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Ruegsegger L, Xiao J, Naziripour A, Kanumuambidi T, Brown D, Williams F, Marshall SH, Rudin SD, Yen K, Chu T, Chen L, Sozzi E, Bartelt L, Kreiswirth B, Bonomo RA, van Duin D. Multidrug-Resistant Gram-Negative Bacteria in Burn Patients. Antimicrob Agents Chemother 2022; 66:e0068822. [PMID: 36066237 PMCID: PMC9487463 DOI: 10.1128/aac.00688-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
Patients with burn injuries are at high risk for infectious complications, and infections are the most common cause of death after the first 72 h of hospitalization. Hospital-acquired infections caused by multidrug resistant (MDR) Gram-negative bacteria (GNB) in this population are concerning. Here, we evaluated carriage with MDR GNB in patients in a large tertiary-care burn intensive care unit. Twenty-nine patients in the burn unit were screened for intestinal carriage. Samples were cultured on selective media. Median time from admission to the burn unit to first sample collection was 9 days (IQR 5 - 17 days). In 21 (72%) patients, MDR GNB were recovered; the most common bacterial species isolated was Pseudomonas aeruginosa, which was found in 11/29 (38%) of patients. Two of these patients later developed bloodstream infections with P. aeruginosa. Transmission of KPC-31-producing ST22 Citrobacter freundii was detected. Samples from two patients grew genetically similar C. freundii isolates that were resistant to ceftazidime-avibactam. On analysis of whole-genome sequencing, blaKPC-31 was part of a Tn4401b transposon that was present on two different plasmids in each C. freundii isolate. Plasmid curing experiments showed that removal of both copies of blaKPC-31 was required to restore susceptibility to ceftazidime-avibactam. In summary, MDR GNB colonization is common in burn patients and patient-to-patient transmission of highly resistant GNB occurs. These results emphasize the ongoing need for infection prevention and antimicrobial stewardship efforts in this highly vulnerable population.
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Affiliation(s)
- Laura Ruegsegger
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jamie Xiao
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Arash Naziripour
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Trey Kanumuambidi
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dylan Brown
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Felicia Williams
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Steven H. Marshall
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Susan D. Rudin
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kelly Yen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Tingyu Chu
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Emanuele Sozzi
- Department of Environmental Science and Engineering, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Luther Bartelt
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Barry Kreiswirth
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USA
| | - Robert A. Bonomo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
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2
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Raun-Petersen C, Toft A, Nordestgaard MM, Holm A, Overballe-Petersen S, Hammerum AM, Hasman H, Justesen US. Investigation of an Enterobacter hormaechei OXA-436 carbapenemase outbreak: when everything goes down the drain. Infect Prev Pract 2022; 4:100228. [PMID: 35860606 PMCID: PMC9289634 DOI: 10.1016/j.infpip.2022.100228] [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: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022] Open
Abstract
Over a time period of 18 months an Enterobacter hormaechei sequence type (ST) 90, harboring a blaOXA-436 carbapenemase gene, was isolated from seven patients at Odense University Hospital, Denmark. The patients were all from the same department, but there was no apparent direct epidemiological link. Whole genome sequencing (WGS) was performed on all clinical isolates as well as on a number of environmental samples including two E. hormaechei ST90 isolates carrying the blaOXA-436 gene, which were isolated in samples from two shower drains at the department. These drains were suspected to be the source of the outbreak.
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Affiliation(s)
| | - Annette Toft
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
| | | | - Anette Holm
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
| | | | - Anette M Hammerum
- Statens Serum Institut, Department of Microbiology and Infection Control, Copenhagen, Denmark
| | - Henrik Hasman
- Statens Serum Institut, Department of Microbiology and Infection Control, Copenhagen, Denmark
| | - Ulrik Stenz Justesen
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
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Grohs P, Vilfaillot A, Zahar JR, Barbut F, Frange P, Casetta A, Moulin V, Lawrence C, Baune P, Bourgeois C, Bouffier A, Laussucq C, Sienzonit L, Picard S, Podglajen I, Kassis-Chikhani N. Faecal carriage of multidrug-resistant bacteria and associated risk factors: results from a point prevalence study. J Antimicrob Chemother 2022; 77:2667-2678. [PMID: 36031727 DOI: 10.1093/jac/dkac289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Since 2003, incidences of carbapenemase-producing Gram-negative bacilli (CP-GNB) and vancomycin-resistant Enterococcus faecium (VRE) have steadily increased in France. We therefore conducted a point prevalence study to estimate carriage rates of CP-GNB, VRE and ESBL-producing Enterobacterales (ESBL-PE) and associated risk factors. METHODS Between September 2019 and January 2020, all inpatients hospitalized on a given day in 11 teaching hospitals in the Paris urban area were eligible. Patient interviews and rectal swab screening results were recorded by dedicated nurses. The swabs were plated onto selective chromogenic media and processed using the GeneXpert® system. RESULTS Of 2396 patients, 364 (15.2%) yielded at least one multiresistant bacterial isolate, including 29 CP-GNB carriers (1.2%), 13 VRE carriers (0.5%) and 338 ESBL-PE carriers (14%). In 15 patients (4.4% of ESBL-PE carriers and 36.6% of CP-GNB/VRE carriers), concomitant CP-GNB/VRE and ESBL-PE carriage was observed. In 7/29 CP-GNB and 7/13 VRE carriers, carbapenemase production and vanA in the screening samples was only detected with Xpert® tests. The OXA-48 gene was predominant in 13/34 CP-GNB isolates from 29 carriers. From the 338 ESBL-PE carriers, 372 isolates were recovered, mainly Escherichia coli (61.2%). Among 379 children, 1.1% carried a CP-GNB/VRE strain, and 12.4% carried an ESBL strain. Previous hospitalization outside mainland France, previous antimicrobial treatment and previous ESBL-PE carriage were the main risk factors associated with CP-GNB and/or VRE carriage. CONCLUSIONS The low CP-GNB and VRE prevalence likely reflects the French policy to limit intrahospital spread of CP-GNB and VRE strains.
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Affiliation(s)
- Patrick Grohs
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Aurélie Vilfaillot
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Jean Ralph Zahar
- Equipe Opérationnelle en Hygiène, Hôpitaux Avicenne, Bobigny/Jean Verdier, Bondy/René Muret, Sevran, France
| | - Frédéric Barbut
- Equipe Opérationnelle en Hygiène, Hôpital St Antoine, Paris, France
| | - Pierre Frange
- Equipe Opérationnelle en Hygiène, Laboratoire de microbiologie clinique, Hôpital Necker - Enfants malades, Paris, France
| | - Anne Casetta
- Equipe Opérationnelle en Hygiène, Hôpital Cochin, Paris, France
| | - Véronique Moulin
- Equipe Opérationnelle en Hygiène, Hôpitaux Corentin Celton/Vaugirard, Issy-les-Moulineaux, France
| | - Christine Lawrence
- Equipe Opérationnelle en Hygiène, GHU Paris-Saclay site R, Poincaré, APHP, Garches, France
| | - Patricia Baune
- Equipe Opérationnelle en Hygiène, Hôpital Paul Brousse, Villejuif, France
| | - Cléo Bourgeois
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Axel Bouffier
- Unité de Recherche Clinique, Hôpital Européen Georges Pompidou, Paris, France.,INSERM Centre d'Investigation Clinique 1418 (CIC1418), Paris, France
| | - Claudine Laussucq
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Lydia Sienzonit
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Simon Picard
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Isabelle Podglajen
- Laboratoire de microbiologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Najiby Kassis-Chikhani
- Equipe Opérationnelle en Hygiène, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
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López-Hernández I, López-Cerero L, Fernández-Cuenca F, Pascual Á. The role of the microbiology laboratory in the diagnosis of multidrug-resistant Gram-negative bacilli infections. The importance of the determination of resistance mechanisms. Med Intensiva 2022; 46:455-464. [PMID: 35643635 DOI: 10.1016/j.medine.2022.05.003] [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: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
Early diagnosis and treatment has an important impact on the morbidity and mortality of infections caused by multidrug-resistant bacteria. Multidrug-resistant gram-negative bacilli (MR-GNB) constitute the main current threat in hospitals and especially in intensive care units (ICU). The role of the microbiology laboratory is essential in providing a rapid and effective response. This review updates the microbiology laboratory procedures for the rapid detection of BGN-MR and its resistance determinants. The role of the laboratory in the surveillance and control of outbreaks caused by these bacteria, including typing techniques, is also studied. The importance of providing standardized resistance maps that allow knowing the epidemiological situation of the different units is emphasized. Finally, the importance of effective communication systems for the transmission of results and decision making in the management of patients infected by BGN-MR is reviewed.
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Affiliation(s)
- I López-Hernández
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - L López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernández-Cuenca
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
| | - Á Pascual
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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El papel del laboratorio de microbiología en el diagnóstico de infecciones por bacilos gramnegativos multirresistentes. Importancia de la determinación de mecanismos de resistencias. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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blaVIM in wastewater drains: A hidden circulation of VIM-producing Enterobacterales in the hospital setting? Infect Control Hosp Epidemiol 2021; 43:1277-1278. [PMID: 34743769 DOI: 10.1017/ice.2021.234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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7
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Eveillard M, Lemarié C. Re: 'A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit' by Valentin et al. Clin Microbiol Infect 2021; 27:1367-1368. [PMID: 33975006 DOI: 10.1016/j.cmi.2021.04.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Matthieu Eveillard
- Laboratoire de bactériologie, Département des agents infectieux, Centre hospitalier universitaire, Angers, France; Centre de Recherche en Cancérologie et Immunologie Nantes-Angers Inserm, Université de Nantes, Université d'Angers, Angers, Nantes, France.
| | - Carole Lemarié
- Laboratoire de bactériologie, Département des agents infectieux, Centre hospitalier universitaire, Angers, France
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