who were negative in the second testing showed positive conversion in the third testing. The maximum length of ESBL-E carriage was 17 months. The findings indicated that some residents acquired ESBL-E through potential cross-transmission inside the LTCFs after short-term residence. However, no residents showed positive conversion after long-term residence, which indicates that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures could improve the ESBL-E prevalence in geriatric LTCFs.
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Affiliation(s)
- Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Teppei Sasahara
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan. .,Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan. .,Division of Bacteriology, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Akio Yoshimura
- Medical Corporation Sanikukai Nissin Hospital, Kiryu, Gunma, 376-0001, Japan
| | - Koki Kosami
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazumasa Sasaki
- Clinical Microbiology Laboratory, Jichi Medical University Hospital, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yumiko Kimura
- Clinical Microbiology Laboratory, Jichi Medical University Hospital, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Dai Akine
- Division of Clinical Infectious Diseases, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.,Health Service Center, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Masanori Ogawa
- Health Service Center, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kenji Hamabata
- Gerontological Nursing, School of Nursing, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Longzhu Cui
- Division of Bacteriology, School of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
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Lemenand O, Coeffic T, Thibaut S, Colomb Cotinat M, Caillon J, Birgand G. Decreasing proportion of extended-spectrum beta-lactamase among E. coli infections during the COVID-19 pandemic in France. J Infect 2021; 83:664-670. [PMID: 34600019 DOI: 10.1016/j.jinf.2021.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We investigated the impact of the COVID-19 and national pandemic response on the epidemiology of Extended Spectrum Beta-Lactamase producing E. coli (ESBL-E.coli) in France. METHODS Individual microbiology records from clinical laboratories were analyzed between 1 January 2019 to 31 December 2020. The ESBL-E.coli rates from clinical samples of patients in primary care and nursing home residents were compared before and after the general lockdown in March 2020, according to demographic and geographical characteristics. Interrupted time series analyses were performed to detect measurable changes in the trend of ESBL-E.coli rates. RESULTS Records covering 793,954 E. coli isolates from 1022 clinical laboratories were analyzed. In primary care, 3.1% of E. coli isolates from clinical samples were producing ESBL before March 2020 and 2.9% since May 2020 (p < 0.001). The proportion of ESBL-E.coli decreased significantly among urine cultures, females, age categories 5-19, 40-64, > 65 year-old, and in the North, West, East and South-East regions. In nursing home, the ESBL-E.coli rate was 9.3% (monthly rate min-max: 6.5-10.5%) before March 2020 and 8.3% (7.2-9.1%) since May 2020 (p < 0.001). The reduction rate accelerated from -0.04%/month to -0.22%/month from May 2020 (p < 0.001). CONCLUSION Investigation of factors that led to the decreased proportion of ESBL-E.coli during the COVID-19 pandemic is urgently needed.
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Affiliation(s)
- Olivier Lemenand
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire. CHU - Le Tourville, 5 rue Pr Yves Boquien, Nantes 44093, France
| | - Thomas Coeffic
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire. CHU - Le Tourville, 5 rue Pr Yves Boquien, Nantes 44093, France
| | - Sonia Thibaut
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire. CHU - Le Tourville, 5 rue Pr Yves Boquien, Nantes 44093, France
| | | | - Jocelyne Caillon
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire. CHU - Le Tourville, 5 rue Pr Yves Boquien, Nantes 44093, France
| | - Gabriel Birgand
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire. CHU - Le Tourville, 5 rue Pr Yves Boquien, Nantes 44093, France; NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Hammersmith Campus, Du Cane Road, London, United Kingdom.
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25
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Kohler P, Seiffert SN, Kessler S, Rettenmund G, Lemmenmeier E, Qalla Widmer L, Nolte O, Seth-Smith HMB, Albrich WC, Babouee Flury B, Gardiol C, Harbarth S, Münzer T, Schlegel M, Petignat C, Egli A, Héquet D. Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacterales in Long-Term Care Residents. J Am Med Dir Assoc 2021; 23:475-481.e5. [PMID: 34297981 DOI: 10.1016/j.jamda.2021.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We aimed to assess the burden of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in Swiss long-term care facilities (LTCFs) to describe the molecular epidemiology, describe the intrainstitutional and regional clusters of resistant pathogens, and identify independent institution- and resident-level factors associated with colonization. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS From August to October 2019, we performed a point prevalence study among residents from 16 LTCFs in Western and Eastern Switzerland (8 per region). METHODS Residents underwent screening for ESBL-producing Enterobacterales (ESBL-E); whole-genome sequencing (WGS) was performed. We gathered institution-level (eg, number of beds, staff-resident ratio, alcoholic hand rub consumption) and resident-level [eg, anthropometric data, time in facility, dependency, health care exposure, antibiotic treatment, proton-pump inhibitor (PPI) use] characteristics. Factors associated with colonization were identified using a generalized linear model. RESULTS Among 1185 eligible residents, 606 (51%) consented to the study. ESBL-E prevalence was 11.6% (70/606), ranging from 1.9% to 33.3% between institutions, with a median of 12.5% in the West and 6.9% in the East (P = .03). Among 59 Escherichia coli (from 58 residents), multilocus sequence type (ST) 131 was most common (n = 43/59, 73%), predominantly its subclone H30R1 (n = 37/43, 86%). WGS data identified multiple intrainstitutional and regional clusters. Independent risk factors for ESBL carriage were previous ESBL colonization [adjusted odds ratio (aOR) 23.5, 95% confidence interval (CI) 6.6-83.8, P < .001), male gender (aOR 2.6, 95% CI 1.5-4.6, P = .002), and use of PPIs (aOR 2.2, 95% CI 1.2-3.8, P = .01). CONCLUSIONS AND IMPLICATIONS Overall ESBL-E prevalence in Swiss LTCF residents is low. Yet, we identified several clusters of residents with identical pathogens within the same institution. This implies that particularly affected institutions might benefit from targeted infection control interventions. PPI use was the only modifiable factor associated with carriage of ESBL producers. This study adds to the growing list of adverse outcomes associated with PPIs, calling for action to restrict their use in the long-term care setting.
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Affiliation(s)
- Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
| | - Salome N Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Simone Kessler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Gabriela Rettenmund
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Eva Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Laetitia Qalla Widmer
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Stephan Harbarth
- Division of Infectious Diseases and Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christiane Petignat
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Delphine Héquet
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
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26
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van Kleef E, Wielders CCH, Schouls LM, Feenstra SG, Hertogh CMPM, Bonten MJM, van Weert Y, Tostmann A, van der Lubben M, de Greeff SC. National point prevalence study on carriage of multidrug-resistant microorganisms in Dutch long-term care facilities in 2018. J Antimicrob Chemother 2021; 76:1604-1613. [PMID: 33694365 DOI: 10.1093/jac/dkab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Long-term care facilities (LTCFs) may act as a reservoir of ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) for hospitals and the general population. In this study, we estimated the prevalence and molecular epidemiology of rectal carriage with ESBL-E and CPE in residents of Dutch LTCFs between March 2018 and December 2018. METHODS LTCFs were geographically selected across the country. For each LTCF, a random sample of residents were tested for ESBL-E and CPE in 2018. To identify risk factors for high carriage prevalence and/or individual carriage, characteristics of LTCFs and of a subset of the tested residents were collected. WGS was conducted on isolates from LTCFs with an ESBL-E prevalence of >10% and all CPE isolates to identify institutional clonal transmission. RESULTS A total of 4420 residents of 159 LTCFs were included. The weighted mean ESBL-E prevalence was 8.3% (95% CI: 6.8-10.0) and no CPE were found. In 53 LTCFs (33%), where ESBL-E prevalence was >10%, MLST using WGS (wgMLST) was performed. This included 264 isolates, the majority being Escherichia coli (n = 224) followed by Klebsiella pneumoniae (n = 30). Genetic clusters were identified in more than half (30/53; 57%) of high ESBL-positive LTCFs. Among the E. coli isolates, blaCTX-M-15 (92/224; 41%) and blaCTX-M-27 (40/224; 18%) were the most prevalent ESBL-encoding genes. For K. pneumoniae isolates, the most common was blaCTX-M-15 (23/30; 80%). CONCLUSIONS The estimated prevalence of ESBL-E rectal carriage in Dutch LTCFs is 8.3% and resistance is observed mainly in E. coli with predominance of blaCTX-M-15 and blaCTX-M-27. ESBL-E prevalence in LTCFs seems comparable to previously reported prevalence in hospitals and the general population.
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Affiliation(s)
- Esther van Kleef
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.,Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Cornelia C H Wielders
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Leo M Schouls
- Centre for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Sabiena G Feenstra
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Cees M P M Hertogh
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands.,Department of General Practice & Old Age Medicine, Amsterdam Public Health Research Institute, Amsterdam Medical Centers, Amsterdam, The Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Yolanda van Weert
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
| | - Alma Tostmann
- Hygiene and Infection Prevention Unit, Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud university medical centre, Nijmegen, The Netherlands.,Regional Epidemiology Consultant, Gelderland AMR and Infection Prevention Network, The Netherlands
| | - Mariken van der Lubben
- Regional laboratory, Municipal Health Service (GGD) Amsterdam, Amsterdam, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM) Bilthoven, The Netherlands
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27
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Moschou A, Ioannou P, Moraitaki E, Stafylaki D, Maraki S, Samonis G, Kofteridis DP. Rectal Colonization by Drug Resistant Bacteria in Nursing Home Residents in Crete, Greece. Trop Med Infect Dis 2021; 6:tropicalmed6030123. [PMID: 34287352 PMCID: PMC8293340 DOI: 10.3390/tropicalmed6030123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: In an area with a high prevalence of multi-drug resistant Gram-negative bacteria (MDR-GNB), we investigated the colonization of nursing home residents by such organisms. (2) Methods: A point prevalence study was performed in six nursing homes of the Heraklion area on the island of Crete. A rectal swab was taken and cultured from each participant, while additional risk factors such as recent hospitalization or antimicrobial usage were recorded and evaluated. (3) Results: A total of 137 nursing home residents were included in the study. Their mean age was 82.1 years and 19.7% were males. In total, cultures yielded 255 GNB; E. coli, K. pneumoniae and P. aeruginosa were the most common. Among the microorganisms cultured, 17.6% had the extended-spectrum beta-lactamase phenotype, while 18% were MDR. A statistically significant association was found between recent antimicrobial use and colonization by MDR-GNB; (4) Conclusions: Colonization by MDR-GNB was found to be highly prevalent in nursing home residents. Recent antimicrobial use was associated with MDR-GNB carriage.
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Affiliation(s)
- Aikaterini Moschou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
- Correspondence: ; Tel.: +30-28-1039-2424
| | - Eleni Moraitaki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - Dimitra Stafylaki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
| | - Diamantis P. Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
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Colmenarejo C, Hernández-García M, Muñoz-Rodríguez JR, Huertas N, Navarro FJ, Mateo AB, Pellejero EM, Illescas S, Vidal MD, Del Campo R. Prevalence and risks factors associated with ESBL-producing faecal carriage in a single long-term-care facility in Spain: emergence of CTX-M-24- and CTX-M-27-producing Escherichia coli ST131-H30R. J Antimicrob Chemother 2021; 75:2480-2484. [PMID: 32542354 DOI: 10.1093/jac/dkaa219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To address the faecal carriage prevalence of antibiotic-multiresistant bacteria and associated risk factors in a public long-term care facility (LTCF). METHODS A prospective study in a single government-funded LTCF of 300 residents in Ciudad Real, Spain. Residents' clinical and demographic data were collected, as well as recent antibiotic consumption in the institution. Each participant contributed a rectal swab, which was plated on selective and differential-selective media. Colonies were identified by MALDI-TOF and ESBL production was confirmed by the double-disc synergy method, with characterization of the molecular mechanism by PCR. Isolates were typed by PFGE and submitted for ST131 screening by PCR. RESULTS Faecal carriage of ESBL-producing Enterobacterales was detected in 58 (31%) of 187 participants and previous infection by MDR bacteria was identified as a risk factor. The genes characterized were: blaCTX-M-15 (40.6%); blaCTX-M-14 (28.8%); blaCTX-M-27 (13.5%); and blaCTX-M-24 (10.1%). Some 56.4% of the isolates were grouped into the E. coli ST131 clone; 70.9% of these corresponded to the O25b serotype, 51.6% of them to Clade C1 (H30) and 12.9% to Clade C2 (H30Rx). Clade C1 isolates were mostly C1-M27, whereas the C2 sublineage was mainly related to the production of CTX-M-15. ST131-CTX-M-24 isolates (n = 6) corresponded to Clade A with serotype O16. CONCLUSIONS A high prevalence of ESBL-producing Enterobacterales faecal carriage has been detected in a single LTCF, highlighting the emergence of ST131 Clade A-M24 and Clade C1-M27 lineages.
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Affiliation(s)
- Cristina Colmenarejo
- Department of Microbiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Marta Hernández-García
- Department of Microbiology, Hospital Universitario Ramón y Cajal and Ramón y Cajal Health Investigation Institute (IRYCIS), Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI-RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Natalia Huertas
- Department of Microbiology, Hospital Universitario Ramón y Cajal and Ramón y Cajal Health Investigation Institute (IRYCIS), Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI-RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ana Belén Mateo
- Long-term care facility Gregorio Marañon, Ciudad Real, Spain
| | | | - Soledad Illescas
- Department of Microbiology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.,Department of Microbiology, Faculty of Medicine, University Castilla-La Mancha, Ciudad Real, Spain
| | - María Dolors Vidal
- Department of Microbiology, Faculty of Medicine, University Castilla-La Mancha, Ciudad Real, Spain.,Grupo Emas, Centro Regional de Investigaciones Biomédicas (CRIB), Albacete, Spain
| | - Rosa Del Campo
- Department of Microbiology, Hospital Universitario Ramón y Cajal and Ramón y Cajal Health Investigation Institute (IRYCIS), Madrid, Spain.,Spanish Network for Research in Infectious Diseases (REIPI-RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.,University Alfonso X El Sabio, Villanueva de la Cañada, Madrid, Spain
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Dualleh N, Chanchiri I, Skjøt-Arkil H, Pedersen AK, Rosenvinge FS, Johansen IS. Colonization with multiresistant bacteria in acute hospital care: the association of prior antibiotic consumption as a risk factor. J Antimicrob Chemother 2021; 75:3675-3681. [PMID: 32814968 DOI: 10.1093/jac/dkaa365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antibiotic resistance poses a worldwide threat and knowledge concerning risk factors for colonization with multiresistant bacteria (MRB) is limited. OBJECTIVES To examine the impact of prior antibiotic consumption on MRB colonization, with focus on type of antibiotic and timeline between antibiotic prescription and MRB colonization. METHODS A nationwide case-control study was conducted and adults visiting emergency departments were invited to participate. All patients were swabbed in the throat, nose and rectum, and analysed for colonization with ESBL-producing Enterobacteriaceae (ESBL-E), MRSA, carbapenemase-producing enterobacteria and VRE. Antibiotic history 2 years prior to enrolment was collected at an individual level through a national register. Multivariate analyses were performed to examine the association between antibiotic consumption and MRB status. A subgroup analysis of ESBL-E-colonized cases was made. RESULTS We included 256 patients colonized with MRB and 4763 controls. In the 2 years prior to study inclusion, 77% of cases and 68% of controls had at least one antibiotic prescription (P = 0.002). We found a significant increase in risk of colonization with ESBL-E if penicillins (OR = 1.58-1.65) or fluoroquinolones (OR = 2.25-6.15) were prescribed. The analysis of all MRB-colonized patients showed similar results. An assessment of the timeline showed a significant increase in risk of colonization up to 2 years after exposure to penicillins, fluoroquinolones and macrolides. CONCLUSIONS The prevalence of ESBL-E colonization was related to fluoroquinolone, macrolide and penicillin consumption for at least 2 years after antibiotic treatment.
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Affiliation(s)
- Nasra Dualleh
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Iman Chanchiri
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Research Unit for Infectious Diseases, Clinical Institute, University of Southern Denmark, Odense, Denmark.,Open Patient data Explorative Network (OPEN), Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Hospital clinical practice around urinalysis is an important opportunity for antimicrobial stewardship improvement activities. Infect Dis Health 2021; 26:243-248. [PMID: 34112628 DOI: 10.1016/j.idh.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND To identify nurses' knowledge, perception and practice around urinalysis and asymptomatic bacteriuria (ASB) and to determine drivers of inappropriate urinalysis practice in an Australian hospital setting. METHODS Undertaken in eight geriatric wards over four hospitals, a questionnaire inviting voluntary, anonymous participation tested nursing staff knowledge on urinalysis, recognition of urinary tract infection (UTI) and perception of the utility of urinalysis as a routine test on all ward admissions. A retrospective one-month audit was performed on admissions to a 32-bed geriatric ward. RESULTS 132 of 220 (60%) distributed surveys were completed. Performing urinalysis on all new admissions was identified as routine practice by 89%, and with indwelling catheter change by 35% of respondents. Over-three-quarters believed that routine urinalysis on admission was useful practice and up to one-third believed urinalysis abnormalities warranted antibiotic prescribing. Dark urine (57.6%), foamy urine (55.3%) and vaginal itch (34.5%) were identified as features suggestive of a UTI. In the ward audit, routine urinalysis on admission accounted for most urinalysis testing (59%, 24/41). Of occasions with clinical prompt, delirium accounted for 60% of urinalysis and urinary symptoms 33% however urine culture was undertaken on 53% of occasions. CONCLUSION There was an overall lack of nursing knowledge regarding ASB, with a high perception that urinalysis abnormalities would be suspicious of a UTI irrespective of clinical findings and that routine urinalysis on ward admission was useful practice. In hospital settings, nursing stewardship can deliver strategies to increase knowledge, motivation and opportunity to improve appropriateness of UTI treatment and recognition of ASB.
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Pilmis B, Mizrahi A, Péan de Ponfilly G, Philippart F, Bruel C, Zahar JR, Le Monnier A. Relative faecal abundance of extended-spectrum β-lactamase-producing Enterobacterales and its impact on infections among intensive care unit patients: a pilot study. J Hosp Infect 2021; 112:92-95. [PMID: 33794294 DOI: 10.1016/j.jhin.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
This pilot prospective study assessed the association between the faecal relative abundance of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and the occurrence of ESBL-PE related infections. Twenty-four patients were included. The median ESBL relative abundance was 32.4%. The mean ESBL-PE relative abundance (ESBL-PE-RA) was more than five-fold higher in patients exposed during the last three months to antibiotics (P = 0.002). Furthermore, the mean ESBL relative abundance was more than two-fold higher in patients colonized with non-E. coli strains (P = 0.044). The mean ESBL-PE-RA was more than 10-fold higher for the concordant patients than for the discordant patients (59.1% vs 4.9%; P < 0.001).
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Affiliation(s)
- B Pilmis
- Équipe mobile de microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Service de maladies infectieuses et tropicales, Hôpital Necker - Enfants Malades, Paris, France; Institut Micalis UMR 1319, Université Paris - Saclay, INRAe, AgroParisTech, Châtenay Malabry, France.
| | - A Mizrahi
- Institut Micalis UMR 1319, Université Paris - Saclay, INRAe, AgroParisTech, Châtenay Malabry, France; Service de microbiologie clinique et plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - G Péan de Ponfilly
- Service de microbiologie clinique et plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - F Philippart
- Service de réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - C Bruel
- Service de réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J-R Zahar
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France
| | - A Le Monnier
- Institut Micalis UMR 1319, Université Paris - Saclay, INRAe, AgroParisTech, Châtenay Malabry, France; Service de microbiologie clinique et plateforme de dosage des anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Prevalence of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Ethiopia: A Systematic Review and Meta-Analysis. Int J Microbiol 2021; 2021:6669778. [PMID: 33859697 PMCID: PMC8026286 DOI: 10.1155/2021/6669778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/19/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Antimicrobial resistance especially caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) has become a global public health concern. Globally, these isolates have remained the most important causes of several infections and associated mortality. Their rapid spread in Ethiopia is associated with a lack of regular surveillance and antibiotic stewardship programs. Isolates of ESBL-PE from different regions of Ethiopia were searched exhaustively. However, published data regarding the pooled estimate of ESBL-PE are not conducted in Ethiopia. For this reason, we systematically reviewed laboratory-based studies to summarize the overall pooled prevalence of the isolates recovered from various human specimens. Methods An exhaustive literature search was carried out using the major electronic databases including PubMed, Web of Science, MEDLINE, EMBASE, CINAHL, Google Scholar, Cochrane Library, Scopus, and Wiley Online Library to identify potentially relevant studies without date restriction. Original articles which address the research question were identified, screened, and included using the PRISMA follow diagram. Data extraction form was prepared in Microsoft Excel, and data quality was assessed by using 9-point Joanna Briggs Institute critical appraisal tools. Then, data were exported to STATA 16.0 software for analyses of pooled estimation of outcome measures. Estimation of outcome measures at 95% confidence interval was performed using Der-Simonian-Laird's random-effects model. Finally, results were presented via text, figures, and tables. Results A comprehensive electronic database literature search has yielded a total of 86 articles. Among the total, 68 original articles were excluded after the review process. A total of 18 studies with 1191 bacterial isolates recovered from 7919 various clinical samples sizes were included for systematic review and meta-analysis. In this study, the pooled prevalence of ESBL-PE was 18% (95% CI: 9–26). Nine out of the total (50%) reviewed articles were studied using the combination disk test. Likewise, E. coli and K. pneumoniae (50% both) were the predominant isolates of ESBL-PE in addition to other isolates such as Salmonella spp. and Shigella spp. Conclusion This meta-analysis has shown a low pooled estimate of ESBL-PE in Ethiopia.
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Harbin NJ, Haug JB, Romøren M, Lindbæk M. Oral and parenteral antibiotic use in Norwegian nursing homes: are primary care institutions becoming our new local hospitals? JAC Antimicrob Resist 2020; 2:dlaa093. [PMID: 34223046 PMCID: PMC8209996 DOI: 10.1093/jacamr/dlaa093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Norwegian nursing homes (NHs) have over the last 10 years increasingly applied the use of parenteral treatment, which in turn allows more broad-spectrum use of antibiotics. Previous studies from Norwegian NHs have for the most part not described parenteral formulations. Objectives To describe systemic antibiotic use in Norwegian NHs. Methods Thirty-seven NHs in the county of Østfold, Norway, were invited to participate in this retrospective cross-sectional study. Associated pharmacies provided sales data for systemic antibiotic use for the participating NHs for 1 year (October 2015 to October 2016). General institutional characteristics were collected through a questionnaire. Results Thirty-four NHs participated in the study. Mean use of antibiotics was 9.5 DDD/100 bed days (range 0.6–30.9 DDD/100 bed days). Oral antibiotics accounted for 83% and parenteral antibiotics for 17% of the total antibiotic use. Of parenteral antibiotics, ampicillin was most used (31.1%) followed by cefotaxime (17.7%) and penicillin G (16.6%). The proportion of antibiotics compliant with guideline recommendations was 60%. Being a short-term NH was associated with increased antibiotic use, with an unstandardized coefficient of 13.1 (95% CI 4.2–21.9; P = 0.005). Conclusions We found a high level of total and parenteral antibiotic use compared with previous studies from Norwegian NHs. Data showed wide variations in total antibiotic use and that only a moderate proportion of the antibiotic use was considered guideline compliant. This highlights the necessity of further implementation strategies regarding the national guidelines for antibiotic use in NHs.
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Affiliation(s)
| | - Jon Birger Haug
- Department of Infection Control, Østfold Health Trust, Kalnes, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten Lindbæk
- Antibiotic Center for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Vink J, Edgeworth J, Bailey SL. Acquisition of MDR-GNB in hospital settings: a systematic review and meta-analysis focusing on ESBL-E. J Hosp Infect 2020; 106:419-428. [PMID: 32918969 DOI: 10.1016/j.jhin.2020.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/03/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and other multi-drug-resistant Gram-negative bacteria (MDR-GNB) have disseminated globally since their discovery in the late 20th century. Various infection prevention and control measures are in place to prevent nosocomial transmission of these organisms, but their efficacy remains disputed. New literature has emerged in recent years providing further evidence which can be used to formulate effective strategies to tackle this issue in the future. METHODS A systematic review was performed to characterize the prevalence of colonization of multi-drug-resistant organisms and subsequent acquisition of these organisms within hospital settings. A meta-analysis was performed to characterize the prevalence and acquisition of ESBL-E in Europe and North America. RESULTS Twenty-eight studies fulfilled the inclusion criteria. Escherichia coli formed the main burden of MDR-GNB colonization worldwide. Patient-to-patient transmission of ESBL-E was found to be rare, but increased transmissibility of Klebsiella pneumoniae was described over E. coli. Within European and North American healthcare settings, a meta-analysis of eight studies identified a pooled prevalence of ESBL-E on admission to hospital of 7.91% and an acquisition rate of 3.73%. DISCUSSION Low prevalence at the point of hospital admission and insufficient evidence of patient-to-patient transmission suggests that infection prevention and control measures such as universal surveillance screening and single-room isolation are unlikely to be practical or effective interventions in reducing the overall burden of ESBL-E in hospitals, in line with current European guidelines. Instead, it is argued that efforts should be placed on controlling the spread of these organisms and other MDR-GNB in the community, predominantly long-term care facilities.
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Affiliation(s)
- J Vink
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - J Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - S L Bailey
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
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Fodor A, Abate BA, Deák P, Fodor L, Gyenge E, Klein MG, Koncz Z, Muvevi J, Ötvös L, Székely G, Vozik D, Makrai L. Multidrug Resistance (MDR) and Collateral Sensitivity in Bacteria, with Special Attention to Genetic and Evolutionary Aspects and to the Perspectives of Antimicrobial Peptides-A Review. Pathogens 2020; 9:pathogens9070522. [PMID: 32610480 PMCID: PMC7399985 DOI: 10.3390/pathogens9070522] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/18/2022] Open
Abstract
Antibiotic poly-resistance (multidrug-, extreme-, and pan-drug resistance) is controlled by adaptive evolution. Darwinian and Lamarckian interpretations of resistance evolution are discussed. Arguments for, and against, pessimistic forecasts on a fatal “post-antibiotic era” are evaluated. In commensal niches, the appearance of a new antibiotic resistance often reduces fitness, but compensatory mutations may counteract this tendency. The appearance of new antibiotic resistance is frequently accompanied by a collateral sensitivity to other resistances. Organisms with an expanding open pan-genome, such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, can withstand an increased number of resistances by exploiting their evolutionary plasticity and disseminating clonally or poly-clonally. Multidrug-resistant pathogen clones can become predominant under antibiotic stress conditions but, under the influence of negative frequency-dependent selection, are prevented from rising to dominance in a population in a commensal niche. Antimicrobial peptides have a great potential to combat multidrug resistance, since antibiotic-resistant bacteria have shown a high frequency of collateral sensitivity to antimicrobial peptides. In addition, the mobility patterns of antibiotic resistance, and antimicrobial peptide resistance, genes are completely different. The integron trade in commensal niches is fortunately limited by the species-specificity of resistance genes. Hence, we theorize that the suggested post-antibiotic era has not yet come, and indeed might never come.
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Affiliation(s)
- András Fodor
- Department of Genetics, University of Szeged, H-6726 Szeged, Hungary;
- Correspondence: or (A.F.); (L.M.); Tel.: +36-(30)-490-9294 (A.F.); +36-(30)-271-2513 (L.M.)
| | - Birhan Addisie Abate
- Ethiopian Biotechnology Institute, Agricultural Biotechnology Directorate, Addis Ababa 5954, Ethiopia;
| | - Péter Deák
- Department of Genetics, University of Szeged, H-6726 Szeged, Hungary;
- Institute of Biochemistry, Biological Research Centre, H-6726 Szeged, Hungary
| | - László Fodor
- Department of Microbiology and Infectious Diseases, University of Veterinary Medicine, P.O. Box 22, H-1581 Budapest, Hungary;
| | - Ervin Gyenge
- Hungarian Department of Biology and Ecology, Faculty of Biology and Geology, Babeș-Bolyai University, 5-7 Clinicilor St., 400006 Cluj-Napoca, Romania; (E.G.); (G.S.)
- Institute for Research-Development-Innovation in Applied Natural Sciences, Babeș-Bolyai University, 30 Fântânele St., 400294 Cluj-Napoca, Romania
| | - Michael G. Klein
- Department of Entomology, The Ohio State University, 1680 Madison Ave., Wooster, OH 44691, USA;
| | - Zsuzsanna Koncz
- Max-Planck Institut für Pflanzenzüchtungsforschung, Carl-von-Linné-Weg 10, D-50829 Köln, Germany;
| | | | - László Ötvös
- OLPE, LLC, Audubon, PA 19403-1965, USA;
- Institute of Medical Microbiology, Semmelweis University, H-1085 Budapest, Hungary
- Arrevus, Inc., Raleigh, NC 27612, USA
| | - Gyöngyi Székely
- Hungarian Department of Biology and Ecology, Faculty of Biology and Geology, Babeș-Bolyai University, 5-7 Clinicilor St., 400006 Cluj-Napoca, Romania; (E.G.); (G.S.)
- Institute for Research-Development-Innovation in Applied Natural Sciences, Babeș-Bolyai University, 30 Fântânele St., 400294 Cluj-Napoca, Romania
- Centre for Systems Biology, Biodiversity and Bioresources, Babeș-Bolyai University, 5-7 Clinicilor St., 400006 Cluj-Napoca, Romania
| | - Dávid Vozik
- Research Institute on Bioengineering, Membrane Technology and Energetics, Faculty of Engineering, University of Veszprem, H-8200 Veszprém, Hungary; or or
| | - László Makrai
- Department of Microbiology and Infectious Diseases, University of Veterinary Medicine, P.O. Box 22, H-1581 Budapest, Hungary;
- Correspondence: or (A.F.); (L.M.); Tel.: +36-(30)-490-9294 (A.F.); +36-(30)-271-2513 (L.M.)
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Le MNT, Kayama S, Yoshikawa M, Hara T, Kashiyama S, Hisatsune J, Tsuruda K, Onodera M, Ohge H, Tsuga K, Sugai M. Oral colonisation by antimicrobial-resistant Gram-negative bacteria among long-term care facility residents: prevalence, risk factors, and molecular epidemiology. Antimicrob Resist Infect Control 2020; 9:45. [PMID: 32131899 PMCID: PMC7057508 DOI: 10.1186/s13756-020-0705-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background For residents of long-term care facilities (LTCFs), antimicrobial-resistant bacteria (ARB) are a risk factor, yet their oral colonisation, potentially leading to aspiration pneumonia, remains unclear. This study was undertaken to survey the prevalence, phenotypic characteristics, and molecular epidemiology of antimicrobial-resistant Gram-negative bacteria in the oral cavity of LTCF residents, and to analyse the risk factors for such carriers. Methods This study involved 98 residents of a LTCF in Hiroshima City, Japan, aged between 55 and 101 years. Oropharyngeal swabs were collected and plated on screening media for ESBL-producing and carbapenem-resistant bacteria; isolates were identified and tested for antibiotic susceptibility; biofilm formation was tested in vitro; identification of epidemic clones were pre-determined by PCR; resistance genes, sequence types, and whole-genome comparison of strains were conducted using draft genome sequences. Demographic data and clinical characterisations were collected and risk factors analysed. Results Fifty-four strains from 38% of the residents grew on screening media and comprised predominantly of Acinetobacter spp. (35%), Enterobacteriaceae spp. (22%), and Pseudomonas spp. (19%). All Escherichia coli isolates carried CTX-M-9 group and belonged to the phylogroup B2, O25:H4 ST131 fimH30 lineage. Six Acinetobacter baumannii isolates presented identical molecular characteristics and revealed more biofilm production than the others, strongly suggesting their clonal lineage. One Acinetobacter ursingii isolate displayed extensive resistance to various ß-lactams due to multiple acquired resistance genes. One Pseudomonas aeruginosa isolate showed exceptional resistance to all ß-lactams including carbapenems, aminoglycosides, and a new quinolone, showing a multidrug-resistant Pseudomonas aeruginosa (MDRP) phenotype and remarkable biofilm formation. Genome sequence analysis revealed this isolate was the blaIMP-1-positive clone ST235 in Japan. Strokes (cerebral infarction or cerebral haemorrhage) and percutaneous endoscopic gastrostomy tubes were recognised as risk factors for oral colonisation by ARB in the LTCF residents. Conclusions ARB, as defined by growth on screening agar plates, which carried mobile resistance genes or elements or conferred high biofilm formation, were already prevalent in the oral cavity of LTCF residents. Health-care workers involved in oral care should be aware of antimicrobial resistance and pay special attention to transmission prevention and infection control measures to diminish ARB or mobile resistance elements dissemination in LTCFs.
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Affiliation(s)
- Mi Nguyen-Tra Le
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Shizuo Kayama
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.,Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Higashi Murayama, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshinori Hara
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.,Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan
| | - Seiya Kashiyama
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.,Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan
| | - Junzo Hisatsune
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.,Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Higashi Murayama, Japan
| | - Keiko Tsuruda
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical & Health Sciences, Hhiroshima, Japan
| | - Makoto Onodera
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Clinical Laboratory, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroki Ohge
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan.,Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Motoyuki Sugai
- Project Research Centre for Nosocomial Infectious Diseases, Hiroshima University, Hiroshima, Japan. .,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan. .,Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Higashi Murayama, Japan.
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Rotz MV, Abdulazim A, Sendi P, Khanna N, Baettig V. [A Holiday Souvenir with Consequences - an Interdisciplinary Challenge]. PRAXIS 2020; 109:109-115. [PMID: 32019460 DOI: 10.1024/1661-8157/a003381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A Holiday Souvenir with Consequences - an Interdisciplinary Challenge Abstract. We describe a patient with a diabetic foot and challenging infectious complications. After a hospital stay in Sri Lanka due to a soft tissue infection of the foot he was relocated to Switzerland. After proof of multiple resistant bacteria, an amputation of the forefoot with a split skin cover was performed, followed by a short resistance-adapted antibiotic treatment, with good clinical results. This case illustrates the increase of multidrug-resistant bacteria, even in Switzerland. It emphasizes the importance of infection control measures in travellers returning from countries with high prevalence of multidrug-resistant bacteria (especially after a hospitalisation), and the need of a close interdisciplinary collaboration in these cases to guarantee the best treatment and to limit the spreading of multidrug-resistant bacteria.
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Affiliation(s)
- Matthias von Rotz
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Universität Basel
| | - Ahmed Abdulazim
- Klinik für Orthopädie und Traumatologie, Universitätsspital Basel, Universität Basel
| | - Parham Sendi
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Universität Basel
- Klinik für Orthopädie und Traumatologie, Universitätsspital Basel, Universität Basel
| | - Nina Khanna
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Universität Basel
| | - Veronika Baettig
- Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel, Universität Basel
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Jang DK, Kim J, Park WB, Yi SY, Lee JK, Yoon WJ. Increasing burden of biliary tract infection caused by extended-spectrum beta-lactamase-producing organisms in Korea: A nationwide population-based study. J Gastroenterol Hepatol 2020; 35:56-64. [PMID: 31359494 DOI: 10.1111/jgh.14809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Biliary tract infections (BTIs) are a major cause of bacteremia. The prevalence of antibiotic-resistant pathogens in BTI patients is reported to be increasing. We used a nationwide database to evaluate the prevalence of, and risk factors for, BTIs caused by extended-spectrum beta-lactamase-producing organisms (ESBL-PO) in Korea. METHODS Patients with a BTI diagnosis, an admission history, a history of a BTI-related procedure, and antibiotic use for ≥ 4 days between 2007 and 2016 were identified from the Health Insurance Review and Assessment Service database. A BTI treated with carbapenems (BTI-TC) was used as the surrogate for a BTI caused by ESBL-PO. We conducted a multivariate logistic regression analysis to determine the risk factors for BTI-TC. RESULTS In total, 341 002 patients were enrolled. The overall percentage of BTI-TC among BTIs was 2.4%, with an increasing annual trend (P < 0.0001). The risk of acute cholangitis caused by ESBL-PO increased significantly in men, older patients, patients with comorbidities, patients with a history of a biliary procedure within the previous year, and patients with a history of antibiotic use within the previous 90 days. Regarding antibiotic use, the patients at highest risk were those previously prescribed carbapenems (adjusted odds ratio, 4.77; P < 0.0001). CONCLUSIONS The prevalence of BTIs caused by ESBL-PO has increased during the last 10 years. Initial carbapenem therapy should be considered for elderly patients with acute cholangitis if they have had a previous biliary procedure and/or a history of carbapenem administration within the previous 90 days.
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Affiliation(s)
- Dong Kee Jang
- Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jungmee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Young Yi
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Won Jae Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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Broussier M, Gbaguidi-Haoré H, Rachidi-Berjamy F, Bertrand X, Slekovec C. Prevalence, genetic diversity of and factors associated with ESBL-producing Enterobacterales carriage in residents of French nursing homes. J Hosp Infect 2019; 104:469-475. [PMID: 31843559 DOI: 10.1016/j.jhin.2019.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the prevalence and genotypic characteristics of extended-spectrum β-lactamase-producing Enterobacterales (ESBLE) and carbapenemase-producing Enterobacterales (CPE) in nursing homes (NHs) in a French region. Risk factors associated with their carriage were also investigated. METHODS A point-prevalence survey was proposed from November 2017 to June 2018 to NHs in the study region. Volunteer residents were screened for ESBLE and CPE carriage. Escherichia coli and Klebsiella pneumoniae isolates were genotyped using multi-locus sequence typing, pulsed-field gel electrophoresis (PFGE) and phylogrouping (for E. coli alone). Collective and individual data were analysed by random-effects logistic regression. RESULTS The study was conducted in 18 NHs and included 262 patients. Fifty-two patients (19.8%) carried at least one ESBLE, corresponding to 56 isolates (42 E. coli, 11 K. pneumoniae and three others), while no CPE was detected. The majority (27/42) of ESBL E. coli belonged to phylogroup B2, and ST131 was over-represented in this subset (21/27). PFGE analysis revealed ST131 cross-transmission within NHs. Regarding ESBL K. pneumoniae, nine of 11 isolates belonged to ST663, and PFGE suggested diffusion of the clone in six NHs. Significant individual risk factors for colonization by ESBLE were: use of a shared bathroom, previous antibiotic use and recent history of hospitalization. Significant collective protective factors were proper compliance with glove use and support of the NH by a healthcare facility. CONCLUSION This study shows that NHs in the study region are an important reservoir of ESBLE, whereas no residents were CPE carriers. The control of ESBLE in NHs should focus on antibiotic stewardship and excreta management policies.
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Affiliation(s)
- M Broussier
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France
| | - H Gbaguidi-Haoré
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - F Rachidi-Berjamy
- CPias Bourgogne-Franche-Comté, Centre Hospitalier Régional Universitaire, Besançon, France
| | - X Bertrand
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - C Slekovec
- UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France; CPias Bourgogne-Franche-Comté, Centre Hospitalier Régional Universitaire, Besançon, France.
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Aslan AT, Akova M. Extended spectrum β-lactamase producing enterobacteriaceae: carbapenem sparing options. Expert Rev Anti Infect Ther 2019; 17:969-981. [PMID: 31722185 DOI: 10.1080/14787210.2019.1693258] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Carbapenems have an important place in our antibiotic armamentarium and have been trusted to effectively treat infections caused by ESBL-producing Enterobacteriaceae for many years. However, the utility of carbapenems has been compromised by the emergence of resistance especially in Enterobacteriaceae. Therefore, carbapenem-sparing alternative antibiotics are of extreme importance in clinical practice.Areas covered: We reviewed studies addressing currently available antibiotic options used as both empiric and definitive therapy for the treatment of infections due to ESBL-producing Enterobacteriaceae published in the PubMed/MEDLINE, Web of Science and Scopus databases without any date restriction. Current treatment alternatives included beta-lactam/beta-lactamase inhibitor combinations, cefepime, cephamycins, fluoroquinolones, aminoglycosides, fosfomycin, pivmecillinam, temocillin and, various oral alternative agents. We also summarized the clinical and molecular epidemiology, early prediction methods and impact of initial empirical therapy and de-escalation approach for ESBL-producing Enterobacteriaceae infections.Expert opinion: The current literature would endorse the carbapenem utilization for patients with severe and high inoculum-high risk infections. However, for milder infections particularly for urinary tract infections, various carbapenem-sparing antibiotics can be considered in selected cases. For infections including easily drainable intra-abdominal infections and catheter-related infections in which catheter removal is readily available more reliable data are needed to recommend non-carbapenem antibiotics confidently.
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Affiliation(s)
| | - Murat Akova
- Hacettepe University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Sıhhıye Campus, Sihhiye, Ankara, Turkey
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Stepan D, Ušaj L, Petek Šter M, Smolinger Galun M, Smole H, Beović B. Antimicrobial prescribing in long-term care facilities: a nationwide point-prevalence study, Slovenia, 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458914 PMCID: PMC6247456 DOI: 10.2807/1560-7917.es.2018.23.46.1800100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Residents in long-term care are at high risk of infections because of their old age and many related health problems that lead to frequent antibiotic prescribing. The aim of the study was to assess antibiotic use in Slovenian long-term care facilities (LTCFs). The point-prevalence study was conducted between April and June 2016. Online questionnaires were sent to all Slovenian LTCFs. Eighty (68.4%) of the 117 LTCFs contacted, caring for 13,032 residents (70.6% of all Slovenian LTCF residents), responded to the survey. On the day of the study, the mean antibiotic prevalence per LTCF was 2.4% (95% confidence interval: 1.94-2.66). Most (70.2%) of the residents taking antibiotics were female. Most residents were being treated for respiratory tract (42.7%) or urinary tract (33.3%) infections. Co-amoxiclav and fluoroquinolones were the most frequently prescribed antibiotics (41.0% and 22.3% respectively). Microbiological tests were performed for 5.2% of residents receiving antibiotics. Forty nine (19.8%) residents receiving antibiotics were colonised with multidrug-resistant bacteria (MDR). Antibiotic use in Slovenian LTCFs is not very high, but most prescribed antibiotics are broad-spectrum. Together with low use of microbiological testing and high prevalence of colonisation with MDR bacteria the situation is worrisome and warrants the introduction of antimicrobial stewardship interventions.
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Affiliation(s)
- Dora Stepan
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Lea Ušaj
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Hermina Smole
- Long-term care facility for the elderly Trebnje, Trebnje, Slovenia
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Furmenti M, Rossello P, Bianco S, Olivero E, Thomas R, Emelurumonye I, Zotti C, Moro ML, Brusaferro S, Sticchi C, Chadenier GM, D'Errico M, Ripabelli G, Prato R, Mura II, Agodi A, Collini F, Torri E, Novati R, Fedeli U. Healthcare-associated infections and antimicrobial use in long-term care facilities (HALT3): an overview of the Italian situation. J Hosp Infect 2019; 102:425-430. [DOI: 10.1016/j.jhin.2019.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 11/26/2022]
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Prevel R, Boyer A, M’Zali F, Cockenpot T, Lasheras A, Dubois V, Gruson D. Extended spectrum beta-lactamase producing Enterobacterales faecal carriage in a medical intensive care unit: low rates of cross-transmission and infection. Antimicrob Resist Infect Control 2019; 8:112. [PMID: 31333839 PMCID: PMC6617905 DOI: 10.1186/s13756-019-0572-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background Extended-spectrum beta-lactamases-producing Enterobacterales (ESBL-E) are disseminating worldwide especially in Intensive Care Units (ICUs) and are responsible for increased health costs and mortality. The aims of this work were to study ESBL-E dissemination in ICU and to assess the impact of ESBL-E fecal carriage on subsequent infections during a non-outbreak situation. Methods We therefore screened every patient at admission then once a week in a medical ICU between January and June 2015. Each ESBL-E isolate was characterized by ESBL genes PCR amplification and the clonal dissemination was assessed by Pulsed-Field Gel Electrophoresis (PFGE). Results Among the 608 screened patients, 55 (9%) were colonized by ESBL-E. Forty-four isolates were available for further analysis. Most of them (43/44, 98%) contained a ESBL gene from the CTX-M group. Only one case of ESBL-E cross-transmission occurred, even for acquired ESBL-E colonization. Subsequent infection by ESBL-E occurred in 6/55 (11%) patients and infecting ESBL-E strains were the colonizing ones. ESBL-E faecal carriage had a negative predictive value of 100% and a positive predictive value of 40% to predict ESBL-E ventilator associated-pneumonia (VAP). Alternatives to carbapenems consisting in piperacillin-tazobactam, ceftolozane-tazobactam and ceftazidime-avibactam were all active on this panel of ESBL-E. Conclusions ESBL-E expansion and acquisition in ICU in a non-outbreak situation are not any more fully explained by cross-transmission. Mechanisms underlying ESBL-E dissemination in ICU are still to investigate. Interestingly, as far as we know, our study demonstrates for the first time by PFGE that the colonizing strain is indeed the infecting one in case of subsequent ESBL-E infection. Nevertheless, subsequent ESBL-E infection remains a rare event conferring poor positive predictive value for ESBL-E colonization to predict ESBL-E VAP. Relevance of systematic ESBL-E faecal screening at ICU admission and during ICU stay needs further investigation.
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Affiliation(s)
- Renaud Prevel
- Medical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospital, Place Amélie Raba-Léon, F-33000 Bordeaux, France
- UMR 5234 CNRS, Bordeaux University, F-33000 Bordeaux, France
| | - Alexandre Boyer
- Medical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospital, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - Fatima M’Zali
- UMR 5234 CNRS, Bordeaux University, F-33000 Bordeaux, France
| | | | | | - Véronique Dubois
- UMR 5234 CNRS, Bordeaux University, F-33000 Bordeaux, France
- Bacteriology laboratory, CHU Bordeaux, F-33000 Bordeaux, France
| | - Didier Gruson
- Medical Intensive Care Unit, CHU Bordeaux, Pellegrin universitary hospital, Place Amélie Raba-Léon, F-33000 Bordeaux, France
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Jalilian N, Kooshkiforooshani M, Ahmadi S, Nankali A. Colonisation with extended-spectrum β-lactamase-producing Enterobacteriaceae in pregnant/post-partum women: Systematic review and meta-analysis. J Glob Antimicrob Resist 2019; 19:338-347. [PMID: 31212106 DOI: 10.1016/j.jgar.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/26/2019] [Accepted: 06/10/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Maternal colonisation with extended-spectrum β-lactamase (ESBL)-producing micro-organisms can lead to transmission of such pathogens to neonates, resulting in considerable morbidity. The aim of this study was to determine the global prevalence of maternal colonisation with ESBL-producing Enterobacteriaceae (ESBL-E). METHODS A systematic review of PubMed, Embase, Scopus, Web of Science and ProQuest databases as well as the grey literature was performed. Studies reporting the prevalence of ESBL-E colonisation during pregnancy or postpartum period were included. Prevalence data were grouped by geographic region. The pooled prevalence and 95% confidence interval (CI) was estimated by meta-analysis using a random-effects model. RESULTS Nineteen studies with reports from 16 countries (seven studies from Africa, one study from South America, two studies from Asia and nine studies from Europe) reporting data for 7352 pregnant/postpartum women were included. The pooled prevalence of ESBL-E colonisation was 8% (95% CI 5-10%). Prevalence estimates were 15% (95% CI 5-24%) in Africa, 6% (95% CI 4-10%) in South America, 5% (95% CI 4-6%) in Asia and 4% (95% CI 2-5%) in Europe. The pooled prevalence was higher in studies with low risk of bias (10%; 95% CI 7-13%) compared with those with high risk of bias (3%; 95% CI 2-3%). CONCLUSION There was heterogeneity regarding ESBL-E colonisation rates in different continents. The pooled prevalence rate was higher in Africa compared with other areas. Given that the highest rate was observed in Africa, implementing screening efforts for ESBL-E colonisation during pregnancy may be justified.
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Affiliation(s)
- Nasrin Jalilian
- Fertility and Infertility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Shooba Ahmadi
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Anisodowleh Nankali
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Prevel R, Boyer A, M'Zali F, Lasheras A, Zahar JR, Rogues AM, Gruson D. Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:170. [PMID: 31088542 PMCID: PMC6518813 DOI: 10.1186/s13054-019-2460-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are disseminating worldwide leading to increased hospital length of stay and mortality in intensive care units (ICU). ESBL-E dissemination was first due to outbreaks in hospital settings which led to the implementation of systematic fecal carriage screening to improve hygiene procedures by contact precautions. ESBLs have since spread in the community, and the relevance of contact precautions is questioned. ESBL-E dissemination led to an overuse of carbapenems triggering the emergence of carbapenem-resistant Enterobacteriaceae. Empirical antimicrobial therapy based on ESBL-E fecal carriage has been proposed but is debated as it could increase the consumption of carbapenems among ESBL-E carriers without any clinical benefit. Finally, selective decontamination among ESBL-E fecal carriers is evoked to decrease the risk for subsequent ESBL-E infection, but its efficacy remains debated. We propose to systematically review the evidence to recommend or not such systematic ESBL-E fecal carriage screening in adult ICU. METHODS Every article focusing on ESBL-E and ICU available on the MEDLINE database was assessed. Articles were included if focusing on cross-transmission, efficacy of hygiene procedures, link between ESBL-E colonization and infection or guidance of empirical therapy or selective decontamination efficacy. RESULTS Among 330 articles referenced on PubMed, 39 abstracts were selected for full-text assessment and 25 studies were included. Systematic screening of ESBL-E fecal carriage to guide contact precautions do not seem to decrease the rate of ESBL-E cross-transmission. It has a very good negative predictive value for subsequent ESBL-E infections but a positive predictive value between 40 and 50% and so does not help to spare carbapenems. Cessation of ESBL-E carriage systematic screening could decrease the use of carbapenems in ICU without any clinical harm. Nevertheless, further studies are needed to validate these results from monocentric before-after study. Selective decontamination strategy applied to ESBL-E fecal carriers could be helpful, but available data are conflicting. CONCLUSION Current knowledge lacks of high-quality evidence to strongly recommend in favor of or against a systematic ESBL-E fecal carriage screening policy for ICU patients in a non-outbreak situation. Further evaluation of selective decontamination or fecal microbiota transplantation among ESBL-E fecal carriers is needed.
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Affiliation(s)
- Renaud Prevel
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France. .,UMR 5234 CNRS, Bordeaux University, F-33000, Bordeaux, France. .,, Bordeaux, France.
| | - Alexandre Boyer
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France
| | - Fatima M'Zali
- UMR 5234 CNRS, Bordeaux University, F-33000, Bordeaux, France
| | - Agnès Lasheras
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000, Bordeaux, France
| | - Jean-Ralph Zahar
- Unité INSERM - IAME UMR 1137, Université Paris-13, Bobigny, France
| | - Anne-Marie Rogues
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France
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Latour K, Huang TD, Jans B, Berhin C, Bogaerts P, Noel A, Nonhoff C, Dodémont M, Denis O, Ieven M, Loens K, Schoevaerdts D, Catry B, Glupczynski Y. Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015. PLoS One 2019; 14:e0214327. [PMID: 30921364 PMCID: PMC6438666 DOI: 10.1371/journal.pone.0214327] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/11/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives Following two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in NH residents. Risk factors for MDRO carriage were also explored. Methods Up to 51 randomly selected residents per NH were screened for MDRO carriage by trained local nurses between June and October 2015. Rectal swabs were cultured for ESBLE, CPE and VRE, while pooled samples of nose, throat and perineum and chronic wound swabs were obtained for culture of MRSA. Antimicrobial susceptibility testing, molecular detection of resistance genes and strain genotyping were performed. Significant risk factors for MDRO colonization MDRO was determined by univariate and multivariable analysis. Results Overall, 1447 residents from 29 NHs were enrolled. The mean weighted prevalence of ESBLE and MRSA colonization was 11.3% and 9.0%, respectively. Co-colonization occurred in 1.8% of the residents. VRE and CPE carriage were identified in only one resident each. Impaired mobility and recent treatment with fluoroquinolones or with combinations of sulphonamides and trimethoprim were identified as risk factors for ESBLE carriage, while for MRSA these were previous MRSA carriage/infection, a stay in several different hospital wards during the past year, and a recent treatment with nitrofuran derivatives. Current antacid use was a predictor for both ESBL and MRSA carriage. Conclusions In line with the evolution of MRSA and ESBL colonization/infection in hospitals, a decline in MRSA carriage and an increase in ESBLE prevalence was seen in Belgian NHs between 2005 and 2015. These results show that a systemic approach, including surveillance and enhancement of infection control and antimicrobial stewardship programs is needed in both acute and chronic care facilities.
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Affiliation(s)
- Katrien Latour
- Operational Directorate Epidemiology & Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
- * E-mail:
| | - Te-Din Huang
- National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Béatrice Jans
- Operational Directorate Epidemiology & Public Health, Sciensano, Brussels, Belgium
| | - Catherine Berhin
- National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Pierre Bogaerts
- National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Audrey Noel
- National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Claire Nonhoff
- National Reference Centre for methicillin-resistant Staphylococcus aureus and staphylococci, Department of Clinical Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Magali Dodémont
- National Reference Centre for methicillin-resistant Staphylococcus aureus and staphylococci, Department of Clinical Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Denis
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Margareta Ieven
- National Reference Centre for vancomycin-resistant enterococci, Department of Clinical Microbiology, University Hospital of Antwerp, Edegem, Belgium
| | - Katherine Loens
- National Reference Centre for vancomycin-resistant enterococci, Department of Clinical Microbiology, University Hospital of Antwerp, Edegem, Belgium
| | - Didier Schoevaerdts
- Department of Geriatric Medicine, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Mont-Godinne, Belgium
- Institute of Health and Society, Ecole de Santé Publique, Université catholique de Louvain, Brussels, Belgium
| | - Boudewijn Catry
- Operational Directorate Epidemiology & Public Health, Sciensano, Brussels, Belgium
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Youri Glupczynski
- National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium
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Haaijman J, Stobberingh EE, van Buul LW, Hertogh CMPM, Horninge H. Urine cultures in a long-term care facility (LTCF): time for improvement. BMC Geriatr 2018; 18:221. [PMID: 30236062 PMCID: PMC6149184 DOI: 10.1186/s12877-018-0909-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/05/2018] [Indexed: 01/02/2023] Open
Abstract
Background Urinary tract infections (UTIs) are the most prevalent infections in long-term care facilities (LTCFs). Numerous studies have described the problem of inadequate UTI diagnosis and treatment. We assessed the role of urine cultures in the diagnosis and treatment of UTIs in a LTCF. Methods In a 370-bed non-academic LTCF a retrospective assessment of antibiotic (AB) prescriptions for UTIs and urine cultures was performed from July 2014 to January 2016. The reasons why physicians, including 11 nursing home physicians and 2 junior doctors, ordered urine cultures were recorded using questionnaires. Results During the study period, 378 residents were prescribed 1672 AB courses; 803 were for UTIs. One hundred and fifty-five urine cultures were obtained from 135 residents; 66 of these cultures were performed on the same day as ABs were prescribed (8% of all prescriptions for UTI), while 89 were not. There was a discrepancy between the actions that seemed logical based on the culture results and the actions that were actually taken in 75% of the cases. In these cases, initial AB treatment was not adjusted when the isolated microorganism was resistant to the AB prescribed, the urine culture was positive and no ABs had previously been administered, or ABs were prescribed and no microorganism was isolated. The most frequent reason for ordering a urine culture was to confirm the diagnosis of a UTI. Conclusion In the majority of patients, AB therapy was not adjusted when the urine culture results suggested it may be appropriate. The physicians were erroneously convinced that UTIs could be diagnosed by a positive urine culture. Electronic supplementary material The online version of this article (10.1186/s12877-018-0909-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Haaijman
- River Region Elderly Care Centers (SZR), Burgemeester Meslaan 49, 4003CA, Tiel, The Netherlands.
| | - E E Stobberingh
- Faculty of Health, Medicine and Life sciences, Department of Medical Microbiology, Maastricht University Medical Center (MUMC), School of Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands
| | - L W van Buul
- Amsterdam Public Health Research institute and Department of General Practice & Old Age Medicine, VU University Medical Center, 1081, BT, Amsterdam, The Netherlands
| | - C M P M Hertogh
- Amsterdam Public Health Research institute and Department of General Practice & Old Age Medicine, VU University Medical Center, 1081, BT, Amsterdam, The Netherlands
| | - H Horninge
- River Region Elderly Care Centers (SZR), Burgemeester Meslaan 49, 4003CA, Tiel, The Netherlands
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Kawamura K, Hayashi K, Matsuo N, Kitaoka K, Kimura K, Wachino JI, Kondo T, Iinuma Y, Murakami N, Fujimoto S, Arakawa Y. Prevalence of CTX-M-Type Extended-Spectrum β-Lactamase-Producing Escherichia coli B2-O25-ST131 H30R Among Residents in Nonacute Care Facilities in Japan. Microb Drug Resist 2018; 24:1513-1520. [PMID: 29791251 DOI: 10.1089/mdr.2018.0068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We investigated the prevalence and characteristics of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli among 258 residents of long-term care facilities (LTCFs) in Japan. Out of 258 fecal samples collected from nine LTCFs between November 2015 and March 2017, we recovered 59 ESBL-producing E. coli isolates. All isolates carried blaCTX-M genes, mainly blaCTX-M-27 (42.4%), blaCTX-M-14 (23.7%), and blaCTX-M-15 (18.6%). The isolates showed 7 serotypes (STs), including ST131 (n = 49, 83.1%) and ST38 (n = 4, 6.8%), and 47 (79.7%) out of 49 isolates belonging to ST131 were identified as H30R. The 59 ESBL producers were divided into four groups, B2 (86.4%), D (8.5%), A (3.4%), and C (1.7%); 44 (74.6%) were epidemic clone B2-O25-ST131 H30R, of which 21, 11, and 6 harbored blaCTX-M-27, blaCTX-M-15, and blaCTX-M-14, respectively. Most plasmids were of IncF replicon types (n = 33), and 22 blaCTX-M-27-carrying plasmids showed multiple replicon types, including IncFII, FIA, and FIB. The ESBL producers were susceptible to imipenem, amikacin, and fosfomycin, but resistant to ceftazidime (49.2%), and ciprofloxacin (88.1%); in particular, the isolates harboring the blaCTX-M-15 gene showed significantly high resistance rate to ceftazidime (p < 0.01). Our findings indicate that a considerable proportion of the examined LTCF residents carried ESBL-producing E. coli isolates in feces and had high prevalence of epidemic clone B2-O25-ST131. Furthermore, continuous investigations would be very necessary to monitor actual carriage states of ESBL-producers among the LTCF residents from the viewpoint of both public health and healthcare viewpoints.
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Affiliation(s)
- Kumiko Kawamura
- 1Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kengo Hayashi
- 1Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Nao Matsuo
- 1Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kazuki Kitaoka
- 2Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kouji Kimura
- 2Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jun-Ichi Wachino
- 2Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takaaki Kondo
- 1Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshitsugu Iinuma
- 3Department of Infectious Diseases, Kanazawa Medical University, Ishikawa, Japan
| | - Nobuo Murakami
- 4Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan
| | - Shuhei Fujimoto
- 5Department of Bacteriology and Bacterial Infection Division of Host Defence Mechanism, Tokai University School of Medicine, Kanagawa, Japan
| | - Yoshichika Arakawa
- 2Department of Bacteriology, Nagoya University Graduate School of Medicine, Aichi, Japan
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49
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Chong Y, Shimoda S, Shimono N. Current epidemiology, genetic evolution and clinical impact of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae. INFECTION GENETICS AND EVOLUTION 2018; 61:185-188. [PMID: 29626676 DOI: 10.1016/j.meegid.2018.04.005] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 01/01/2023]
Abstract
The worldwide spread of extended-spectrum β-lactamase (ESBL)-producing bacteria, particularly Escherichia coli and Klebsiella pneumoniae, is a critical concern for the development of therapies against multidrug-resistant bacteria. Since the 2000s, detection rates of CTX-M types ESBL-producing E. coli in the community have been high, possibly contributing to their nosocomial detection. Various factors, such as environmental sources, food animals, and international travel, accelerate the global ESBL spread in the community. The dramatic dissemination of ESBLs in the community is associated with the relatively recent emergence of CTX-M-15-producing ST131 E. coli clones, which often carry many other antibiotic resistance genes (including quinolone). The usefulness of β-lactam/β-lactamase inhibitor, particularly, piperacillin/tazobactam, has been considered as a carbapenem-sparing regimen for ESBL infections, although the global trend of AmpC β-lactamase-producing bacteria should be monitored carefully. Careful therapeutic selection and continued surveillance for the detection of multidrug-resistant bacteria are required.
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Affiliation(s)
- Yong Chong
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan.
| | - Shinji Shimoda
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
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Datta R, Juthani-Mehta M. Burden and Management of Multidrug-Resistant Organisms in Palliative Care. Palliat Care 2017; 10:1178224217749233. [PMID: 29317826 PMCID: PMC5753884 DOI: 10.1177/1178224217749233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/10/2017] [Indexed: 12/26/2022] Open
Abstract
Palliative care includes comprehensive strategies to optimize quality of life for patients and families confronting terminal illness. Infections are a common complication in terminal illness, and infections due to multidrug-resistant organisms (MDROs) are particularly challenging to manage in palliative care. Limited data suggest that palliative care patients often harbor MDRO. When MDROs are present, distinguishing colonization from infection is challenging due to cognitive impairment or metastatic disease limiting symptom assessment and the lack of common signs of infection. Multidrug-resistant organisms also add psychological burden through infection prevention measures including patient isolation and contact precautions which conflict with the goals of palliation. Moreover, if antimicrobial therapy is indicated per goals of care discussions, available treatment options are often limited, invasive, expensive, or associated with adverse effects that burden patients and families. These issues raise important ethical considerations for managing and containing MDROs in the palliative care setting.
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Affiliation(s)
- Rupak Datta
- Rupak Datta, Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA.
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