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Yasmeen N, Aslam B, Fang LX, Baloch Z, Liu Y. Occurrence of extended- spectrum β-lactamase harboring K. pneumoniae in various sources: a one health perspective. Front Cell Infect Microbiol 2023; 13:1103319. [PMID: 37287469 PMCID: PMC10242356 DOI: 10.3389/fcimb.2023.1103319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
This study was designed to investigate the occurrence and dissemination of extended-spectrum β-lactamase (ESBL) harboring Klebsiella pneumoniae in various ecological niches under the one health approach. A total of 793 samples were collected from animals, humans, and the environment. The findings of the study revealed the occurrence of K. pneumoniae as follows: animals (11.6%), humans (8.4%), and associated environments (7.0%), respectively. A high occurrence rate of ESBL genes was found in animals compared to human and environmental isolates. A total of 18 distinct sequence types (STs) and 12 clonal complexes of K. pneumoniae were observed. Overall, six STs of K. pneumoniae were identified in commercial chickens, and three were found in rural poultry. The majority of K. pneumoniae STs found in this study were positive for blaSHV, while the positivity of other ESBL-encoding genes combinations was different in different STs. The high occurrence rate of ESBL-harboring K. pneumoniae found in animals as compared to other sources is alarming and has the potential to be disseminated to the associated environment and community.
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Affiliation(s)
- Nafeesa Yasmeen
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Bilal Aslam
- Institute of Microbiology, Government College University, Faisalabad, Pakistan
| | - Liang-xing Fang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Zulqarnain Baloch
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yahong Liu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
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2
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Chen L, Hua J, Hong SJ, Yuan CY, Jing RC, Luo XY, Xue HW, Yue Y, He XP. Comparison of the relative efficacy of β-lactam/β-lactamase inhibitors and carbapenems in the treatment of complicated urinary tract infections caused by ceftriaxone-non-susceptible Enterobacterales: a multicentre retrospective observational cohort study. J Antimicrob Chemother 2023; 78:710-718. [PMID: 36691860 DOI: 10.1093/jac/dkac448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Treating complicated urinary tract infections (cUTIs) caused by ESBL-producing Enterobacterales represents a significant clinical challenge. The present study was thus developed to explore the relative efficacy of β-lactam/β-lactamase inhibitors (BLBLIs) and carbapenems for the treatment of hospitalized patients suffering from cUTIs caused by BLBLI-susceptible ceftriaxone-non-susceptible Enterobacterales. METHODS Data from 557 patients from four Chinese teaching hospitals diagnosed with cUTIs caused by ceftriaxone-non-susceptible Enterobacterales from January 2017 to May 2022 were retrospectively assessed. RESULT The 30 day rate of treatment failure, defined by unresolved symptoms or mortality, was 10.4% (58/557). Independent predictors of 30 day treatment failure included immunocompromised status, bacteraemia, septic shock, lack of infection source control and appropriate empirical treatment. When data were controlled for potential confounding variables, BLBLI treatment exhibited a comparable risk of 14 day (OR 1.61, 95% CI 0.86-3.00, P = 0.133) and 30 day treatment failure (OR 1.45, 95% CI 0.66-3.15, P = 0.354) relative to carbapenem treatment for the overall cohort of patients. In contrast, BLBLI treatment in immunocompromised patients was associated with an elevated risk of both 14 day (OR 3.18, 95% CI 1.43-7.10, P = 0.005) and 30 day treatment failure (OR 3.06, 95% CI 1.07-8.80, P = 0.038) relative to carbapenem treatment. CONCLUSIONS These results suggested that carbapenem treatment may be superior to BLBLI treatment for immunocompromised patients suffering from cUTIs caused by ceftriaxone-non-susceptible Enterobacterales species. However, these results will need to be validated in appropriately constructed randomized controlled trials to ensure appropriate patient treatment.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Jie Hua
- Department of Gastroenterology, Liyang People's Hospital, Liyang Branch Hospital of Jiangsu Province Hospital, Nanjing, China
| | - Shu-Jie Hong
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Chen-Yang Yuan
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Ruo-Chen Jing
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Xuan-Yu Luo
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Hao-Wen Xue
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Yue Yue
- Department of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Xiao-Pu He
- Department of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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3
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Yoon YK, Moon C, Kim J, Heo ST, Lee MS, Lee S, Kwon KT, Kim SW. Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults. Infect Chemother 2022; 54:812-853. [PMID: 36596690 PMCID: PMC9840951 DOI: 10.3947/ic.2022.0156] [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: 11/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The guidelines are intended to provide practical information for the correct use of antibiotics for intra-abdominal infections in Korea. With the aim of realizing evidence-based treatment, these guidelines for the use of antibiotics were written to help clinicians find answers to key clinical questions that arise in the course of patient care, using the latest research results based on systematic literature review. The guidelines were prepared in consideration of the data on the causative pathogens of intra-abdominal infections in Korea, the antibiotic susceptibility of the causative pathogens, and the antibiotics available in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Chisook Moon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Sang Taek Heo
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Mi Suk Lee
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Shinwon Lee
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ki-Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Pfaller M, Shortridge D, Chen WT, Sader H, Castanheira M. Ceftolozane/Tazobactam Activity Against Drug-Resistant Pseudomonas aeruginosa and Enterobacterales Causing Healthcare-Associated Infections in Eight Asian Countries: Report from an Antimicrobial Surveillance Program (2016-2018). Infect Drug Resist 2022; 15:6739-6753. [PMID: 36444213 PMCID: PMC9700433 DOI: 10.2147/idr.s387097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/14/2022] [Indexed: 12/01/2023] Open
Abstract
PURPOSE To evaluate the in vitro activity of ceftolozane/tazobactam and comparator agents tested against Pseudomonas aeruginosa and Enterobacterales isolates from hospitalised patients in Asia. Ceftolozane/tazobactam is an antipseudomonal cephalosporin combined with a well-established β-lactamase inhibitor. METHODS A total of 2038 Gram-negative organisms (376 P. aeruginosa and 1662 Enterobacterales) were collected consecutively using a prevalence-based approach from 11 medical centres. Organisms were susceptibility tested by broth microdilution according to CLSI guidelines. CLSI and EUCAST breakpoint criteria were used. RESULTS Ceftolozane/tazobactam was the most potent (MIC50/90, 0.5/4 mg/L) β-lactam agent tested against P. aeruginosa isolates, inhibiting 91.0% of the isolates at an MIC of ≤4 mg/L. P. aeruginosa exhibited high rates of susceptibility to amikacin (92.0/92.0% [CLSI/EUCAST]) and colistin by EUCAST criteria only (99.2% intermediate [CLSI]/99.2% susceptible [EUCAST]). Ceftolozane/tazobactam (MIC50/90, 0.25/16 mg/L; 86.8/86.8% susceptible [CLSI/EUCAST]) and meropenem (MIC50/90, 0.03/0.12 mg/L; 93.0/93.3% susceptible [CLSI/EUCAST]) were the most active compounds tested against Enterobacterales. Isolates displayed susceptibility rates to other β-lactam agents, ranging from 81.5/77.7% for piperacillin/tazobactam, 66.0/64.5% for cefepime, and 65.3/60.9% for ceftazidime using CLSI/EUCAST breakpoints. Among the Enterobacterales isolates, 6.8% were carbapenem-resistant Enterobacterales (CRE) and 29.6% exhibited an extended-spectrum β-lactamase (ESBL) non-CRE phenotype. Ceftolozane/tazobactam showed good activity against ESBL non-CRE phenotype strains of Enterobacterales (MIC50/90, 0.5/8 mg/L; 84.8/84.8% susceptible), but not against isolates with a CRE phenotype (MIC50/90, >32/>32 mg/L). CONCLUSION Ceftolozane/tazobactam was the most active β-lactam agent tested against P. aeruginosa and demonstrated higher in vitro activity than the available cephalosporins when tested against Enterobacterales from Asian countries.
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Affiliation(s)
- Michael Pfaller
- JMI Laboratories, North Liberty, IA, USA
- University of Iowa College of Medicine, Iowa City, IA, USA
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5
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Cornely OA, Cisneros JM, Torre-Cisneros J, Rodríguez-Hernández MJ, Tallón-Aguilar L, Calbo E, Horcajada JP, Queckenberg C, Zettelmeyer U, Arenz D, Rosso-Fernández CM, Jiménez-Jorge S, Turner G, Raber S, O'Brien S, Luckey A. Pharmacokinetics and safety of aztreonam/avibactam for the treatment of complicated intra-abdominal infections in hospitalized adults: results from the REJUVENATE study. J Antimicrob Chemother 2021; 75:618-627. [PMID: 31828337 PMCID: PMC7021089 DOI: 10.1093/jac/dkz497] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives To investigate pharmacokinetics (PK) and safety (primary objectives) and efficacy (secondary objective) of the investigational monobactam/β-lactamase inhibitor combination aztreonam/avibactam in patients with complicated intra-abdominal infection (cIAI). Methods This Phase 2a open-label, multicentre study (NCT02655419; EudraCT 2015-002726-39) enrolled adults with cIAI into sequential cohorts for 5–14 days treatment. Cohort 1 patients received an aztreonam/avibactam loading dose of 500/137 mg (30 min infusion), followed by maintenance doses of 1500/410 mg (3 h infusions) q6h; Cohort 2 received 500/167 mg (30 min infusion), followed by 1500/500 mg (3 h infusions) q6h. Cohort 3 was an extension of exposure at the higher dose regimen. Doses were adjusted for creatinine clearance of 31–50 mL/min (Cohorts 2 + 3). All patients received IV metronidazole 500 mg q8h. PK, safety and efficacy were assessed. Results Thirty-four patients (Cohort 1, n = 16; Cohorts 2 + 3, n = 18) comprised the modified ITT (MITT) population. Mean exposures of aztreonam and avibactam in Cohorts 2 + 3 were consistent with those predicted to achieve joint PK/pharmacodynamic target attainment in >90% patients. Adverse events (AEs) were similar between cohorts. The most common AEs were hepatic enzyme increases [n = 9 (26.5%)] and diarrhoea [n = 5 (14.7%)]. Clinical cure rates at the test-of-cure visit overall were 20/34 (58.8%) (MITT) and 14/23 (60.9%) (microbiological-MITT population). Conclusions Observed AEs were consistent with the known safety profile of aztreonam monotherapy, with no new safety concerns identified. These data support selection of the aztreonam/avibactam 500/167 mg (30 min infusion) loading dose and 1500/500 mg (3 h infusions) maintenance dose q6h regimen, in patients with creatinine clearance >50 mL/min, for the Phase 3 development programme.
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Affiliation(s)
- Oliver A Cornely
- University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (CTC Cologne), Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, German Centre for Infection Research (DZIF) partner site Cologne, Cologne, Germany
| | | | | | | | | | - Esther Calbo
- Hospital Universitario Mútua de Tarrasa and Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Christian Queckenberg
- University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (CTC Cologne), Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, German Centre for Infection Research (DZIF) partner site Cologne, Cologne, Germany
| | - Ulrike Zettelmeyer
- University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (CTC Cologne), Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, German Centre for Infection Research (DZIF) partner site Cologne, Cologne, Germany
| | - Dorothee Arenz
- University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Clinical Trials Centre Cologne (CTC Cologne), Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, German Centre for Infection Research (DZIF) partner site Cologne, Cologne, Germany
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6
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Bart SM, Farley JJ, Bala S, Amini T, Cox E. Geographic Shifts in Antibacterial Drug Clinical Trial Enrollment: Implications for Generalizability. Clin Infect Dis 2021; 72:1422-1428. [PMID: 32161946 DOI: 10.1093/cid/ciaa246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/09/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As drug development has globalized, trials have increasingly enrolled participants from all parts of the world rather than just the United States and Western Europe. For antibacterial drug trials, understanding enrollment trends and regional differences is important for generalizability considerations. METHODS We retrospectively analyzed 42 phase 3 trials submitted to the US Food and Drug Administration after 2001 for complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), community-acquired bacterial pneumonia (CABP), and acute bacterial skin and skin structure infection (ABSSSI) (n = 29 282 participants). Enrollment numbers, demographics, clinical characteristics, and microbiological data were compared to identify temporal and geographic trends. RESULTS For cUTI, cIAI, and CABP trials, Eastern European enrollment greatly increased over the study period. For ABSSSI trials, North American enrollment increased. Demographic characteristics and regional microbiology among regions were broadly similar with several exceptions. For cIAI trials, Eastern European participants had the lowest proportion of participants with prior antibacterial drug therapy. For ABSSSI trials, North American participants more commonly reported intravenous drug use. Microbiological differences relative to North America included a greater proportion of Klebsiella pneumoniae among Asian cIAI isolates (17.8% vs 9.0%, P = .0057), a higher proportion of cephalosporin resistance in South American Enterobacteriaceae cUTI isolates (26.8% vs 15.7%, P = .044), and a lower proportion of Staphylococcus aureus in Eastern European ABSSSI isolates (43.7% vs 61.9%, P < .0001). CONCLUSIONS Geographic trends in recruitment for recent antibacterial clinical trials differ by indication. Regional similarities in demographic characteristics and microbiology across regions lessen concerns regarding generalizability due to shifting enrollment trends.
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Affiliation(s)
- Stephen M Bart
- Office of Infectious Diseases, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - John J Farley
- Office of Infectious Diseases, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shukal Bala
- Office of Infectious Diseases, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Thushi Amini
- Office of Infectious Diseases, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - Edward Cox
- Office of Infectious Diseases, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland, USA
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7
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Wu X, Wu J, Wang P, Fang X, Yu Y, Tang J, Xiao Y, Wang M, Li S, Zhang Y, Hu B, Ma T, Li Q, Wang Z, Wu A, Liu C, Dai M, Ma X, Yi H, Kang Y, Wang D, Han G, Zhang P, Wang J, Yuan Y, Wang D, Wang J, Zhou Z, Ren Z, Liu Y, Guan X, Ren J. Diagnosis and Management of Intraabdominal Infection: Guidelines by the Chinese Society of Surgical Infection and Intensive Care and the Chinese College of Gastrointestinal Fistula Surgeons. Clin Infect Dis 2021; 71:S337-S362. [PMID: 33367581 DOI: 10.1093/cid/ciaa1513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Chinese guidelines for IAI presented here were developed by a panel that included experts from the fields of surgery, critical care, microbiology, infection control, pharmacology, and evidence-based medicine. All questions were structured in population, intervention, comparison, and outcomes format, and evidence profiles were generated. Recommendations were generated following the principles of the Grading of Recommendations Assessment, Development, and Evaluation system or Best Practice Statement (BPS), when applicable. The final guidelines include 45 graded recommendations and 17 BPSs, including the classification of disease severity, diagnosis, source control, antimicrobial therapy, microbiologic evaluation, nutritional therapy, other supportive therapies, diagnosis and management of specific IAIs, and recognition and management of source control failure. Recommendations on fluid resuscitation and organ support therapy could not be formulated and thus were not included. Accordingly, additional high-quality clinical studies should be performed in the future to address the clinicians' concerns.
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Affiliation(s)
- Xiuwen Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Wu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.,BenQ Medical Center, Nanjing Medical University, Nanjing, China
| | - Peige Wang
- Department of Emergency Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xueling Fang
- Department of Critical Care Medicine, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianguo Tang
- Department of Emergency Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - Yonghong Xiao
- Department of Infectious Diseases, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Shikuan Li
- Department of Emergency Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiang Li
- Department of General Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhiming Wang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Menghua Dai
- Department of Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huimin Yi
- Department of Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Gang Han
- Department of Gastroenterology, Second Hospital of Jilin University, Changchun, China
| | - Ping Zhang
- Department of General Surgery, First Hospital of Jilin University, Changchun, China
| | - Jianzhong Wang
- Department of Gastroenterology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yufeng Yuan
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong Wang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China
| | - Jian Wang
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zheng Zhou
- Department of General Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Zeqiang Ren
- Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuxiu Liu
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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8
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Azab KSM, Abdel-Rahman MA, El-Sheikh HH, Azab E, Gobouri AA, Farag MMS. Distribution of Extended-Spectrum β-Lactamase (ESBL)-Encoding Genes among Multidrug-Resistant Gram-Negative Pathogens Collected from Three Different Countries. Antibiotics (Basel) 2021; 10:247. [PMID: 33801418 PMCID: PMC7998439 DOI: 10.3390/antibiotics10030247] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
The incidence of Extended-spectrum β-lactamase (ESBL)-encoding genes (blaCTX-M and blaTEM) among Gram-negative multidrug-resistant pathogens collected from three different countries was investigated. Two hundred and ninety-two clinical isolates were collected from Egypt (n = 90), Saudi Arabia (n = 162), and Sudan (n = 40). Based on the antimicrobial sensitivity against 20 antimicrobial agents from 11 antibiotic classes, the most resistant strains were selected and identified using the Vitek2 system and 16S rRNA gene sequence analysis. A total of 85.6% of the isolates were found to be resistant to more than three antibiotic classes. The ratios of the multidrug-resistant strains for Egypt, Saudi Arabia, and Sudan were 74.4%, 90.1%, and 97.5%, respectively. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa showed inconstant resistance levels to the different classes of antibiotics. Escherichia coli and Klebsiella pneumoniae had the highest levels of resistance against macrolides followed by penicillins and cephalosporin, while Pseudomonas aeruginosa was most resistant to penicillins followed by classes that varied among different countries. The isolates were positive for the presence of the blaCTX-M and blaTEM genes. The blaCTX-M gene was the predominant gene in all isolates (100%), while blaTEM was detected in 66.7% of the selected isolates. This work highlights the detection of multidrug-resistant bacteria and resistant genes among different countries. We suggest that the medical authorities urgently implement antimicrobial surveillance plans and infection control policies for early detection and effective prevention of the rapid spread of these pathogens.
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Affiliation(s)
- Khaled S. M. Azab
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, Egypt; (K.S.M.A.); (H.H.E.-S.)
| | - Mohamed Ali Abdel-Rahman
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, Egypt; (K.S.M.A.); (H.H.E.-S.)
- Al-Azhar Center of Fermentation Biotechnology and Applied Microbiology, Al-Azhar University, Nasr City, Cairo 11884, Egypt
| | - Hussien H. El-Sheikh
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, Egypt; (K.S.M.A.); (H.H.E.-S.)
| | - Ehab Azab
- Department of Biotechnology, College of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Adil A. Gobouri
- Department of Chemistry, College of Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia;
| | - Mohamed M. S. Farag
- Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Nasr City, Cairo 11884, Egypt; (K.S.M.A.); (H.H.E.-S.)
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9
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Wang C, Hao W, Jin Y, Shen C, Wang B. Pharmacokinetic/Pharmacodynamic Modeling of Seven Antimicrobials for Empiric Treatment of Adult Bloodstream Infections with Gram-Negative Bacteria in China. Microb Drug Resist 2020; 26:1559-1567. [PMID: 31794682 DOI: 10.1089/mdr.2019.0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cuicui Wang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Wei Hao
- Pediatric Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yan Jin
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Cuihua Shen
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Bo Wang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
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10
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Shirani K, Seydayi E, Boroujeni KS. Prevalence and antibiotic resistance pattern of extended-spectrum beta-lactamase-producing Escherichia coli in clinical specimens. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:103. [PMID: 31949454 PMCID: PMC6950332 DOI: 10.4103/jrms.jrms_634_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/26/2018] [Accepted: 09/24/2019] [Indexed: 11/04/2022]
Abstract
Background Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae seem to have an extended antibiotic resistance, but have different resistance patterns throughout different sites and regions. This study aimed to evaluate the antibiotic resistance pattern of ESBL-producing Escherichia coli. Materials and Methods One hundred swab samples from patients hospitalized due to a clinical suspicion of any kind of infection (with manifestations such as fever, leukocytosis, and an active urinalysis result) were processed in Alzahra Microbiology Laboratory, Isfahan, Iran. Isolated E. coli were cultured on Mueller-Hinton agar and antibiotic susceptibility was tested by Kirby-Bauer disk diffusion method following the Clinical and Laboratory Standard Institute 2017 guidelines. Results ESBL-producing samples had higher antibiotic resistance rates than ESBL-non-producing samples: ceftriaxone (58.8% vs. 27.3%), cefotaxime (73.5% vs. 30.3%), ceftizoxime (76.5% vs. 33.3%), cefixime (79.4% vs. 40.9%), and cefpodoxime (73.5% vs. 53%), except for carbenicillin (29.4% vs. 48.5%). Imipenem and meropenem were the least resisted antibiotics in ESBL-producing samples (5.9% and 11.8%). Conclusion ESBL-producing Enterobacteriaceae have a high resistance rate to third-generation cephalosporins and high susceptibility to imipenem and meropenem.
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Affiliation(s)
- Kiana Shirani
- Isfahan Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Seydayi
- Isfahan Infectious Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Zhang H, Tong D, Johnson A, Zhang G, Xu Z, Yang Y, Zhang J, Li D, Duan S, Wang Y, Yang Q, Xu Y. Antimicrobial susceptibility changes of Escherichia coli and Klebsiella pneumoniae intra-abdominal infection isolate-derived pathogens from Chinese intra-abdominal infections from 2011 to 2015. Infect Drug Resist 2019; 12:2477-2486. [PMID: 31496762 PMCID: PMC6693086 DOI: 10.2147/idr.s211952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background To explore the susceptibility trends of antimicrobials and resistance increase to antibiotics of Enterobacteriaceae isolated from patients in China with intra-abdominal infections (IAI) from 2011 to 2015. Methods MIC90 and MIC50 values of 12 commonly used antibiotics from Escherichia coli and Klebsiella pneumoniae isolated from IAI samples were determined. Results A total of 8,477 Gram-negative bacterial pathogens were collected from 21 medical centers in China. The majority of IAI isolate-derived pathogens were E. coli (3,854, 45.5%) and K. pneumoniae (1,670, 19.7%) of which 1,990 (23.5%) were consecutively collected from community acquired (CA) and 6,186 (73.0%) from hospital acquired (HA) IAIs. The drugs with the highest efficacy against E. coli and K. pneumoniae isolates derived from IAI samples were imipenem, ertapenem, amikacin and piperacillin-tazobactam. MIC90 values for piperacillin-tazobactam were 64 µg/mL in 2015 with fluctuations from 16–64 µg/mL through the years for E. coli, but were stable at ≥64 µg/mL from 2011 to 2015 for K. pneumoniae isolates. Susceptibilities to ertapenem, imipenem and amikacin were high for E. coli isolates throughout the study, but K. pneumoniae isolated from abscesses, colon and peritoneal fluid collected from medical and surgical ICUs showed an increasing trend of carbapenem resistance in 2015. Conclusion In 2015 there was a trend of enhanced carbapenem resistance, particularly for K. pneumoniae isolated from IAI samples obtained from patients in ICUs.
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Affiliation(s)
- Hui Zhang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Dawei Tong
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Aaron Johnson
- Department of Microbiology, International Health Management Associates, Schaumburg, IL 60173-3817, USA
| | - Ge Zhang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Zhipeng Xu
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Yang Yang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Jingjia Zhang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Dongxue Li
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Simeng Duan
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Yao Wang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Qiwen Yang
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
| | - Yingchun Xu
- Department of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, People's Republic of China
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12
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Najmi A, Karimi F, Kunhikatta V, Varma M, Nair S. Resistance Trend, Antibiotic Utilization and Mortality in Patients with E. coli Bacteraemia. Open Access Maced J Med Sci 2019; 7:1119-1123. [PMID: 31049092 PMCID: PMC6490482 DOI: 10.3889/oamjms.2019.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Incidence of bacteraemia and driving concerns about antibiotic resistance is increasing globally. Risk factors for developing antimicrobial resistance are antibiotic overuse, incorrect dosing and extended duration of administration. AIM: This study was conducted to examine the prescription and susceptibility pattern of antibiotics in bacteraemia patients with ESBL producing and Non-ESBL-producing E. coli and their correlation with mortality. METHODS: Data were collected from medical records of the patients aged 18 years and above, diagnosed with E. coli bacteremia from January 2013 through July 2017. Institutional ethics committee approval was obtained before the study (IEC 483/2017). Cumulative sensitivity/resistance pattern of isolated microorganisms and DDD/100 bed days of prescribed antibiotics were obtained. RESULTS: 182 cases of E. coli bacteraemia were reviewed. 59.9% (n = 109) were male with an age range of 20-90 years. The mortality rate was 24.9% (n = 44). 55.5% (n = 101) of the isolated organisms were ESBL-producing. A high percentage of resistance to cephalosporins and fluoroquinolones were observed among the patients, and most of the identified isolates were sensitive to the aminoglycosides, carbapenems and β-lactam and β-lactamase inhibitor combinations (BLBLIs). CONCLUSIONS: Frequent utilisation of the high-end antibiotics and increase in microorganism’s resistance to different antibiotics can lead to a worrisome level. Local antibiotic resistance data and consumption policy are essential to prevent and slow down this process. We observed a descending resistance trend for amoxicillin-clavulanic acid combination in our setting to both the ESBL producing and non-producing.
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Affiliation(s)
- Amirreza Najmi
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Fateme Karimi
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijayanarayan Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar Varma
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sreedharan Nair
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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13
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Zhang J, Zhao C, Chen H, Li H, Wang Q, Wang Z, Zhang F, Wang H. A multicenter epidemiology study on the risk factors and clinical outcomes of nosocomial intra-abdominal infections in China: results from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) 2007-2016. Infect Drug Resist 2018; 11:2311-2319. [PMID: 30532564 PMCID: PMC6245374 DOI: 10.2147/idr.s182180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to determine the risk factors for intra-abdominal infections (IAIs), assess the clinical outcomes of IAIs, and investigate the spectrum and antimicrobial resistance of major pathogens causing IAIs. Patients and methods This prospective observational study enrolled patients from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) program between 2007 and 2016. Data on the clinicopathological factors and causative pathogens were collected. The results of antimicrobial susceptibility tests were interpreted according to the minimum inhibitory concentration (MIC) interpretive breakpoints recommended by the Clinical and Laboratory Standards Institute in 2017. Results A total of 2,756 patients were included. The 30-day all-cause mortality was 9.5% (262/2,756). Multivariable analysis showed that the following independent risk factors were associated with the 30-day mortality: age >60 years, pulmonary disease, tracheal cannula, infection occurring in intensive care unit (ICU), prior admission within 3 months, antibiotic use before infection, recent use of immunosuppressants, and multidrug-resistant organisms. In addition, 2,913 clinical isolates were collected. The Gram-negative and Gram-positive bacteria accounted for 70.8% and 29.2% of all isolates, respectively. The most common pathogens were Escherichia coli (33.4%), Klebsiella pneumoniae (10.8%), and Enterococcus faecium (10.7%). Pseudomonas aeruginosa and Acinetobacter baumannii were the most common non-Enterobacteriaceae Gram-negative pathogens. E. faecium, Enterococcus faecalis, and Staphylococcus aureus were the most common Gram-positive pathogens. E. coli, A. baumannii, and Enterobacter cloacae were more commonly found in ICU patients than in non-ICU patients. Overall, the antibiotics tested in the CARES exhibited diminished susceptibility to pathogens over the study period, especially extended spectrum β-lactamase producing isolates. Conclusion Considering the current data set and high-level resistance of intra-abdominal pathogens to various antibiotics, further monitoring of the epidemiology of IAIs and their susceptibility to antibiotics through the CARES is warranted.
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Affiliation(s)
- Jiangang Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Henan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Zhanwei Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China,
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14
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Pfaller M, Shortridge D, Sader H, Castanheira M, Flamm R. Ceftolozane/tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing healthcare-associated infections in the Asia-Pacific region (minus China, Australia and New Zealand): report from an Antimicrobial Surveillance Programme (2013–2015). Int J Antimicrob Agents 2018; 51:181-189. [DOI: 10.1016/j.ijantimicag.2017.09.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/11/2017] [Accepted: 09/30/2017] [Indexed: 01/21/2023]
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15
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Bevan ER, Jones AM, Hawkey PM. Global epidemiology of CTX-M β-lactamases: temporal and geographical shifts in genotype. J Antimicrob Chemother 2018; 72:2145-2155. [PMID: 28541467 DOI: 10.1093/jac/dkx146] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Globally, rates of ESBL-producing Enterobacteriaceae are rising. We undertook a literature review, and present the temporal trends in blaCTX-M epidemiology, showing that blaCTX-M-15 and blaCTX-M-14 have displaced other genotypes in many parts of the world. Explanations for these changes can be attributed to: (i) horizontal gene transfer (HGT) of plasmids; (ii) successful Escherichia coli clones; (iii) ESBLs in food animals; (iv) the natural environment; and (v) human migration and access to basic sanitation. We also provide explanations for the changing epidemiology of blaCTX-M-2 and blaCTX-M-27. Modifiable anthropogenic factors, such as poor access to basic sanitary facilities, encourage the spread of blaCTX-M and other antimicrobial resistance (AMR) genes, such as blaNDM, blaKPC and mcr-1. We provide further justification for novel preventative and interventional strategies to reduce transmission of these AMR genes.
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Affiliation(s)
- Edward R Bevan
- Institute of Microbiology and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Public Health England, West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham B5 9SS, UK
| | - Annie M Jones
- Magus Strategic Communications Ltd, Marr House, Scagglethorpe, Malton YO17?8ED, UK
| | - Peter M Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Public Health England, West Midlands Public Health Laboratory, Heart of England NHS Foundation Trust, Birmingham B5 9SS, UK
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16
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Gomi H, Solomkin JS, Schlossberg D, Okamoto K, Takada T, Strasberg SM, Ukai T, Endo I, Iwashita Y, Hibi T, Pitt HA, Matsunaga N, Takamori Y, Umezawa A, Asai K, Suzuki K, Han HS, Hwang TL, Mori Y, Yoon YS, Huang WSW, Belli G, Dervenis C, Yokoe M, Kiriyama S, Itoi T, Jagannath P, Garden OJ, Miura F, de Santibañes E, Shikata S, Noguchi Y, Wada K, Honda G, Supe AN, Yoshida M, Mayumi T, Gouma DJ, Deziel DJ, Liau KH, Chen MF, Liu KH, Su CH, Chan ACW, Yoon DS, Choi IS, Jonas E, Chen XP, Fan ST, Ker CG, Giménez ME, Kitano S, Inomata M, Mukai S, Higuchi R, Hirata K, Inui K, Sumiyama Y, Yamamoto M. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2018; 25:3-16. [PMID: 29090866 DOI: 10.1002/jhbp.518] [Citation(s) in RCA: 206] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. The Tokyo Guidelines 2018 (TG18) provides recommendations for the appropriate use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy provided before the infecting isolates are identified. Antimicrobial agents are listed by class-definitions and TG18 severity grade I, II, and III subcategorized by clinical settings. In the era of emerging and increasing antimicrobial resistance, monitoring and updating local antibiograms is underscored. Prudent antimicrobial usage and early de-escalation or termination of antimicrobial therapy are now important parts of decision-making. What is new in TG18 is that the duration of antimicrobial therapy for both acute cholangitis and cholecystitis is systematically reviewed. Prophylactic antimicrobial usage for elective endoscopic retrograde cholangiopancreatography is no longer recommended and the section was deleted in TG18. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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Affiliation(s)
- Harumi Gomi
- Center for Global Health, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David Schlossberg
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
| | - Tadahiro Takada
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Steven M Strasberg
- Section of HPB Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Tomohiko Ukai
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, Mie, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Henry A Pitt
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Naohisa Matsunaga
- Department of Infection Control and Prevention, Teikyo University, Tokyo, Japan
| | - Yoriyuki Takamori
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Akiko Umezawa
- Minimally Invasive Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kenji Suzuki
- Department of Surgery, Fujinomiya City General Hospital, Shizuoka, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tsann-Long Hwang
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Giulio Belli
- Department of General and HPB Surgery, Loreto Nuovo Hospital, Naples, Italy
| | | | - Masamichi Yokoe
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Seiki Kiriyama
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Palepu Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research Centre, Mumbai, India
| | - O James Garden
- Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Fumihiko Miura
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Eduardo de Santibañes
- Department of Surgery, Hospital Italiano, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Yoshinori Noguchi
- Department of General Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University, School of Medicine, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
| | - Avinash Nivritti Supe
- Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai, India
| | - Masahiro Yoshida
- Department of Hemodialysis and Surgery, Ichikawa Hospital, International University of Health and Welfare, Chiba, Japan.,Department of EBM and Guidelines, Japan Council for Quality Health Care, Tokyo, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine University of Occupational and Environmental Health, Fukuoka, Japan
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel J Deziel
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kui-Hin Liau
- Liau KH Consulting PL, Mt Elizabeth Novena Hospital, Singapore, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Miin-Fu Chen
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Division of General Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsi Su
- Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Angus C W Chan
- Surgery Centre, Department of Surgery, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Dong-Sup Yoon
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - In-Seok Choi
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Eduard Jonas
- Surgical Gastroenterology/Hepatopancreatobiliary Unit, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Xiao-Ping Chen
- Hepatic Surgery Centre, Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheung Tat Fan
- Liver Surgery Centre, Hong Kong Sanatorium and Hospital, Hong Kong, Hong Kong
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Mariano Eduardo Giménez
- Chair of General Surgery and Minimal Invasive Surgery "Taquini", University of Buenos Aires, Argentina, DAICIM Foundation, Buenos Aires, Argentina
| | | | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, Oita, Japan
| | - Shuntaro Mukai
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, Hokkaido, Japan
| | - Kazuo Inui
- Department of Gastroenterology, Second Teaching Hospital, Fujita Health University, Aichi, Japan
| | | | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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17
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Samonis G, Vardakas KZ, Maraki S, Stamouli P, Mavromanolaki VE, Kofteridis DP, Falagas ME. Resistance phenotypes and susceptibility of contemporarySerratiaisolates in the university hospital of Crete, Greece. Infect Dis (Lond) 2017; 49:847-853. [DOI: 10.1080/23744235.2017.1361546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- George Samonis
- Department of Internal Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Konstantinos Z. Vardakas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital Center, Athens, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Petroula Stamouli
- Department of Applied Mathematics and Physics, National Technical University of Athens, Athens, Greece
| | | | | | - Matthew E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital Center, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
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18
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Gomila A, Badia JM, Carratalà J, Serra-Aracil X, Shaw E, Diaz-Brito V, Castro A, Espejo E, Nicolás C, Piriz M, Brugués M, Obradors J, Lérida A, Cuquet J, Limón E, Gudiol F, Pujol M. Current outcomes and predictors of treatment failure in patients with surgical site infection after elective colorectal surgery. A multicentre prospective cohort study. J Infect 2017; 74:555-563. [PMID: 28315721 DOI: 10.1016/j.jinf.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/27/2017] [Accepted: 03/08/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To determine current outcomes and predictors of treatment failure among patients with surgical site infection (SSI) after colorectal surgery. METHODS A multicentre observational prospective cohort study of adults undergoing elective colorectal surgery in 10 Spanish hospitals (2011-2014). Treatment failure was defined as persistence of signs/symptoms of SSI or death at 30 days post-surgery. RESULTS Of 3701 patients, 669 (18.1%) developed SSI; 336 (9.1%) were organ-space infections. Among patients with organ-space SSI, 81.2% required source control: 60.4% reoperation and 20.8% percutaneous/transrectal drainage. Overall treatment failure rate was 21.7%: 9% in incisional SSIs and 34.2% in organ-space SSIs (p < 0.001). Median length of stay was 15 days (IQR 9-22) for incisional SSIs and 24 days (IQR 17-35) for organ-space SSIs (p < 0.001). One hundred and twenty-seven patients (19%) required readmission and 35 patients died (5.2%). Risk factors for treatment failure among patients with organ-space SSI were age ≥65 years (OR 1.83, 95% CI: 1.07-1.83), laparoscopy (OR 1.7, 95% CI: 1.06-2.77), and reoperation (OR 2.8, 95% CI: 1.7-4.6). CONCLUSIONS Rates of SSI and treatment failure in organ-space SSI after elective colorectal surgery are notably high. Careful attention should be paid to older patients with previous laparoscopy requiring reoperation for organ-space SSI, so that treatment failure can be identified early.
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Affiliation(s)
- Aina Gomila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Josep Ma Badia
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Xavier Serra-Aracil
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu de Sant Boi, Barcelona, Spain.
| | - Antoni Castro
- Department of Internal Medicine, Hospital Universitari Sant Joan de Reus, Tarragona, Spain; VINCat Program, Spain.
| | - Elena Espejo
- Department of Infectious Diseases, Consorci Sanitari de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Carmen Nicolás
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Barcelona, Spain; VINCat Program, Spain.
| | - Marta Piriz
- Department of Surgery and Infection Control Team, Corporació Sanitària Parc Taulí, Barcelona, Spain; VINCat Program, Spain.
| | - Montserrat Brugués
- Department of Internal Medicine, Consorci Sanitari de l'Anoia, Barcelona, Spain; VINCat Program, Spain.
| | - Josefina Obradors
- Department of Internal Medicine, Fundació Althaia, Barcelona, Spain; VINCat Program, Spain.
| | - Ana Lérida
- Department of Internal Medicine, Hospital de Viladecans, Barcelona, Spain; VINCat Program, Spain.
| | - Jordi Cuquet
- Department of General Surgery, Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona, Spain; VINCat Program, Spain.
| | | | - Francesc Gudiol
- VINCat Program, Spain; University of Barcelona, Barcelona, Spain.
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain; VINCat Program, Spain.
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Maraki S, Vardakas KZ, Mavromanolaki VE, Kyriakidou M, Spais G, Kofteridis DP, Samonis G, Falagas ME. In vitro susceptibility and resistance phenotypes in contemporary Citrobacter isolates in a University Hospital in Crete, Greece. Infect Dis (Lond) 2017; 49:532-539. [PMID: 28276281 DOI: 10.1080/23744235.2017.1297896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Data on Citrobacter spp. susceptibility are scarce. We sought to study the evolution in the susceptibility of 385 Citrobacter spp. at the University Hospital of Heraklion, Crete, Greece during a six-year period (2010-2015). METHODS Non-duplicate strains isolated from inpatients (intensive care unit, oncology, surgery, internal medicine, paediatrics) and outpatients were studied using Vitek 2. Phenotypic confirmatory tests were applied for detection of β-lactamases and aminoglycoside modifying enzymes. RESULTS C. freundii (172, 44.7%) and C. koseri (166, 43.1%) were the most commonly isolated species. C. braakii (34), C. amalonaticus (6), C. youngae (6) and C. sedlakii (1) were the remaining isolates. Colistin and fosfomycin were the most active antibiotics (both 99.2%) followed by carbapenems (99%) aminoglycosides (96.6-98.4%), tigecycline (96.1%), cefepime (94.8%), ciprofloxacin (94.3%), tetracycline (92.7%), trimethoprim/sulphamethoxazole (91.4%), chloramphenicol (88.1%), piperacillin/tazobactam (86.5%) and 3rd generation cephalosporins (85.7%). C. freundii were more resistant than C. koseri. Antibiotic resistance did not increase during the study period for most antibiotics. Lower susceptibility to all antibiotics was observed among multi-drug resistant (MDR) strains. AmpC was the most common resistant mechanism (10.9%); carbapenemases (1.3%) and aminoglycoside modifying enzymes (2.9%) were also detected. All AmpC producers were resistant to cephalosporins but not to carbapenems. In all but one isolates aminoglycoside resistance was accompanied by acquired β-lactamases. CONCLUSIONS Although Citrobacter species in general were susceptible, antibiotic susceptibility testing is required for the detection of resistant isolates.
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Affiliation(s)
- Sofia Maraki
- a Department of Clinical Microbiology , University Hospital of Heraklion , Heraklion , Greece
| | - Konstantinos Z Vardakas
- b Alfa Institute of Biomedical Sciences (AIBS) , Athens , Greece.,c Department of Internal Medicine-Infectious Diseases , Iaso General Hospital , Athens , Greece
| | | | - Margarita Kyriakidou
- e Department of Applied Mathematics and Physics , National Technical University of Athens , Athens , Greece
| | - George Spais
- e Department of Applied Mathematics and Physics , National Technical University of Athens , Athens , Greece
| | - Diamantis P Kofteridis
- d Department of Internal Medicine , University of Crete School of Medicine , Heraklion , Greece
| | - George Samonis
- d Department of Internal Medicine , University of Crete School of Medicine , Heraklion , Greece
| | - Matthew E Falagas
- b Alfa Institute of Biomedical Sciences (AIBS) , Athens , Greece.,c Department of Internal Medicine-Infectious Diseases , Iaso General Hospital , Athens , Greece.,f Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
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Fernández J, Bert F, Nicolas-Chanoine MH. The challenges of multi-drug-resistance in hepatology. J Hepatol 2016; 65:1043-1054. [PMID: 27544545 DOI: 10.1016/j.jhep.2016.08.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 02/08/2023]
Abstract
Antimicrobial resistance has become a major global public health security problem that needs coordinated approaches at regional, national and international levels. Antibiotic overuse and the failure of control measures to prevent the spread of resistant bacteria in the healthcare environment have led to an alarming increase in the number of infections caused by resistant bacteria, organisms that resist many (multi-drug and extensively drug-resistant strains), if not all (pan-drug-resistant bacteria) currently available antibiotics. While Gram-positive cocci resistance (methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci) shows a heterogeneous geographical distribution, extended-spectrum β-lactamase-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae have become pandemic worldwide and endemic in some parts of the world, respectively. Moreover, currently available therapeutic options for resistant bacteria are very limited, with very few new agents in development. Antimicrobial resistance is especially relevant in decompensated cirrhosis. Firstly, cirrhotic patients are highly susceptible to develop infections caused by resistant bacteria as risk factors of multiresistance concentrate in this population (mainly repeated hospitalizations and antibiotic exposure). Secondly, inappropriate empirical antibiotic schedules easily translate into increased morbidity (acute kidney injury, acute-on-chronic liver failure, septic shock) and hospital mortality in advanced cirrhosis. Therefore, hepatologists must face nowadays a complex clinical scenario that requires new empirical antibiotic strategies that may further spread resistance. Global, regional and local preventive measures should therefore be implemented to combat antimicrobial resistance in cirrhosis including the restriction of antibiotic prophylaxis to high-risk populations, investigation on non-antibiotic prophylaxis, stewardship programs on adequate antibiotic prescription and on increasing awareness of the problem among health professionals, and well-defined early de-escalation policies based on rapid microbiological diagnostic tests. Other infection control practices such as hand hygiene and barrier precautions are also important. Clinical impact and cost-effectiveness of epidemiological surveillance programs (periodic rectal and nasal swabs) should also be explored.
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Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clínic Barcelona, University of Barcelona, Spain; Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHED), Spain.
| | - Frédéric Bert
- Service de Microbiologie, Hôpital Beaujon, AP-HP, Clichy, France; INSERM UMR 1149, Université Paris 7, Paris, France
| | - Marie-Hélène Nicolas-Chanoine
- Service de Microbiologie, Hôpital Beaujon, AP-HP, Clichy, France; INSERM UMR 1149, Université Paris 7, Paris, France; Faculté de Médecine Paris Diderot, Paris, France
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A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae. Antimicrob Agents Chemother 2016; 60:4159-69. [PMID: 27139473 DOI: 10.1128/aac.00365-16] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/24/2016] [Indexed: 12/13/2022] Open
Abstract
The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.).
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Mashaly GES. Activity of Fosfomycin in Extended-Spectrum Beta-Lactamases Producing <i>Klebsiella pneumonae</i> from Hospital Acquired Urinary Tract Infections. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojmm.2016.63014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zahar JR, Poirel L, Dupont C, Fortineau N, Nassif X, Nordmann P. About the usefulness of contact precautions for carriers of extended-spectrum beta-lactamase-producing Escherichia coli. BMC Infect Dis 2015; 15:512. [PMID: 26563141 PMCID: PMC4642679 DOI: 10.1186/s12879-015-1244-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 10/23/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Extended-spectrum β-lactamases producing Escherichia coli (ESBL-E) are increasingly identified in health care facilities. As previously done for the control of methicillin-resistant Staphylococcus aureus, many hospitals have established screening strategies for early identification of patients being carriers of ESBL producers in general and ESBL-E in particular, and have implemented contact precautions (CP) for infected and colonized patients. METHODS The incidence of ESBL-E has been compared retrospectively between two French university hospitals (A and B) with different infection control policies over a 5-year long period of time (2006-2010). RESULTS While hospital A only implemented standard precautions after identification of patients colonized with ESBL-E, hospital B recommended additional CP. During the period of the study, the ESBL-E incidence rate significantly increased in both hospitals, but no significant difference was observed between the two hospitals. CONCLUSIONS This observational study did not reveal that additional CP measures had a greater impact on the incidence of ESBL-E in hospital settings.
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Affiliation(s)
- Jean-Ralph Zahar
- Infection Control Unit, CHU Angers, Angers, France. .,Service de Microbiologie-Hygiène, Hôpital Necker-Enfants-Malades, Paris, France.
| | - Laurent Poirel
- Service de Bactériologie - Hygiène, Hôpital de Bicêtre, K.-Bicêtre, France. .,Department of Medicine, Medical and Molecular Microbiology « Emerging Antibiotic Resistance » Unit, Faculty of Science, University of Fribourg, Rue Albert Gockel 3, CH-1700, Fribourg, Switzerland.
| | - Claire Dupont
- Service de Bactériologie - Hygiène, Hôpital de Bicêtre, K.-Bicêtre, France.
| | - Nicolas Fortineau
- Service de Bactériologie - Hygiène, Hôpital de Bicêtre, K.-Bicêtre, France.
| | - Xavier Nassif
- Service de Microbiologie-Hygiène, Hôpital Necker-Enfants-Malades, Paris, France.
| | - Patrice Nordmann
- Service de Bactériologie - Hygiène, Hôpital de Bicêtre, K.-Bicêtre, France. .,Department of Medicine, Medical and Molecular Microbiology « Emerging Antibiotic Resistance » Unit, Faculty of Science, University of Fribourg, Rue Albert Gockel 3, CH-1700, Fribourg, Switzerland. .,Hôpital Fribourgeois-hôpital Cantonal, Fribourg, Switzerland.
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Characterization of extended-spectrum beta-lactamases and antimicrobial resistance of Klebsiella pneumoniae in intra-abdominal infection isolates in Latin America, 2008–2012. Results of the Study for Monitoring Antimicrobial Resistance Trends. Diagn Microbiol Infect Dis 2015; 82:209-14. [DOI: 10.1016/j.diagmicrobio.2015.03.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 11/22/2022]
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Cho YH, Jung SI, Chung HS, Yu HS, Hwang EC, Kim SO, Kang TW, Kwon DD, Park K. Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin. Int Urol Nephrol 2015; 47:1059-66. [PMID: 26026972 DOI: 10.1007/s11255-015-1018-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE The appearance of extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria in urinary tract infection (UTI) constitutes an important therapeutic challenge. The aim of this study was to describe drug susceptibility profiles of ESBL-producing bacteria isolated from urine samples. We also determined the antimicrobial co-resistance to several agents, including fosfomycin. METHODS The computerized database was used to identify ESBL-positive urine samples. We analyzed E. coli and Klebsiella isolates obtained from urine cultures, and duplicate isolates and isolates not tested against fosfomycin were excluded. The cases were further categorized according to UTI definition [community-acquired (CoA) UTI, community-onset health care-associated (HCA) UTI, and hospital-acquired (HA) UTI]. ESBL isolates were stratified according to their origin into two groups: urology and non-urology isolates. RESULTS Antimicrobial susceptibilities of the strains to fosfomycin were tested in 277 ESBL-positive strains, 217 ESBL-EC strains, and 60 ESBL-KP strains. The most effective agents were carbapenems, such as imipenem and meropenem. The least active substances were ciprofloxacin (20.7 %), levofloxacin (22.7 %), trimethoprim-sulfamethoxazole (34.3 %), and ampicillin-clavulanate (42.9 %). Overall, 243 out of the 277 (87.7 %) isolates tested were susceptible to fosfomycin. Higher fosfomycin sensitivity was observed in E. coli (94.9 %) compared to Klebsiella (61.7 %) (p = 0.001). ESBL-positive isolates from urological (68 isolates) and non-urological patients (209 isolates) showed similar susceptibility profiles. Other than carbapenems, isolates from CoA-UTI showed higher sensitivity to fosfomycin (100 %) and nitrofurantoin (93.1 %), isolates from HCA-UTI showed higher sensitivity to amikacin (94.1 %), and isolates from HA-UTI showed overall poor sensitivity to antibiotics. CONCLUSIONS Fosfomycin could be an alternative treatment option for UTIs related to ESBL-producing E. coli spp. and CoA-UTI, but not for UTIs related to ESBL-producing Klebsiella spp. Antimicrobial susceptibilities of ESBL-producing strains were different according to the UTI classification. Fosfomycin showed decreased activity against isolates from HCA-UTI and HA-UTI. However, further clinical verification is required to assess the clinical efficacy of fosfomycin for the treatment of UTIs caused by ESBL-producing E. coli isolates.
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Affiliation(s)
- Yang Hyun Cho
- Departments of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Harris PNA, Yin M, Jureen R, Chew J, Ali J, Paynter S, Paterson DL, Tambyah PA. Comparable outcomes for β-lactam/β-lactamase inhibitor combinations and carbapenems in definitive treatment of bloodstream infections caused by cefotaxime-resistant Escherichia coli or Klebsiella pneumoniae. Antimicrob Resist Infect Control 2015; 4:14. [PMID: 25932324 PMCID: PMC4414382 DOI: 10.1186/s13756-015-0055-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are often susceptible in vitro to β-lactam/β-lactamase inhibitor (BLBLI) combination antibiotics, but their use has been limited by concerns of clinical inefficacy. We aimed to compare outcomes between patients treated with BLBLIs and carbapenems for bloodstream infection (BSI) caused by cefotaxime non-susceptible (likely ESBL- or AmpC β-lactamase-producing) Escherichia coli and Klebsiella pneumoniae. METHODS All adult patients with a BSI caused by cefotaxime non-susceptible E. coli or K. pneumoniae were included from May 2012-May 2013. We compared outcomes between patients who had definitive monotherapy with a carbapenem to those who had definitive monotherapy with a BLBLI. RESULTS There were 92 BSIs that fulfilled the microbiological inclusion criteria. 79 (85.9%) were caused by E. coli and 13 (14.1%) by K. pneumoniae. Four out of 23 (17.4%) patients treated with carbapenem monotherapy and 2 out of 24 (8.3%) patients treated with BLBLI monotherapy died (adjusted HR for survival 0.91, 95% CI 0.13 to 6.28; p = 0.92). The time to resolution of systemic inflammatory response syndrome (SIRS) criteria did not vary between the treatment groups (adjusted HR 0.91, 95% CI 0.32 to 2.59; p = 0.97). The length of hospital admission post-positive blood culture was slightly longer in patients treated with BLBLIs (median duration 15 vs. 11 days), although this was not significant (adjusted HR 0.62; 95% CI 0.27 to 1.42; p = 0.26). There were no significant differences in subsequent isolation of carbapenem resistant organisms (4.3% vs. 4.2%, p = 1.0), C. difficile infection (13.0% vs. 8.3%, p = 0.67) or relapsed BSI (0% vs. 2%, p = 0.23). CONCLUSIONS BLBLIs appear to have a similar efficacy to carbapenems in the treatment of cefotaxime-resistant E. coli and K. pneumoniae bloodstream infections. Directed therapy with a BLBLI, when susceptibility is proven, may represent an appropriate carbapenem-sparing option.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland Centre for Clinical Research, Brisbane, Queensland Australia ; Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mo Yin
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roland Jureen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Jonathan Chew
- International Medical University, Kuala Lumpur, Malaysia
| | - Jaminah Ali
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Stuart Paynter
- School of Population Health, University of Queensland, Brisbane, QLD Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Brisbane, Queensland Australia
| | - Paul A Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? THE LANCET. INFECTIOUS DISEASES 2015; 15:475-85. [PMID: 25716293 DOI: 10.1016/s1473-3099(14)70950-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The spread of extended-spectrum β-lactamase (ESBL) genes in Enterobacteriaceae such as Escherichia coli or Klebsiella spp is a major challenge to modern medical practice. Carbapenems are the treatment of choice for serious infections caused by ESBL producers; however, carbapenem resistance has increased globally. ESBL producers might be susceptible to β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics such piperacillin-tazobactam or amoxicillin-clavulanate. These drugs are frequently avoided in serious infections caused by ESBL producers because of the inoculum effect in-vitro (especially for piperacillin-tazobactam), animal data suggesting inferior efficacy when compared with carbapenems, concerns about pharmacokinetic-pharmacodynamic drug target attainment with standard doses, and poor outcomes shown in some observational studies. Prospective cohort data and a meta-analysis suggest that BLBLIs are non-inferior to carbapenems in the treatment of bloodstream infections caused by ESBL producers. We examine why BLBLIs are perceived as inferior in the treatment of infection with ESBL producers, and discuss data that suggest these concerns might not be strongly supported by clinical evidence.
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Harris PNA, Peleg AY, Iredell J, Ingram PR, Miyakis S, Stewardson AJ, Rogers BA, McBryde ES, Roberts JA, Lipman J, Athan E, Paul SK, Baker P, Harris-Brown T, Paterson DL. Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp (the MERINO trial): study protocol for a randomised controlled trial. Trials 2015; 16:24. [PMID: 25623485 PMCID: PMC4311465 DOI: 10.1186/s13063-014-0541-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022] Open
Abstract
Background Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define carbapenem-sparing alternatives for these infections. Methods/Design The study will use a multicentre randomised controlled open-label non-inferiority trial design comparing two treatments, meropenem (standard arm) and piperacillin-tazobactam (carbapenem-sparing arm) in adult patients with bacteraemia caused by E. coli or Klebsiella spp. demonstrating non-susceptibility to third generation cephalosporins. Recruitment is planned to occur in sites across three countries (Australia, New Zealand and Singapore). A total sample size of 454 patients will be required to achieve 80% power to determine non-inferiority with a margin of 5%. Once randomised, definitive treatment will be for a minimum of 4 days, but up to 14 days with total duration determined by treating clinicians. Data describing demographic information, antibiotic use, co-morbid conditions, illness severity, source of infection and other risk factors will be collected. Vital signs, white cell count, use of vasopressors and days to bacteraemia clearance will be recorded up to day 7. The primary outcome measure will be mortality at 30 days, with secondary outcomes including days to clinical and microbiological resolution, microbiological failure or relapse, isolation of a multi-resistant organism or Clostridium difficile infection. Trial registration The MERINO trial is registered under the Australian New Zealand Clinical Trials Register (ANZCTR), reference number: ACTRN12613000532707 (registered 13 May 2013) and the US National Institute of Health ClinicalTrials.gov register, reference number: NCT02176122 (registered 24 June 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-014-0541-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland Centre for Clinical Research, Building 71/918 Royal Brisbane & Women's Hospital Campus, Herston, 4029, Brisbane, QLD, Australia.
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC, Australia.
| | - Jon Iredell
- Westmead Millenium Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia.
| | - Paul R Ingram
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia. .,School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia.
| | - Spiros Miyakis
- Department of Infectious Diseases, School of Medicine, University of Wollongong and The Wollongong Hospital, Wollongong, NSW, Australia.
| | - Andrew J Stewardson
- Department of Infectious Diseases, Austin Health, Melbourne, VIC, Australia.
| | | | - Emma S McBryde
- Victorian Infectious Diseases Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.
| | - Jeff Lipman
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Deakin University, Geelong, VIC, Australia.
| | - Sanjoy K Paul
- Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Peter Baker
- Queensland Clinical Trials and Biostatistics Centre, University of Queensland, Brisbane, QLD, Australia.
| | - Tiffany Harris-Brown
- University of Queensland Centre for Clinical Research, Building 71/918 Royal Brisbane & Women's Hospital Campus, Herston, 4029, Brisbane, QLD, Australia.
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Building 71/918 Royal Brisbane & Women's Hospital Campus, Herston, 4029, Brisbane, QLD, Australia.
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Tamma PD, Han JH, Rock C, Harris AD, Lautenbach E, Hsu AJ, Avdic E, Cosgrove SE. Carbapenem therapy is associated with improved survival compared with piperacillin-tazobactam for patients with extended-spectrum β-lactamase bacteremia. Clin Infect Dis 2015; 60:1319-25. [PMID: 25586681 DOI: 10.1093/cid/civ003] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The effectiveness of piperacillin-tazobactam (PTZ) for the treatment of extended-spectrum β-lactamase (ESBL) bacteremia is controversial. We compared 14-day mortality of PTZ vs carbapenems as empiric therapy in a cohort of patients with ESBL bacteremia who all received definitive therapy with a carbapenem. METHODS Patients hospitalized between January 2007 and April 2014 with monomicrobial ESBL bacteremia were included. A decrease of >3 doubling dilutions in the minimum inhibitory concentration for third-generation cephalosporins tested in combination with 4 µg/mL of clavulanic acid was used to confirm ESBL status. The primary exposure was empiric therapy, defined as antibiotic therapy administered to a patient before ESBL status was known. Patients were excluded if they did not receive a carbapenem after ESBL production was identified. The primary outcome was time to death from the first day of bacteremia. Propensity scores using inverse probability of exposure weighting (IPW) were used to estimate the probability that a patient would receive PTZ vs carbapenems empirically. We calculated overall hazard ratios for mortality censored at 14 days using Cox proportional hazards models on an IPW-adjusted cohort. RESULTS A total of 331 unique patients with ESBL bacteremia were identified. One hundred three (48%) patients received PTZ empirically and 110 (52%) received carbapenems empirically. The adjusted risk of death was 1.92 times higher for patients receiving empiric PTZ compared with empiric carbapenem therapy (95% confidence interval, 1.07-3.45). CONCLUSIONS PTZ appears inferior to carbapenems for the treatment of ESBL bacteremia. For patients at high risk of invasive ESBL infections, early carbapenem therapy should be considered. Our findings should not be extended to β-lactam/β-lactamase inhibitor combinations in development, as limited clinical data are available for these agents.
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Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer H Han
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Clare Rock
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine
| | - Ebbing Lautenbach
- Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia
| | - Alice J Hsu
- Department of Pharmacy, Johns Hopkins Hospital
| | - Edina Avdic
- Department of Pharmacy, Johns Hopkins Hospital
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kuenzli E, Jaeger VK, Frei R, Neumayr A, DeCrom S, Haller S, Blum J, Widmer AF, Furrer H, Battegay M, Endimiani A, Hatz C. High colonization rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in Swiss travellers to South Asia- a prospective observational multicentre cohort study looking at epidemiology, microbiology and risk factors. BMC Infect Dis 2014; 14:528. [PMID: 25270732 PMCID: PMC4262238 DOI: 10.1186/1471-2334-14-528] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International travel contributes to the worldwide spread of multidrug resistant Gram-negative bacteria. Rates of travel-related faecal colonization with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae vary for different destinations. Especially travellers returning from the Indian subcontinent show high colonization rates. So far, nothing is known about region-specific risk factors for becoming colonized. METHODS An observational prospective multicentre cohort study investigated travellers to South Asia. Before and after travelling, rectal swabs were screened for third-generation cephalosporin- and carbapenem-resistant Enterobacteriaceae. Participants completed questionnaires to identify risk factors for becoming colonized. Covariates were assessed univariately, followed by a multivariate regression. RESULTS Hundred and seventy persons were enrolled, the largest data set on travellers to the Indian subcontinent so far. The acquired colonization rate with ESBL-producing Escherichia coli overall was 69.4% (95% CI 62.1-75.9%), being highest in travellers returning from India (86.8%; 95% CI 78.5-95.0%) and lowest in travellers returning from Sri Lanka (34.7%; 95% CI 22.9-48.7%). Associated risk factors were travel destination, length of stay, visiting friends and relatives, and eating ice cream and pastry. CONCLUSIONS High colonization rates with ESBL-producing Enterobacteriaceae were found in travellers returning from South Asia. Though risk factors were identified, a more common source, i.e. environmental, appears to better explain the high colonization rates.
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Affiliation(s)
- Esther Kuenzli
- Division for Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
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Jean SS, Ko WC, Xie Y, Pawar V, Zhang D, Prajapati G, Mendoza M, Kiratisin P, Ramalheira E, Castro AP, Rosso F, Hsueh PR. Clinical characteristics of patients with community-acquired complicated intra-abdominal infections: A prospective, multicentre, observational study. Int J Antimicrob Agents 2014; 44:222-8. [DOI: 10.1016/j.ijantimicag.2014.05.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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Kurup A, Liau KH, Ren J, Lu MC, Navarro NS, Farooka MW, Usman N, Destura RV, Sirichindakul B, Tantawichien T, Lee CKC, Solomkin JS. Antibiotic management of complicated intra-abdominal infections in adults: The Asian perspective. Ann Med Surg (Lond) 2014; 3:85-91. [PMID: 25568794 PMCID: PMC4284456 DOI: 10.1016/j.amsu.2014.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 01/29/2023] Open
Abstract
Regional epidemiological data and resistance profiles are essential for selecting appropriate antibiotic therapy for intra-abdominal infections (IAIs). However, such information may not be readily available in many areas of Asia and current international guidelines on antibiotic therapy for IAIs are for Western countries, with the most recent guidance for the Asian region dating from 2007. Therefore, the Asian Consensus Taskforce on Complicated Intra-Abdominal Infections (ACT-cIAI) was convened to develop updated recommendations for antibiotic management of complicated IAIs (cIAIs) in Asia. This review article is based on a thorough literature review of Asian and international publications related to clinical management, epidemiology, microbiology, and bacterial resistance patterns in cIAIs, combined with the expert consensus of the Taskforce members. The microbiological profiles of IAIs in the Asian region are outlined and compared with Western data, and the latest available data on antimicrobial resistance in key pathogens causing IAIs in Asia is presented. From this information, antimicrobial therapies suitable for treating cIAIs in patients in Asian settings are proposed in the hope that guidance relevant to Asian practices will prove beneficial to local physicians managing IAIs.
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Affiliation(s)
- Asok Kurup
- Infectious Diseases Care, #03-01 Mount Elizabeth Medical Centre, Singapore 228510, Singapore
| | - Kui-Hin Liau
- Nexus Surgical Associates Pte Ltd, Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road, Singapore 329563, Singapore
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Min-Chi Lu
- Division of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan ; Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Narciso S Navarro
- Faculty of Medicine and Surgery, University of Santo Tomas, Espana Boulevard, Manila 1008, Philippines
| | | | - Nurhayat Usman
- Hasan Sadikin Hospital, Department of Surgery, 38 Pasteur Street, Bandung, West Java, 40136, Indonesia
| | - Raul V Destura
- National Institutes of Health, University of the Philippines Manila, Pedro Gil Street, Ermita Manila 1000, Philippines
| | - Boonchoo Sirichindakul
- Division of General Surgery, Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Terapong Tantawichien
- Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Rama 4 Rd, Phatumwan, Bangkok 10330, Thailand
| | - Christopher K C Lee
- Department of Medicine, Sungai Buloh Hospital, Jalan Hospital, Sungai Buloh 47000, Malaysia
| | - Joseph S Solomkin
- Department of Surgery, University of Cincinnati College of Medicine, 231 Albert B. Sabin Way, Cincinnati, OH 45267-0558, USA
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Jafri SA, Qasim M, Masoud MS, Rahman MU, Izhar M, Kazmi S. Antibiotic resistance of E. coli isolates from urine samples of Urinary Tract Infection (UTI) patients in Pakistan. Bioinformation 2014; 10:419-22. [PMID: 25187681 PMCID: PMC4135289 DOI: 10.6026/97320630010419] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/23/2022] Open
Abstract
Drug resistance is becoming alarming with the passage of time worldwide in general and in third world countries in particular.
Human urine specimens of patients of urinary tract infection at Sheikh Zayed hospital, Lahore, Pakistan were analyzed for drug
resistance in Escherichia coli. A total of 69 Escherichia coli isolates from human urine specimens were obtained and screened for their
antibiograms. A total of seven antibiotic resistance profiles were obtained with over 65% of the isolates showing multi-drug
resistance. Very high resistance levels were detected against augmentin and gentamicin (87.5 &77.5 % respectively) while
imipenem and tazocin recorded the least resistance levels (32.5% and 12.5% respectively) among the isolates.
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Affiliation(s)
| | - Muhammad Qasim
- Department of Bioinformatics & Biotechnology, Government College University, Faisalabad
| | - Muhammad S Masoud
- Department of Bioinformatics & Biotechnology, Government College University, Faisalabad
| | - Mahmood-Ur- Rahman
- Department of Bioinformatics & Biotechnology, Government College University, Faisalabad
| | - Mateen Izhar
- Institute of Molecular Biology & Biotechnology, The university of Lahore, Pakistan
| | - Saqib Kazmi
- FPGMI, Sheikh Zayed Hospital, Lahore, Pakistan
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Hoban DJ, Badal R, Bouchillon S, Hackel M, Kazmierczak K, Lascols C, Hawser S. In vitro susceptibility and distribution of beta-lactamases in Enterobacteriaceae causing intra-abdominal infections in North America 2010–2011. Diagn Microbiol Infect Dis 2014; 79:367-72. [DOI: 10.1016/j.diagmicrobio.2014.03.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 02/08/2023]
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Biedenbach DJ, Bouchillon SK, Hoban DJ, Hackel M, Phuong DM, Nga TTT, Phuong NTM, Phuong TTL, Badal RE. Antimicrobial susceptibility and extended-spectrum beta-lactamase rates in aerobic gram-negative bacteria causing intra-abdominal infections in Vietnam: report from the Study for Monitoring Antimicrobial Resistance Trends (SMART 2009-2011). Diagn Microbiol Infect Dis 2014; 79:463-7. [PMID: 24923210 DOI: 10.1016/j.diagmicrobio.2014.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/09/2014] [Accepted: 05/10/2014] [Indexed: 01/08/2023]
Abstract
Treatment options for multidrug-resistant pathogens remain problematic in many regions and individual countries, warranting ongoing surveillance and analysis. Limited antimicrobial susceptibility information is available for pathogens from Vietnam. This study determined the bacterial susceptibility of aerobic gram-negative pathogens of intra-abdominal infections among patients in Vietnam during 2009-2011. A total of 905 isolates were collected from 4 medical centers in this investigation as part of the Study for Monitoring Antimicrobial Resistance Trends. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) rates among the appropriate species were determined by a central laboratory using Clinical and Laboratory Standards Institute methods. Among the species collected, Escherichia coli (48.1% ESBL-positive) and Klebsiella pneumoniae (39.5% ESBL-positive) represented the majority (46.4%) of the isolates submitted for this study. Ertapenem MIC90 values were lowest for these 2 species at 0.12 and 0.25μg/mL and remained unchanged for ESBL-positive isolates. Imipenem MIC90 values were also the same for all isolates and ESBL-positive strains at 0.25 and 0.5μg/mL, respectively. Ertapenem MIC90 values for additional species with sufficient numbers for analysis, including Enterobacter cloacae, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa, were 1, 0.06, >4, and >4μg/mL, respectively. Analysis of beta-lactamases in a subset of 132 phenotypically ESBL-positive Enterobacteriaceae demonstrated that CTX-M variants, particularly CTX-M-27 and CTX-M-15, were the predominant enzymes. High resistance rates in Vietnam hospitals dictate continuous monitoring as antimicrobial inactivating enzymes continue to spread throughout Asia and globally.
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Affiliation(s)
| | | | - Daryl J Hoban
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | - Meredith Hackel
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | | | | | | | | | - Robert E Badal
- International Health Management Associates, Inc., Schaumburg, IL, USA
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Mustafa M, Chan WM, Lee C, Harijanto E, Loo CM, Van Kinh N, Anh ND, Garcia J. A PROspective study on the Usage patterns of Doripenem in the Asia-Pacific region (PROUD study). Int J Antimicrob Agents 2014; 43:353-60. [PMID: 24636429 DOI: 10.1016/j.ijantimicag.2014.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 11/04/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
Doripenem is approved in the Asia-Pacific (APAC) region for treating nosocomial pneumonia (NP) including ventilator-associated pneumonia (VAP), complicated intra-abdominal infections (cIAIs) and complicated urinary tract infections (cUTIs). Clinical usage of doripenem (500mg intravenously, infused over 1h or 4h every 8h for 5-14 days) in APAC was evaluated in a prospective, open-label, non-comparative, multicentre study of inpatients (≥18 years) with NP, VAP, cIAI or cUTI. A total of 216 [intention-to-treat (ITT)] patients received doripenem: 53 NP (24.5%); 77 VAP (35.6%); 67 cIAI (31.0%); and 19 cUTI (8.8%). Doripenem MIC90 values for Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were 32, 32, 0.094 and 0.64μg/mL, respectively. Doripenem was used most commonly as monotherapy (86.6%) and as second-line therapy (62.0%). The clinical cure rate in clinically evaluable patients was 86.7% at the end of therapy (EOT) and 87.1% at test of cure (TOC) (7-14 days after EOT). In the ITT population, overall clinical cure rates were 66.2% at EOT and 56.5% at TOC. The median duration of hospital stay, intensive care unit (ICU) stay and mechanical ventilation was 20, 12 and 10 days, respectively. Of 146 discharged patients, 7 were re-admitted within 28 days of EOT; 1 VAP patient was re-admitted to the ICU. The all-cause mortality rate was 22.7% (49/216). The most common treatment-related adverse events were diarrhoea (1.4%) and vomiting (1.4%). Doripenem is a viable option for treating APAC patients with NP, VAP, cIAI or cUTI. [ClinicalTrials.gov: NCT 00986102].
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Affiliation(s)
- Mahiran Mustafa
- Department of Medicine, Hospital Raja Perempuan Zainab II, 15000 Kota Bharu, Kelantan, Malaysia.
| | - Wai Ming Chan
- Adult Intensive Care Unit, Queen Mary Hospital, University of Hong Kong, 102 Pokfulam Road, Hong Kong
| | - Christopher Lee
- Department of Medicine, ID Unit and Department of Medicine, Hospital Sungai Buloh, Selangor 47000, Malaysia
| | - Eddy Harijanto
- Department of Anesthesiology, Dr Cipto Mangunkusumo Hospital, Diponegoro St No. 71, Kenari Village, Senen, Central Jakarta City 10430, Indonesia
| | - Chian Min Loo
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Nguyen Van Kinh
- Intensive Care Unit, National Hospital for Tropical Diseases, Giai Phong Street, Hanoi, Vietnam
| | - Nguyen Dat Anh
- Emergency Department, Bach Mai Hospital, 78 Duong Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam
| | - Jemelyn Garcia
- Janssen Pharmaceutica, A Division of Johnson & Johnson Pte Ltd., Edison Road, Barrio Ibayo, Parañaque City 1700, Philippines
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Gomi H, Solomkin JS. Response to re: TG13 antimicrobial therapy for acute cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 21:E11. [DOI: 10.1002/jhbp.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Harumi Gomi
- Center for Clinical Infectious Diseases; Jichi Medical University; 3311-1 Yakushiji, Shimotsuke Tochigi 329-0431 Japan
| | - Joseph S Solomkin
- Department of Surgery; University of Cincinnati College of Medicine; Cincinnati OH USA
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Li B, Li M, Qu L, Wang M, Guo J. Prevalence and characteristics of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolated from pediatric inpatients with respiratory tract infections at a teaching hospital in China. ACTA ACUST UNITED AC 2013; 46:200-3. [PMID: 24359516 DOI: 10.3109/00365548.2013.859393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to investigate the prevalence and characteristics of resistant Klebsiella pneumoniae isolates in the pediatric setting in China. A total of 201 non-duplicate K. pneumoniae isolates were obtained from 432 pediatric inpatients suffering from respiratory tract infections. One hundred and thirty-eight K. pneumoniae isolates were determined to be extended-spectrum beta-lactamase-producers. Of all ESBL-producing isolates, 138 (100%) were resistant to piperacillin, ampicillin, cefazolin, and aztreonam, 136 (98.4%) to cefuroxime, 126 (91.2%) to ceftriaxone and co-trimoxazole, 120 (87.4%) to cefoperazone, 91 (65.8%) to ceftazidime, 78 (56.5%) to gentamicin, and 72 (52.4%) to cefepime. TEM was the main type of beta-lactamase among ESBL-producing K. pneumoniae, followed by SHV and CTX-M-1. Of the 30 isolates harboring CTX-M-producers, 53.3% co-produced TEM, 36.7% co-produced SHV, and the remaining isolates co-produced SHV and TEM. The data show that there is a high prevalence of ESBL-producing K. pneumoniae infections among pediatric inpatients in the region.
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Affiliation(s)
- Binxian Li
- From the Associated Hospital, Beihua University
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Strategies to minimize antibiotic resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4274-305. [PMID: 24036486 PMCID: PMC3799537 DOI: 10.3390/ijerph10094274] [Citation(s) in RCA: 229] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs (ASPs) and various data such as pharmacokinetic (PK) and pharmacodynamic (PD) properties of antibiotics, diagnostic testing, antimicrobial susceptibility testing (AST), clinical response, and effects on the microbiota, as well as by new antibiotic developments. The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children (e.g., through schools and day care), the public, and relevant healthcare professionals (e.g., primary-care physicians, pharmacists, and medical students) regarding unique features of bacterial infections and antibiotics, prudent antibiotic prescribing as a positive construct, and personal hygiene (e.g., handwashing). The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics.
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Chen YH, Ko WC, Hsueh PR. Emerging resistance problems and future perspectives in pharmacotherapy for complicated urinary tract infections. Expert Opin Pharmacother 2013; 14:587-96. [PMID: 23480061 DOI: 10.1517/14656566.2013.778827] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Urinary tract infections (UTIs) are among the most common infectious diseases and contribute to high financial burden worldwide. Administration of appropriate antibiotic therapy is the key to achieving good therapeutic outcomes. The authors review the current status of global or regional epidemiology, especially on the antimicrobial resistance and several potential agents against complicated UTIs by multidrug-resistant (MDR) pathogens. AREAS COVERED The authors summarized the susceptibility status on several major surveillance programs on uropathogens, focusing on Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Besides, the current perspectives of several potential antimicrobials against MDR uropathogens available for UTIs were also reviewed. EXPERT OPINION High resistance to broad-spectrum antibiotics, especially to extended-spectrum β-lactams, carbapenems, and fluoroquinolones among uropathogens emerges as a critical problem in many countries. Appropriate antimicrobial stewardship and continuous surveillance are necessary to monitor the trends of susceptibility for main pathogens. For these MDR uropathogens, polymyxin, fosfomycin, tigecycline, nitrofurantoin, linezolid, and daptomycin might be potential treatments for patients with uncomplicated and complicated UTIs in some countries, although they might not be approved by their regulation. However, more clinical evidence and more extensive meta-analyses are needed to evaluate and confirm the effectiveness of their usage in countries with a high prevalence of multidrug resistance.
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Affiliation(s)
- Yen-Hsu Chen
- Kaohsiung Medical University, Kaohsiung Medical University Hospital, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung, Taiwan
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Jean SS, Lee WS, Bai KJ, Lam C, Hsu CW, Yu KW, Liao CH, Chang FY, Ko WC, Wu JJ, Chen YH, Chen YS, Liu JW, Lu MC, Liu CY, Chen RJ, Hsueh PR. Relationship between the distribution of cefepime minimum inhibitory concentrations and detection of extended-spectrum β-lactamase production among clinically important Enterobacteriaceae isolates obtained from patients in intensive care units in Taiwan: results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART) in 2007. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 48:85-91. [PMID: 23973410 DOI: 10.1016/j.jmii.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/22/2013] [Accepted: 07/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The data on susceptibility of important cephalosporins against four Enterobacteriaceae members producing potential extended-spectrum β-lactamase (ESBL) collected from Taiwanese intensive care units are lacking. METHODS Minimum inhibitory concentrations (MICs) of cefotaxime, ceftazidime, and cefepime were determined using agar dilution method, against Escherichia coli (n = 344), Klebsiella pneumoniae (n = 359), Enterobacter cloacae (n = 103), and Proteus mirabilis (n = 78). Susceptibilities of these isolates to three cephalosporins were assessed according to MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013. The double-disk synergy test using disks containing cefepime (30 μg) with or without clavulanate (10 μg) was applied to confirm production of ESBL for isolates with cephalosporin MIC ≥ 2 μg/mL. RESULTS A total of 175 isolates were verified as ESBL producers. The rates of cefepime susceptibility among the ESBL-producing isolates, according to CLSI (EUCAST) criteria, were 56.7% (22.4%) for E. coli, 61.3% (12.0%) for K. pneumoniae, 57.9% (31.6%) for E. cloacae, and 71.4% (7.1%) for P. mirabilis. Using different cefepime MIC breakpoints (MICs ≥ 16 μg/mL recommended by CLSI criteria and ≥ 2 μg/mL by EUCAST criteria) to define nonsusceptibility, we found that both criteria were poorer at predicting ESBL producers among K. pneumoniae and E. cloacae than among the other two species. In addition, we also found that the cefepime MIC level of 1.0 μg/mL best distinguished non-ESBL- from ESBL-producing K. pneumoniae and E. cloacae. CONCLUSION To detect ESBLs, CLSI should revise the cefepime MIC breakpoint against Enterobacteriaceae.
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Affiliation(s)
- Shio-Shin Jean
- Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Jen Bai
- Department of Pulmonary, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Carlos Lam
- Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Wang Hsu
- Department of Emergency and Critical Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kwok-Woon Yu
- Department of Internal Medicine, Pathology, and Laboratory Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Feng-Yi Chang
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center (NDMC), Taipei, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Jiunn-Jong Wu
- School of Medical Technology, National Cheng-Kung University College of Medicine, Tainan, Taiwan
| | - Yen-Hsu Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jien-Wei Liu
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung Medical College, Kaohsiung, Taiwan
| | - Min-Chi Lu
- Department of Laboratory Medicine and Internal Medicine, Chung Shan Medical and Dental University, Taichung, Taiwan
| | - Cheng-Yi Liu
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Liu LT, Wan LH, Song XH, Xiong Y, Jin SJ, Zhou LM. Relevance of class 1 integrons and extended-spectrum β-lactamases in drug-resistant Escherichia coli. Mol Med Rep 2013; 8:1251-5. [PMID: 23939784 DOI: 10.3892/mmr.2013.1626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 07/29/2013] [Indexed: 11/05/2022] Open
Abstract
Escherichia coli is a common cause of community‑ and hospital‑acquired urinary tract infections, and class 1 integrons are the prior elements of gene transference in the capture and distribution of gene cassettes among clinical gram-negative bacillus. In the present study, the resistance of Escherichia coli to antimicrobial agents was investigated. A total of 97 isolates were found to be susceptible to 16 antimicrobial agents and were detected in the production of extended β‑lactamases (ESBLs), distribution of CTX‑M‑type β‑lactamases, presence and characterization of class 1 integrons and a variable region of integron‑positive isolates. Escherichia coli isolates possessing CTX‑M (31; 32%) were detected in 19 isolates (61.5%). The presence of ESBLs was associated with resistance to penicillins, third-generation cephalosporins, ciprofloxacin, aminoglycosides and monocyclic β‑lactam antibiotics. Escherichia coli isolates (69; 71.1%) possessed class 1 integrons associated with resistance to ciprofloxacin and numerous third-generation cephalosporins, penicillins, tobramycin and trimethoprim‑sulfamethoxazole. The four gene cassette arrangements were as follows: dfrA17‑aadA5, aadA1, aacC4‑cmlA1 and dfr2d, and 8 carried two disparate class 1 integrons. Five isolates presented class 1 integrons containing no gene cassettes. The distribution of ESBLs and class 1 integrons in Escherichia coli were prevalent with drug resistance in Chengdu. In addition, the resistance range of Escherichia coli isolates that harboured ESBLs and carried class 1 integrons were similar. The current study demonstrated the presence of class 1 integrons and ESBLs, which jointly mediate the resistance of Escherichia coli isolates to a number of antibacterial agents.
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Affiliation(s)
- Li-Tao Liu
- Department of Pharmacology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Bloodstream infection among adults in Phnom Penh, Cambodia: key pathogens and resistance patterns. PLoS One 2013; 8:e59775. [PMID: 23555777 PMCID: PMC3612098 DOI: 10.1371/journal.pone.0059775] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bloodstream infections (BSI) cause important morbidity and mortality worldwide. In Cambodia, no surveillance data on BSI are available so far. METHODS From all adults presenting with SIRS at Sihanouk Hospital Centre of HOPE (July 2007-December 2010), 20 ml blood was cultured. Isolates were identified using standard microbiological techniques; antibiotic susceptibilities were assessed using disk diffusion and MicroScan®, with additional E-test, D-test and double disk test where applicable, according to CLSI guidelines. RESULTS A total of 5714 samples from 4833 adult patients yielded 501 clinically significant organisms (8.8%) of which 445 available for further analysis. The patients' median age was 45 years (range 15-99 y), 52.7% were women. HIV-infection and diabetes were present in 15.6% and 8.8% of patients respectively. The overall mortality was 22.5%. Key pathogens included Escherichia coli (n = 132; 29.7%), Salmonella spp. (n = 64; 14.4%), Burkholderia pseudomallei (n = 56; 12.6%) and Staphylococcus aureus (n = 53; 11.9%). Methicillin resistance was seen in 10/46 (21.7%) S. aureus; 4 of them were co-resistant to erythromycin, clindamycin, moxifloxacin and sulphamethoxazole-trimethoprim (SMX-TMP). We noted combined resistance to amoxicillin, SMX-TMP and ciprofloxacin in 81 E. coli isolates (62.3%); 62 isolates (47.7%) were confirmed as producers of extended spectrum beta-lactamase. Salmonella isolates displayed high rates of multidrug resistance (71.2%) with high rates of decreased ciprofloxacin susceptibility (90.0%) in Salmonella Typhi while carbapenem resistance was observed in 5.0% of 20 Acinetobacter sp. isolates. CONCLUSIONS BSI in Cambodian adults is mainly caused by difficult-to-treat pathogens. These data urge for microbiological capacity building, nationwide surveillance and solid interventions to contain antibiotic resistance.
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Marimuthu K, Ng TM, Teng C, Lim TP, Koh TH, Yen Tan T, Unny Krishnan P, Lye D. Risk factors and treatment outcome of ertapenem non-susceptible enterobacteriaceae bacteraemia. J Infect 2013. [DOI: 10.1016/j.jinf.2012.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Extended-spectrum cephalosporin-resistant Gram-negative organisms in livestock: an emerging problem for human health? Drug Resist Updat 2013; 16:22-45. [PMID: 23395305 DOI: 10.1016/j.drup.2012.12.001] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/22/2012] [Indexed: 12/18/2022]
Abstract
Escherichia coli, Salmonella spp. and Acinetobacter spp. are important human pathogens. Serious infections due to these organisms are usually treated with extended-spectrum cephalosporins (ESCs). However, in the past two decades we have faced a rapid increasing of infections and colonization caused by ESC-resistant (ESC-R) isolates due to production of extended-spectrum-β-lactamases (ESBLs), plasmid-mediated AmpCs (pAmpCs) and/or carbapenemase enzymes. This situation limits drastically our therapeutic armamentarium and puts under peril the human health. Animals are considered as potential reservoirs of multidrug-resistant (MDR) Gram-negative organisms. The massive and indiscriminate use of antibiotics in veterinary medicine has contributed to the selection of ESC-R E. coli, ESC-R Salmonella spp. and, to less extent, MDR Acinetobacter spp. among animals, food, and environment. This complex scenario is responsible for the expansion of these MDR organisms which may have life-threatening clinical significance. Nowadays, the prevalence of food-producing animals carrying ESC-R E. coli and ESC-R Salmonella (especially those producing CTX-M-type ESBLs and the CMY-2 pAmpC) has reached worryingly high values. More recently, the appearance of carbapenem-resistant isolates (i.e., VIM-1-producing Enterobacteriaceae and NDM-1 or OXA-23-producing Acinetobacter spp.) in livestock has even drawn greater concerns. In this review, we describe the aspects related to the spread of the above MDR organisms among pigs, cattle, and poultry, focusing on epidemiology, molecular mechanisms of resistance, impact of antibiotic use, and strategies to contain the overall problem. The link and the impact of ESC-R organisms of livestock origin for the human scenario are also discussed.
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Lynch JP, Clark NM, Zhanel GG. Evolution of antimicrobial resistance among Enterobacteriaceae (focus on extended spectrum β-lactamases and carbapenemases). Expert Opin Pharmacother 2013; 14:199-210. [DOI: 10.1517/14656566.2013.763030] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gomi H, Solomkin JS, Takada T, Strasberg SM, Pitt HA, Yoshida M, Kusachi S, Mayumi T, Miura F, Kiriyama S, Yokoe M, Kimura Y, Higuchi R, Windsor JA, Dervenis C, Liau KH, Kim MH. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:60-70. [DOI: 10.1007/s00534-012-0572-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Harumi Gomi
- Center for Clinical Infectious Diseases; Jichi Medical University; 3311-1, Yakushiji, Shimotsuke Tochigi 329-0431 Japan
| | - Joseph S. Solomkin
- Department of Surgery; University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Tadahiro Takada
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Steven M. Strasberg
- Section of Hepatobiliary and Pancreatic Surgery; Washington University in Saint Louis School of Medicine; Saint Louis MO USA
| | - Henry A. Pitt
- Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Masahiro Yoshida
- Clinical Research Center Kaken Hospital; International University of Health and Welfare; Ichikawa Japan
| | - Shinya Kusachi
- Department of Surgery; Toho University Medical Center Ohashi Hospital; Tokyo Japan
| | - Toshihiko Mayumi
- Department of Emergency and Critical Care Medicine; Ichinomiya Municipal Hospital; Ichinomiya Japan
| | - Fumihiko Miura
- Department of Surgery; Teikyo University School of Medicine; Tokyo Japan
| | - Seiki Kiriyama
- Department of Gastroenterology; Ogaki Municipal Hospital; Ogaki Japan
| | - Masamichi Yokoe
- General Internal Medicine, Nagoya Daini Red Cross Hospital; Nagoya Japan
| | - Yasutoshi Kimura
- Department of Surgical Oncology and Gastroenterological Surgery; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology; Tokyo Women's Medical University; Tokyo Japan
| | - John A. Windsor
- Department of Surgery; The University of Auckland; Auckland New Zealand
| | | | - Kui-Hin Liau
- Hepatobiliary and Pancreatic Surgery, Nexus Surgical Associates; Mount Elizabeth Hospital; Singapore Singapore
| | - Myung-Hwan Kim
- Department of Internal Medicine, Asan Medical Center; University of Ulsan; Seoul Korea
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Dai W, Sun S, Yang P, Huang S, Zhang X, Zhang L. Characterization of carbapenemases, extended spectrum β-lactamases and molecular epidemiology of carbapenem-non-susceptible Enterobacter cloacae in a Chinese hospital in Chongqing. INFECTION GENETICS AND EVOLUTION 2012; 14:1-7. [PMID: 23220359 DOI: 10.1016/j.meegid.2012.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Carbapenem-resistant Enterobacteriaceae, including strains from multiple species harboring metallo-β-lactamases (IMP, NDM or VIM) and non-metallo (KPC) carbapenemases, as well as those combining an extended-spectrum β-lactamase (ESBL) enzyme with porin loss, present an increasingly urgent clinical danger. The aim of this study was to characterize the carbapenemases and ESBLs in carbapenem-non-susceptible (CNS) Enterobacter cloacae (E. cloacae) isolates from a Chinese teaching hospital. A total of 986 non-duplicated E. cloacae isolates collected between September 2009 and February 2012 were analyzed via antimicrobial susceptibility testing. Carbapenemase and ESBL genes were examined using PCR amplification and DNA sequencing. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) and dendrogram analysis. We demonstrated that CNSs were prevalent (35/986, 3.55%) in E. cloacae. Phenotypes of carbapenemases and ESBLs were respectively found in 9 (25.7%) and 23 (65.7%) of the 35 CNS E. cloacae strains. KPC-2, IMP-8, IMP-26, NDM-1, TEM-6, CTX-M-3', CTX-M-14' and SHV-12 type β-lactamases were identified in 3 (8.6%), 5 (14.3%), 1 (2.9%), 1 (2.9%), 13 (37.1%), 9 (25.7%), 8 (22.9%) and 9 (25.7%) isolates, respectively. Importantly, multiple resistance genes were found to be co-expressed in the same CNS E. cloacae isolates. PFGE and dendrogram analysis showed clonal diversity among these isolates. Our study suggested that over-production of carbapenemases and ESBLs contributed together to the CNS of E. cloacae in China. Furthermore, the decreased susceptibility to carbapenems in E. cloaca in the hospital might arise via stepwise accumulations of multiple drug-resistance determinants in different clones. The prevalence of CNS E. cloacae isolates was not caused by clonal dissemination. Most importantly, we identified a CNS E. cloacae isolate co-expressing IMP-26 and NDM-1, which is the first reported to the best of our knowledge. This is also the first report of NDM-1-producing Enterobacteriaceae in mainland China.
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Affiliation(s)
- Wei Dai
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Abstract
PURPOSE OF REVIEW This review focuses on recent changes in epidemiological aspects of bacteria-induced intra-abdominal infections (IAIs), including the dominant pathogens, antimicrobial susceptibility profiles, and emerging resistance phenotypes. RECENT FINDINGS Enterobacteriaceae species, including Escherichia coli and Klebsiella pneumoniae, remain the major pathogens contributing to abdominal sepsis, although Pseudomonas aeruginosa and Acinetobacter baumannii have recently become common causes of hospital-acquired IAIs. The prevalence of multidrug-resistant Gram-negative bacilli, especially those that produce extended-spectrum β-lactamases (ESBLs), has increased worldwide, although the distribution of those organisms varies from region to region. Furthermore, recent changes in interpretive breakpoints for antimicrobial susceptibility testing recommended by the Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) have resulted in a marked increase in the reported rates of resistance among Gram-negative bacilli to carbapenems, extended-spectrum cephalosporins, and fluoroquinolones. Besides, routine detection and reporting of ESBL phenotypes for clinical isolates have not been recommended after following new interpretive breakpoints. More studies are needed to investigate the impacts of these changes on therapeutic strategies and epidemiological surveillance. In addition, pathogens carrying New Delhi metallo-β-lactamases (NDMs), K. pneumoniae carbapenemases (KPCs), and other carbapenemases show extended resistance to currently available antibiotics and rapid transfer between species and countries. Although some of these pathogens are still susceptible to tigecycline and colistin, rates of resistance to these two agents are rising. SUMMARY Abdominal sepsis due to multidrug-resistant bacteria, especially ESBL producers, and international and interspecies spreading of metallo-β-lactamase raise key therapeutic problems.
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