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Mokline A, Zarrouk S, Jemi I, Fraj H, Gasri B, Ben Saad M, Thabet L, Messadi A. [DISTRIBUTION OF CARBAPENEMASES IN TUNISIAN BURN PATIENTS]. ANNALS OF BURNS AND FIRE DISASTERS 2024; 37:106-111. [PMID: 38974797 PMCID: PMC11225287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/16/2023] [Indexed: 07/09/2024]
Abstract
Resistance to carpabenems in burns is rapidly spreading in many countries. Therefore identification of carbapenemase pathogen carriers is imperative in order to establish adequate infection control precautions and stop outbreaks of these multidrug-resistant bacteria. The aim of our study was to evaluate the distribution of carbapenemase producers in burn patients admitted to a burn center in Tunisia over 9 months. PCR for carbapenemase portage was performed in all patients within 48 hours of admission. Seventeen patients carried a single carbapenemase, 11 carried two, and 25 carried three. The enzymes detected were VIM (n=41), NDM (n=41) and OXA48 (n=32). Enzyme mapping revealed two main areas of carriage in central western Tunisia: Kairouan (NDM/OXA48) and Kasserine (NDM/VIM). Predictive factors for carriage of carbapenemase were: prior antibiotic therapy (n=24); mechanical ventilation (n=30); vascular catheterization (n=31) and a previous stay in intensive care (n=11).
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Affiliation(s)
- A. Mokline
- Autrice correspondante: Amel Mokline, Service de Réanimation des Brûlés, Centre de Traumatologie et des Grands Brûlés, Tunis, Tunisie. Tel. : + 216 98 964 509 ; email :
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Manageiro V, Cano M, Furtado C, Iglesias C, Reis L, Vieira P, Teixeira A, Martins C, Veloso I, Machado J, Paiva JA, Caniça M. Genomic and epidemiological insight of an outbreak of carbapenemase-producing Enterobacterales in a Portuguese hospital with the emergence of the new KPC-124. J Infect Public Health 2024; 17:386-395. [PMID: 38246112 DOI: 10.1016/j.jiph.2023.12.014] [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: 11/06/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) is an increasing problem in healthcare settings. This study aimed to identify the source of a CPE outbreak that occurred in 2022, in a tertiary hospital in the North of Portugal, to identify exposed patients, and to assess the risk of becoming CPE-positive following hospital admission. METHODS A multi-disciplinary investigation was conducted including descriptive, analytical, and molecular epidemiology, environmental screening, and assessment of infection control measures. Clinical and environmental isolates were analyzed using whole-genome sequencing and phylogenetic analysis. Additionally, a prospective observational cohort study was conducted to further investigate the risk factors associated with the emergence of new cases in cohorts of CPE-negative admitted patients. RESULTS We observed the presence of multispecies KPC-, IMP-, and/or NDM-producing isolates. Genetically indistinguishable clinical and environmental isolates were found on the same room/ward. The ST45 KPC-3-producing Klebsiella pneumoniae clone was the responsible for the outbreak. During patients' treatment, we detected the emergence of resistance to ceftazidime-avibactam, associated with mutations in the blaKPC-3 gene (blaKPC-46, blaKPC-66 and blaKPC-124, the last variant never previously reported), suggesting a vertical evolutionary trajectory. Patients aged ≥ 75 years, hygiene/feeding-care dependent, and/or subjected to secretion aspiration were risk factors for CPE colonization after hospital admission. Additionally, cases with previous admission to the emergency department suggest that CPE dissemination may occur not only during hospitalization but also in the emergency department. CONCLUSION Overall, the study highlights that selection pressure with antibiotics, like ceftazidime-avibactam, is a contributing factor to the emergence of new β-lactamase variants and antibiotic resistance. It also shows that the hospital environment can be a significant source of CPE transmission, and that routine use of infection control measures and real-time molecular epidemiology investigations are essential to ensure the long-term termination of CPE outbreaks and prevent future resurgences.
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Affiliation(s)
- Vera Manageiro
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Manuela Cano
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Cristina Furtado
- Reference and Surveillance Unit, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Carmen Iglesias
- Clinical Pathology Service, Hospital de Braga, Braga, Portugal
| | - Lígia Reis
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Patrícia Vieira
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Aida Teixeira
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Cláudia Martins
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Isabel Veloso
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Jorge Machado
- Coordination of the Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Service, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal; Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal; Infections and Antimicrobial Resistance Prevention Programme, Directorate General of Health, Portugal
| | - Manuela Caniça
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for the Studies of Animal Science, Institute of Agrarian and Agri-Food Sciences and Technologies, University of Porto, Porto, Portugal; AL4AnimalS, Associate Laboratory for Animal and Veterinary Sciences, Portugal.
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Xiong Z, Zhang C, Sarbandi K, Liang Z, Mai J, Liang B, Cai H, Chen X, Gao F, Lan F, Liu X, Liu S, Zhou Z. Clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients in South China. Microbiol Spectr 2023; 11:e0283923. [PMID: 37819092 PMCID: PMC10714942 DOI: 10.1128/spectrum.02839-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
IMPORTANCE This study assessed the clinical and molecular epidemiology of carbapenem-resistant Enterobacteriaceae in pediatric inpatients at three hospitals in South China by means of screening stool samples for carbapenem-resistant genes and a nested case-control study to determine risk factors for carriage of carbapenem-resistant Enterobacteriaceae. Of 4,033 fecal samples screened, 158 (3.92%) were positive for CRE, including Escherichia coli (51.27 %), Klebsiella pneumoniae (37.97%), and Enterobacter cloacae (6.96%). The most common carbapenemase genes harbored by gastrointestinal CRE strains were blaNDM-5, blaNDM-1, and blaIMP-4. Hematological malignancies, respiratory diseases, otolaryngological diseases, nervous system diseases, oral administration of third-generation cephalosporins, and the combined use of two or more antibiotics were independently associated with CRE colonization.
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Affiliation(s)
- Zhile Xiong
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Chao Zhang
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Kurosh Sarbandi
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Zhuwei Liang
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Jialiang Mai
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Bingshao Liang
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Hao Cai
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Xiantang Chen
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Fei Gao
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
| | - Fangjun Lan
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
| | - Xiaochun Liu
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
| | - Shuyan Liu
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
| | - Zhenwen Zhou
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Clinical Laboratory, Guangzhou, Guangdong, China
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Bar Ilan M, Kjerulf A. Who should be screened for carbapenemase-producing Enterobacterales and when? A systematic review. J Hosp Infect 2023; 142:74-87. [PMID: 37802236 DOI: 10.1016/j.jhin.2023.09.018] [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: 07/20/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Carbapenemase-producing Enterobacterales (CPE) cases increases every year in Denmark and the proportion of CPE-positive cases with a travel history decreases. Several epidemiological links show transmission in Danish healthcare setting indicating infection prevention and control challenges and raising questions about the Danish CPE screening protocol. The aim of this review was to identify additional risk factors to those described in the Danish CPE-screening protocol in order to detect the Danish CPE-positive patients and thereby reduce the risk of transmission and outbreaks. A systematic literature search was conducted in PubMed, Embase and Cochrane Library during March 2022. A total of 1487 articles were screened, and 19 studies were included. Retrieved studies dealt with patients with laboratory-confirmed CPE (colonization and/or infection) and associated risk factors. Antimicrobial therapy, especially broad-spectrum antimicrobial agents, prior or current hospitalization of approximately one week in ICU and 20-28 days in other wards and travel history with or without hospitalization abroad were significant risk factors associated with CPE acquisition. Comorbidities and invasive procedures were identified as risk factors, but without identifying specific comorbidities or invasive procedures associated with risk for CPE-acquisition. This study suggests the need to develop an additional algorithm for CPE-screening in Denmark. In addition to risk-based screening on admission, screening of inpatients should be considered. The screening protocol might include screening of inpatients with comorbidities who are hospitalized >1 week in ICU or >3 weeks in other wards and who have previously received or currently are receiving antibiotic treatment. Further research is needed to develop a new CPE-screening algorithm.
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Affiliation(s)
- M Bar Ilan
- Infection Prevention and Control Unit, Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
| | - A Kjerulf
- National Center for Infection Control, Department for Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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Wilson JE, Sanderson W, Westgate PM, Winter K, Forster D. Risk factors of carbapenemase-producing Enterobacterales acquisition among adult intensive care unit patients at a Kentucky Academic Medical Center. Infect Prev Pract 2023; 5:100310. [PMID: 37767313 PMCID: PMC10520311 DOI: 10.1016/j.infpip.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Background Acquisition of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are associated with negative health outcomes. Our adult intensive care unit (ICU) population has experienced low levels of CP-CRE acquisition; however, specific risk factors for this population at our medical facility have not been studied. Aims To identify risk factors of CP-CRE acquisition and describe CP-CRE epidemiology among adult ICU patients at our medical facility. Methods A retrospective cohort study was performed at a Kentucky Academic Medical Center. Surveillance specimens were collected at admission and weekly thereafter to identify CP-CRE colonization. Clinical data were extracted from patient medical records. Cases were defined as those who tested positive for CP-CRE on ICU admission day 3 or greater. Risk of CP-CRE acquisition was calculated using Modified Poisson regression. Findings Independent risk factors of CP-CRE acquisition included administration of enteral tube feeds (risk ratio [RR], 4.46; 95% confidence interval [CI], 1.74-11.43); diagnosis of Clostridioides difficile enterocolitis (RR, 3.51; 95% CI, 1.27-9.68), pressure ulcer (RR, 3.48; 95% CI, 1.91-6.36), and morbid obesity (RR, 2.10; 95% CI, 1.12-3.95); having a drainage tube (RR, 2.63; 95% CI, 1.38-4.98); admission to a medical ICU (RR, 2.39; 95% CI, 1.32-4.35); 90-day use of a carbapenem (RR, 2.27; 95% CI, 1.21-4.26); and dialysis procedure (RR, 2.22; 95% CI, 1.15-4.27). Conclusion Most CP-CRE risk factors were associated with alteration of colon microbiota and/or invasive procedures/devices. These results will assist in creating a more targeted CP-CRE active surveillance system and highlight areas for infection prevention intervention.
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Affiliation(s)
- Jason Eric Wilson
- University of Kentucky, Department of Epidemiology, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Wayne Sanderson
- University of Kentucky, Department of Biosystems and Agricultural Engineering, College of Agriculture, Food, and the Environment, AG Science Bldg, S107, Lexington, KY, 40508, USA
| | - Philip M. Westgate
- University of Kentucky, Department of Biostatistics, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Kathleen Winter
- University of Kentucky, Department of Epidemiology, College of Public Health, 111 Washington Ave, Lexington, KY, 40536, USA
| | - Derek Forster
- Veterans Health Association VISN9 Clinical Resource Hub, Louisville, KY, USA
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Tofarides AG, Dimitriou P, Nikolopoulos GK, Rogkas D, Flourou C, Khattab E, Kasapi D, Azina C, Christaki E. Factors Associated with Extended-Spectrum β-Lactamases and Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infections: A Five-Year Retrospective Study. Pathogens 2023; 12:1277. [PMID: 38003742 PMCID: PMC10675166 DOI: 10.3390/pathogens12111277] [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: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
Klebsiella pneumoniae is one of the leading causes of nosocomial infections. It has been estimated that nosocomial infection by Klebsiella pneumoniae comprises 3-8% of all nosocomial infections. Klebsiella pneumoniae bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum beta-lactamases (ESBL) and carbapenemases, are becoming increasingly common, especially in hospital settings, posing therapeutic challenges. In this article, we aimed to study the epidemiology and risk factors of BSIs due to resistant Klebsiella pneumoniae strains in the period 1 January 2014-31 December 2018 at the Nicosia General Hospital, the largest tertiary hospital in Cyprus. Data on demographics, co-morbidities, prior hospitalization, prior intensive care unit (ICU) admission, previous antimicrobial use, nosocomial acquisition of the infection, the presence of a prosthetic device or surgery, and the primary site of infection were retrospectively recorded. Associations between the detection of ESBL Klebsiella pneumoniae BSIs and factors/covariates were examined using logistic regression. This study involved 175 patients with BSI caused by Klebsiella pneumoniae. Of these, 61 BSIs were caused by ESBL strains, 101 by non-ESBL, and 13 by carbapenem-resistant (CR) strains. In univariable analyses, age, sex, heart disease, antimicrobial use during current admission, previous hospitalization (ward or ICU), and primary BSI were associated with the presence of an ESBL strain. Antibiotic use during current admission and heart disease remained statistically significantly associated with ESBL Klebsiella pneumoniae BSI in multivariable models. Antibiotic use during current admission, respiratory infection, and a recent history of surgery were more prevalent among CR Klebsiella pneumoniae BSI patients than among non-CR Klebsiella pneumoniae BSI patients. Our study showed that recent antimicrobial use and heart disease were associated with BSI due to ESBL-producing Klebsiella pneumoniae. This finding could inform clinical practice in hospital settings.
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Affiliation(s)
- Andreas G. Tofarides
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Panagiotis Dimitriou
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | | | - Dimitrios Rogkas
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
| | - Christina Flourou
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Elina Khattab
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Diamanto Kasapi
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Chara Azina
- Department of Internal Medicine, Nicosia General Hospital, 2029 Nicosia, Cyprus; (P.D.); (C.F.); (E.K.); (D.K.); (C.A.)
| | - Eirini Christaki
- 1st Division of Internal Medicine & Infectious Diseases Unit, University Hospital of Ioannina, Faculty of Medicine, University of Ioannina, 45500 Ioannina, Greece;
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Kagambèga AB, Dembélé R, Bientz L, M’Zali F, Mayonnove L, Mohamed AH, Coulibaly H, Barro N, Dubois V. Detection and Characterization of Carbapenemase-Producing Escherichia coli and Klebsiella pneumoniae from Hospital Effluents of Ouagadougou, Burkina Faso. Antibiotics (Basel) 2023; 12:1494. [PMID: 37887195 PMCID: PMC10603891 DOI: 10.3390/antibiotics12101494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Hospital wastewater is a recognized reservoir for resistant Gram-negative bacteria. This study aimed to screen for carbapenemase-producing Escherichia coli and Klebsiella pneumoniae and their resistance determinants in two hospital effluents of Ouagadougou. Carbapenem-resistant E. coli and K. pneumoniae were selectively isolated from wastewater collected from two public hospitals in Ouagadougou, Burkina Faso. Bacterial species were identified via MALDI-TOF mass spectrometry. Carbapenemase production was studied phenotypically using antibiotic susceptibility testing via the disk diffusion method. The presence of carbapenemases was further characterized by PCR. A total of 14 E. coli (13.59%) and 19 K. pneumoniae (17.92%) carbapenemase-producing isolates were identified with different distributions. They were, respectively, blaNDM (71.43%), blaVIM (42.86%), blaIMP (28.57%), blaKPC (14.29%), blaOXA-48 (14.29%); and blaKPC (68.42%), blaNDM (68.42%), blaIMP (10.53%), blaVIM (10.53%), and blaOXA-48 (5.26%). In addition, eight (57.14%) E. coli and eleven (57.89%) K. pneumoniae isolates exhibited more than one carbapenemase, KPC and NDM being the most prevalent combination. Our results highlight the presence of clinically relevant carbapenemase-producing isolates in hospital effluents, suggesting their presence also in hospitals. Their spread into the environment via hospital effluents calls for intensive antimicrobial resistance (AMR) surveillance.
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Affiliation(s)
- Alix Bénédicte Kagambèga
- Laboratory of Molecular Biology, Epidemiology and Surveillance of Foodborne Bacteria and Viruses, University Joseph KI-ZERBO of Ouagadougou, Ouagadougou 03 BP 7021, Burkina Faso; (A.H.M.); (H.C.); (N.B.)
| | - René Dembélé
- Laboratory of Molecular Biology, Epidemiology and Surveillance of Foodborne Bacteria and Viruses, University Joseph KI-ZERBO of Ouagadougou, Ouagadougou 03 BP 7021, Burkina Faso; (A.H.M.); (H.C.); (N.B.)
- Training and Research Unit in Applied Sciences and Technologies, University of Dedougou, Dedougou 03 BP 176, Burkina Faso
| | - Léa Bientz
- UMR 5234, CNRS, Fundamental Microbiology and Pathogenicity, University of Bordeaux, 33000 Bordeaux, France; (L.B.); (F.M.); (L.M.); (V.D.)
| | - Fatima M’Zali
- UMR 5234, CNRS, Fundamental Microbiology and Pathogenicity, University of Bordeaux, 33000 Bordeaux, France; (L.B.); (F.M.); (L.M.); (V.D.)
| | - Laure Mayonnove
- UMR 5234, CNRS, Fundamental Microbiology and Pathogenicity, University of Bordeaux, 33000 Bordeaux, France; (L.B.); (F.M.); (L.M.); (V.D.)
| | - Alassane Halawen Mohamed
- Laboratory of Molecular Biology, Epidemiology and Surveillance of Foodborne Bacteria and Viruses, University Joseph KI-ZERBO of Ouagadougou, Ouagadougou 03 BP 7021, Burkina Faso; (A.H.M.); (H.C.); (N.B.)
- Microbiology Laboratory of the General Reference Hospital (GRH), Niamey BP 12674, Niger
| | - Hiliassa Coulibaly
- Laboratory of Molecular Biology, Epidemiology and Surveillance of Foodborne Bacteria and Viruses, University Joseph KI-ZERBO of Ouagadougou, Ouagadougou 03 BP 7021, Burkina Faso; (A.H.M.); (H.C.); (N.B.)
| | - Nicolas Barro
- Laboratory of Molecular Biology, Epidemiology and Surveillance of Foodborne Bacteria and Viruses, University Joseph KI-ZERBO of Ouagadougou, Ouagadougou 03 BP 7021, Burkina Faso; (A.H.M.); (H.C.); (N.B.)
| | - Véronique Dubois
- UMR 5234, CNRS, Fundamental Microbiology and Pathogenicity, University of Bordeaux, 33000 Bordeaux, France; (L.B.); (F.M.); (L.M.); (V.D.)
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Zarras C, Iosifidis E, Simitsopoulou M, Pappa S, Kontou A, Roilides E, Papa A. Neonatal Bloodstream Infection with Ceftazidime-Avibactam-Resistant blaKPC-2-Producing Klebsiella pneumoniae Carrying blaVEB-25. Antibiotics (Basel) 2023; 12:1290. [PMID: 37627710 PMCID: PMC10451261 DOI: 10.3390/antibiotics12081290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Although ceftazidime/avibactam (CAZ/AVI) has become an important option for treating adults and children, no data or recommendations exist for neonates. We report a neonatal sepsis case due to CAZ/AVI-resistant blaKPC-2-harboring Klebsiella pneumoniae carrying blaVEB-25 and the use of a customized active surveillance program in conjunction with enhanced infection control measures. METHODS The index case was an extremely premature neonate hospitalized for 110 days that had been previously treated with multiple antibiotics. Customized molecular surveillance was implemented at hospital level and enhanced infection control measures were taken for early recognition and prevention of outbreak. Detection and identification of blaVEB-25 was performed using next-generation sequencing. RESULTS This was the first case of a bloodstream infection caused by KPC-producing K. pneumoniae that was resistant to CAZ/AVI without the presence of a metalo-β-lactamase in the multiplex PCR platform in a neonate. All 36 additional patients tested (12 in the same NICU and 24 from other hospital departments) carried wild-type blaVEB-1 but they did not harbor blaVEB-25. CONCLUSION The emergence of blaVEB-25 is signal for the horizontal transfer of plasmids at hospital facilities and it is of greatest concern for maintaining a sharp vigilance for the surveillance of novel resistance mechanisms. Molecular diagnostics can guide appropriate antimicrobial therapy and the early implementation of infection control measures against antimicrobial resistance.
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Affiliation(s)
- Charalampos Zarras
- Microbiology Department, Hippokration Hospital, 54642 Thessaloniki, Greece;
- Department of Microbiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.P.); (A.P.)
| | - Elias Iosifidis
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Hippokration Hospital, 54642 Thessaloniki, Greece; (M.S.); (E.R.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Maria Simitsopoulou
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Hippokration Hospital, 54642 Thessaloniki, Greece; (M.S.); (E.R.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Styliani Pappa
- Department of Microbiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.P.); (A.P.)
| | - Angeliki Kontou
- 1st Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Hippokration Hospital, 54642 Thessaloniki, Greece; (M.S.); (E.R.)
- Basic and Translational Research Unit, Special Unit for Biomedical Research and Education, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (S.P.); (A.P.)
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Papafotiou C, Roussos S, Sypsa V, Bampali S, Spyridopoulou K, Karapanou A, Moussouli A, Samarkos M, Daikos GL, Psichogiou M. Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area. J Antimicrob Chemother 2022; 77:3331-3339. [PMID: 36203392 DOI: 10.1093/jac/dkac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. METHODS The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. RESULTS Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. CONCLUSIONS This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures.
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Affiliation(s)
- Chrysanthe Papafotiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Bampali
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kalliopi Spyridopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasia Moussouli
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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10
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O'Connell N, Gasior S, Slevin B, Power L, Barrett S, Bhutta S, Minihan B, Powell J, Dunne C. Microbial epidemiology and clinical risk factors of carbapenemase-producing Enterobacterales amongst Irish patients from first detection in 2009 until 2020. Infect Prev Pract 2022; 4:100230. [PMID: 35935263 PMCID: PMC9352914 DOI: 10.1016/j.infpip.2022.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenemase producing Enterobacterales (CPE) are major public health threats. Aim To review microbial epidemiology of CPE, as well as clinical risk factors and infections, amongst CPE positive patients over 12 years in an Irish tertiary hospital. Methods Retrospective observational study of data extracted from a laboratory CPE database, electronic healthcare records and manual review of patient charts. Common risk factors, treatment regimens for all CPE related infections, and clinical outcomes were ascertained. Findings Among CPE strains isolated from 460 patients, Klebsiella pneumoniae carbapenemase (KPC) was the carbapenemase most frequently detected, accounting for 87.4% (459) of all CPE enzymes. Citrobacter species 177 (33.7%) were the most common species harbouring this enzyme. 428 CPE positive patients (93%) were identified in the acute hospital setting; the most common risk factor for CPE acquisition was history of hospitalisation, observed in 305 (66%) cases. Thirty patients (6.5%) had confirmed infections post-acquisition, of which four were bloodstream infections. There were 19 subsequent episodes of non CPE-related bacteraemia in this cohort. All causal mortality at 30 days was 41 patients (8.9%). However, clinical review determined that CPE was an indirect associative factor in 8 patient deaths. Conclusions In this tertiary hospital setting, microbial epidemiology is changing; with both OXA-48 enzymes and KPC-producing Citrobacter species becoming more prevalent. Whilst the burden of CPE related infections, especially bacteraemia, was low over the study period, it remains critical that basic infection prevention and control practices are adhered to lest the observed changes in epidemiology result in an increase in clinical manifestations.
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Affiliation(s)
- N.H. O'Connell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S. Gasior
- School of Medicine, University of Limerick, Limerick, Ireland
| | - B. Slevin
- Department of Infection Prevention and Control, ULHG, Limerick, Ireland
| | - L. Power
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - S. Barrett
- Department of Pharmacy, ULHG, Limerick, Ireland
| | - S.I. Bhutta
- Department of Gastroenterology, ULHG, Limerick, Ireland
| | - B. Minihan
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - J. Powell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C.P. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
- Corresponding author. Address: Foundation Chair and Director of Research, School of Medicine, University of Limerick, Ireland. Tel.: +35361234703.
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11
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de Oliveira Santos JV, da Costa Júnior SD, de Fátima Ramos Dos Santos Medeiros SM, Cavalcanti IDL, de Souza JB, Coriolano DL, da Silva WRC, Alves MHME, Cavalcanti IMF. Panorama of Bacterial Infections Caused by Epidemic Resistant Strains. Curr Microbiol 2022; 79:175. [PMID: 35488983 PMCID: PMC9055366 DOI: 10.1007/s00284-022-02875-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance (AMR) represents a critical obstacle to public health worldwide, due to the high incidence of strains resistant to available antibiotic therapies. In recent years, there has been a significant increase in the prevalence of resistant epidemic strains, associated with this, public health authorities have been alarmed about a possible scenario of uncontrolled dissemination of these microorganisms and the difficulty in interrupting their transmission, as nosocomial pathogens with resistance profiles previously considered sporadic. They become frequent bacteria in the community. In addition, therapy for infections caused by these pathogens is based on broad-spectrum antibiotic therapy, which favors an increase in the tolerance of remaining bacterial cells and is commonly associated with a poor prognosis. In this review, we present the current status of epidemic strains of methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), MDR Mycobacterium tuberculosis, extended-spectrum β-lactamase-producing Enterobacterales (ESBL), Klebsiella pneumoniae carbapenemase (KPC), and—New Delhi Metallo-beta-lactamase-producing Pseudomonas aeruginosa (NDM).
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Affiliation(s)
- João Victor de Oliveira Santos
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Sérgio Dias da Costa Júnior
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | | | - Iago Dillion Lima Cavalcanti
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Jaqueline Barbosa de Souza
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Davi Lacerda Coriolano
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Wagner Roberto Cirilo da Silva
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Maria Helena Menezes Estevam Alves
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Isabella Macário Ferro Cavalcanti
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil.
- Laboratory of Microbiology and Immunology, Academic Center of Vitória (CAV), Federal University of Pernambuco (UFPE), Vitória de Santo Antão, Rua Do Alto Do Reservatório S/N, Bela Vista, Vitória de Santo Antão, Pernambuco, CEP: 55608-680, Brazil.
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12
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The Clinical Manifestation of SARS-CoV-2 in Critically Ill Patients with Klebsiella pneumoniae NDM Hospitalized in the ICU of a Modular Hospital during the Third Wave of the Pandemic in Poland—An Observational Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12051118. [PMID: 35626274 PMCID: PMC9139503 DOI: 10.3390/diagnostics12051118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
There is limited information on the clinical characteristics of critically ill patients infected with SARS-CoV-2 and Klebsiella pneumoniae NDM. The objective of this study was to describe such a group of patients hospitalised in the intensive care unit of a large academic hospital during the third wave of the COVID-19 pandemic in Poland. Between 1 March and 30 June 2021, 103 patients were hospitalised, of whom 23 (22.3%) were positive for K. pneumoniae NDM; 14 (61%) of those patients died. Their hospitalisation time varied between 9 and 47 days. Five of the 23 patients (21.7%) were otherwise healthy. In contrast, the others suffered from cardiovascular problems (11, 47.8%), obesity (6, 26.1%), diabetes (5, 21.7%), neurological problems (4, 17.4%), or kidney disease (1, 4.3%); 4 (17.4%) were heavy smokers, and 1 (4.3%) had a history of alcohol abuse. K. pneumoniae NDM was isolated from urine samples of all patients. In 17 patients (73.9%), it was also isolated from other sources: from the respiratory tract in 10 (43.8%), from the blood in 2 (8.7%), and the central venous catheter was contaminated in 1 case (4.3%). Fourteen of the patients (60.9%) were colonised K. pneumoniae NDM. In four patients (17.4%), bacterial and fungal coinfection occurred. In one case (4.4%), two fungal species, Candida albicans and Candida glabrata, were isolated simultaneously. The most frequently administered antimicrobial agent was colistin (60.9%), followed by meropenem (47.8%), vancomycin (47.8%), ceftriaxone (34.8%), linezolid (30.4%), piperacillin/tazobactam (30.4%), and trimethoprim/sulfamethoxazole (30.4%). Other less-frequently administered agents included amikacin, amoxicillin/clavulanate, tigecycline, ciprofloxacin, fosfomycin, clindamycin, and cloxacillin. Fluconazole was administered in 14 patients (60.7%) and micafungin was administered in 2 (8.7%).
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13
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Tinelli M, Rossini A, Scudeller L, Zabzuni D, Errico G, Fogato E, D'Angelo R, Gentiloni Silverj F, Cesana E, Bergamaschini LC, Pasi F, Monaco M, Cerquetti M, Pantosti A, Giufrè M. Dynamics of carbapenemase-producing Enterobacterales intestinal colonisation in the elderly population after hospital discharge, Italy, 2018-2020. Int J Antimicrob Agents 2022; 59:106594. [PMID: 35483624 DOI: 10.1016/j.ijantimicag.2022.106594] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
Carbapenemase-producing Enterobacterales (CPE) represent a serious threat to public health worldwide. Elderly patients are at increased risk of colonisation/infection with CPE. This study aimed to evaluate the persistence of CPE colonisation and the genotypic characteristics of persistent strains in elderly people discharged from Italian hospitals. A longitudinal study was conducted in two Italian cities (March 2018 to September 2020) enrolling 137 patients aged ≥65 years with CPE intestinal colonisation at hospital discharge. CPE colonisation was evaluated after 4, 8 and 12 months. Competing risk analysis was used to explore the association between baseline characteristics and persistence at 4 months. For all isolates, carbapenemase typing and multilocus sequence typing were performed. Persistent isolates underwent whole-genome sequencing. Of 137 patients, 91% carried carbapenemase-producing Klebsiella pneumoniae (CP-KP) and 8.8% carried carbapenemase-producing Escherichia coli. Although a large number of patients were lost to follow-up owing to death or withdrawal, 28/65 patients (43.1%) remained colonised at Month 4; 16/42 (38.1%) and 5/28 (17.9%) were found colonised up to Months 8 and 12, respectively. Colonisation persistence was more frequent in patients with bacteraemia or complicated urinary tract infection while in hospital and in those staying in long-term care facilities (LTCFs). Clonal characteristics of CP-KP isolates did not appear to influence persistence. Isolates obtained from each persistent carrier were identical or highly related by SNP phylogenetic analysis. Identification of patients at higher risk of persistent intestinal carriage after hospital discharge can prompt control measures to limit the transmission of CPE in the community, especially in LTCF settings.
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Affiliation(s)
- Marco Tinelli
- Italian Society of Infectious and Tropical Diseases (SIMIT), Prato, Italy; IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | | | - Luigia Scudeller
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dorjan Zabzuni
- IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Giulia Errico
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elena Fogato
- Laboratory of Clinical Microbiology, ASP 'Golgi-Redaelli', Milan, Italy
| | - Roberto D'Angelo
- Laboratory of Clinical Microbiology, ASP 'Golgi-Redaelli', Milan, Italy
| | | | | | | | - Francesca Pasi
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Cerquetti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Giufrè
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
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14
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Loudermilk EM, Kotay SM, Barry KE, Parikh HI, Colosi LM, Mathers AJ. Tracking Klebsiella pneumoniae carbapenemase gene as an indicator of antimicrobial resistance dissemination from a hospital to surface water via a municipal wastewater treatment plant. WATER RESEARCH 2022; 213:118151. [PMID: 35167966 DOI: 10.1016/j.watres.2022.118151] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 05/10/2023]
Abstract
Antibiotic-resistant bacteria originating from hospitals are ultimately discharged to municipal wastewater treatment plants (WWTP), which may serve as important reservoirs for the spread of antibiotic resistant genes. This study traced and quantified the presence of a rare but clinically relevant antimicrobial resistance gene; Klebsiella pneumoniae carbapenamase (KPC)-and the viable organisms (KPCO) which carried this gene in hospital, non-hospital wastewater discharges, various compartments within a municipal WWTP, receiving water and sediment samples. High concentration of the gene, blaKPC harbored in viable and multispecies KPCO was detected in the hospital wastewater and in the forepart stages of the WWTP, but was not detected in the final effluent following UV disinfection. KPCO were not detected in multiple non-hospital sources of wastewater discharges tested. The treatment train used in the sampled WWTP was found to help remove and reduce KPCO load. Using whole-genome sequencing, a KPC-producing Klebsiella oxytoca strain identical to strains seen in the patients and hospital environment was isolated from the downstream receiving water on one sampling event. KPCO were also found to persist in the biosolids throughout the WWTP, but were not detected in the processed compost-products made from WWTP-biosolids. This study systematically demonstrates dissemination of KPCO from hospital point source to environment via municipal WWTP. Understanding hospitals as the origin and source of spread of some of the most clinically urgent antimicrobial-resistant organisms may help direct interventions that target rate at which antibiotic resistant bacteria evolve and spread via enhancement of wastewater treatment and mitigation of dissemination at source.
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Affiliation(s)
- Erica M Loudermilk
- Department of Engineering Systems and Environment, University of Virginia, 151 Engineer's Way, Charlottesville, VA 22903, United States
| | - Shireen M Kotay
- Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States.
| | - Katie E Barry
- Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States
| | - Hardik I Parikh
- Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States
| | - Lisa M Colosi
- Department of Engineering Systems and Environment, University of Virginia, 151 Engineer's Way, Charlottesville, VA 22903, United States
| | - Amy J Mathers
- Division of Infectious Diseases, School of Medicine, University of Virginia, P.O. Box 800255, Charlottesville, VA 22903, United States; Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health System, Charlottesville, VA, United States
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15
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Dumitru IM, Dumitrascu M, Vlad ND, Cernat RC, Ilie-Serban C, Hangan A, Slujitoru RE, Gherghina A, Mitroi-Maxim C, Curtali L, Carp DS, Dumitrescu A, Mitan R, Lesanu R, Rugina S. Carbapenem-Resistant Klebsiella pneumoniae Associated with COVID-19. Antibiotics (Basel) 2021; 10:561. [PMID: 34065029 PMCID: PMC8151469 DOI: 10.3390/antibiotics10050561] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
Infections with carbapenem-resistant Enterobacteriaceae are emerging as an important challenge in healthcare settings. Currently, carbapenem-resistant Klebsiella pneumoniae (CRKP) are the species of CRE most commonly encountered in hospitals. CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have been associated with high rates of morbidity and mortality, particularly among persons with prolonged hospitalization exposed to invasive devices. We report nine patients hospitalized in an intensive care unit (ICU) with severe coronavirus disease 2019 (COVID-19) who developed invasive infections due to carbapenemase-producing Klebsiella pneumoniae (CP-Kp), KPC and OXA-48, strains that have not been previously identified in our hospital. Despite ceftazidime/avibactam therapy, five patients died. Coinfections can contribute to a poor prognosis for patients with COVID-19, especially for high-risk populations such as elderly patients. Therefore, it is crucial to establish a rigorous program of antibiotic administration in intensive care units.
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Affiliation(s)
- Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
| | - Mirela Dumitrascu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Nicoleta Dorina Vlad
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
| | - Roxana Carmen Cernat
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
| | - Carmen Ilie-Serban
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Aurelia Hangan
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
| | - Raluca Elena Slujitoru
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Aura Gherghina
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Corina Mitroi-Maxim
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Licdan Curtali
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Dalia Sorina Carp
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Anca Dumitrescu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Romelia Mitan
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Rodica Lesanu
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
| | - Sorin Rugina
- Clinical Infectious Diseases Hospital, 100 Ferdinand Str, 900709 Constanta, Romania; (M.D.); (N.D.V.); (R.C.C.); (C.I.-S.); (A.H.); (R.E.S.); (A.G.); (C.M.-M.); (L.C.); (D.S.C.); (A.D.); (R.M.); (R.L.); (S.R.)
- Faculty of Medicine, Ovidius University of Constanta, Aleea Universității, nr. 1, 900470 Constanta, Romania
- Doctoral School of Medicine, Ovidius University of Constanta, Aleea Universității nr. 1, 900470 Constanta, Romania
- Romanian Academy of Scientists, Spl. Independentei 54, 030167 București, Romania
- Romanian Academy of Medical Sciences, Bulevardul Ion C. Brătianu 1, 030167 București, Romania
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16
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Cortés JA, Leal AL, Muñetón López G, Bravo-Ojeda JS, Nócua-Báez LC, Avila V, Silva E, Álvarez-Moreno CA, Espitia P, Gualtero SM, Valderrama SL, Guevara FO, Esparza G, Saavedra CH, Díaz JA, Valderrama-Ríos MC. Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasas y el manejo de infecciones causadas por estas bacterias. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.90140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbilidad y mortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario.
Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por EPC en este escenario.
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García-Rodríguez JF, Bardán-García B, Juiz-González PM, Vilariño-Maneiro L, Álvarez-Díaz H, Mariño-Callejo A. Long-Term Carbapenems Antimicrobial Stewardship Program. Antibiotics (Basel) 2020; 10:antibiotics10010015. [PMID: 33375237 PMCID: PMC7823722 DOI: 10.3390/antibiotics10010015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.
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Affiliation(s)
- José Francisco García-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
- Correspondence:
| | - Belén Bardán-García
- Department of Pharmacy, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain;
| | | | - Laura Vilariño-Maneiro
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
| | - Hortensia Álvarez-Díaz
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
| | - Ana Mariño-Callejo
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
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Carbapenemase-producing Enterobacterales outbreak: Another dark side of COVID-19. Am J Infect Control 2020; 48:1533-1536. [PMID: 33011336 PMCID: PMC7529666 DOI: 10.1016/j.ajic.2020.09.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/28/2023]
Abstract
In the hospital department dedicated to COVID-19-patient, infection prevention and control measures were upgraded. Therefore, the cross-transmission of other micro-organisms was thought unlikely to occur. However, we report an outbreak of NDM-5-producing Escherichia. coli in a 12-beds ICU dedicated to COVID-19 patients. This outbreak involved 6 patients of which 5 were asymptomatic carriers and 1 was infected. Several findings might have contributed to cross-transmission including the multiple-bedroom configuration of the department, uncomplete compliance for standard and contact precautions, overwork due to the burden of the disease, lack of training of staff for the care of ICU-patients, and misuse of gloves. Furthermore, as infection prevention and control measures were thought to be applied, contact patients were not screened for eXDR carriage. Applying rigorously standard and contact precautions and performing screening in contact patients when indicated must be the rules in COVID-19 wards.
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Guerra AM, Lira A, Lameirão A, Selaru A, Abreu G, Lopes P, Mota M, Novais Â, Peixe L. Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak. Antibiotics (Basel) 2020; 9:E806. [PMID: 33202755 PMCID: PMC7696612 DOI: 10.3390/antibiotics9110806] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 11/16/2022] Open
Abstract
Carbapenem resistance rates increased exponentially between 2014 and 2017 in Portugal (~80%), especially in Klebsiella pneumoniae. We characterized the population of carbapanemase-producing Enterobacterales (CPE) infecting or colonizing hospitalized patients (2017-2018) in a central hospital from northern Portugal, where KPC-3-producing K. pneumoniae capsular type K64 has caused an initial outbreak. We gathered phenotypic (susceptibility data), molecular (population structure, carbapenemase, capsular type) and biochemical (FT-IR) data, together with patients' clinical and epidemiological information. A high diversity of Enterobacterales species, clones (including E. coli ST131) and carbapenemases (mainly KPC-3 but also OXA-48 and VIM) was identified three years after the onset of carbapenemases spread in the hospital studied. ST147-K64 K. pneumoniae, the initial outbreak clone, is still predominant though other high-risk clones have emerged (e.g., ST307, ST392, ST22), some of them with pandrug resistance profiles. Rectal carriage, previous hospitalization or antibiotherapy were presumptively identified as risk factors for subsequent infection. In addition, our previously described Fourier Transform infrared (FT-IR) spectroscopy method typed 94% of K. pneumoniae isolates with high accuracy (98%), and allowed to identify previously circulating clones. This work highlights an increasing diversity of CPE infecting or colonizing patients in Portugal, despite the infection control measures applied, and the need to improve the accuracy and speed of bacterial strain typing, a goal that can be met by simple and cost-effective FT-IR based typing.
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Affiliation(s)
| | - Agostinho Lira
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Angelina Lameirão
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Aurélia Selaru
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Gabriela Abreu
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Paulo Lopes
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Margarida Mota
- Centro Hospitalar Vila Nova de Gaia/Espinho, 4434-502 Vila Nova de Gaia, Portugal; (A.L.); (A.L.); (A.S.); (G.A.); (P.L.); (M.M.)
| | - Ângela Novais
- UCIBIO, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal;
| | - Luísa Peixe
- UCIBIO, Faculdade de Farmácia, Universidade do Porto, 4050-313 Porto, Portugal;
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20
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Bloomfield MG, Wilson AD, Studd RC, Blackmore TK. Highly effective prophylaxis with ertapenem for transrectal ultrasound-guided prostate biopsy: effects on overall antibiotic use and inpatient hospital exposure. J Hosp Infect 2020; 106:483-489. [PMID: 32861740 DOI: 10.1016/j.jhin.2020.08.020] [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] [Received: 07/13/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ertapenem prophylaxis for transrectal ultrasound-guided prostate biopsy (TRUS-PB) has proven highly effective at our institution. A subsequent study showed no selection for carbapenem resistance, but antimicrobial stewardship concerns remained. AIM To assess the effects of this prophylaxis on overall antibiotic consumption and exposure to the hospital environment. METHODS All men undergoing TRUS-PB from November 2006 to July 2019 were included. Hospital records of men presenting within 30 days of biopsy were searched to determine whether post-biopsy infection (PBI) occurred, antibiotic usage, and duration of hospitalization. Prophylaxis during the pre-ertapenem period (period 1: 2006 to 2012) was oral ciprofloxacin for three days, with oral amoxicillin-clavulanate added in 2009. During the subsequent period (period 2: 2012 to 2019) a single intramuscular dose of ertapenem was used. FINDINGS From periods 1 and 2, 1663 and 2357 men, respectively, were included. Median age was 65 years for both groups. Between periods 1 and 2, PBI incidence decreased from 2.65% to 0.34% (risk ratio: 0.13; 95% confidence interval (CI): 0.06, 0.27), and PBI-related bacteraemia from 1.14% to 0.04% (0.04; 0.01, 0.22), with a single bacteraemia during period 2. PBI treatment antibiotic consumption decreased from 57.6 to 4.3 defined daily doses (DDDs) per 100 biopsies (mean difference: -53.3; 95% CI: -73.1, -33.5) and overall consumption (treatment plus prophylaxis) decreased from 580.8 to 104.3 DDDs per 100 biopsies (mean difference: -476.5). PBI-related hospitalized bed-days per 100 biopsies decreased from 9.44 to 0.89 (mean difference: -8.55; 95% CI: -12.31, -4.79). CONCLUSION Ertapenem prophylaxis was highly effective and resulted in marked reductions in overall antibiotic consumption and inpatient bed-days. Effective prophylaxis has advantages from an antimicrobial stewardship perspective.
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Affiliation(s)
- M G Bloomfield
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand.
| | - A D Wilson
- School of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - R C Studd
- Department of Urology, Wellington Regional Hospital, Wellington, New Zealand
| | - T K Blackmore
- Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand
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Risk factors and outcomes of patients colonized with carbapenemase-producing and non–carbapenemase-producing carbapenem-resistant Enterobacteriaceae. Infect Control Hosp Epidemiol 2020; 41:1154-1161. [DOI: 10.1017/ice.2020.266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AbstractObjective:To compare risk factors and outcome of patients colonized with carbapenemase-producing (CP) carbapenem-resistant Enterobactereaceae (CRE) and non–CP-CRE.Design:A comparative historical study.Setting:A 1,000-bed tertiary-care university hospital.Patients:Adults with CP-CRE positive rectal swab cultures, non–CP-CRE positive rectal swab cultures, and negative rectal swab cultures (non-CRE).Methods:CP-CRE and non–CP-CRE colonized adult patients versus patients not colonized with CRE hospitalized during 24 months were included. We identified patients retrospectively through the microbiology laboratory, and we reviewed their files for demographics, underlying diseases, Charlson Index, treatment, and outcome.Results:This study included 447 patients for whom a rectal swab for CRE was obtained: 147 positive for CP-CRE, 147 positive for non–CP-CRE, and 147 negative for both. Patients with CP-CRE and non–CP-CRE versus no CRE more frequently resided in nursing homes (P<0.001), received antibiotics 3 months prior to admission (P < .001), and received glucocorticosteroids 3 months prior to admission (P = .047 and P < .001, respectively). Risk factors unique for non–CP-CRE versus CP-CRE colonization included mechanical ventilation and patient movement between hospital departments. Non–CP-CRE was a predictor for mechanical ventilation 2.5 that of CP-CRE colonization. In-hospital mortality was highest among non–CP-CRE–colonized patients. On COX multivariate regression for mortality prediction age, Charlson index and steroid treatment 3 months before admission influenced mortality (P = .027, P = .023, and P = .013, respectively).Conclusions:Overlapping and unique risk factors are associated with CP-CRE and non–CP-CRE colonization. Non–CP-CRE colonized patients had a higher in-hospital mortality rate.
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