[Antibiotic multiresistance in critical care units]

Characterization of Cronobacter sakazakii and Cronobacter malonaticus Strains Isolated from Powdered Dairy Products Intended for Consumption by Adults and Older Adults

The objective of this study was to characterize Cronobacter spp. and related organisms isolated from powder dairy products intended for consumption by adults and older adults using whole-genome sequencing (WGS), and to identify genes and traits that encode antibiotic resistance and virulence. Virulence (VGs) and antibiotic resistance genes (ARGs) were detected with the Comprehensive Antibiotic Resistance Database (CARD) platform, ResFinder, and MOB-suite tools. Susceptibility testing was performed using disk diffusion. Five presumptive strains of Cronobacter spp. were identified by MALDI-TOF MS and ribosomal MLST. Three C. sakazakii strains were of the clinical pathovar ST1, one was ST31, and the remaining isolate was C. malonaticus ST60. In addition, Franconibacter helveticus ST345 was identified. The C. sakazakii ST1 strains were further distinguished using core genome MLST based on 2831 loci. Moreover, 100% of the strains were resistant to cefalotin, 75% to ampicillin, and 50% to amikacin. The C. sakazakii ST1 strains were multiresistant (MDR) to four antibiotics. Additionally, all the strains adhered to the N1E-115 cell line, and two invaded it. Eighteen ARGs mainly involved in antibiotic target alteration and antibiotic efflux were detected. Thirty VGs were detected and clustered as flagellar proteins, outer membrane proteins, chemotaxis, hemolysins, and genes involved in metabolism and stress. The pESA3, pSP291-1, and pCMA1 plasmids were detected, and the prevalent mobile genetic elements (MGEs) were ISEsa1, ISEc52, and IS26. The isolates of C. sakazakii and C. malonaticus exhibited multiresistance to antibiotics, harbored genes encoding various antibiotic resistance proteins, and various virulence factors. Consequently, these contaminated powdered dairy products pose a risk to the health of hypersensitive adults.

Molecular mechanisms of multidrug resistance in clinically relevant enteropathogenic bacteria (Review)

Multidrug resistant (MDR) enteropathogenic bacteria are a growing problem within the clinical environment due to their acquired tolerance to a wide range of antibiotics, thus causing severe illnesses and a tremendous economic impact in the healthcare sector. Due to its difficult treatment, knowledge and understanding of the molecular mechanisms that confer this resistance are needed. The aim of the present review is to describe the mechanisms of antibiotic resistance from a genomic perspective observed in bacteria, including naturally acquired resistance. The present review also discusses common pharmacological and alternative treatments used in cases of infection caused by MDR bacteria, thus covering necessary information for the development of novel antimicrobials and adjuvant molecules inhibiting bacterial proliferation.

Antibacterial Potential of Caesalpinia coriaria (Jacq) Willd Fruit against Aeromonas spp. of Aquaculture Importance

Simple Summary

Aquaculture remains an important source of food, however, aquaculture systems are affected by different factors including the appearance of resistant or multiresistant bacteria to antimicrobials. An alternative in the search for new treatments for these bacteria is plant extracts. The aim of the present study was to determine the antibacterial activity of Caesalpinia coriaria fruit hydroalcoholic extract and gallic acid over Aeromonas hydrophila, Aeromonas veronii, and Aeromonas dhakensis to identify new molecules for the treatment of diseases caused by Aeromona spp. The hydroalcoholic extract of Caesalpinia coriaria and its fractions have antibacterial activity against Aeromonas hydrophila, Aeromonas veronii, and Aeromonas dhakensis and could be alternatives for the treatment of diseases caused by the genus Aeromonas.

Abstract

Aquaculture is an important source of food and livelihood for hundreds of millions of people around the world, however, aquaculture systems are affected by different factors, among them the appearance of resistant or multiresistant bacteria to antimicrobials. The secondary metabolites of plants have been proposed as alternatives for the treatment of these bacteria. The aim of the present study was to determine the antibacterial activity of Caesalpinia coriaria fruit hydroalcoholic extract and gallic acid over Aeromonas hydrophila, Aeromonas veronii,  and Aeromonas dhakensis to identify new molecules for the treatment of diseases caused by Aeromonas spp. The C. coriaria fruit hydroalcoholic extract (HECc) was obtained by hydroalcoholic maceration and subjected to bipartition with ethyl acetate and water to obtain an aqueous fraction (Ac-FrCc) and an organic fraction (Ac-FrEtCc); gallic acid was purchased commercially. The Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), MBC/MIC ratio, and cytotoxicity of HECc, its fractions, and gallic acid were determined. The results indicate that HECc fractions (Ac-FrCc and Ac-FrEtCc) and gallic acid have bactericidal activity against A. hydrophila and A. dhakensis, but only gallic acid showed bactericidal activity against A. veronii. The HECc and Ac-FrCc showed no toxicity, Ac-FrEtCc showed low toxicity, and gallic acid showed medium toxicity. The HECc, Ac-FrCc, and Ac-FrEtCc may be alternatives for the treatment of diseases caused by the genus Aeromonas, however, in vivo assays are necessary to corroborate these results.

Prevalence and Characterization of Antibiotic-Resistant Staphylococcus aureus Recovered from Pasteurized Cheese Commercialized in Panama City Markets

Foodborne bacteria, with a high degree of antibiotic resistance, play an important role in the morbidity and mortality of gastrointestinal diseases worldwide. Among 250 disease-causing bacteria, Staphylococcus aureus is one of the major causes of food poisoning, and its resistance to multiple antimicrobials remains of crucial concern. Cheese is often contaminated when proper sanitary procedures are not followed during its production and marketing. This work aimed to evaluate the microbiological quality of pasteurized white cheese commercialized in Panama City. Cheese from five different brands sold in local supermarkets were selected to determine the presence of S. aureus as well as its antibiotic resistance profile. The results showed significant contamination of S. aureus with a geometric median sample of 104–107 CFU/g. Four out of five (4/5) cheese brands analyzed presented risk of food poisoning by exceeding the allowed range of consumption with a geometric median sample of 1,8 × 106–1,4 × 107 CFU/g. Fourteen different resistance phenotypes were found. Fifty-five percent (55%) of the analyzed strains were resistant to erythromycin. The data confirm a relatively high prevalence and high levels of S. aureus, most likely originated during handling in Panama City retail markets. Further studies are needed to reduce bacterial contamination and to decrease the risk of food poisoning in the consumption of pasteurized cheese.

Synthesis of arylidene hydrazinylpyrido[2,3-d]pyrimidin-4-ones as potent anti-microbial agents

Combination of arylidene hydrazinyl moiety with pyrido[2,3-d]pyrimidin-4-one skeleton in compounds 7‒26 results in the output of unprecedented anti-microbial agents. Arylidene hydrazinyl based on Pyrido[2,3-d]pyrimidin-4-one analoges 7‒26 prepared by the treatment of [2,3-d]pyrimidin-4-ones 6a,b with various aromatic aldehydes. The antimicrobial action for recently synthesized compounds was considered towards gram positive bacterial species (Staphylococcus aurous ATCC- 47077; Bacillus cereus ATCC-12228), gram negative bacterial species (Escherichia coli ATCC-25922; Salmonella typhi ATCC-15566) and Candida albicans ATCC-10231 as fungal strains. The antimicrobial action expanded by expanding the electron donating group in position 2 and 5 for Pyrido[2,3-d]pyrimidin-4-one core. Derivatives 13, 14, 15, 16 and 12; individually appeared hopeful anti-microbial action towards all strains utilized with inhibition zone higher than that of standard reference drug with lowest MIC.

Effectiveness of Electronic Guidelines (GERH®) to Improve the Clinical Use of Antibiotics in An Intensive Care Unit

The objective of the study was to evaluate the capacity of GERH^®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH^® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection.

In Vitro Antibacterial Potential of Salix babylonica Extract against Bacteria that Affect Oncorhynchus mykiss and Oreochromis spp

Aquaculture development is limited by bacteria associated with several diseases; antibiotics are used for the treatment of these affections, but bacteria have developed resistance to these drugs. It is important to develop effective treatments that allow the production of antibiotic-free food. The aim of the present study is to evaluate the in vitro antibacterial effects of Salix babylonica hydro-alcoholic extract (SbHE) against Aeromonas hydrophila, Listonella anguillarum, Edwarsiella tarda, and Streptococcus iniae, bacteria that affect Oncorhynchus mykiss and Oreochromis spp. production. SbHE was obtained through the maceration technique. Reference strains were used and their sensitivity to antibiotics was determined. Minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of SbHE were determined. Results showed that three of four evaluated bacteria were multidrug resistant, except S. iniae. SbHE showed antibacterial activity against all bacteria. Results indicate an MIC of 1.56 to 25 mg/mL and an MBC of 3.12 to 100 mg/mL. The greatest inhibitory activity occurred against L. anguillarum obtaining a MIC of 1.56 mg/mL and an MBC of 3.12 mg/mL. Results indicate that SbHE has bactericidal activity against A. hydrophila, L.anguilalurm, and S. iniae as well as bacteriostatic activity against E. tarda and could be an alternative treatment against these bacteria.

Antimicrobial resistance trends in methicillin-resistant and methicillin-susceptible Staphylococcus aureus and Staphylococcus epidermidisisolates obtained from patients admitted to intensive care units. 2010-2015

Introducción. La aparición y la diseminación de cepas resistentes en hospitales, principalmente en unidades de cuidado intensivo (UCI), se han convertido en un serio problema de salud pública.Objetivo. Analizar la tendencia de los fenotipos de resistencia de Staphylococcus aureus y Staphylococcus epidermidis resistentes y susceptibles a meticilina aislados en pacientes atendidos en UCI de un hospital de alta complejidad de Cartagena, Colombia, del 2010 al 2015.Materiales y métodos. Estudio analítico transversal realizado entre enero de 2010 y diciembre de 2015. Se utilizaron aislamientos de S. aureus y S. epidermidis meticilino-susceptibles y meticilino-resistentes (SARM, SASR, SERM y SESM). La técnica de susceptibilidad empleada fue el método microdilución en caldo para la detección de la concentración mínima inhibitoria.Resultados. Se identificaron 313 aislamientos de Staphylococcus spp., la mayoría resistentes a meticilina (63.6%). Las cepas SARM y SERM correspondieron al 13.7% y al 27.8% del total de aislamientos, respectivamente. Los mayores porcentajes de resistencia en SARM y SERM correspondieron a eritromicina (57.6% y 81.2%, respectivamente), clindamicina (54.6% y 71.0%), ciprofloxacina (48.4% y 36.4%) y trimetoprima-sulfametoxazol (36.4% y 51.4%).Conclusión. Los resultados encontrados sugieren el replanteamiento de las estrategias de control de la resistencia antimicrobiana en el hospital objeto de estudio.

Virulence factors and integrons are associated with MDR and XDR phenotypes in nosocomial strains of Pseudomonas aeruginosa in a Venezuelan university hospital

Multidrug resistance (MDR), virulence and transferable elements potentiate Pseudomonas aeruginosa's role as an opportunistic pathogen creating a high risk for public health. In this study, we evaluated the possible association of multidrug resistance, virulence factors and integrons with intrahospital P. aeruginosa strains isolated from patients at Cumana hospital, Venezuela. Relevant clinical-epidemiological data were collected to study 176 strains (2009-2016) isolated from different hospital units. Bacterial resistance was classified as susceptible, low-level resistant (LDR), multidrug resistant (MDR) and extensively drug-resistant (XDR). Most strains produced pyoverdine, DNase, gelatinase and hemolysin. Around 73% of the strains showed some type of movement. MDR and XDR strains increased from 2009 (24.2% and 4.8%, respectively) to 2016 (53.1% and 18.8%); while LDR decreased from 64.5% to 6.3%. The exoU and exoS genes were found in a significant number of strains (38.1 and 7.4%, respectively). Class I integrons were detected in 35.8% of the strains and the frequency was associated with resistance (42.9, 22.4, 41.4 and 61.9%, for susceptible, LDR, MDR and XDR, respectively). The MDR/XDR strains were positively associated with hemolysins and exoU, but negatively associated with bacterial twitching. MDR/XDR phenotypes were also associated with the Intensive Care Unit (ICU), septicemia, bronchial infection and diabetic foot ulcers, as well as long hospital stay (≥10 days) and previous antimicrobial treatment. High frequency of MDR/XDR strains and their association with class I integrons and virulence factors can increase the infection potential, as well as morbidity and mortality of patients attending this hospital and could spread infection to the community, creating a health risk for the region.

Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia

A summary of the evidence and recommendations made in the ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia http://ow.ly/S3zA30iZfLa.

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units

AIMS

To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting.

MATERIALS AND METHODS

A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses.

RESULTS

In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG.

LIMITATIONS

Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided.

CONCLUSIONS

Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.

[Five steps to decreasing nosocomial infections in large immature premature infants: A quasi-experimental study]

OBJECTIVES

An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit.

MATERIAL AND METHODS

Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions.

RESULTS

Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs.

CONCLUSIONS

The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

Combatting resistance in intensive care: the multimodal approach of the Spanish ICU "Zero Resistance" program

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

[Nosocomial infections in intensive care units]

Nosocomial infections (NI) still have a high incidence in intensive care units (ICUs), and are becoming one of the most important problems in these units. It is well known that these infections are a major cause of morbidity and mortality in critically ill patients, and are associated with increases in the length of stay and excessive hospital costs. Based on the data from the ENVIN-UCI study, the rates and aetiology of the main nosocomial infections have been described, and include ventilator-associated pneumonia, urinary tract infection, and both primary and catheter related bloodstream infections, as well as the incidence of multidrug-resistant bacteria. A literature review on the impact of different nosocomial infections in critically ill patients is also presented. Infection control programs such as zero bacteraemia and pneumonia have been also analysed, and show a significant decrease in NI rates in ICUs.