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Ben-Amram H, Azrad M, Cohen-Assodi J, Sharabi-Nov A, Edelstein S, Agay-Shay K, Peretz A. Biofilm Formation by Hospital-Acquired Resistant Bacteria Isolated from Respiratory Samples. J Epidemiol Glob Health 2024; 14:291-297. [PMID: 38564110 PMCID: PMC11176280 DOI: 10.1007/s44197-024-00215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Hospital-acquired resistant infections (HARI) are infections, which develop 48 h or more after admission to a healthcare facility. HARI pose a considerably acute challenge, due to limited treatment options. These infections are associated bacterial biofilms, which act as a physical barrier to diverse external stresses, such as desiccation, antimicrobials and biocides. We assessed the influence of multiple factors on biofilm production by HARI -associated bacteria. METHODS Bacteria were isolated from samples of patients with respiratory HARI who were hospitalized during 2020-2022 in north Israel. Following antibiotic susceptibility testing by disc diffusion or broth microdilution, biofilm formation capacities of resistant bacteria (methicillin-resistant staphylococcus aureus, extended spectrum beta-lactamase-producing Escherichia coli and Klebsiela pneumonia, and multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii) was assessed using the crystalline violet staining method. Data regarding season, time to infection, bacterial species, patient age and gender, year, and medical department were collected from the patient medical records. RESULTS Among the 226 study isolates, K. pneumonia was the most prevalent (35.4%) bacteria, followed by P. aeruginosa (23.5%), and methicillin-resistant staphylococcus aureus (MRSA) (21.7%). A significantly higher rate of HARI was documented in 2022 compared to 2020-2021. The majority of isolates (63.3%) were strong biofilm producers, with K. pneumonia (50.3%) being most dominant, followed by P. aeruginosa (29.4%). Biofilm production strength was significantly affected by seasonality and hospitalization length, with strong biofilm production in autumn and in cases where hospitalization length exceeded 30 days. CONCLUSION Biofilm production by HARI bacteria is influenced by bacterial species, season and hospitalization length.
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Affiliation(s)
- Hila Ben-Amram
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- The Clinical Microbiology Laboratory, Ziv Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Azrad
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Jackie Cohen-Assodi
- The Clinical Microbiology Laboratory, Ziv Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Shimon Edelstein
- The Infectious Diseases, Ziv Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, 1311502, Safed, Israel
| | - Keren Agay-Shay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Avi Peretz
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- The Clinical Microbiology Laboratory, Tzafon Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Manyi-Loh CE, Lues R. A South African Perspective on the Microbiological and Chemical Quality of Meat: Plausible Public Health Implications. Microorganisms 2023; 11:2484. [PMID: 37894142 PMCID: PMC10608972 DOI: 10.3390/microorganisms11102484] [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: 06/30/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Meat comprises proteins, fats, vitamins, and trace elements, essential nutrients for the growth and development of the body. The increased demand for meat necessitates the use of antibiotics in intensive farming to sustain and raise productivity. However, the high water activity, the neutral pH, and the high protein content of meat create a favourable milieu for the growth and the persistence of bacteria. Meat serves as a portal for the spread of foodborne diseases. This occurs because of contamination. This review presents information on animal farming in South Africa, the microbial and chemical contamination of meat, and the consequential effects on public health. In South Africa, the sales of meat can be operated both formally and informally. Meat becomes exposed to contamination with different categories of microbes, originating from varying sources during preparation, processing, packaging, storage, and serving to consumers. Apparently, meat harbours diverse pathogenic microorganisms and antibiotic residues alongside the occurrence of drug resistance in zoonotic pathogens, due to the improper use of antibiotics during farming. Different findings obtained across the country showed variations in prevalence of bacteria and multidrug-resistant bacteria studied, which could be explained by the differences in the manufacturer practices, handling processes from producers to consumers, and the success of the hygienic measures employed during production. Furthermore, variation in the socioeconomic and political factors and differences in bacterial strains, geographical area, time, climatic factors, etc. could be responsible for the discrepancy in the level of antibiotic resistance between the provinces. Bacteria identified in meat including Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, Campylobacter spp., Salmonella spp., etc. are incriminated as pathogenic agents causing serious infections in human and their drug-resistant counterparts can cause prolonged infection plus long hospital stays, increased mortality and morbidity as well as huge socioeconomic burden and even death. Therefore, uncooked meat or improperly cooked meat consumed by the population serves as a risk to human health.
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Affiliation(s)
- Christy E. Manyi-Loh
- Centre of Applied Food Sustainability and Biotechnology, Central University of Technology, Bloemfontein 9301, South Africa;
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Lee ALH, Leung ECM, Wong BWH, Wong LCH, Wong YLY, Hung RKY, Ho SSY, Chow VCY. Clean clothes or dirty clothes? Outbreak investigation of carbapenem-resistant Acinetobacter baumannii related to laundry contamination through multilocus sequence typing (MLST). Infect Control Hosp Epidemiol 2023; 44:1274-1280. [PMID: 36345791 DOI: 10.1017/ice.2022.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the source in an outbreak of carbapenem-resistant Acinetobacter baumannii (CRA) in a general hospital due to contamination of a laundry evaporative cooler and the laundry environment using multilocus sequence typing (MLST). METHODS For CRA culture, clinical samples were collected from infected patients and close contacts, and environmental sampling was performed in patient surroundings and laundry facilities. MLST was used for the molecular typing of representative CRA isolates. Bacterial isolates with identical sequence types were considered epidemiologically linked and attributable to the same source. OXA genes in Acinetobacter baumannii were detected using polymerase chain reaction (PCR). RESULTS In total, 58 patients were affected in this outbreak. The mean patient age was 75.3, and 50% were female. The most common diagnoses at admission were skin and soft-tissue infection (n = 12, 20.7%) and pneumonia (n = 12, 20.7%). OXA-23 was positive in 64.7% of isolates. A CRA isolate from the evaporative cooler in the laundry was identical to that of 11 patients across 3 wards, belonging to ST345. Isolates from 3 laundry linen racks were identical to those of 7 patients from 3 wards, classified as ST1145. Isolates found on another linen rack and a pajama shelf were identical to isolates from 3 other patients from 2 wards, belonging to ST2207. There was no significant difference between sequence type distributions of clinical and environmental isolates (P = .12), indicating high likelihood of CRA originating from the same source. CONCLUSIONS MLST confirmed that contamination of the laundry evaporative cooler and surrounding environment caused a polyclonal CRA hospital outbreak. Hospital laundry is an important area for infection control and outbreak investigations of CRA.
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Affiliation(s)
| | | | | | | | | | - Rosana Ka Yin Hung
- Infection Control Team, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Sindy Sin Yee Ho
- Infection Control Team, New Territories East Cluster, Hospital Authority, Hong Kong
| | - Viola Chi Ying Chow
- Department of Microbiology, Prince of Wales Hospital, Hong Kong
- Infection Control Team, New Territories East Cluster, Hospital Authority, Hong Kong
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Blatnik P, Bojnec Š. Analysis of impact of nosocomial infections on cost of patient hospitalisation. Cent Eur J Public Health 2023; 31:90-96. [PMID: 37451240 DOI: 10.21101/cejph.a7631] [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: 10/10/2022] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The scale of the economic problem of the occurrence of nosocomial infections and the resulting high additional costs of treatment can only be assessed using economic analyses. The aim of the study was to analyse the impact of a nosocomial infection in a patient in the treatment process and the direct costs of patient hospitalisation. The article contributes to a cost analysis, which is a relevant basis for adopting effective solutions and decisions on the introduction of new programmes and measures to reduce nosocomial infections and associated costs. METHODS In the first phase of the micro-economic analysis, we analysed the course of hospitalisation of a non-colonised patient treated in an ordinary hospital room. In the second phase, we analysed the process of hospitalisation of a patient who developed a nosocomial infection and was transferred to an isolation room. The difference in cost of both types of treatment allowed us to carry out an economic analysis to estimate the direct costs of nosocomial infection, which are not related to the initial diagnosis of the patient but only to the patient hospitalisation. To calculate the individual types of direct costs of both alternative treatments, we first used the process flow diagram method, which then enabled us to analyse the impact of the occurrence of nosocomial infection on the efficiency and costs of the hospital. RESULTS The results showed that the total direct cost of hospitalisation of a non-colonised patient was 1,317.58 euro per day, and the direct cost of hospitalisation of a patient with a nosocomial infection was 2,268.14 euro per day of hospitalisation. CONCLUSIONS We found that reducing nosocomial infections would have a significant impact on the savings or reduction in healthcare costs associated with a different work process for patients in isolation. It would save 950.56 euro per patient for each day of hospitalisation for individual treatment of a patient hospitalised in an isolation room as consequence of a nosocomial infection.
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Affiliation(s)
- Patricia Blatnik
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
| | - Štefan Bojnec
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
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Contribution to the Personalized Management of the Nosocomial Infections: A New Paradigm Regarding the Influence of the Community Microbial Environment on the Incidence of the Healthcare-Associated Infections (HAI) in Emergency Hospital Surgical Departments. J Pers Med 2023; 13:jpm13020210. [PMID: 36836443 PMCID: PMC9968232 DOI: 10.3390/jpm13020210] [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: 12/08/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023] Open
Abstract
Background: The management of acute surgical pathology implies not only the diagnosis-treatment sequence but also an important preventive component. In the surgical hospital department, wound infection is one of the most frequent complications which must be managed both in a preventive and a personalized manner. To achieve this goal, several factors of negative local evolution, contributing to the slowdown of the healing processes, such as the colonization and contamination of the wounds, need to be emphasized and controlled from the first moment. In this context, knowing the bacteriological status at admission ensures the distinction between the colonization and infection processes and could help to manage in an efficient way the fight against bacterial pathogen infections from the beginning. Methods: A prospective study was performed for 21 months on 973 patients hospitalized as emergencies in the Plastic and Reconstructive Surgery Department within the Emergency University County Hospital of Brasov, Romania. We analyzed the bacteriological profile of the patients from admission to discharge and the bidirectional and cyclic microorganism dynamics both in the hospital and the community microbial environment. Results: Of the 973 samples collected at admission, 702 were positive, with 17 bacterial species and one fungal, with a predominance of Gram-positive cocci at 74,85%. The most frequently isolated strains were Staphylococcus species (86.51% of the Gram-positive/64.7% of the total isolated strains), while Klebsiella at 8.16% and Pseudomonas aeruginosa species at 5.63% were mainly emphasized in the case of Gram-negative bacilli. Two to seven pathogens were introduced after admission, suggesting that the community microbial environment is in a process of evolution and enrichment with hospital pathogens. Conclusions: The high level of positive bacteriological samples and the complex associations of the pathogens found at the admission bacteriological screening sustain the new idea that the pathogenic microorganisms existing in the community microbial environment have started to increasingly influence the hospital microbial environment, in contrast with the previous consideration, which emphasized only the unidirectional relationship between hospital infections and the changing bacteriological characteristics of the community environment. This modified paradigm must become the basis of a new personalized approach to the management of nosocomial infections.
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Yamaguchi K, Maeda M, Ohmagari N, Muraki Y. Association between Carbapenem Consumption and Clinical Outcomes in an In-Hospital Setting: Analysis of a Japanese Nationwide Administrative Database in 2020. Antibiotics (Basel) 2022; 11:antibiotics11121807. [PMID: 36551464 PMCID: PMC9774290 DOI: 10.3390/antibiotics11121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation into five facilities and calculated the median values, including facility characteristics, clinical outcomes, and carbapenem consumption. Next, a correlation analysis was performed between carbapenem consumption and clinical outcome, as well as a multiple regression analysis between carbapenem consumption as the dependent variable and clinical outcome, bed size, and proportion of patients by disease as independent variables. Additionally, three clinical outcomes available from the DPC payment system database were selected, including cure, readmission within 4 weeks, and the average length of stay. This study revealed no relationship between carbapenem consumption and clinical outcome in university hospitals and university hospital-equivalent community hospitals; however, a relationship was suggested in the community, DPC-prepared, and non-DPC hospitals. University hospitals and university hospital-equivalent community hospitals with a high consumption of carbapenems may need to reconsider the classification because of the limited number of facilities in this classification.
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Affiliation(s)
- Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
- Correspondence:
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto 607-8414, Japan
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Taušan Ð, Rančić N, Kostić Z, Ljubenović N, Rakonjac B, Šuljagić V. An assessment of burden of hospital-acquired pneumonia among abdominal surgical patients in tertiary university hospital in Serbia: A matched nested case-control study. Front Med (Lausanne) 2022; 9:1040654. [PMID: 36569168 PMCID: PMC9780448 DOI: 10.3389/fmed.2022.1040654] [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: 09/09/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background In the population of abdominal surgical patients hospital-acquired pneumonia (HAP) significantly increases morbidity and mortality. Patients and methods Through regular hospital surveillance of patients who received abdominal operations, we identified postoperative HAP from 2007 to 2019. In an initial nested case-control study, every surgical patient with HAP was compared with three control patients without HAP. Control patients were matched to the cases by age, gender, the American Society of Anesthesiologists score, and type of surgical operation. Also, the patients with HAP, who died were compared with those who survived. Results Multivariate logistic regression analysis (MLRA) revealed that other postoperative infections, length of intensive care unit stay, use of H2RA, use of PPI/ H2RA, multiple transfusion, and use of vancomycin in surgical prophylaxis were independent RFs for occurrence of HAP. Also, MLRA identified that age, lenght of hospital stay, use of mechanical ventilation and ceftriaxone in HAP therapy were indepedenttly associated with poor outcome of HAP. All Acinetobacter baumannii isolates were resistant to aminoglycoside antimicrobial agents and showed carbapenem resistance. The most frequently used antibiotics in patients with HAP and without HAP were vancomycin and metronidazole, respectively. Conclusion Our study provided an insight into the burden of HAP in abdominal surgical patients, and highlighted several priority areas and targets for quality improvement.
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Affiliation(s)
- Ðorde Taušan
- Pulmonology Clinic, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rančić
- Center for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia,Medical Faculty, University of Defence, Belgrade, Serbia
| | - Zoran Kostić
- Medical Faculty, University of Defence, Belgrade, Serbia,Clinic for General Surgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Ljubenović
- Institute of Epidemiology, Military Medical Academy, Belgrade, Serbia
| | - Bojan Rakonjac
- Institute of Medical Microbiology, Military Medical Academy, Belgrade, Serbia
| | - Vesna Šuljagić
- Medical Faculty, University of Defence, Belgrade, Serbia,Department of Healthcare-Associated Infection Prevention and Control, Military Medical Academy, Belgrade, Serbia,*Correspondence: Vesna Šuljagić
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Hu Q, Chen J, Sun S, Deng S. Mortality-Related Risk Factors and Novel Antimicrobial Regimens for Carbapenem-Resistant Enterobacteriaceae Infections: A Systematic Review. Infect Drug Resist 2022; 15:6907-6926. [PMID: 36465807 PMCID: PMC9717588 DOI: 10.2147/idr.s390635] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/09/2022] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Carbapenem-resistant Enterobacteriaceae (CRE) has become a significant public health problem in the last decade. We aimed to explore the risk factors of mortality in patients with CRE infections and to focus on the current evidence on antimicrobial regimens for CRE infections, particularly from the perspective of mortality. METHODS A systematic literature review was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library to identify studies that evaluated mortality-related risk factors and antimicrobial regimens for CRE infections published from 2012 to 2022. RESULTS In total, 33 and 28 studies were included to analyze risk factors and antibiotic treatment, respectively. The risk factors most frequently reported as significantly associated with CRE mortality were antibiotic use (92.9%; 26/28 studies), comorbidities (88.7%; 23/26 studies), and hospital-related factors (82.8%; 24/29 studies). In 10 studies that did not contain ceftazidime/avibactam (CAZ-AVI) therapy, seven demonstrated significantly lower mortality in combination therapy than in monotherapy. However, 5 of 6 studies identified no substantial difference between CAZ-AVI monotherapy and CAZ-AVI combination therapy. Six studies reported substantially lower mortality in CAZ-AVI regimens than in other regimens. CONCLUSION Several risk factors, particularly antibiotic use and patients' comorbidities, are strong risk factors for CRE mortality. The optimal regimen for CRE infections remains controversial. Combination therapy should be considered when carbapenems, colistin, tigecycline, or aminoglycosides are administered. CAZ-AVI appears to be a promising antibiotic for CRE infections. Most importantly, treatment should be individualized according to the source and severity of the disease or other highly related risk factors.
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Affiliation(s)
- Qin Hu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Hospital Institute Administration, Central South University, Changsha, People’s Republic of China
- Xiangya Health Development Research Center, Changsha, People’s Republic of China
| | - Jinglan Chen
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, People’s Republic of China
| | - Shusen Sun
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Western New England University, Springfeld, MA, USA
| | - Sheng Deng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- The Hunan Institute of Pharmacy Practice and Clinical Research, Changsha, People’s Republic of China
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Implementation of Chromatic Super CAZ/AVI ® medium for active surveillance of ceftazidime-avibactam resistance: preventing the loop from becoming a spiral. Eur J Clin Microbiol Infect Dis 2022; 41:1165-1171. [PMID: 35933457 PMCID: PMC9362390 DOI: 10.1007/s10096-022-04480-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Acquired resistance towards ceftazidime-avibactam (CAZ-AVI) is increasingly reported. Several mechanisms can be involved, but mutations in the Ω-loop region of β-lactamases are the most described. Herein, we assessed the implementation of Chromatic Super CAZ/AVI® medium in rectal swab surveillance cultures in a geographic area with endemic distribution of KPC-producing Klebsiella pneumoniae. Routine rectal swabs collected from the intensive care unit (ICU) and non-ICU patients were screened for carbapenemase-producing Enterobacterales (CPE), carbapenem-resistant Gram-negative organisms (CR-GN) and CAZ-AVI-resistant organisms by Chromatic CRE and Super CAZ/AVI® media. Among the 1839 patients screened, 146 (7.9%) were found to be colonized by one or more CPE and/or CR-GN isolates during hospitalization. Overall, among colonized patients the most common bacteria encountered were KPC-producing Enterobacterales (n = 60; 41.1%), carbapenem-resistant Pseudomonas aeruginosa (n = 41; 28.1%) and carbapenem-resistant A. baumannii (n = 34; 23.3%). Among patients colonized by KPC-producing Enterobacterales, thirty-five (58.3%) had CAZ-AVI-resistant strains. A 30.5% rate of faecal carriage of CAZ-AVI-resistant KPC-producing K. pneumoniae, substantially higher than that of susceptible isolates (2.8%), was observed in the COVID-19 ICU. Prevalence of faecal carriage of metallo-β-lactamase-producing organisms was low (0.5% and 0.2% for Enterobacterales and P. aeruginosa, respectively). Chromatic Super CAZ/AVI® medium showed 100% sensitivity in detecting CPE or CR-GN isolates resistant to CAZ-AVI regardless of both MIC values and carbapenemase content. Specificity was 86.8%. The Chromatic Super CAZ/AVI® medium might be implemented in rectal swab surveillance cultures for identification of patients carrying CAZ-AVI-resistant organisms to contain the spread of these difficult-to-treat pathogens.
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Chen Z, Hu Y, Mao X, Nie D, Zhao H, Hou Z, Li M, Meng J, Luo X, Xue X. Amphipathic dendritic poly-peptides carrier to deliver antisense oligonucleotides against multi-drug resistant bacteria in vitro and in vivo. J Nanobiotechnology 2022; 20:180. [PMID: 35366899 PMCID: PMC8977034 DOI: 10.1186/s12951-022-01384-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Outbreaks of infection due to multidrug-resistant (MDR) bacteria, especially Gram-negative bacteria, have become a global health issue in both hospitals and communities. Antisense oligonucleotides (ASOs) based therapeutics hold a great promise for treating infections caused by MDR bacteria. However, ASOs therapeutics are strangled because of its low cell penetration efficiency caused by the high molecular weight and hydrophilicity. Results Here, we designed a series of dendritic poly-peptides (DPP1 to DPP12) to encapsulate ASOs to form DSPE-mPEG2000 decorated ASOs/DPP nanoparticles (DP-AD1 to DP-AD12) and observed that amphipathic DP-AD2, 3, 7 or 8 with a positive charge ≥ 8 showed great efficiency to deliver ASOs into bacteria, but only the two histidine residues contained DP-AD7 and DP-AD8 significantly inhibited the bacterial growth and the targeted gene expression of tested bacteria in vitro. DP-AD7anti-acpP remarkably increased the survival rate of septic mice infected by ESBLs-E. coli, exhibiting strong antibacterial effects in vivo. Conclusions For the first time, we designed DPP as a potent carrier to deliver ASOs for combating MDR bacteria and demonstrated the essential features, namely, amphipathicity, 8–10 positive charges, and 2 histidine residues, that are required for efficient DPP based delivery, and provide a novel approach for the development and research of the antisense antibacterial strategy. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12951-022-01384-y.
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Zhang J, Liu W, Shi W, Cui X, Liu Y, Lu Z, Xiao W, Hua T, Yang M. A Nomogram With Six Variables Is Useful to Predict the Risk of Acquiring Carbapenem-Resistant Microorganism Infection in ICU Patients. Front Cell Infect Microbiol 2022; 12:852761. [PMID: 35402310 PMCID: PMC8990894 DOI: 10.3389/fcimb.2022.852761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carbapenem-resistant microorganism (CRO) transmission in the medical setting confers a global threat to public health. However, there is no established risk prediction model for infection due to CRO in ICU patients. This study aimed to develop a nomogram to predict the risk of acquiring CRO infection in patients with the first ICU admission and to determine the length of ICU stay (ICU-LOS) and 28-day survival. Methods Patient data were retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV) database based on predetermined inclusion and exclusion criteria. A CRO was defined as a bacterium isolated from any humoral microbial culture that showed insensitivity or resistance to carbapenems. The characteristics of CRO and non-CRO patients in the first ICU admission were compared. Propensity score matching was applied to balance the differences between the CRO and non-CRO cohorts. Kaplan–Meier curves were constructed to determine the 28-day survival rate and ICU-LOS. Furthermore, after randomization of the CRO cohort into the training and validation sets, a predictive nomogram was constructed based on LASSO regression and Logistic regression analysis, and its performance was verified by internal validation. Results Overall, 4531 patients who had first ICU admission as recorded in MIMIC-IV were enrolled, 183 (4.04%) of whom were diagnosed with CRO infection. Moreover, CRO infection was independently associated with 28-day survival and ICU-LOS in ICU patients. Parameters eligible for inclusion in this nomogram were male sex, hemoglobin-min, temperature-max, use of a peripherally inserted central catheter line, dialysis treatment, and use of carbapenems. This nomogram showed a better performance as indicated by the area under the receiver operating characteristic curve values of 0.776 (95% confidence interval [CI] 0.667-0.750) and 0.723 (95% CI 0.556-0.855) in the training and validation sets, respectively, in terms of predicting the risk of acquiring CRO infection. Conclusions CRO infection was independently associated with ICU-LOS and 28-day survival in patients with first ICU admission. The nomogram showed the best prediction of the risk of acquiring CRO infection in ICU patients. Based on the nomogram-based scoring, we can management the risk factors and guide individualized prevention and control of CRO.
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Affiliation(s)
- Jin Zhang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wanjun Liu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Shi
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xuanxuan Cui
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing and Signal Processing, Ministry of Education, Anhui University, Hefei, China
| | - Zongqing Lu
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Min Yang,
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12
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Rose LJ, Houston H, Martinez-Smith M, Lyons AK, Whitworth C, Reddy SC, Noble-Wang J. Factors influencing environmental sampling recovery of healthcare pathogens from non-porous surfaces with cellulose sponges. PLoS One 2022; 17:e0261588. [PMID: 35025906 PMCID: PMC8757884 DOI: 10.1371/journal.pone.0261588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
Results from sampling healthcare surfaces for pathogens are difficult to interpret without understanding the factors that influence pathogen detection. We investigated the recovery of four healthcare-associated pathogens from three common surface materials, and how a body fluid simulant (artificial test soil, ATS), deposition method, and contamination levels influence the percent of organisms recovered (%R). Known quantities of carbapenemase-producing KPC+ Klebsiella pneumoniae (KPC), Acinetobacter baumannii, vancomycin-resistant Enterococcus faecalis, and Clostridioides difficile spores (CD) were suspended in Butterfield's buffer or ATS, deposited on 323cm2 steel, plastic, and laminate surfaces, allowed to dry 1h, then sampled with a cellulose sponge wipe. Bacteria were eluted, cultured, CFU counted and %R determined relative to the inoculum. The %R varied by organism, from <1% (KPC) to almost 60% (CD) and was more dependent upon the organism's characteristics and presence of ATS than on surface type. KPC persistence as determined by culture also declined by >1 log10 within the 60 min drying time. For all organisms, the %R was significantly greater if suspended in ATS than if suspended in Butterfield's buffer (p<0.05), and for most organisms the %R was not significantly different when sampled from any of the three surfaces. Organisms deposited in multiple droplets were recovered at equal or higher %R than if spread evenly on the surface. This work assists in interpreting data collected while investigating a healthcare infection outbreak or while conducting infection intervention studies.
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Affiliation(s)
- Laura J. Rose
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hollis Houston
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marla Martinez-Smith
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amanda K. Lyons
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Carrie Whitworth
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sujan C. Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Judith Noble-Wang
- Division of Healthcare Quality Promotion, National Center for Emerging and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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13
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Pathogen profile of urinary tract infections in Nephrology Unit. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2021. [DOI: 10.2478/cipms-2021-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Urinary tract infection (UTI) is one of the most common types of infection in both hospitalized and outpatient settings. The etiology is mostly bacterial, and the typical causative agent is uropathogenic Escherichia coli. There is a noticeable increase in drug resistance of pathogenic microorganisms.
The aim of the study was retrospective analyses of etiological agents of UTI and their antibiotic resistance patterns in Nephrology Unit patients.
Material and methods. An infection was diagnosed based on the patient’s symptoms and positive results of urine culture, carried out over 26 months. The clinical material was tested by using the VITEK system, the drug susceptibility of the emerged pathogens was identified.
Results. The most common etiological agents of UTI were Gram-negative rods: Escherichia coli (51.23%), Klebsiella spp. (19.3%) and Proteus spp. (13.68%). The analysis of drug resistance profiles of these pathogens showed a high percentage of strains resistant to broad-spectrum penicillins and fluoroquinolones. At the same time, it seems that E. coli isolates presented the most favorable pattern of drug susceptibility in this comparison.
Conclusions. The alarming tendency of increasing drug resistance among pathogens causing UTIs to antibiotics such as penicillins or fluoroquinolones prompts a careful choice of drugs in empirical therapies. The most appropriate practice in this regard seems to be meticulous control of nosocomial infections and making therapeutic decisions based on the knowledge of local microbiological data.
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14
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Bouza E, de Alarcón A, Fariñas MC, Gálvez J, Goenaga MÁ, Gutiérrez-Díez F, Hortal J, Lasso J, Mestres CA, Miró JM, Navas E, Nieto M, Parra A, Pérez de la Sota E, Rodríguez-Abella H, Rodríguez-Créixems M, Rodríguez-Roda J, Sánchez Espín G, Sousa D, Velasco García de Sierra C, Muñoz P, Kestler M. Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections ( SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery ( SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases ( CIBERES). J Clin Med 2021; 10:5566. [PMID: 34884268 PMCID: PMC8658224 DOI: 10.3390/jcm10235566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 01/04/2023] Open
Abstract
This is a consensus document of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES). These three entities have brought together a multidisciplinary group of experts that includes anaesthesiologists, cardiac and cardiothoracic surgeons, clinical microbiologists, infectious diseases and intensive care specialists, internal medicine doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidence-based guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.
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Affiliation(s)
- Emilio Bouza
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | | | - Juan Gálvez
- Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Francisco Gutiérrez-Díez
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | - Javier Hortal
- Anesthesia and Intensive Care Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - José Lasso
- Plastic Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Carlos A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - José M. Miró
- Infectious Diseases Services, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Enrique Navas
- Infectious Diseases Department, Ramón y Cajal University Hospital, 28034 Madrid, Spain;
| | - Mercedes Nieto
- Cardiovascular Unit, Intensive Care Department, San Carlos Clinical Hospital, 28040 Madrid, Spain;
| | - Antonio Parra
- Department of Radiology, Marquez de Valdecilla University Hospital, 39008 Santander, Cantabria, Spain;
| | | | - Hugo Rodríguez-Abella
- Cardiac Surgery Department, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Marta Rodríguez-Créixems
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | | | - Gemma Sánchez Espín
- Heart Clinical Management Unit, Virgen de la Victoria University Hospital, 29006 Malaga, Spain;
| | - Dolores Sousa
- Infectious Diseases Department, A Coruña Hospital Complex, 15006 A Coruña, Spain;
| | | | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
| | - Martha Kestler
- Clinical Microbiology and Infectious Diseases Department, Gregorio Marañon University Hospital, Gregorio Marañon Health Research Institute, Complutense University of Madrid, CIBER of Respiratory Diseases—CIBERES, 28007 Madrid, Spain; (E.B.); (M.R.-C.); (P.M.)
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15
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Nijsingh N, Munthe C, Lindblom A, Åhrén C. Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable? Monash Bioeth Rev 2021; 38:72-90. [PMID: 32356217 PMCID: PMC7749868 DOI: 10.1007/s40592-020-00113-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
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Affiliation(s)
- Niels Nijsingh
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden. .,Institute for Ethics, History and Theory of Medicine, Ludwig-Maximilians University, Lessingstr. 2, 80336, Munich, Germany.
| | - Christian Munthe
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Philosophy, Linguistics and Theory of Science (FLoV), University of Gothenburg, Gothenburg, Sweden
| | - Anna Lindblom
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Åhrén
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg, Sweden.,Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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16
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N-acyl homoserine lactone molecules assisted quorum sensing: effects consequences and monitoring of bacteria talking in real life. Arch Microbiol 2021; 203:3739-3749. [PMID: 34002253 DOI: 10.1007/s00203-021-02381-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022]
Abstract
Bacteria utilize small signal molecules to monitor population densities. Bacteria arrange gene regulation in a method called Quorum Sensing (QS). The most widespread signalling molecules are N-Acyl Homoserine Lactones (AHLs/HSLs) for Gram-negative bacteria communities. QS plays significant role in the organizing of the bacterial gene that adapts to harsh environmental conditions for bacteria. It is involved in the arrangement of duties, such as biofilm formation occurrence, virulence activity of bacteria, production of antibiotics, plasmid conjugal transfer incident, pigmentation phenomenon and production of exopolysaccharide (EPS). QS obviously impacts on human health, agriculture and environment. AHL-related QS researches have been extensively studied and understood in depth for cell to cell intercommunication channel in Gram-negative bacteria. It is understood that AHL-based QS research has been extensively studied for cell-to-cell communication in Gram-negative bacteria; hence, a comprehensive study of AHLs, which are bacterial signal molecules, is required. The purpose of this review is to examine the effects of QS-mediated AHLs in many areas by looking at them from a different perspectives, such as clinic samples, food industry, aquatic life and wastewater treatment system.
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17
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Fernández P, Moreno L, Yagüe G, Andreu E, Jara R, Segovia M. Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic. Med Intensiva 2021; 45:313-315. [PMID: 34059221 PMCID: PMC8086975 DOI: 10.1016/j.medine.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/14/2021] [Indexed: 11/02/2022]
Affiliation(s)
- P Fernández
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - L Moreno
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - G Yagüe
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - E Andreu
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - R Jara
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M Segovia
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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18
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Ellington MJ, Davies F, Jauneikaite E, Hopkins KL, Turton JF, Adams G, Pavlu J, Innes AJ, Eades C, Brannigan ET, Findlay J, White L, Bolt F, Kadhani T, Chow Y, Patel B, Mookerjee S, Otter JA, Sriskandan S, Woodford N, Holmes A. A Multispecies Cluster of GES-5 Carbapenemase-Producing Enterobacterales Linked by a Geographically Disseminated Plasmid. Clin Infect Dis 2021; 71:2553-2560. [PMID: 31746994 PMCID: PMC7744980 DOI: 10.1093/cid/ciz1130] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early and accurate treatment of infections due to carbapenem-resistant organisms is facilitated by rapid diagnostics, but rare resistance mechanisms can compromise detection. One year after a Guiana Extended-Spectrum (GES)-5 carbapenemase-positive Klebsiella oxytoca infection was identified by whole-genome sequencing (WGS; later found to be part of a cluster of 3 cases), a cluster of 11 patients with GES-5-positive K. oxytoca was identified over 18 weeks in the same hospital. METHODS Bacteria were identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry, antimicrobial susceptibility testing followed European Committee on Antimicrobial Susceptibility Testing guidelines. Ertapenem-resistant isolates were referred to Public Health England for characterization using polymerase chain reaction (PCR) detection of GES, pulsed-field gel electrophoresis (PFGE), and WGS for the second cluster. RESULTS The identification of the first GES-5 K. oxytoca isolate was delayed, being identified by WGS. Implementation of a GES-gene PCR informed the occurrence of the second cluster in real time. In contrast to PFGE, WGS phylogenetic analysis refuted an epidemiological link between the 2 clusters; it also suggested a cascade of patient-to-patient transmission in the later cluster. A novel GES-5-encoding plasmid was present in K. oxytoca, Escherichia coli, and Enterobacter cloacae isolates from unlinked patients within the same hospital group and in human and wastewater isolates from 3 hospitals elsewhere in the United Kingdom. CONCLUSIONS Genomic sequencing revolutionized the epidemiological understanding of the clusters; it also underlined the risk of covert plasmid propagation in healthcare settings and revealed the national distribution of the resistance-encoding plasmid. Sequencing results also informed and led to the ongoing use of enhanced diagnostic tests for detecting carbapenemases locally and nationally.
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Affiliation(s)
- Matthew J Ellington
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infections Service, Public Health England, London, United Kingdom
| | - Frances Davies
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Elita Jauneikaite
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Katie L Hopkins
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infections Service, Public Health England, London, United Kingdom
| | - Jane F Turton
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infections Service, Public Health England, London, United Kingdom
| | - George Adams
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Jiri Pavlu
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Andrew J Innes
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Christopher Eades
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Eimear T Brannigan
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Jacqueline Findlay
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infections Service, Public Health England, London, United Kingdom
| | - Leila White
- Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals National Health Service Foundation Trust, Preston, United Kingdom
| | - Frances Bolt
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Tokozani Kadhani
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Yimmy Chow
- North West London Health Protection Team, Public Health England, London, United Kingdom
| | - Bharat Patel
- Public Health Laboratory London, National Infections Service, Public Health England, London, United Kingdom
| | - Siddharth Mookerjee
- Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Jonathan A Otter
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Shiranee Sriskandan
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Neil Woodford
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infections Service, Public Health England, London, United Kingdom
| | - Alison Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom.,Imperial College Healthcare National Health Service Trust, London, United Kingdom
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19
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Long-Term Exposure to Octenidine in a Simulated Sink Trap Environment Results in Selection of Pseudomonas aeruginosa, Citrobacter, and Enterobacter Isolates with Mutations in Efflux Pump Regulators. Appl Environ Microbiol 2021; 87:AEM.00210-21. [PMID: 33674437 DOI: 10.1128/aem.00210-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Octenidine-based disinfection products are becoming increasingly popular for infection control of multidrug-resistant (MDR) Gram-negative isolates. When a waste trap was removed from a hospital and allowed to acclimatize in a standard tap rig in our laboratory, it was shown that Klebsiella pneumoniae, Pseudomonas aeruginosa, and Citrobacter and Enterobacter spp. were readily isolated. This study aimed to understand the potential impact of prolonged exposure to low doses of a commercial product containing octenidine on these bacteria. Phenotypic and genotypic analyses showed that P. aeruginosa strains had increased tolerance to octenidine, which was characterized by mutations in the Tet repressor SmvR. Enterobacter species demonstrated increased tolerance to many other cationic biocides, although not octenidine, as well as the antibiotics ciprofloxacin, chloramphenicol, and ceftazidime, through mutations in another Tet repressor, RamR. Citrobacter species with mutations in RamR and MarR were identified following octenidine exposure, and this is linked to development of resistance to ampicillin, piperacillin, and chloramphenicol, as well as an increased MIC for ciprofloxacin. Isolates were able to retain fitness, as characterized by growth, biofilm formation, and virulence in Galleria mellonella, after prolonged contact with octenidine, although there were strain-to-strain differences. These results demonstrate that continued low-level octenidine exposure in a simulated sink trap environment selects for mutations that affect smvR It may also promote microbial adaptation to other cationic biocides and cross-resistance to antibiotics, while not incurring a fitness cost. This suggests that hospital sink traps may act as a reservoir for more biocide-tolerant organisms.IMPORTANCE Multidrug-resistant (MDR) strains of bacteria are a major clinical problem, and several reports have linked outbreaks of MDR bacteria with bacterial populations in hospital sinks. Biocides such as octenidine are used clinically in body washes and other products, such as wound dressings for infection control. Therefore, increased tolerance to these biocides would be detrimental to infection control processes. Here, we exposed bacterial populations originally from hospital sink traps to repeated dosing with an octenidine-containing product over several weeks and observed how particular species adapted. We found mutations in genes related to biocide and antibiotic susceptibility, which resulted in increased tolerance, although this was species dependent. Bacteria that became more tolerant to octenidine also showed no loss of fitness. This shows that prolonged octenidine exposure has the potential to promote microbial adaptation in the environment and that hospital sink traps may act as a reservoir for increased biocide- and antibiotic-tolerant organisms.
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20
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A Novel Validated Injectable Colistimethate Sodium Analysis Combining Advanced Chemometrics and Design of Experiments. Molecules 2021; 26:molecules26061546. [PMID: 33799846 PMCID: PMC8000333 DOI: 10.3390/molecules26061546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Colistimethate sodium (CMS) is widely administrated for the treatment of life-threatening infections caused by multidrug-resistant Gram-negative bacteria. Until now, the quality control of CMS formulations has been based on microbiological assays. Herein, an ultra-high-performance liquid chromatography coupled to ultraviolet detector methodology was developed for the quantitation of CMS in injectable formulations. The design of experiments was performed for the optimization of the chromatographic parameters. The chromatographic separation was achieved using a Waters Acquity BEH C8 column employing gradient elution with a mobile phase consisting of (A) 0.001 M aq. ammonium formate and (B) methanol/acetonitrile 79/21 (v/v). CMS compounds were detected at 214 nm. In all, 23 univariate linear-regression models were constructed to measure CMS compounds separately, and one partial least-square regression (PLSr) model constructed to assess the total CMS amount in formulations. The method was validated over the range 100–220 μg mL−1. The developed methodology was employed to analyze several batches of CMS injectable formulations that were also compared against a reference batch employing a Principal Component Analysis, similarity and distance measures, heatmaps and the structural similarity index. The methodology was based on freely available software in order to be readily available for the pharmaceutical industry.
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21
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Fernández P, Moreno L, Yagüe G, Andreu E, Jara R, Segovia M. [Colonization by multidrug-resistant microorganisms in ICU patients during the COVID-19 pandemic]. Med Intensiva 2021; 45:313-315. [PMID: 34054174 PMCID: PMC7945882 DOI: 10.1016/j.medin.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Affiliation(s)
- P Fernández
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - L Moreno
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - G Yagüe
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.,Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, España.,Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
| | - E Andreu
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - R Jara
- Unidad de Medicina Intensiva, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M Segovia
- Servicio de Microbiología y Parasitología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.,Departamento de Genética y Microbiología, Universidad de Murcia, Murcia, España.,Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España
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22
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Lu Q, Zhu HH, Li GH, Qi TT, Ye LJ, Teng XQ, Qu Q, He GF, Qu J. A Comparative Study of the Microbiological Efficacy of Polymyxin B on Different Carbapenem-Resistant Gram-Negative Bacteria Infections. Front Med (Lausanne) 2021; 8:620885. [PMID: 33634151 PMCID: PMC7902010 DOI: 10.3389/fmed.2021.620885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: The emergence of carbapenem-resistant gram-negative bacteria (CR-GNB) has brought great challenges to clinical anti-infection treatment around the world. Polymyxins are often considered as the last line of defense in the treatment of CR-GNB infections. In this study, we explored the microbiological efficacy of Polymyxin B (PMB) on different CR-GNB infections as well as the factors influencing microbiological efficacy. Methods: CR-GNB infected patients with PMB-based regimens were enrolled. Clinical and microbiological data were collected from the medical electronic record system of the Second Xiangya hospital. The efficacy of PMB on different CR-GNB was evaluated by the clearance rate at 7-days and within the course of treatment, as well as the 30-day mortality rate. Results: A total of 294 CR-GNB infected patients were enrolled: 154 CR-Acinetobacter baumannii (CRAB), 55 CR-Klebsiella pneumoniae (CRKP), and 85 CR-Pseudomonas aeruginosa (CRPA). The CRAB group had the highest 7-day bacterial clearance rate [(CRAB: 39.0%) vs. (CRKP: 29.4%) vs. (CRPA: 14.5%), P = 0.003] and total bacterial clearance rate [(CRAB: 49.0%) vs. (CRKP: 39.8%) vs. (CRPA: 18.2%), P < 0.001] among the three groups, while the bacterial clearance rate of the CRPA group was the lowest. Multivariate logistic regression showed that the differences among the three groups were multiple CR-GNB infections (P = 0.004), respiratory infections (P = 0.001), PMB resistance (P < 0.001), and the combination of tigecycline (P < 0.001). Binary logistic regression showed that multiple CR-GNB infection [(7-day bacterial clearance: P = 0.004) & (total bacterial clearance: P = 0.011)] and bacterial species [(7-day bacterial clearance: P < 0.001) & (total bacterial clearance: P < 0.001)] were independent risk factors for microbiological efficacy. Conclusion: PMB exhibited differential microbiological efficacy on different types of CR-GNB infections; it had the best effect on CRAB, followed by CRKP and CRPA. Multiple CR-GNB infections and bacterial species were independent risk factors for microbiological efficacy.
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Affiliation(s)
- Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hai-Hong Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Guo-Hua Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting-Ting Qi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Liang-Jun Ye
- Department of Pharmacy, Hunan Provincial Corps Hospital of Chinese People's Armed Police Force, Changsha, China
| | - Xin-Qi Teng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Ge-Fei He
- Department of Pharmacy, The First Hospital of Changsha, Changsha, China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
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Bedard J, Caschera A, Foucher DA. Access to thermally robust and abrasion resistant antimicrobial plastics: synthesis of UV-curable phosphonium small molecule coatings and extrudable additives. RSC Adv 2021; 11:5548-5555. [PMID: 35423119 PMCID: PMC8694774 DOI: 10.1039/d1ra00555c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
The threat of antibiotic-resistant, biofilm-forming bacteria necessitates a preventative approach to combat the proliferation of robust, pathogenic strains on "high touch surfaces" in the food packaging, biomedical, and healthcare industries. The development of both biocide-releasing and tethered, immobilized biocide surface coatings has risen to meet this demand. While these surface coatings have demonstrated excellent antimicrobial efficacy, there are few examples of antimicrobial surfaces with long-term durability and performance. To this end, UV-curable phosphoniums bearing benzophenone anchors with either an alkyl, aryl, or fluoroalkyl group were synthesized and their efficacy as thermally stable antimicrobial additives in extruded plastics or as surface attached coatings probed. The surface topology and characteristics of these materials were studied to gain insight into the mechanism of their antimicrobial activity. Efficacy against both Gram negative and Gram positive bacteria as either a coating or additive showed compete reductions of the initial bacterial load. Crucially, the materials maintained the ability to kill biofilm-forming bacteria even after being subject to several cycles of abrasion.
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Affiliation(s)
- Joseph Bedard
- Department of Chemistry and Biology, Ryerson University 350 Victoria Street Toronto Ontario M5B-2K3 Canada
| | - Alexander Caschera
- Department of Chemistry and Biology, Ryerson University 350 Victoria Street Toronto Ontario M5B-2K3 Canada
| | - Daniel A Foucher
- Department of Chemistry and Biology, Ryerson University 350 Victoria Street Toronto Ontario M5B-2K3 Canada
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24
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Nohl A, Hamsen U, Jensen KO, Sprengel K, Ziegenhain F, Lefering R, Dudda M, Schildhauer TA, Wegner A. Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study. Eur J Trauma Emerg Surg 2020; 48:659-665. [PMID: 33221987 DOI: 10.1007/s00068-020-01545-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. METHODS Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). RESULTS Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04-2.89]), ISS (OR 1.01 [95% CI 1.00-1.03]), PRBC's given (OR 1.73 [95% CI 1.09-2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06-7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01-3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p < 0.001). CONCLUSIONS MDRO in severely injured patients are rare but associated with a worse outcome at hospital discharge. We identified potential risk factors for MDRO in severely injured patients. Based on our results, we recommend a standardized screening procedure for major trauma patients.
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Affiliation(s)
- André Nohl
- Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany.
- University of Duisburg-Essen, Essen, Germany.
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Zurich, Switzerland
| | | | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany
| | - Marcel Dudda
- Department of Trauma Surgery, BG Hospital Duisburg, BG Klinikum Duisburg, Grossenbaumer Allee 250, 47249, Duisburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, University Duisburg-Essen, Essen, Germany
| | | | - Alexander Wegner
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Chair of Orthopaedics and Trauma Surgery, St. Marien-Hospital Mülheim a. d. Ruhr, University Duisburg-Essen, Mülheim a.d. Ruhr, Germany
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Chew KL, Octavia S, Ng OT, Marimuthu K, Venkatachalam I, Cheng B, Lin RTP, Teo JWP. Challenge of drug resistance in Pseudomonas aeruginosa: clonal spread of NDM-1-positive ST-308 within a tertiary hospital. J Antimicrob Chemother 2020; 74:2220-2224. [PMID: 31081022 DOI: 10.1093/jac/dkz169] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES MDR Pseudomonas aeruginosa is a serious global threat to healthcare institutions. The mechanism by which drug resistance can be acquired is variable, but acquired carbapenemase production has been reported in P. aeruginosa. An investigation was performed to determine the rate and genomic epidemiology of New Delhi MBL (NDM) in β-lactam-non-susceptible isolates. METHODS P. aeruginosa isolates from a tertiary hospital in Singapore between January 2015 and February 2018 were investigated for the presence of NDM genes. RESULTS Out of 298 pan-β-lactam-non-susceptible isolates, 31 were found to be NDM positive (10.4%). WGS demonstrated that all 31 NDM-positive isolates were clonal, belonging to ST-308. blaNDM was chromosomally inserted within an integrative and conjugative element (ICE), ICETn43716385. The NDM-P. aeruginosa isolates possessed an extensive repertoire of both cell-associated [flagella, pili, alginate/biofilm, LPS, type III secretion system (T3SS) and type VI secretion system (T6SS)] and secreted virulence factors. Antibiograms revealed higher rates of drug resistance in NDM-positive isolates compared with their non-NDM counterparts. The NDM isolates remained 100% susceptible only to colistin. CONCLUSIONS The combination of chromosomal mutations, acquired resistance genes and virulence factors likely facilitated the persistent and ongoing spread of the ST-308 clade of P. aeruginosa within the hospital. Our study illustrates the particular threat of NDM-positive P. aeruginosa in a tertiary hospital setting in the era of antimicrobial resistance.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sophie Octavia
- National Public Health Laboratory, Ministry of Health, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kalisvar Marimuthu
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National Centre for Infectious Diseases, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Bernadette Cheng
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Raymond T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, Ministry of Health, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
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Liu L, Liu B, Li W. Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection Acinetobacter baumannii Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital. Infect Drug Resist 2020; 13:2557-2570. [PMID: 32801793 PMCID: PMC7396956 DOI: 10.2147/idr.s260525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/05/2020] [Indexed: 01/22/2023] Open
Abstract
Objective We estimated the efficacy of antimicrobial stewardship (AMS), infection control programs (ICP), and environmental cleaning (ENC) for controlling the resistance of Acinetobacter baumannii (AB) and controlling the incidence of multidrug-resistant AB (MDRAB), extensively drug-resistant AB (XDRAB), and nosocomial infection AB in the ICU (NIAB-ICU) at a university hospital. Methods The intervention included 4-year AMS+ICP and 3-year AMS+ICP+ENC between January 2012 and December 2019. Results A total of 2636 AB isolates were collected totally, and 64.98% of AB isolates were MDR and 29.97% were XDR. Preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP measures ranged from 84.96% to 71.98%, 41.96% to 33.13%, and 45.6% to 38%, respectively. However, all of them were not statistically changed (P=0.085, 0.072, 0.061, separately). The preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP+ENC measures ranged from 71.98% to 36.55%, 33.13% to 19.88%, and 38% to 22.5%, respectively. Statistically significant declines were observed (P=0.016, 0.041, 0.032, separately). The defined daily doses (DDD) per 1000 patient-days (PD) decreased from 45±3.3 to 30.81±1.5 per 1000 PD across from 2012 to 2019, and a statistical decline was seen (P=0.01). Concurrently, the alcohol-based hand gel (ABHG) consumption per 1000 PD increased from 0.6±0.05 L to 12.5±2.3 L per 1000 PD, and a statistical increase was observed (P=0.0001). A statistically positive correlation was revealed between the DDD and incidence of MDRAB, XDRAB, and NIAB-ICU (r=0.905 and p=0.002; r=0.939 and p=0.001; r=0.956 and p=0.0002; respectively). Simultaneously, a statistically negative correlation was showed between the ABHG and incidence of MDRAB, XDRAB, and NIAB-ICU (r=-0.858 and p=0.006; r=-0.888 and p=0.003; r=-0.882 and p=0.004, separately). Conclusion The AMS, ICP, and ENC may be one of the most effective and best measures to address the increasing incidence of MDRAB, XDRAB, and NIAB-ICU currently.
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Affiliation(s)
- Lei Liu
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China.,Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Bin Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Wei Li
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
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27
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Dagla I, Tsarbopoulos A, Gikas E. Design of experiments guided multivariate calibration for the quantitation of injectable colistimethate sodium by ultra performance liquid chromatography - High resolution mass spectrometry. Talanta 2020; 220:121406. [PMID: 32928422 DOI: 10.1016/j.talanta.2020.121406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
Colistimethate sodium (CMS) is a widely administrated old-generation prodrug for the treatment of the life-threatening infections caused by multi-resistant Gram-negative bacteria. Until now, the quality control procedure of the CMS commercial products is based on microbiological assays. The aim of the study is the development of a chemical analysis methodology based on liquid chromatography - mass spectrometry (LC-MS) that could be used for the quality control of CMS products. The careful optimization of the LC and QToF-MS parameters was deemed crucial, as CMS is known to be a very complex mixture. Thus, a two stage Design of Experiments (DoE) pipeline has been followed, aiming towards the separation of the mixture components. According to the DoE results, a baseline-resolved chromatogram revealing more than 20 compounds was achieved. The separation was performed using a Waters Acquity BEH C8 column employing gradient elution. The mobile phase consisted of aq. ammonium formate 0.005 M (pH 6) (solvent A) and methanol/acetonitrile 79/21 (v/v) (solvent B). A second optimization experiment for the MS signal was employed in order to achieve maximum sensitivity. The singly charged signals were monitored for the validation in the positive ion mode. The calibration curve range was 50-110 μg mL-1, corresponding to the 80-120% of the nominal CMS amount in the commercial products. Due to the complexity of the CMS chromatograms and the corresponding spectrum of each chromatographic peak, untargeted and targeted approaches were performed employing the MZmine software. Furthermore, apart from the classical univariate statistical analysis, partial least squares regression (PLS-R) model was also employed, as the variables were more than the observations. The developed methodology has been employed to analyze several batches and inconsistences have been discovered.
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Affiliation(s)
- Ioanna Dagla
- Laboratory of Pharmaceutical Analysis, Division of Pharmaceutical Chemistry, Faculty of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, Panepistiomiopolis, Zografou, 157 71, Athens, Greece
| | - Anthony Tsarbopoulos
- Laboratory of Pharmacology, Department of Descriptive-Functional Studies, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evagelos Gikas
- Laboratory of Analytical Chemistry, School of Chemistry, National and Kapodistrian University of Athens, Panepistiomiopolis, Zografou, 157 71, Athens, Greece.
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Yavor A, Ben-Zvi H, Freeman S, Geffen Y, Adler A. Institutional Burden of Carbapenemase-Producing Enterobacterales: The Effect of Changes in Surveillance Culture Methodology. Microb Drug Resist 2020; 26:1350-1356. [PMID: 32380896 DOI: 10.1089/mdr.2019.0478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An essential part of the Israeli intervention program aimed to contain the spread of carbapenemase-producing Enterobacterales (CPE) has been the establishment of national surveillance system, where the institutional rates are determined by both clinical and surveillance cultures. The objectives of the study were to analyze the effect of changes in surveillance culture media on the rates and microbiological characteristics of CPE in a multicenter study. The rates were compared during 2 years in and between four centers. Two centers (Tel-Aviv and Beilinson) had changed their surveillance media to CHROMagar™ mSuperCARBA™ after 1 year, and two centers (Rambam and Hillel-Yaffe) had continued to use CHROMagar KPC. There was an increase in the rates of surveillance CPE in Tel-Aviv and Beilinson following the change in media, whereas the rates remained the same or declined in Rambam and Hillel-Yaffe, respectively. The rates of clinical CPE remained unchanged in Rambam and Hillel-Yaffe, declined in Tel-Aviv, and increased in Beilinson but to a lesser extent compared with the increase in surveillance CPE. The relative composition of the CPE mechanisms and species changed in Tel-Aviv, with an increase in non-Klebsiella pneumoniae species and in carbapenemase other than KPC. Our study shows that changes in surveillance media may contribute to significant changes in the rate of surveillance CPE that may be irrespective of actual epidemiological changes. Therefore, determination of institutional burden of CPE and the assessment of intervention results should be based primarily on the rate of clinical CPE rather than surveillance culture reports.
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Affiliation(s)
- Amit Yavor
- Department of Epidemiology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Haim Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Sarit Freeman
- Microbiology Laboratory, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Yuval Geffen
- Microbiology Laboratory, Rambam Medical Center, Haifa, Israel
| | - Amos Adler
- Department of Epidemiology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Labi AK, Bjerrum S, Enweronu-Laryea CC, Ayibor PK, Nielsen KL, Marvig RL, Newman MJ, Andersen LP, Kurtzhals JAL. High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana. Open Forum Infect Dis 2020; 7:ofaa109. [PMID: 32373647 PMCID: PMC7192099 DOI: 10.1093/ofid/ofaa109] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/25/2020] [Indexed: 12/23/2022] Open
Abstract
Background Carriage of multidrug resistant (MDR) Gram-negative bacteria (GN) in hospitalized neonates may increase the risk of difficult-to-treat invasive infections at neonatal intensive care units (NICUs). Data on MDRGN carriage among hospitalized newborns in Africa are limited. Methods We conducted a cross-sectional study at the NICUs of 2 tertiary hospitals in Ghana. Swabs from the axilla, groin, perianal region, and the environment were cultured, GN were identified, and antibiotic susceptibility was tested. We obtained blood culture isolates from neonates with sepsis. Whole-genome sequencing was used to characterize carbapenemase-producing Klebsiella pneumoniae. Typing was done by multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis. Results A total of 276 GN were isolated from 228 screened neonates. Pathogenic GN were cultured in 76.8% (175 of 228) of neonates. Klebsiella spp (41.7%; 115 of 276) and Escherichia coli (26.4%; 73 of 276) were the commonest organisms. Carriage rates of MDRGN and third-generation cephalosporin resistant organisms were 49.6% (113 of 228) and 46.1% (105 of 228), respectively. Among Klebsiella spp, 75.6% (87 of 115) phenotypically expressed extended-spectrum β-lactamase activity, whereas 15.6% expressed carbapenemase and harbored bla-OXA-181 and bla-CTX-M-15. Overall, 7.0% (16 of 228) of neonates developed GN bloodstream infection. In 2 of 11 neonates, sequencing showed the same identity between carriage and the bloodstream isolate. Length of stay before specimen collection and antibiotic use were independently associated with carriage rates, which increased from 13% at admission to 42% by day 2 and reached a plateau at 91% by day 15. Conclusions High carriage rates of MDRGN, including carbapenemase-producing enterobacterales may be an emerging problem in NICUs in Africa.
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Affiliation(s)
- Appiah-Korang Labi
- Department of Microbiology, Korle-Bu Teaching Hospital, Accra, Ghana.,Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Stephanie Bjerrum
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Karen L Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rasmus L Marvig
- Centre for Genomic Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mercy J Newman
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Leif P Andersen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jorgen A L Kurtzhals
- Centre for Medical Parasitology at Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Maeda M, Muraki Y, Anno Y, Sawa A, Kusama Y, Ishikane M, Ohmagari N, Ohge H. Development of the predicted and standardized carbapenem usage metric: Analysis of the Japanese Diagnosis Procedure Combination payment system data. J Infect Chemother 2020; 26:633-635. [PMID: 32146108 DOI: 10.1016/j.jiac.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/01/2020] [Accepted: 02/11/2020] [Indexed: 11/18/2022]
Abstract
This study aimed to develop a metric for standardized and predicted carbapenem consumption using the Diagnosis Procedure Combination payment system database and patients' characteristics. Based on Diagnosis Procedure Combination data analysis, the developed metric will provide useful benchmarks that stewardship programs can use to help drive improvements.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Yuka Anno
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Akihiro Sawa
- Laboratory of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Yoshiki Kusama
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Antimicrobial Resistance Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
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31
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Maynard E. An overview of a seminar on patient infections and drinking water management within healthcare buildings in the UK. Perspect Public Health 2020; 140:79. [DOI: 10.1177/1757913919899581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shirani K, Seydayi E, Boroujeni KS. Prevalence and antibiotic resistance pattern of extended-spectrum beta-lactamase-producing Escherichia coli in clinical specimens. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:103. [PMID: 31949454 PMCID: PMC6950332 DOI: 10.4103/jrms.jrms_634_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/26/2018] [Accepted: 09/24/2019] [Indexed: 11/04/2022]
Abstract
Background Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae seem to have an extended antibiotic resistance, but have different resistance patterns throughout different sites and regions. This study aimed to evaluate the antibiotic resistance pattern of ESBL-producing Escherichia coli. Materials and Methods One hundred swab samples from patients hospitalized due to a clinical suspicion of any kind of infection (with manifestations such as fever, leukocytosis, and an active urinalysis result) were processed in Alzahra Microbiology Laboratory, Isfahan, Iran. Isolated E. coli were cultured on Mueller-Hinton agar and antibiotic susceptibility was tested by Kirby-Bauer disk diffusion method following the Clinical and Laboratory Standard Institute 2017 guidelines. Results ESBL-producing samples had higher antibiotic resistance rates than ESBL-non-producing samples: ceftriaxone (58.8% vs. 27.3%), cefotaxime (73.5% vs. 30.3%), ceftizoxime (76.5% vs. 33.3%), cefixime (79.4% vs. 40.9%), and cefpodoxime (73.5% vs. 53%), except for carbenicillin (29.4% vs. 48.5%). Imipenem and meropenem were the least resisted antibiotics in ESBL-producing samples (5.9% and 11.8%). Conclusion ESBL-producing Enterobacteriaceae have a high resistance rate to third-generation cephalosporins and high susceptibility to imipenem and meropenem.
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Affiliation(s)
- Kiana Shirani
- Isfahan Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Seydayi
- Isfahan Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Prospective evaluation of the Amplidiag® CarbaR+VRE assay for direct screening of carbapenemase producing gram-negative bacilli from rectal swabs. Diagn Microbiol Infect Dis 2019; 95:114890. [DOI: 10.1016/j.diagmicrobio.2019.114890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/25/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022]
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Köhler AT, Rodloff AC, Labahn M, Reinhardt M, Truyen U, Speck S. Evaluation of disinfectant efficacy against multidrug-resistant bacteria: A comprehensive analysis of different methods. Am J Infect Control 2019; 47:1181-1187. [PMID: 31060869 DOI: 10.1016/j.ajic.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multidrug-resistant gram-negative bacteria (MDR-GNB) constitute a threat to health care worldwide. Disinfectants are used to prevent and control the spread of MDR-GNB in a hospital setting but their efficacy might be impaired by bacterial mechanisms that may act on both antimicrobials and disinfectants. Determination of minimum inhibitory concentrations is mainly used to determine bacterial susceptibility against disinfectants, but practical tests on surfaces might be more suitable to predict in-use conditions. Our objective was to compare and evaluate 4 different methods widely used to assess surface disinfectant efficacy. METHODS The efficacy of benzalkonium chloride (BAC), peracetic acid (PAA), and ethanol (ETH) against multidrug-resistant Acinetobacter, Pseudomonas, and Klebsiella strains was assessed by minimum inhibitory concentration determinations, quantitative suspension tests, qualitative suspension tests, and carrier tests. Test results were compared to ascertain the most appropriate method. RESULTS ETH, PAA, and BAC were highly effective against MDR-GNB, but we observed marked differences in efficacious concentrations (up to 100-fold) as a function of the test method applied. Minimum inhibitory concentration determination was not reliable for evaluating susceptibility or resistance to BAC. CONCLUSIONS Surface tests should be used to determine bacterial susceptibility against disinfectants. Moreover, suitable guidelines are needed that allow for the standardization and comparison of bactericidal values obtained by different investigators.
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Warde E, Davies E, Ward A. Control of a multidrug-resistant Acinetobacter baumannii outbreak. ACTA ACUST UNITED AC 2019; 28:242-248. [PMID: 30811227 DOI: 10.12968/bjon.2019.28.4.242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes the management of an outbreak of multidrug-resistant Acinetobacter baumannii (MDR-Ab) at an acute NHS Foundation Trust. The outbreak affected two respiratory wards and the initial outbreak lasted 9 months, with the first patient (index case) being identified in April 2015 and the final, tenth case, in September 2015. The outbreak was declared closed in January 2016, but a further two cases were identified in July and August 2016. Of the 12 identified patients, eight were colonised with the bacterium and four were infected. The four infections were of the respiratory tract with MDR-Ab, of identical variable number tandem repeat, isolated from sputum in all cases. All 12 patients were decolonised and this continued throughout the outbreak. Some negative rescreening results were achieved. At the time of the outbreak, decolonisation using octenidine had not been reported in any guidelines. The sensitivity of MDR-Ab to octenidine was microbiologically tested and antibacterial action of octenidine against this organism was demonstrated. The use of octenidine appeared to be one element in helping to control this testing situation. This report seeks to demonstrate not only the complexity of managing and containing an outbreak of MDR-Ab but also how, with the use of a range of effective infection prevention measures, the spread of this pathogen can be successfully controlled. It is hoped that this article will increase awareness among healthcare providers and infection prevention and control (IPC) teams of the threat posed by this organism in the healthcare environment.
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Affiliation(s)
- Elizabeth Warde
- Infection Prevention and Control Nurse, North Tees and Hartlepool NHS Foundation Trust
| | - Emma Davies
- Infection Prevention and Control Nurse, North Tees and Hartlepool NHS Foundation Trust
| | - Andrew Ward
- Senior Biomedical Scientist-Microbiology, North Tees and Hartlepool NHS Foundation Trust
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Evaluation of an Ultraviolet C (UVC) Light-Emitting Device for Disinfection of High Touch Surfaces in Hospital Critical Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193572. [PMID: 31554297 PMCID: PMC6801766 DOI: 10.3390/ijerph16193572] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/17/2022]
Abstract
Implementation of environmental cleaning and disinfection has been shown to reduce the incidences of healthcare-associated infections. The effect of an enhanced strategy for terminal room disinfection, applying the pulsed xenon-based ultraviolet light no-touch disinfection systems (PX-UVC) after the current standard operating protocol (SOP) was evaluated. In a teaching hospital, the effectiveness in reducing the total bacterial count (TBC) and in eliminating high-concern microorganisms was assessed on five high-touch surfaces in different critical areas, immediately pre- and post-cleaning and disinfection procedures (345 sampling sites). PX-UVC showed only 18% (15/85) of positive samples after treatment compared to 63% (72/115) after SOP. The effectiveness of PX-UVC was also observed in the absence of manual cleaning and application of a chemical disinfectant. According to the hygienic standards proposed by the Italian Workers Compensation Authority, 9 of 80 (11%) surfaces in operating rooms showed TBC ≥15 CFU/24 cm2 after the SOP, while all samples were compliant applying the SOP plus PX-UVC disinfection. Clostridium difficile (CD) spores and Klebsiella pneumoniae (KPC) were isolated only after the SOP. The implementation of the standard cleaning and disinfection procedure with the integration of the PX-UVC treatment had effective results in both the reduction of hygiene failures and in control environmental contamination by high-concern microorganisms.
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Thatrimontrichai A, Apisarnthanarak A. Active surveillance culture program in asymptomatic patients as a strategy to control multidrug-resistant gram-negative organisms: What should be considered? J Formos Med Assoc 2019; 119:1581-1585. [PMID: 31471223 DOI: 10.1016/j.jfma.2019.08.015] [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] [Received: 07/20/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
The increasing burden of multidrug-resistant gram-negative bacilli (MDR-GNB) infection has highlighted the urgent requirement for efficient prevention and control strategies. A routine active surveillance culture (ASC) program of asymptomatic carriers as part of an infection prevention strategy for MDR-GNB still has some controversy. An ASC program for colonized patients may be beneficial depending on the targeted population, level of endemicity, the species of pathogen, and the combination of multifaceted strategies. Multimodal infection control and prevention strategies are crucial for implementation in resources-limited settings. After discovering the culprit, it is a challenge to control MDR-GNB by containment or eradication and prevent cross-transmission. An ASC program should consider both the local epidemiology and cost-effectiveness based on the available resources in endemic MDR-GNB areas in the Asia-Pacific region.
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Affiliation(s)
- Anucha Thatrimontrichai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Department of Medicine, Thammasat University Hospital, Pratumthani, Thailand.
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Soman R, Veeraraghavan B, Hegde A, Jiandani P, Mehta Y, Nagavekar V, Rodrigues C, Singh RK, Swaminathan S, Todi S, Varma S, Patil S, Barkate H. Indian consensus on the management of CRE infection in critically ill patients (ICONIC) - India. Expert Rev Anti Infect Ther 2019; 17:647-660. [PMID: 31375039 DOI: 10.1080/14787210.2019.1647103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: The increasing burden of carbapenem-resistant Enterobacteriaceae (CRE) carriage and infection in different patient settings in India has created an acute need for guidance for clinicians regarding optimal strategies for the management of CRE infection in critically ill patients. Research design and methods: A multidisciplinary panel of 11 Indian experts in CRE infection assembled for comprehensive discussion and consensus development. The experts developed clinical statements through a systematic review of key literature. Main outcome measures: The panel voted anonymously on 60 clinically relevant questions, through a modified Delphi process. Results: Forty-six key clinical consensus statements (CCS) were proposed. The panel reached a consensus on several important issues, providing recommendations on surveillance, diagnosis, prevention, pharmacokinetic challenges, combination therapy, and cornerstone molecules in CRE infections. The panel also proposed a treatment algorithm for NDM-prevalent settings. Conclusion: These consensus statements may offer clinicians expert guidance on the management of CRE infections. There is a dearth of high-/moderate-level evidence on managing CRE infections; the recommendations presented herein are based on expert opinion.
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Affiliation(s)
- Rajeev Soman
- a Infectious Diseases, Jupiter Hospital , Pune , India
| | - Balaji Veeraraghavan
- b Department of Clinical Microbiology, Christian Medical College , Vellore , India
| | - Ashit Hegde
- c Critical Care, Hinduja Hospital , Mumbai , India
| | | | - Yatin Mehta
- e Institute of Critical Care and Anesthesiology, Medanta, The Medicity , Gurugram , India
| | | | | | - R K Singh
- h Department of Emergency Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | | | - Subhash Todi
- j Critical Care, Critical Care AMRI Hospitals , Kolkata , India
| | - Subhash Varma
- k Internal Medicine/Hematology, Fortis Hospital , Mohali , India
| | - Saiprasad Patil
- l Medical Services, IF, Glenmark Pharmaceuticals Ltd ., Mumbai , India
| | - Hanmant Barkate
- m Medical Services, IF & MEA, Glenmark Pharmaceuticals Ltd ., Mumbai , India
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Using data linkage methodologies to augment healthcare-associated infection surveillance data. Infect Control Hosp Epidemiol 2019; 40:1144-1150. [DOI: 10.1017/ice.2019.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractBackground and objectives:The landscape of antimicrobial resistance (AMR) surveillance is changing rapidly. The primary objective of this study was to assess the benefit of linking population-based infection prevention and control surveillance data on methicillin-resistant Staphylococcus aureus (MRSA) to hospital discharge abstract data (DAD). We assessed the value of this novel data linkage for the characterization of hospital-acquired (HA) and community-acquired MRSA (CA-MRSA) cases.Methods:Incident inpatient MRSA surveillance data for all adults (≥18 years) from 4 acute-care facilities in Calgary, Alberta, between April 1, 2011, and March 31, 2017, were linked to DAD. Personal health number (PHN) and gender were used to identify specific individuals, and specimen collection time-points were used to identify specific hospitalization records. A third common variable on admission date between these databases was used to validate the linkage process. Descriptive statistics were used to characterize HA-MRSA and CA-MRSA cases identified through the linkage process.Results:A total of 2,430 surveillance records (94.6%) were successfully linked to the correct hospitalization period. By linking surveillance and administrative data, we were able to identify key differences between patients with HA- and CA-MRSA. These differences are consistent with previously reported findings in the literature. Data linkage to DAD may be a novel tool to enhance and augment the details of base surveillance data.Conclusion and recommendations:This is the first Canadian study linking a frontline healthcare-associated infection AMR surveillance database to an administrative population database. This work represents an important methodological step toward complementing traditional AMR surveillance data practices. Data linkage to other data types, such as primary care, emergency, social, and biological data, may be the basis of achieving more precise data focused around AMR.
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The evidence for infection prevention and control: problems of design and implementation. INT J EVID-BASED HEA 2019; 17 Suppl 1:S24-S25. [PMID: 31283574 DOI: 10.1097/xeb.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The article discusses the methodological and socioadaptive issues that impact on the development and implementation of evidence-based guidelines for the prevention and control of healthcare-associated infections.
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Implementation research for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva infection prevention and control (IPC)-think tank (part 1). Antimicrob Resist Infect Control 2019; 8:87. [PMID: 31161034 PMCID: PMC6540528 DOI: 10.1186/s13756-019-0527-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/23/2019] [Indexed: 01/30/2023] Open
Abstract
Background Around 5–15% of all hospital patients worldwide suffer from healthcare-associated infections (HAIs), and years of excessive antimicrobial use in human and animal medicine have created emerging antimicrobial resistance (AMR). A considerable amount of evidence-based measures have been published to address these challenges, but the largest challenge seems to be their implementation. Methods In June 2017, a total of 42 experts convened at the Geneva IPC-Think Tank to discuss four domains in implementation science: 1) teaching implementation skills; 2) fostering implementation of IPC and antimicrobial stewardship (AMS) by policy making; 3) national/international actions to foster implementation skills; and 4) translational research bridging social sciences and clinical research in infection prevention and control (IPC) and AMR. Results Although neglected in the past, implementation skills have become a priority in IPC and AMS. They should now be part of any curriculum in health care, and IPC career paths should be created. Guidelines and policies should be aligned with each other and evidence-based, each document providing a section on implementing elements of IPC and AMS in patient care. International organisations should be advocates for IPC and AMS, framing them as patient safety issues and emphasizing the importance of implementation skills. Healthcare authorities at the national level should adopt a similar approach and provide legal frameworks, guidelines, and resources to allow better implementation of patient safety measures in IPC and AMS. Rather than repeating effectiveness studies in every setting, we should invest in methods to improve the implementation of evidence-based measures in different healthcare contexts. For this, we need to encourage and financially support collaborations between social sciences and clinical IPC research. Conclusions Experts of the 2017 Geneva Think Tank on IPC and AMS, CDC, and WHO agreed that sustained efforts on implementation of IPC and AMS strategies are required at international, country, and hospital management levels, to provide an adequate multimodal framework that addresses (not exclusively) leadership, resources, education and training for implementing IPC and AMS. Future strategies can build on this agreement to make strategies on IPC and AMS more effective.
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Lin L, Jia L, Fu Y, Zhao R, Huang Y, Tang C, Meng C, Zhao D, Liang J. A comparative analysis of infection in patients with malignant cancer: A clinical pharmacist consultation study. J Infect Public Health 2019; 12:789-793. [PMID: 31003836 DOI: 10.1016/j.jiph.2019.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Infection analysisamongst malignant cancer patients remains elusive. The objective of this study is to investigate the characteristics of both infection and anti-infection treatments in patients group with malignant cancer. METHODS We retrospectively studied the clinical data of 148 patients with malignant cancer and 171 benign patients enrolled in the pharmacist consultation from April 2015 to April 2017. Statistical analysis was performed by chi-square test to compare the classification of primary disease, sites of infection, composition of pathogenic bacteria, and the effectiveness of drug treatment. P value <0.05 was considered statistically significant. RESULTS A total of 102 pathogen strains were detected in the patients with malignant cancer and 129 pathogen strains were noted in the benign patient group, respectively. Statistics indicated that more abdominal infections were observed in malignant cancer patients rather than in non-cancer patients. Additionally, more pseudomonas aeruginosa infection was found in the malignant cancer patient group while more Klebsiella pneumonia infection was noted in the benign group. These findings were supported by statistical evidence. There were fewer extended-spectrum β-lactamases (ESBL) that produced Escherichia coli, which was commonly found in a gastrointestinal cancer patient group compared to patients under other types of cancer; it accounted for 51.3% of all malignant cases involved in the current study. CONCLUSIONS Patients with malignant cancer are more likely to suffer from an infection containing pathogenic bacteria in comparison to benign patients. There have been considerable differences in the composition of pathogenic bacteria and its resistance to drugs. Overall, evaluating pathogens plays an essential role in the anti-infection treatment of patients with malignant cancer.
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Affiliation(s)
- Li Lin
- Department of Oncology, Peking University International Hospital, Beijing 102206, China
| | - Lihua Jia
- Department of Pharmacy, Beijing Electric Power Hospital, State Electric Grid Co., Beijing 100071, China
| | - Yali Fu
- Department of Oncology, Peking University International Hospital, Beijing 102206, China
| | - Ruonan Zhao
- Medical Department, Beijing Electric Power Hospital, State Electric Grid Co., Beijing 100071, China
| | - Yuan Huang
- Department of Clinical Laboratory, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China
| | - Chuanhao Tang
- Department of Oncology, Peking University International Hospital, Beijing 102206, China
| | - Chao Meng
- Department of Oncology, Peking University International Hospital, Beijing 102206, China
| | - Dazhong Zhao
- Department of Orthopedic, Beijing Electric Power Hospital, State Electric Grid Co., Beijing 100071, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing 102206, China.
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Hawkey PM, Warren RE, Livermore DM, McNulty CAM, Enoch DA, Otter JA, Wilson APR. Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party. J Antimicrob Chemother 2019. [PMID: 29514274 DOI: 10.1093/jac/dky027] [Citation(s) in RCA: 189] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed. The treatment options available in hospitals using intravenous antibiotics and in primary care using oral agents have been reviewed, ending with a consideration of antibiotic stewardship and recommendations. The guidance has been derived from current peer-reviewed publications and expert opinion with open consultation. Methods for systematic review were NICE compliant and in accordance with the SIGN 50 Handbook; critical appraisal was applied using AGREE II. Published guidelines were used as part of the evidence base and to support expert consensus. The guidance includes recommendations for stakeholders (including prescribers) and antibiotic-specific recommendations. The clinical efficacy of different agents is critically reviewed. We found there are very few good-quality comparative randomized clinical trials to support treatment regimens, particularly for licensed older agents. Susceptibility testing of MDR GNB causing infection to guide treatment needs critical enhancements. Meropenem- or imipenem-resistant Enterobacteriaceae should have their carbapenem MICs tested urgently, and any carbapenemase class should be identified: mandatory reporting of these isolates from all anatomical sites and specimens would improve risk assessments. Broth microdilution methods should be adopted for colistin susceptibility testing. Antimicrobial stewardship programmes should be instituted in all care settings, based on resistance rates and audit of compliance with guidelines, but should be augmented by improved surveillance of outcome in Gram-negative bacteraemia, and feedback to prescribers. Local and national surveillance of antibiotic use, resistance and outcomes should be supported and antibiotic prescribing guidelines should be informed by these data. The diagnosis and treatment of both presumptive and confirmed cases of infection by GNB should be improved. This guidance, with infection control to arrest increases in MDR, should be used to improve the outcome of infections with such strains. Anticipated users include medical, scientific, nursing, antimicrobial pharmacy and paramedical staff where they can be adapted for local use.
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Affiliation(s)
- Peter M Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | | | | | - Cliodna A M McNulty
- Microbiology Department, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
| | - David A Enoch
- Public Health England, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - A Peter R Wilson
- Department of Microbiology and Virology, University College London Hospitals, London, UK
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Ben Ayed H, Koubaa M, Hammami F, Marrakchi C, Rekik K, Ben Jemaa T, Maaloul I, Yaich S, Damak J, Ben Jemaa M. Performance of an Easy and Simple New Scoring Model in Predicting Multidrug-Resistant Enterobacteriaceae in Community-Acquired Urinary Tract Infections. Open Forum Infect Dis 2019; 6:ofz103. [PMID: 30949542 PMCID: PMC6441566 DOI: 10.1093/ofid/ofz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/03/2019] [Indexed: 12/22/2022] Open
Abstract
Background Multidrug resistance (MDR) is a growing global problem in bacterial community-acquired urinary tract infections (CUTIs). We aimed to propose an easy-to-use clinical prediction model to identify patients with MDR in CUTI. Methods We conducted a retrospective study including 770 patients with documented CUTI diagnosed during 2010–2017. Logistic regression–based prediction scores were calculated based on variables independently associated with MDR. Sensitivities and specificities at various cutoff points were determined, and the area under the receiver operating characteristic curve (AUROC) was computed. Results We found MDR Enterobacteriaceae in 372 cases (45.1%). Multivariate analysis showed that age ≥70 years (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.8–3.5), diabetes mellitus (aOR, 1.65; 95% CI, 1.19–2.3), history of urinary tract surgery in the last 12 months (aOR, 4.5; 95% CI, 1.22–17), and previous antimicrobial therapy in the last 3 months (aOR, 4.6; 95% CI, 3–7) were independent risk factors of MDR in CUTI. The results of Hosmer-Lemshow chi-square testing were indicative of good calibration of the model (χ2 = 3.4; P = .49). At a cutoff of ≥2, the score had an AUROC of 0.71, a sensitivity of 70.5%, a specificity of 60%, a positive predictive value of 60%, a negative predictive value of 70%, and an overall diagnostic accuracy of 65%. When the cutoff was raised to 6, the sensitivity dropped (43%), and the specificity increased appreciably (85%). Conclusions We developed a novel scoring system that can reliably identify patients likely to be harboring MDR in CUTI.
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Affiliation(s)
- Houda Ben Ayed
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Makram Koubaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Fatma Hammami
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Chakib Marrakchi
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Khaoula Rekik
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Tarak Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Imed Maaloul
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jamel Damak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Mounir Ben Jemaa
- Infectious Diseases Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
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Pazzini C, Ahmad-Nejad P, Ghebremedhin B. Ceftolozane/Tazobactam Susceptibility Testing in Extended-Spectrum Betalactamase- and Carbapenemase-Producing Gram-Negative Bacteria of Various Clonal Lineages. Eur J Microbiol Immunol (Bp) 2019; 9:1-4. [PMID: 30967968 PMCID: PMC6444803 DOI: 10.1556/1886.2019.00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/19/2022] Open
Abstract
Nowadays, multidrug-resistant bacteria are considered as an increasing serious threat to public health worldwide. Global and local surveillance data are helpful in the application of the most efficient antimicrobial agent in bacterial infections. In the current study, we aimed to analyze the activity of the previously cleared agent ceftolozane/ tazobactam (C/T) in African and European multidrug-resistant Gram-negative bacteria. Susceptibility testing was performed on 147 extended-spectrum β-lactamase (107 Escherichiacoli and 40 Klebsiellapneumoniae) and 103 carbapenemase-producing Gram-negative bacteria using Etest according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints. Among the extended-spectrum β-lactamase producing isolates, 91 Escherichiacoli isolates (85%) and 23 Klebsiellapneumoniaeisolates (57.5%) were susceptible towards C/T whereas out of the 103 carbapenemase-producing isolates 102 (99.0%) were C/T-resistant. C/T should be included in susceptibility testing to fairly administer this antimicrobial agent in infections caused by multidrug-resistant bacteria. It may be considered as a therapy option for infections caused by extended-spectrum β-lactamase-producing bacteria once susceptibility to this antimicrobial combination has been confirmed.
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Affiliation(s)
- Carlo Pazzini
- Faculty of Health, Center for Clinical and Translational Research, Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Parviz Ahmad-Nejad
- Faculty of Health, Center for Clinical and Translational Research, Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
| | - Beniam Ghebremedhin
- Faculty of Health, Center for Clinical and Translational Research, Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
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Dagla I, Karkoula E, Baira E, Tsarbopoulos A, Gikas E. Analytical methodologies used for the determination of colistin in biological fluids. Is it still a challenge? J Pharm Biomed Anal 2019; 164:777-788. [DOI: 10.1016/j.jpba.2018.11.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
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Lynch BL, Schaffer K. Can guidelines for the control of multi-drug-resistant Gram-negative organisms be put into practice? A national survey of guideline compliance and comparison of available guidelines. J Hosp Infect 2019; 102:1-7. [PMID: 30615958 DOI: 10.1016/j.jhin.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022]
Abstract
Multi-drug-resistant Gram-negative organisms (MDRGNO) are an emerging global threat, reflected in the increasing incidence of infections in Ireland and elsewhere. The response to this threat has been the development of Infection Prevention and Control (IPC) guidelines. A survey of IPC teams in Ireland was undertaken to assess compliance with national guidelines. To place these survey results in context, IPC guidelines from the Irish Health Protection Surveillance Centre (HPSC) are compared with guidelines from Healthcare Infection Society (HIS), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Centre for Disease Control (CDC). Thirty-three percent of hospitals responded across a range of hospital types. The results highlight the variability in implementation of guidelines across Ireland, as well as the variability between guidelines internationally. Respondents are less than 90% compliant with the majority of MDRGNO screening guidelines. Hospitals have variable access to isolation facilities with an average of 29% single rooms available (range 2.6-100%), resulting in some patients with MDRGNO not being isolated. Broad variability in application of guidance on personal protective equipment was demonstrated. This survey gives an insight into the real-life applicability of HPSC guidelines. Survey results are placed in context with a comparison of five MDRGNO IPC guidelines. Although core tenets of IPC are standard across guidelines, research into which practices are efficient in reducing MDRGNO transmission while being cost-effective would be worthwhile.
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Affiliation(s)
- B L Lynch
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin 7, Ireland; School of Medicine, University College Dublin, Dublin 4, Ireland.
| | - K Schaffer
- School of Medicine, University College Dublin, Dublin 4, Ireland; Department of Clinical Microbiology, St Vincent's University Hospital, Dublin 4, Ireland
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48
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Gao X, Chen Y, Chen Z, Xue Z, Jia Y, guo Q, Ma Q, Zhang M, Chen H. Identification and antimicrobial activity evaluation of three peptides from laba garlic and the related mechanism. Food Funct 2019; 10:4486-4496. [DOI: 10.1039/c9fo00236g] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Laba garlic is a traditional Chinese processed garlic (Allium sativum L.) with multiple health benefits.
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Affiliation(s)
- Xudong Gao
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Yue Chen
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Zhongqin Chen
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Zihan Xue
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Yanan Jia
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Qingwen guo
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Qiqi Ma
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
| | - Min Zhang
- College of Food Engineering and Biotechnology
- Tianjin University of Science and Technology
- Tianjin 300457
- P.R. China
| | - Haixia Chen
- Tianjin Key Laboratory for Modern Drug Delivery & High-Efficiency
- School of Pharmaceutical Science and Technology
- Tianjin University
- Tianjin
- P. R. China
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49
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Gray J, Winzor G, Mahdia N, Oppenheim B, Johnston A. Preventing healthcare-associated infection by sharing research, evidence and best practice. J Hosp Infect 2018; 101:117-119. [PMID: 30550770 DOI: 10.1016/j.jhin.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Affiliation(s)
- J Gray
- Healthcare Infection Society, UK.
| | - G Winzor
- Healthcare Infection Society, UK
| | - N Mahdia
- Healthcare Infection Society, UK
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50
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Coppéré Z, Voiriot G, Blayau C, Gibelin A, Labbe V, Fulgencio JP, Fartoukh M, Djibré M. Disparity of the "screen-and-isolate" policy for multidrug-resistant organisms: A national survey in French adult ICUs. Am J Infect Control 2018; 46:1322-1328. [PMID: 29980315 DOI: 10.1016/j.ajic.2018.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The prevalence of multidrug-resistant organisms (MDROs) has dramatically increased. The aim of this survey was to describe and analyze the different screening and isolation policies regarding MDROs in French adult intensive care units (ICUs). MATERIALS AND METHODS A multicenter online survey was performed among French ICUs, including 63 questions distributed into 4 parts: characteristics of the unit, MDRO screening policy, policy regarding contact precautions, and ecology of the unit. RESULTS From April 2015 to June 2016, 73 of 301 ICUs (24%) participated in the survey. MDRO screening was performed on admission in 96% of ICUs, for at least 1 MDRO (78%). MDRO screening was performed weekly during ICU stay in 83% of ICUs. Preemptive isolation was initiated on admission in 82% of ICUs, mostly in a targeted way (71%). Imported and acquired MDRO rates >10% were reported in 44% and 27% of ICUs, respectively. An MDRO outbreak had occurred within the past 3 years in 48% of cases. CONCLUSION French ICUs have variable screening and isolation approaches for MDROs, as up to 10 combinations were met. Discrepancies with the 2009 national guidelines were observed. Very few ICUs practice without some form of screening and isolation of patients upon admission.
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