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Vieira Filho JF, Ribeiro VN, do Nascimento ÁMA, Maria Alves de Melo M. Infections in Children with Cancer Admitted in an Oncology Reference Hospital: A Cross-sectional Study. Curr Microbiol 2023; 80:315. [PMID: 37544971 DOI: 10.1007/s00284-023-03420-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
Pediatric oncology patients are usually immunosuppressed due to factors such as the neoplasm and its treatment, making them more susceptible to infections. This article aims to determine the infection profile of pediatric oncology patients admitted to an oncology reference hospital in Natal, Rio Grande do Norte, Brazil. A retrospective and cross-sectional study was conducted, collecting data from patients hospitalized due to infection in a pediatric oncology unit exclusively for the Brazilian public health system, spanning from 2018 to 2021. A total of 168 episodes of infections were identified in 96 patients, resulting in 157 hospitalizations. Among the patients with infections, 62.4% had hematological malignancies, and out of these cases, 74.6% specifically had Acute Lymphoid Leukemia. The Escherichia coli (31.9%) was the most prevalent microorganism isolated from the samples. Multidrug-resistant microorganisms accounted for 52% of all identified microorganisms. Fluoroquinolones and beta-lactam were the most prevalent antibiotic classes in the analyzed antibiograms. Factors such as Sex, type of cancer, chemotherapy in the last 30 days, were found to be associated with the occurrence of infection (p < 0.05). Conducting epidemiological studies regarding infections in pediatric oncology is crucial to development of empirical protocols, and the implementation of strategies to better control future infections.
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Affiliation(s)
- Jonas Fernandes Vieira Filho
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | - Viviane Nunes Ribeiro
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil
| | | | - Menilla Maria Alves de Melo
- Instituto de Ensino, Pesquisa e Inovação, Liga Norte Riograndense Contra o Câncer Hospital, Natal, Rio Grande do Norte, Brazil.
- Department of Pharmacy, Pesquisa e Inovação, Instituto de Ensino, Liga Norte Riograndense Contra o Câncer Hospital, Av. Miguel Castro, Nossa Senhora de Nazaré, Natal, 1355, CEP 59062-000, Rio Grande do Norte, Brazil.
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2
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Beauchamp-Walters J, Aleti G, Herrera L, Debelius J, Lima N, Dalal P, Hong S, Knight R, Rhee KE. Impact of exclusive enteral nutrition on the gut microbiome of children with medical complexity. JPEN J Parenter Enteral Nutr 2023; 47:77-86. [PMID: 35526141 DOI: 10.1002/jpen.2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 05/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Children with medical complexity (CMC) often require enteral tube feedings to meet their nutrition needs. Many, however, experience symptoms of feeding intolerance, such as vomiting and pain. The goal of this analysis was to examine the relationship between diet and the gut microbiome, controlling for medications, among CMC receiving enteral tube feedings, CMC consuming oral nutrition, and healthy controls. Given the variety of available commercial formula preparations, we were also interested in examining the impact of different formula types on the CMC microbiome. METHODS Fecal samples from 91 children (57 CMC and 34 healthy controls) were collected and analyzed. Parents completed clinical and dietary questionnaires. 16S ribosomal RNA amplicon sequencing was completed using the QIIME2 pipeline. RESULTS A significant decrease in alpha diversity among CMC receiving exclusive enteral nutrition (CMC EEN) compared with healthy controls (Shannon P = 0.006 and Faith's phylogenetic distance P = 0.006) was found that was not observed between CMC receiving oral nutrition and healthy controls. Significant differences in beta diversity were also observed between CMC EEN and healthy controls, with CMC EEN having a greater relative abundance of Enterobacteriaceae and obligate anaerobes. Differences were also noted between CMC EEN and CMC receiving oral nutrition (Aitchison distance P = 0.001); however, no differences were observed between CMC receiving oral nutrition and healthy controls. CONCLUSION Despite similarities in medication profiles, CMC EEN have decreased alpha diversity and differences in beta diversity compared with healthy controls not observed in CMC receiving oral nutrition, highlighting the impact of diet over medications.
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Affiliation(s)
- Julia Beauchamp-Walters
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Rady's Children's Hospital, San Diego, California, USA
| | - Gajender Aleti
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Lourdes Herrera
- Department of Pediatrics, Billings Clinic, Billings, Montana, USA
| | - Justine Debelius
- Centre for Translational Microbiome Research, Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Lima
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, California, USA
| | - Pritha Dalal
- Rady's Children's Hospital, San Diego, California, USA.,Department of Orthopedics, University of California San Diego, La Jolla, California, USA
| | - Suzi Hong
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Department of Computer Science and Engineering, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA.,Department of Bioengineering, Jacobs School of Engineering, University of California San Diego, La Jolla, California, USA.,Center for Microbiome Innovation, University of California San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Rady's Children's Hospital, San Diego, California, USA
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Alsubaie MA, Alsuheili AZ, Aljehani MN, Alothman AA, Alzahrani AS, Mohammedfadel HA, Alnajjar AA. Pediatric community acquired urinary tract infections due to extended-spectrum beta-lactamase versus non-extended-spectrum beta-lactamase producing bacteria. Pediatr Int 2023; 65:e15620. [PMID: 37735838 DOI: 10.1111/ped.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/29/2023] [Accepted: 07/09/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND This study aimed to evaluate the demographics, clinical characteristics, risk factors, and antibiotic resistance of pediatric community-acquired urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing uropathogens. METHODS This retrospective study was conducted at a tertiary care hospital in Saudi Arabia, among children aged between 0 and 14 years, with a culture-proven diagnosis of community-acquired UTI between February 2019 and September 2021. Patients were divided into two groups based on whether or not their UTI was caused by ESBL-producing bacteria. RESULTS A total of 383 patients with community-acquired UTI were evaluated. Escherichia coli was detected in 72.6% of cultures. Extended-spectrum beta-lactamase-producing organisms were responsible for 35.7% of UTI episodes. Of these 69% and 31% were caused by E. coli and Klebsiella pneumoniae, respectively. There were no significant differences between the two groups with regard to clinical presentation or urine analysis. The resistance rates in the ESBL-producing group were 39.4% for amoxicillin/clavulanic acid, 65.7% for ciprofloxacin, 72.3% for co-trimoxazole, 32.8% for nitrofurantoin, 21.2% for gentamicin, and 0.7% for amikacin and carbapenems. In the non-ESBL-producing group, it was 22.4% for amoxicillin/clavulanic acid, 22.4% for ciprofloxacin, 38.2% for co-trimoxazole, 23.6% for nitrofurantoin, 6.1% for gentamicin, and zero for amikacin and carbapenems. The presence of renal abnormalities (p = 0.014) and male gender (p = 0.026) were determined to be independent risk factors for ESBL UTIs. CONCLUSIONS Recognizing risk factors and antibiotic resistance for ESBL-producing bacteria may aid in tailoring an antibiotic regimen for pediatric patients at high risk of ESBL-UTIs.
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Affiliation(s)
| | | | | | | | | | | | - Abeer A Alnajjar
- Infectious Diseases Unit, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Zakaria AS, Edward EA, Mohamed NM. Pathogenicity Islands in Uropathogenic Escherichia coli Clinical Isolate of the Globally Disseminated O25:H4-ST131 Pandemic Clonal Lineage: First Report from Egypt. Antibiotics (Basel) 2022; 11:1620. [PMID: 36421264 PMCID: PMC9686529 DOI: 10.3390/antibiotics11111620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 10/25/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) is the main etiological agent of urinary tract infections (UTIs). The pathogenesis of UTIs relies upon UPEC's acquisition of virulence determinants that are commonly inserted into large chromosomal blocks which are termed 'pathogenicity islands' (PAIs). In this study, we investigated the virulence-associated genes embedded in the chromosome of a UPEC Egyptian strain, EC14142. Additionally, we present a detailed characterization of the PAIs in the EGY_EC14142 chromosome. The isolate displayed a multidrug-resistant phenotype, and whole genome sequencing indicated that it belonged to the globally disseminated O25:H4-ST131 pandemic lineage and the H30-Rx clade. EGY_EC14142 carried genes that are responsible for resistance to aminoglycosides, fluoroquinolones, extended-spectrum β-lactams, macrolides, folate pathway antagonists, and tetracyclines. It encoded five PAIs with a high similarity to PAI II536, PAI IV536, PAI V536, PAI-536-icd, and PAIusp. The genome analysis of EGY_EC14142 with other closely related UPEC strains revealed that they have a high nucleotide sequence identity. The constructed maximum-likelihood phylogenetic tree showed the close clonality of EGY_EC14142 with the previously published ST131 UPEC international isolates, thus endorsing the broad geographical distribution of this clone. This is the first report characterizing PAIs in a UPEC Egyptian strain belonging to the globally disseminated pandemic clone O25:H4-ST131.
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Affiliation(s)
- Azza S. Zakaria
- Microbiology and Immunology Department, Faculty of Pharmacy, Alexandria University, Alexandria 25435, Egypt
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5
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Obiero CW, Williams P, Murunga S, Thitiri J, Omollo R, Walker AS, Egondi T, Nyaoke B, Correia E, Kane Z, Gastine S, Kipper K, Standing JF, Ellis S, Sharland M, Berkley JA. Randomised controlled trial of fosfomycin in neonatal sepsis: pharmacokinetics and safety in relation to sodium overload. Arch Dis Child 2022; 107:802-810. [PMID: 35078765 PMCID: PMC9411916 DOI: 10.1136/archdischild-2021-322483] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess pharmacokinetics and changes to sodium levels in addition to adverse events (AEs) associated with fosfomycin among neonates with clinical sepsis. DESIGN A single-centre open-label randomised controlled trial. SETTING Kilifi County Hospital, Kenya. PATIENTS 120 neonates aged ≤28 days admitted being treated with standard-of-care (SOC) antibiotics for sepsis: ampicillin and gentamicin between March 2018 and February 2019. INTERVENTION We randomly assigned half the participants to receive additional intravenous then oral fosfomycin at 100 mg/kg two times per day for up to 7 days (SOC-F) and followed up for 28 days. MAIN OUTCOMES AND MEASURES Serum sodium, AEs and fosfomycin pharmacokinetics. RESULTS 61 and 59 infants aged 0-23 days were assigned to SOC-F and SOC, respectively. There was no evidence of impact of fosfomycin on serum sodium or gastrointestinal side effects. We observed 35 AEs among 25 SOC-F participants and 50 AEs among 34 SOC participants during 1560 and 1565 infant-days observation, respectively (2.2 vs 3.2 events/100 infant-days; incidence rate difference -0.95 events/100 infant-days (95% CI -2.1 to 0.20)). Four SOC-F and 3 SOC participants died. From 238 pharmacokinetic samples, modelling suggests an intravenous dose of 150 mg/kg two times per day is required for pharmacodynamic target attainment in most children, reduced to 100 mg/kg two times per day in neonates aged <7 days or weighing <1500 g. CONCLUSION AND RELEVANCE Fosfomycin offers potential as an affordable regimen with a simple dosing schedule for neonatal sepsis. Further research on its safety is needed in larger cohorts of hospitalised neonates, including very preterm neonates or those critically ill. Resistance suppression would only be achieved for the most sensitive of organisms so fosfomycin is recommended to be used in combination with another antimicrobial. TRIAL REGISTRATION NUMBER NCT03453177.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Phoebe Williams
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sheila Murunga
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Raymond Omollo
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | | | - Thaddaeus Egondi
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Borna Nyaoke
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Erika Correia
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Zoe Kane
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Silke Gastine
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Karin Kipper
- Institute of Chemistry, University of Tartu, Tartu, Estonia.,Analytical Services International (ASI) Ltd, St George's - University of London, London, UK
| | - Joseph F Standing
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, University of London, London, UK
| | - James Alexander Berkley
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya .,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Heteroaryl-Ethylenes as New Effective Agents for High Priority Gram-Positive and Gram-Negative Bacterial Clinical Isolates. Antibiotics (Basel) 2022; 11:antibiotics11060767. [PMID: 35740173 PMCID: PMC9219758 DOI: 10.3390/antibiotics11060767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
The World Health Organization has identified antimicrobial resistance as a public health emergency and developed a global priority pathogens list of antibiotic-resistant bacteria that can be summarized in the acronym ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales species), reminding us of their ability to escape the effect of antibacterial drugs. We previously tested new heteroaryl-ethylene compounds in order to define their spectrum of activity and antibacterial capability. Now, we focus our attention on PB4, a compound with promising MIC and MBC values in all conditions tested. In the present study, we evaluate the activity of PB4 on selected samples of ESKAPE isolates from nosocomial infections: 14 S. aureus, 6 E. faecalis, 7 E. faecium, 12 E. coli and 14 A. baumannii. Furthermore, an ATCC control strain was selected for all species tested. The MIC tests were performed according to the standard method. The PB4 MIC values were within very low ranges regardless of bacterial species and resistance profiles: from 0.12 to 2 mg/L for S. aureus, E. faecalis, E. faecium and A. baumannii. For E. coli, the MIC values obtained were slightly higher (4–64 mg/L) but still promising. The PB4 heteroaryl-ethylenic compound was able to counteract the bacterial growth of both high-priority Gram-positive and Gram-negative clinical strains. Our study contributes to the search for new molecules that can fight bacterial infections, in particular those caused by MDR bacteria in hospitals. In the future, it would be interesting to evaluate the activity of PB4 in animal models to test for its toxicity.
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Lu J, Wang L, Wei Y, Wu S, Wei G. Trends and risk factors of extended-spectrum beta-lactamase urinary tract infection in Chinese children: a nomogram is built and urologist should act in time. Transl Pediatr 2022; 11:859-868. [PMID: 35800289 PMCID: PMC9253944 DOI: 10.21037/tp-21-523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the etiological characteristics and risk factors of extended-spectrum beta-lactamase (ESBL) urinary tract infection (UTI) and construct a corresponding nomogram to predict the probability of ESBL(+) UTI. METHODS We retrospectively reviewed the records among patients experiencing UTI events in Chongqing Medical University Affiliated Children's Hospital from 1994 and 2019. RESULTS A total of 854 patients with UTI were evaluated and ESBL-producing bacteria increased significantly. Significant potential risk factors of ESBL-UTI were congenital urological abnormalities, vesicoureteral reflux, neurologic disorder, age <12 months, fever and previous use of antibiotics. On logistic regression analysis, neurological disorder (OR =8, 95% CI: 1.845-34.695) and antibiotics administration in the last 3 months (OR =4.764, 95% CI: 3.114-7.289) were identified as an independent significant risk factor for ESBL-UTI. The nomogram generated was well calibrated for all predictions of ESBL+ probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.741. CONCLUSIONS The current situation of multiple bacterial antibiotic resistance has become a worrisome issue in UTI and early identification of ESBL production is important in terms of appropriate treatment and effective infection control. We may choose broad-spectrum antibiotics as empirical antibiotics for UTI among children with neurological disease and used antibiotic in the last three months.
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Affiliation(s)
- Jiandong Lu
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Lin Wang
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yi Wei
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Guanghui Wei
- Department of Urology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
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8
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Agud M, de Medrano I, Mendez-Echevarria A, Sainz T, Román F, Ruiz Carrascoso G, Escosa-Garcia L, Molina Amores C, Climent FJ, Rodríguez A, Garcia-Fernandez de Villalta M, Calvo C. Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions. Sci Rep 2022; 12:7223. [PMID: 35508685 PMCID: PMC9068800 DOI: 10.1038/s41598-022-11295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Abstract
To assess drug-resistant bacterial colonisation rates and associated risk factors in children with complex chronic conditions admitted to a national reference unit in Spain. Cross-sectional study that included all children admitted to our unit from September 2018 to July 2019. Rectal swabs were obtained to determine multidrug-resistant Gram-negative bacilli (MR-GNB) colonisation, and nasal swab to determine S. aureus and methicillin-resistant S. aureus (MRSA) colonisation. Medical records were reviewed. 100 children were included, with a median of four complex chronic conditions. Sixteen percent had S. aureus colonisation, including two MRSA. S. aureus colonisation was associated with technology-dependent children, while being on antibiotic prophylaxis or having undergone antibiotic therapy in the previous month were protective factors. The prevalence of MR-GNB colonisation was 27%, which was associated with immunosuppressive therapy (aOR 31; 2.02–47]; p = 0.01), antibiotic prophylaxis (aOR 4.56; 1.4–14.86; p = 0.012), previously treated skin-infections (aOR 2.9; 1.07–8.14; p = 0.03), surgery in the previous year (aOR 1.4; 1.06–1.8; p = 0.014), and hospital admission in the previous year (aOR 1.79; [1.26–2.56]; p = 0.001). The rate of S. aureus nasal colonisation in this series was not high despite the presence of chronic conditions, and few cases corresponded to MRSA. Antibiotic prophylaxis, immunosuppressive therapies, history of infections, previous surgeries, and length of admission in the previous year were risk factors for MR-GNB colonisation.
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Affiliation(s)
- Martin Agud
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Ines de Medrano
- Paediatric Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Mendez-Echevarria
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Talia Sainz
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Federico Román
- Nosocomial Infections Unit, CNM, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Guillermo Ruiz Carrascoso
- Department of Clinical Microbiology, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Luis Escosa-Garcia
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Clara Molina Amores
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Francisco José Climent
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Aroa Rodríguez
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Cristina Calvo
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
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9
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Gatya Al-Mayahie SM, Al-Guranie DRT, Hussein AA, Bachai ZA. Prevalence of common carbapenemase genes and multidrug resistance among uropathogenic Escherichia coli phylogroup B2 isolates from outpatients in Wasit Province/ Iraq. PLoS One 2022; 17:e0262984. [PMID: 35077517 PMCID: PMC8789106 DOI: 10.1371/journal.pone.0262984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/10/2022] [Indexed: 01/04/2023] Open
Abstract
Carbapenems are the last resort antimicrobials for the treatment of extended spectrum β-lactamases (ESBLs) producing Enterobacteriaceae. Emergence of carbapenems resistant group B2 uropathogenic E. coli (UPEC) is a major concern because of their high virulence. Prevalence of these enzymes and multidrug resistance (MDR) among B2 UPEC isolates from Iraqi outpatients with acute urinary tract infection (UTI) was evaluated in this research. Urine cultures were performed and the isolates were identified biochemically. Escherichia coli isolates were tested for phylogroup reference by quadraplex PCR, then B2 isolates were detected for antimicrobial resistance by disc diffusion test and carbapenemase genes by PCR. Escherichia coli was the most prevalent among Gram-negative isolates (66.6%) and B2 was the most detected phylogroup among E. coli isolates (33.9%). Most of B2 isolates showed high resistance rates to tested antimicrobials, especially β-lactams with MDR revealed in 100% of them. Whereas, low resistance rates were noted against carbapenems, aminoglycosides and nitrofurantoin. Carbapenemase genes were detected in 76.3% of B2 isolates. Of which, blaOXA-48 was the most frequent (57.8%), followed by blaPER (47.3%), blaKPC (15.7%), blaVEB and blaVIM (10.5%, for each). Whereas, blaGES and blaIMP genes were not found. Coproduction of these genes occurred among 17 isolates. The combination of blaOXA-48 and blaPER was the most frequent (41.1%). All carbapenemase producing isolates were MDR. These results revealed high prevalence of carbapenemase genes and MDR among B2 UPEC recovered in this study. In the study area. it is strongly advised to use aminoglycosides and nitrofurantoin for empirical treatment of UPEC.
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Affiliation(s)
| | | | - Aya Aziz Hussein
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
| | - Zaineb Ali Bachai
- Department of Biology, College of Science, Wasit University, Al-Kut City, Wasit Province, Iraq
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10
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Matloko K, Fri J, Ateba TP, Molale-Tom LG, Ateba CN. Evidence of potentially unrelated AmpC beta-lactamase producing Enterobacteriaceae from cattle, cattle products and hospital environments commonly harboring the blaACC resistance determinant. PLoS One 2021; 16:e0253647. [PMID: 34324493 PMCID: PMC8321102 DOI: 10.1371/journal.pone.0253647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
The occurrence and genetic relatedness of AmpC beta-lactamase producing Enterobacteriaceae isolated from clinical environments, groundwater, beef, human and cattle faeces were investigated. One hundred seventy-seven (177) samples were collected and cultured on MacConkey agar. A total of 203 non-repetitive isolates were characterised using genus/species-specific PCRs and the identified isolates were subjected to antibiotic susceptibility testing. The production of AmpC beta-lactamases was evaluated using cefoxitin disc, confirmed by the D96C detection test and their encoding genes detected by PCR. The D64C extended-spectrum beta-lactamases (ESBL) test was also performed to appraise ESBLs/AmpC co-production. The genetic fingerprints of AmpC beta-lactamase producers were determined by ERIC-PCR. A total of 116 isolates were identified as E. coli (n = 65), Shigella spp. (n = 36) and Klebsiella pneumoniae (n = 15). Ciprofloxacin resistance (44.4-55.4%) was the most frequent and resistance against the Cephem antibiotics ranged from 15-43.1% for E. coli, 25-36.1% for Shigella spp., and 20-40% for K. pneumoniae. On the other hand, these bacteria strains were most sensitive to Amikacin (0%), Meropenem (2.8%) and Piperacillin-Tazobactam (6.7%) respectively. Nineteen (16.4%) isolates comprising 16 E. coli and 3 Shigella spp. were confirmed as AmpC beta-lactamase producers. However, only E. coli isolates possessed the corresponding resistance determinants: blaACC (73.7%, n = 14), blaCIT (26%, n = 5), blaDHA (11%, n = 2) and blaFOX (16%, n = 3). Thirty-four (27.3%) Enterobacteriaceae strains were confirmed as ESBL producers and a large proportion (79.4%, n = 27) harboured the blaTEM gene, however, only two were ESBLs/AmpC co-producers. Genetic fingerprinting of the AmpC beta-lactamase-producing E. coli isolates revealed low similarity between isolates. In conclusion, the findings indicate the presence of AmpC beta-lactamase-producing Enterobacteriaceae from cattle, beef products and hospital environments that commonly harbour the associated resistance determinants especially the blaACC gene, nonetheless, there is limited possible cross-contamination between these environments.
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Affiliation(s)
- Keduetswe Matloko
- Antimicrobial Resistance and Phage Biocontrol Research Group, Department of Microbiology, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Justine Fri
- Antimicrobial Resistance and Phage Biocontrol Research Group, Department of Microbiology, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Tshepiso Pleasure Ateba
- Centre for Animal Health Studies, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Lesego G. Molale-Tom
- Unit for Environmental Sciences and Management - Microbiology, North-West University, Potchefstroom, South Africa
| | - Collins Njie Ateba
- Antimicrobial Resistance and Phage Biocontrol Research Group, Department of Microbiology, School of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
- Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
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Importance of Reviewing Antibiotic Courses by 48 Hours: Risk Factors for Third-Generation Cephalosporin Resistance Among AmpC Harboring Organisms in Urine and Respiratory Cultures. Pediatr Infect Dis J 2021; 40:440-445. [PMID: 33264210 DOI: 10.1097/inf.0000000000003006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Citrobacter, Enterobacter, Morganella, and Serratia (AmpC organisms) species can exhibit third-generation cephalosporin (TGC) resistance after TGC exposure. We aimed to assess if institutional TGC utilization correlated with institutional AmpC organism susceptibility and if prior TGC exposure ≤48 hours were associated with TGC resistance in the first culture of a future infection episode caused by an AmpC organism. METHODS A 5-year retrospective cohort study was performed, including AmpC organisms isolated from pediatric urinary and respiratory tract cultures at an institution with TGC courses reviewed by the antimicrobial stewardship program at 48 hours. Correlations were assessed by Pearson's correlation. Multivariable logistic regression identified factors independently associated with TGC resistance in a subcohort of infection episodes. RESULTS Among 654 cultures, AmpC organism TGC susceptibility increased from 74% in 2013 to 89.3% in 2017, and this correlated with a 26.1% decrease in TGC utilization (R = -0.906; P = 0.034). Among 275 AmpC organism infections, 21.1% were resistant. Resistance occurred in 13.6%, 17.4%, and 56.5% of infections with no exposure, ≤48 hours, and >48 hours of TGC exposure in the past 30 days, respectively. TGC exposure ≤48 hours was not associated with resistance (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.32-4.94; P = 0.74), whereas, TGC exposure >48 hours was (OR, 8.7; 95% CI, 3.67-20.6; P < 0.001). Infections in 2017 were less likely to be resistant (OR, 0.25; 95% CI, 0.08-0.8; P = 0.019). CONCLUSIONS Decreased TGC utilization, likely related to antimicrobial stewardship, correlated with increased AmpC organism susceptibility. Limiting TGC exposure to ≤48 hours when possible may reduce AmpC organism resistance in future infections.
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Shahandeh Z, Kalantrai N, Sadighian F. Comparison of ertapenem non-susceptibility with 2-mercaptopropionic acid phenotypic tests in predicting NDM-1 and IMP-1 production in clinical isolates of Escherichia coli. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 11:426-431. [PMID: 33680385 PMCID: PMC7911768 DOI: 10.22088/cjim.11.4.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: A routine phenotypic test has not been recommended for the detection of metallo-β-lactamases (MBLs) producing Enterobacteriaceae species such as Escherichia coli. The current study was conducted to compare the 2-mercaptopropionic acid (2-MPA) phenotypic method and ertapenem non-susceptibility test with polymerase chain reaction in predicting the production of MBLs in clinical isolates of E. coli. Methods: Antimicrobial susceptibility test for beta-lactam antibiotics were performed by disk diffusion method. All isolates which showed inhibition zones of ≤ 22 mm for CAZ and ≤ 27 mm for CTX were considered potential MBLs producing isolates. The production of MBLs was confirmed using 2-MPA compound. Also, susceptibility to ertapenem was evaluated in all isolates. Conventional PCR was performed to detect blaIMP-1 and/or blaNDM-1 genes in all potential MBLs producing E. coli isolates. Results: Of 259, 138 (53.3%) isolates were potential MBLs producing bacteria. One hundred and fifteen out of 138 (83.3%) isolates were susceptible to ertapenem. MBLs production was confirmed in 75/138 (54.4%) isolates by 2-MPA phenotypic method. The blaNDM-1 or/and blaIMP-1 genes were found in 30/75(40%) and 39/115(33.9%) isolates which were confirmed by 2-MPA and were susceptible to ertapenem, respectively. The sensitivity of 2-MPA method and ertapenem non-susceptibility test compared with PCR were 65.2% and 15.2%, and the specificity was 52.1% versus 82.6%, respectively. Conclusion: This study demonstrated that the 2-MPA phenotypic method does not have acceptable sensitivity and specificity in comparison with PCR, but its results are more reliable for the detection of MBL producing E. coli isolates compared with non-susceptibility to ertapenem.
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Affiliation(s)
- Zahra Shahandeh
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Babol, Iran
| | - Narges Kalantrai
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farahnaz Sadighian
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Babol, Iran
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13
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Diverse β-lactam antibiotic-resistant bacteria and microbial community in milk from mastitic cows. Appl Microbiol Biotechnol 2021; 105:2109-2121. [PMID: 33587158 DOI: 10.1007/s00253-021-11167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/25/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Intramammary bacterial infection, the most common cause of mastitis, is the most costly disease in dairy cattle in the US and reason for antibiotic usage. Ceftiofur, a third-generation cephalosporin, is generally used to treat such disease, but it has a high treatment failure rate. Though the reason is not known clearly, it is hypothesized that multiple factors are associated with the treatment failure. In this study, we analyzed 169 milk samples from cows with mastitis in two independent dairy farms (Farm A and B) in which 19.4% (Farm A) and 14.3% (Farm B) of the antibiotic treated cows were not cured. The prevalence of cephalosporin-resistant bacteria (CRB) in milk was 72.0% and 42.1% in Farm A and B, respectively. Nineteen and nine bacterial genera were identified in Farm A and B respectively, with the most abundant genus being Staphylococcus (27.1%; Farm A) and Bacillus (63.5%; Farm B). However, no strong relationship between the treatment failure rate and the CRB prevalence was observed. Furthermore, the metagenomic analysis showed no significant differences in the α- and β-diversities of microbiota in milk samples from cured and uncured cows, suggesting that antibiotic-resistant bacteria were not the sole reason for the antibiotic treatment failure. KEY POINTS: • The mastitic milk samples had high prevalence of cephalosporin-resistant bacteria (CRB). • The CRB identified belong to diversified species. • Antibiotic treatment failure was not solely caused by the abundance of CRB.
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14
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Taggar G, Attiq Rheman M, Boerlin P, Diarra MS. Molecular Epidemiology of Carbapenemases in Enterobacteriales from Humans, Animals, Food and the Environment. Antibiotics (Basel) 2020; 9:antibiotics9100693. [PMID: 33066205 PMCID: PMC7602032 DOI: 10.3390/antibiotics9100693] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
The Enterobacteriales order consists of seven families including Enterobacteriaceae, Erwiniaceae, Pectobacteriaceae, Yersiniaceae, Hafniaceae, Morganellaceae, and Budviciaceae and 60 genera encompassing over 250 species. The Enterobacteriaceae is currently considered as the most taxonomically diverse among all seven recognized families. The emergence of carbapenem resistance (CR) in Enterobacteriaceae caused by hydrolytic enzymes called carbapenemases has become a major concern worldwide. Carbapenem-resistant Enterobacteriaceae (CRE) isolates have been reported not only in nosocomial and community-acquired pathogens but also in food-producing animals, companion animals, and the environment. The reported carbapenemases in Enterobacteriaceae from different sources belong to the Ambler class A (blaKPC), class B (blaIMP, blaVIM, blaNDM), and class D (blaOXA-48) β-lactamases. The carbapenem encoding genes are often located on plasmids or associated with various mobile genetic elements (MGEs) like transposons and integrons, which contribute significantly to their spread. These genes are most of the time associated with other antimicrobial resistance genes such as other β-lactamases, as well as aminoglycosides and fluoroquinolones resistance genes leading to multidrug resistance phenotypes. Control strategies to prevent infections due to CRE and their dissemination in human, animal and food have become necessary. Several factors involved in the emergence of CRE have been described. This review mainly focuses on the molecular epidemiology of carbapenemases in members of Enterobacteriaceae family from humans, animals, food and the environment.
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Affiliation(s)
- Gurleen Taggar
- Guelph Research and Development Center, Agriculture and Agri-Food Canada (AAFC), 93, Stone Road West, Guelph, ON N1G 5C6, Canada; (G.T.); (M.A.R.)
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Muhammad Attiq Rheman
- Guelph Research and Development Center, Agriculture and Agri-Food Canada (AAFC), 93, Stone Road West, Guelph, ON N1G 5C6, Canada; (G.T.); (M.A.R.)
| | - Patrick Boerlin
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Moussa Sory Diarra
- Guelph Research and Development Center, Agriculture and Agri-Food Canada (AAFC), 93, Stone Road West, Guelph, ON N1G 5C6, Canada; (G.T.); (M.A.R.)
- Correspondence:
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15
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AbdelRahman MAA, Roshdy H, Samir AH, Hamed EA. Antibiotic resistance and extended-spectrum β-lactamase in Escherichia coli isolates from imported 1-day-old chicks, ducklings, and turkey poults. Vet World 2020; 13:1037-1044. [PMID: 32801552 PMCID: PMC7396329 DOI: 10.14202/vetworld.2020.1037-1044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
Aim: Antimicrobial resistance is a global health threat. This study investigated the prevalence of Escherichia coli in imported 1-day-old chicks, ducklings, and turkey poults. Materials and Methods: The liver, heart, lungs, and yolk sacs of 148 imported batches of 1-day-old flocks (chicks, 45; ducklings, 63; and turkey poults, 40) were bacteriologically examined for the presence of E. coli. Results: We isolated 38 E. coli strains from 13.5%, 6.7%, and 5.4% of imported batches of 1-day-old chicks, ducklings, and turkey poults, respectively. They were serotyped as O91, O125, O145, O78, O44, O36, O169, O124, O15, O26, and untyped in the imported chicks; O91, O119, O145, O15, O169, and untyped in the imported ducklings; and O78, O28, O29, O168, O125, O158, and O115 in the imported turkey poults. The E. coli isolates were investigated for antibiotic resistance against 16 antibiotics using the disk diffusion method and were found resistant to cefotaxime (60.5%), nalidixic acid (44.7%), tetracycline (44.7%), and trimethoprim-sulfamethoxazole (42.1%). The distribution of extended-spectrum β-lactamase (ESBL) and ampC β-lactamase genes was blaTEM (52.6%), blaSHV (28.9%), blaCTX-M (39.5%), blaOXA-1 (13.1%), and ampC (28.9%). Conclusion: Imported 1-day-old poultry flocks may be a potential source for the dissemination of antibiotic-resistant E. coli and the ESBL genes in poultry production.
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Affiliation(s)
- Mona A A AbdelRahman
- Department of Bacteriology, Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center, P.O. Box 264, Dokki, Giza 12618, Egypt
| | - Heba Roshdy
- Department of Bacteriology, Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center, P.O. Box 264, Dokki, Giza 12618, Egypt
| | - Abdelhafez H Samir
- Department of Biotechnology, Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center, P.O. Box 264, Dokki, Giza 12618, Egypt
| | - Engy A Hamed
- Department of Bacteriology, Reference Laboratory for Veterinary Quality Control on Poultry Production, Animal Health Research Institute, Agriculture Research Center, P.O. Box 264, Dokki, Giza 12618, Egypt
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16
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Williams PC. Potential of fosfomycin in treating multidrug-resistant infections in children. J Paediatr Child Health 2020; 56:864-872. [PMID: 32294306 DOI: 10.1111/jpc.14883] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 01/12/2023]
Abstract
In an era of increasing antimicrobial resistance, there are limited treatment options available to treat multidrug-resistant organisms in paediatric patients. Fosfomycin is an antibiotic defined as 'critically important' by The World Health Organization due to its potential efficacy against multidrug-resistant bacteria and is increasingly cited in the international literature as a promising antimicrobial for combating sepsis in an era of increasing antimicrobial resistance. With broad-spectrum cover that includes both Gram-positive and Gram-negative organisms and both parenteral and oral formulations available, fosfomycin provides a promising treatment option for paediatric patients. This review summarises fosfomycin's spectrum of activity, published efficacy in paediatric patients, safety considerations and pharmacokinetic data, as well as identifying current clinical trials delineating pharmacokinetic parameters and safety parameters in neonatal sepsis which will provide further information regarding the use of fosfomycin in neonatal and paediatric infections. Limitations regarding the current standards for fosfomycin susceptibility definitions, variations in dosing regimens and the potential mechanisms for resistance are also discussed.
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Affiliation(s)
- Phoebe Cm Williams
- Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Nuffield Department of Medicine, The University of Oxford, Headington, UK
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The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria. Antibiotics (Basel) 2020; 9:antibiotics9040186. [PMID: 32316342 PMCID: PMC7235769 DOI: 10.3390/antibiotics9040186] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022] Open
Abstract
Carbapenemases are β-lactamases belonging to different Ambler classes (A, B, D) and can be encoded by both chromosomal and plasmid-mediated genes. These enzymes represent the most potent β-lactamases, which hydrolyze a broad variety of β-lactams, including carbapenems, cephalosporins, penicillin, and aztreonam. The major issues associated with carbapenemase production are clinical due to compromising the activity of the last resort antibiotics used for treating serious infections, and epidemiological due to their dissemination into various bacteria across almost all geographic regions. Carbapenemase-producing Enterobacteriaceae have received more attention upon their first report in the early 1990s. Currently, there is increased awareness of the impact of nonfermenting bacteria, such as Acinetobacter baumannii and Pseudomonas aeruginosa, as well as other Gram-negative bacteria that are carbapenemase-producers. Outside the scope of clinical importance, carbapenemases are also detected in bacteria from environmental and zoonotic niches, which raises greater concerns over their prevalence, and the need for public health measures to control consequences of their propagation. The aims of the current review are to define and categorize the different families of carbapenemases, and to overview the main lines of their spread across different bacterial groups.
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18
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Treatment of Urinary Tract Infections Caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae. Pediatr Infect Dis J 2019; 38:e332-e335. [PMID: 31738343 DOI: 10.1097/inf.0000000000002487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Albaramki JH, Abdelghani T, Dalaeen A, Khdair Ahmad F, Alassaf A, Odeh R, Akl K. Urinary tract infection caused by extended-spectrum β-lactamase-producing bacteria: Risk factors and antibiotic resistance. Pediatr Int 2019; 61:1127-1132. [PMID: 31206219 DOI: 10.1111/ped.13911] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to investigate the risk factors for acquisition of extended spectrum β-lactamase (ESBL)-producing bacteria in community-acquired urinary tract infection (UTI) and to evaluate their antimicrobial resistance. METHODS The medical records of hospitalized children were retrospectively evaluated. Children with ESBL-producing bacteria UTI were matched with controls with non-ESBL-producing bacteria UTI of the same age and gender. RESULTS A total of 243 patients with community-acquired UTI in a 5 year period were evaluated, of whom 46% had UTI caused by ESBL bacteria. Seventy-seven cases were matched with 77 controls. There were no significant differences in the clinical presentation between the two groups apart from a longer hospital stay in the ESBL group (9.1 ± 5.5 days vs 8.0 ± 4.4 days, P = 0.013). Significant potential risk factors for ESBL-UTI were previous use of antibiotics in the last 3 months, previous hospitalization in the last 3 months, history of recurrent UTI, and presence of renal anomalies. On logistic regression analysis, history of previous hospitalization in the last 3 months (OR, 3.83; 95%CI: 1.49-9.84) was identified as an independent significant risk factor for ESBL-UTI. There was a significantly higher resistance to amoxicillin-clavulanate, amikacin, gentamycin and quinolones in the ESBL group compared with the control group. CONCLUSION Recognizing the risk factors for ESBL-UTI helps to identify the high-risk cases and enables proper management.
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Affiliation(s)
- Jumana H Albaramki
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Tariq Abdelghani
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Alaa Dalaeen
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Fareed Khdair Ahmad
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Abeer Alassaf
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Kamal Akl
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.,Department of Pediatrics, Jordan University Hospital, University of Jordan, Amman, Jordan
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Safety and Efficacy of Ceftazidime-Avibactam Plus Metronidazole in the Treatment of Children ≥3 Months to <18 Years With Complicated Intra-Abdominal Infection: Results From a Phase 2, Randomized, Controlled Trial. Pediatr Infect Dis J 2019; 38:816-824. [PMID: 31306396 DOI: 10.1097/inf.0000000000002392] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ceftazidime-avibactam plus metronidazole is effective in the treatment of complicated intra-abdominal infection (cIAI) in adults. This single-blind, randomized, multicenter, phase 2 study (NCT02475733) evaluated the safety, efficacy and pharmacokinetics of ceftazidime-avibactam plus metronidazole in children with cIAI. METHODS Hospitalized children (≥3 months to <18 years) with cIAI were randomized 3:1 to receive intravenous ceftazidime-avibactam plus metronidazole, or meropenem, for a minimum of 72 hours (9 doses), with optional switch to oral therapy thereafter for a total treatment duration of 7-15 days. Safety and tolerability were assessed throughout the study, along with clinical and microbiologic outcomes, and pharmacokinetics. A blinded observer determined adverse event (AE) causality, and clinical outcomes up to the late follow-up visit. RESULTS Eighty-three children were randomized and received study drug (61 ceftazidime-avibactam plus metronidazole and 22 meropenem); most (90.4%) had a diagnosis of appendicitis. Predominant Gram-negative baseline pathogens were Escherichia coli (79.7%) and Pseudomonas aeruginosa (33.3%); 2 E. coli isolates were ceftazidime-non-susceptible. AEs occurred in 52.5% and 59.1% of patients in the ceftazidime-avibactam plus metronidazole and meropenem groups, respectively. Serious AEs occurred in 8.2% and 4.5% of patients, respectively; none was considered drug related. No deaths occurred. Favorable clinical/microbiologic responses were observed in ≥90% of patients in both treatment groups at end-of-intravenous treatment and test-of-cure visits. CONCLUSIONS Ceftazidime-avibactam plus metronidazole was well tolerated, with a safety profile similar to ceftazidime alone, and appeared effective in pediatric patients with cIAI due to Gram-negative pathogens, including ceftazidime-non-susceptible strains.
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21
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Ruh E, Zakka J, Hoti K, Fekrat A, Guler E, Gazi U, Erdogmus Z, Suer K. Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus. Antimicrob Resist Infect Control 2019; 8:98. [PMID: 31198531 PMCID: PMC6558775 DOI: 10.1186/s13756-019-0548-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus. Methods A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance. Results Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates (n = 22/107; 20.6%) was found to be co-resistant to CIP (p = 0.000, OR 3.21, 95% CI 1.76-5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09-3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34-34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04-2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16-35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45-11.66) were indentified as risk factors. Conclusion The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.
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Affiliation(s)
- Emrah Ruh
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Jonathan Zakka
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Kujtesa Hoti
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Arezou Fekrat
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Emrah Guler
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Umut Gazi
- Department of Medical Microbiology and Clinical Microbiology, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
| | - Zafer Erdogmus
- Department of Infectious Diseases, Dr. Burhan Nalbantoglu State Hospital, Nicosia, Northern Cyprus
| | - Kaya Suer
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Near East University, Nicosia, Northern Cyprus
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22
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Baquero-Artigao F, Rabes TDR. Fosfomycin in the pediatric setting: Evidence and potential indications. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32 Suppl 1:55-61. [PMID: 31131593 PMCID: PMC6555161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To date, there has been little experience in using fosfomycin in children. However, its broad spectrum of action and excellent safety profile have renewed interest in this antibiotic, especially for treating infections by multidrug-resistant bacteria. The main indication for fosfomycin in pediatrics is currently community-acquired lower urinary tract infection. Given its good activity against bacteria, fosfomycin can also be useful in urinary infections caused by extended-spectrum beta-lactamase-producing enterobacteria. Fosfomycin presents very good dissemination to tissues including bone and is therefore an option in the combined therapy of osteomyelitis, especially in cases produced by methicillin-resistant Staphylococcus aureus (MRSA) or in cases with beta-lactam allergies. Fosfomycin can also be employed in combination for multidrug-resistant Gram-negative bacteremia (especially carbapenemase-producing enterobacteria), S. aureus (if there is a high suspicion of MRSA or complicated infections) and vancomycin-resistant Enterococcus spp. Other infections in which fosfomycin could be part of a combined therapy include staphylococcal endocarditis (in case of beta-lactam allergy or MRSA), central nervous system infections (mainly by MRSA, S. epidermidis, Listeria and resistant pneumococcus), nosocomial pneumonia and infections associated with mechanical ventilation.
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Affiliation(s)
- Fernando Baquero-Artigao
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical. Hospital Universitario La Paz, Madrid,Red Española de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Teresa del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical. Hospital Universitario La Paz, Madrid,Red Española de Investigación Traslacional en Infectología Pediátrica (RITIP)
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23
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Vakkilainen S, Pätäri-Sampo A, Saxén H. Outcome of children with ESBL-E. coli acute pyelonephritis treated with cephalosporins. J Infect 2018; 77:75-81. [DOI: 10.1016/j.jinf.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
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24
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Xu Y, Sun H, Bai X, Fu S, Fan R, Xiong Y. Occurrence of multidrug-resistant and ESBL-producing atypical enteropathogenic Escherichia coli in China. Gut Pathog 2018; 10:8. [PMID: 30038667 PMCID: PMC6054294 DOI: 10.1186/s13099-018-0234-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/19/2018] [Indexed: 01/05/2023] Open
Abstract
Background Atypical enteropathogenic Escherichia coli (aEPEC) is regarded as a globally emerging enteropathogen. aEPECs exhibit various level of resistance to a range of antibiotics, which is increasing alarmingly. The present study investigated the antimicrobial resistance of aEPEC isolates recovered from diarrheal patients, healthy carriers, animals, and raw meats. Results Among 267 aEPEC isolates, 146 (54.7%) were resistant to tetracycline, followed by ampicillin (49.4%), streptomycin (46.1%), and piperacillin (41.2%). Multidrug resistance (MDR) was detected in 128 (47.9%) isolates, and 40 MDR isolates were resistant to ≥ 10 antimicrobial agents. A total of 47 (17.6%) aEPEC isolates were identified as extended-spectrum β-lactamase (ESBL)-producers. The blaCTX-M-14 and blaCTX-M-15 genes were predominant among ESBL-producing isolates. Conclusions This investigation depicted the occurrence of multidrug-resistant and ESBL-producing aEPEC isolates in China. The results suggested that it is necessary to continuously monitor the emergence and spread of MDR aEPEC. Electronic supplementary material The online version of this article (10.1186/s13099-018-0234-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanmei Xu
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Hui Sun
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Xiangning Bai
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Shanshan Fu
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Ruyue Fan
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China
| | - Yanwen Xiong
- 1State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping, Beijing, China.,2Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang China
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25
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Meropol SB, Haupt AA, Debanne SM. Incidence and Outcomes of Infections Caused by Multidrug-Resistant Enterobacteriaceae in Children, 2007-2015. J Pediatric Infect Dis Soc 2018; 7:36-45. [PMID: 28339695 PMCID: PMC5907863 DOI: 10.1093/jpids/piw093] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/02/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The escalating incidence of invasive disease caused by multidrug-resistant Gram-negative enteric Enterobacteriaceae (MDR-GNE) is a global concern. Scant published studies in which the epidemiology of these infections in children is described exist; previous studies focused mainly on adults, described circumscribed populations, or lacked clinical detail. The objective of this study was to examine and describe the incidence, risk factors, and outcomes associated with MDR-GNE infection in children. METHODS In this cohort study, we used data from 48 children's hospitals maintained by the Pediatric Health Information System. We documented the proportion of MDR-GNE diagnoses among children's hospital patients aged 0 to <18 years who were diagnosed with an Enterobacteriaceae-associated infection between January 1, 2007, and March 31, 2015, and we analyzed the association between MDR-GNE infection and hospital length of stay and death before discharge. RESULTS During the study period, 107610 discharges included a diagnosis code for Enterobacteriaceae infection, 724 (0.7%) of which included MDR-GNE infection. The incidence of MDR-GNE, and the proportion of infections with Enterobacteriaceae organisms that were MDR-GNE increased over the study period; from 0.2% in 2007 to 1.5% by 2015 (test for trend < .001). Almost one-quarter (23%) of the infections in children hospitalized for MDR-GNE were nosocomial. Increased odds of MDR-GNE infection were associated with older age and comorbid illnesses. Lengths of stay in patients with MDR-GNE infection were increased 20% (95% confidence interval, 9.9%-30.5%; P < .001) over those without MDR-GNE infection; the increased odds for death did not reach statistical significance (1.46 [95% confidence interval, 0.98-2.18]; P = .06). Results were robust to sensitivity analyses. CONCLUSIONS The incidence of pediatric MDR-GNE infection increased during 2007-2015. MDR-GNE infection was associated with increased length of stay, and we found a trend toward increased risk of death. Infections with Gram-negative enteric bacilli are becoming increasingly difficult to treat; considering the global burden of these antimicrobial-resistant organisms, interventions to curtail or even reverse this trend are needed urgently.
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Affiliation(s)
- Sharon B Meropol
- Departments of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Center for Child Health and Policy, Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Allison A Haupt
- Center for Child Health and Policy, Rainbow Babies and Children’s Hospital and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sara M Debanne
- Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio
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26
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Tanır Basaranoglu S, Ozsurekci Y, Aykac K, Karadag Oncel E, Bıcakcigil A, Sancak B, Cengiz AB, Kara A, Ceyhan M. A comparison of blood stream infections with extended spectrum beta-lactamase-producing and non-producing Klebsiella pneumoniae in pediatric patients. Ital J Pediatr 2017; 43:79. [PMID: 28899399 PMCID: PMC5596860 DOI: 10.1186/s13052-017-0398-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background Rapid development and global spread of multidrug resistant Klebsiella pneumonia (K. pneumoniae) as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes. Methods A retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality. Results Among 111 K. pneumoniae isolates 62% (n = 69) were ESBL –producing K. pneumoniae. The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively (p = 0.001). Previous aminoglycoside use was higher in cases with ESBL –producing isolates (p = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p = 0.01). Conclusion ESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI.
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Affiliation(s)
- Sevgen Tanır Basaranoglu
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey.
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Eda Karadag Oncel
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Asiye Bıcakcigil
- Department of Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Banu Sancak
- Department of Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Bulent Cengiz
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Ates Kara
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey
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27
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First Report of German Cockroaches (Blattella germanica) as Reservoirs of CTX-M-15 Extended-Spectrum-β-Lactamase- and OXA-48 Carbapenemase-Producing Enterobacteriaceae in Batna University Hospital, Algeria. Antimicrob Agents Chemother 2016; 60:6377-80. [PMID: 27458214 DOI: 10.1128/aac.00871-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/17/2016] [Indexed: 12/22/2022] Open
Abstract
Here we report the isolation of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae from German cockroaches caught in the burn unit of Batna University Hospital in Algeria. Nine of 12 isolates harbored the blaCTX-M-15 ESBL gene. One Enterobacter cloacae isolate belonging to sequence type 528 coexpressed the blaOXA-48, blaCTX-M-15, and blaTEM genes. Our findings indicate that cockroaches may be one of the most dangerous reservoirs for ESBL and carbapenemase producers in hospitals.
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