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Ibrahim K, Thwood D, ELgheriani H, Salem M, Elgadiym Z, Zaghdani A, Alhudiri I, Habibi A, Elfahem A, Belaid S, Ermithi O, Almaghrabi M, ELmaryul A, Almadah S, Rayes A, El Meshri SE, El Salabi A, Elzagheid A. Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya. Libyan J Med 2024; 19:2348235. [PMID: 38718270 PMCID: PMC11080667 DOI: 10.1080/19932820.2024.2348235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients', healthcare workers' and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment's samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.
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Affiliation(s)
- Khaled Ibrahim
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Dalal Thwood
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Hajer ELgheriani
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mohamed Salem
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Zaynab Elgadiym
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Ahmed Zaghdani
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Inas Alhudiri
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Abdulraouf Habibi
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Abdurrezagh Elfahem
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Saadeddin Belaid
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Otman Ermithi
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mahmoud Almaghrabi
- Pediatric Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Abubaker ELmaryul
- Medical Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Suad Almadah
- Neonatal Intensive Care Unit, Tripoli University Hospital, Tripoli, Libya
| | - Abdunnabi Rayes
- Infection Control Office, Tripoli University Hospital, Tripoli, Libya
| | - Salah Edin El Meshri
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Allaaeddin El Salabi
- Department of Environmental Health, Faculty of Public Health, University of Benghazi, Benghazi, Libya
| | - Adam Elzagheid
- Department of Microbiology, Libyan Biotechnology Research Center, Tripoli, Libya
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2
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Agosta M, Bencardino D, Argentieri M, Pansani L, Sisto A, Ciofi Degli Atti ML, D'Amore C, Bagolan P, Iacobelli BD, Magnani M, Raponi M, Perno CF, Andreoni F, Bernaschi P. Clonal Spread of Hospital-Acquired NDM-1-Producing Klebsiella pneumoniae and Escherichia coli in an Italian Neonatal Surgery Unit: A Retrospective Study. Antibiotics (Basel) 2023; 12:antibiotics12040642. [PMID: 37107005 PMCID: PMC10135170 DOI: 10.3390/antibiotics12040642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
This article reports a rapid and unexpected spread of colonization cases of NDM-1 carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in a neonatal surgical unit (NSU) at Bambino Gesù Children's Hospital in Rome, Italy. Between the 16th of November 2020 and the 18th of January 2021, a total of 20 NDM-1 carbapenemase-producing K. pneumoniae (n = 8) and E. coli (n = 12) were isolated from 17 out of 230 stool samples collected from neonates admitted in the aforementioned ward and time period by an active surveillance culture program routinely in place to monitor the prevalence of colonization/infection with multidrug-resistant Gram-negative microorganisms. All strains were characterized by antimicrobial susceptibility testing, detection of resistance determinants, PCR-based replicon typing (PBRT) and multilocus-sequence typing (MLST). All isolates were highly resistant to most of the tested antibiotics, and molecular characterization revealed that all of them harbored the blaNDM-1 gene. Overall, IncA/C was the most common Inc group (n = 20/20), followed by IncFIA (n = 17/20), IncFIIK (n = 14/20) and IncFII (n = 11/20). MLST analysis was performed on all 20 carbapenemase-producing Enterobacterales (CPE) strains, revealing three different Sequence Types (STs) among E. coli isolates, with the prevalence of ST131 (n = 10/12; 83%). Additionally, among the 8 K. pneumoniae strains we found 2 STs with the prevalence of ST37 (n = 7/8; 87.5%). Although patient results were positive for CPE colonization during their hospital stay, infection control interventions prevented their dissemination in the ward and no cases of infection were recorded in the same time period.
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Affiliation(s)
- Marilena Agosta
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Daniela Bencardino
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
| | - Marta Argentieri
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Laura Pansani
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Annamaria Sisto
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | | | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Barbara Daniela Iacobelli
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
| | - Massimiliano Raponi
- Health Directorate, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
| | - Francesca Andreoni
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", 61032 Fano, Italy
- Clinical Pathology Unit, Azienda Sanitaria Territoriale, 61029 Urbino, Italy
| | - Paola Bernaschi
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children's Hospital, IRCCS, 00163 Rome, Italy
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Evren AE, Karaduman AB, Sağlik BN, Özkay Y, Yurttaş L. Investigation of Novel Quinoline-Thiazole Derivatives as Antimicrobial Agents: In Vitro and In Silico Approaches. ACS OMEGA 2023; 8:1410-1429. [PMID: 36643421 PMCID: PMC9835529 DOI: 10.1021/acsomega.2c06871] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Infectious diseases are a major concern around the world. Today, it is an urgent need for new chemotherapeutics for infectious diseases. Because of that, our group designed, synthesized, and analyzed 14 new quinoline derivatives endowed with the pharmacophore moiety of fluoroquinolones primarily for their antimicrobial effects. Their cytotoxicity effects were tested against six bacterial and four fungal strains and NIH/3T3 cell line. Additionally, their action mechanisms were evaluated against DNA gyrase and lanosterol 14α-demethylase (LMD). Furthermore, to eliminate the potential side effects, the active compounds were evaluated against the aromatase enzyme. The experimental enzymatic results were evaluated for active compounds' binding modes using molecular docking and molecular dynamics simulation studies. The results were utilized to clarify the structure-activity relationship (SAR). Finally, compound 4m was the most potent compound for its antifungal activity with low cytotoxicity against healthy cells and fewer possible side effects, while compounds 4j and 4l can be used alone for special patients who are suffering from fungal infections in addition to the primer disease.
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Affiliation(s)
- Asaf Evrim Evren
- Department
of Pharmacy Services, Vocational School of Health Services, Bilecik Şeyh Edebali University, Bilecik 11000, Turkey
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Abdullah Burak Karaduman
- Department
of Pharmaceutical Toxicology, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Begüm Nurpelin Sağlik
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
- Central
Research Laboratory, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Yusuf Özkay
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
- Central
Research Laboratory, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
| | - Leyla Yurttaş
- Department
of Pharmaceutical Chemistry, Faculty of Pharmacy, Anadolu University, Eskişehir 26470, Turkey
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Patel S, Prabhakar H, Kapoor I. Rate of Multidrug-resistance to Antimicrobial Drugs in Patients in Pediatric Neurointensive Care. Indian J Crit Care Med 2023; 27:67-72. [PMID: 36756473 PMCID: PMC9886037 DOI: 10.5005/jp-journals-10071-24377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 01/02/2023] Open
Abstract
Background Multidrug-resistant (MDR) organisms in the critical care unit are a worldwide concern. The vulnerability to MDR infection in pediatric patients admitted in neurocritical care are due to altered mental status, immature immune system, higher risk of aspiration, and more frequent use of invasive devices. We aimed to measure the burden of MDR infection in pediatric neurosurgical intensive care unit (NSICU) patients. Methods All pediatric patients between 1 and 18 years for intracranial and spine surgeries admitted for more than 48 hours in NSICU were enrolled in the study. If patients showed a clinical picture of pneumonia, bloodstream infection (BSI), or urinary tract infection (UTI) after receiving mechanical ventilation or an indwelling device for at least 48 hours, samples of tracheal aspirates, urine, blood, and cerebrospinal fluid (CSF) were sent for microbiological culture. We noted the type of organism, MDR infection rate, and associated risk factors. Pearson Chi-squared test and Fisher's test were used for statistical analysis; p < 0.05 was considered statistically significant. Results A total of 274 pediatric patients were studied. In 1 year, there was a total of 1,790 patient days. The inclusive MDR infection rate was 17.3/1,000 patient days. Also, Klebsiella pneumoniae (38.7%) was the commonest MDR pathogen. The commonest source of infection was BSI (32.3%). The risk factors associated with MDR infections were the length of stay in NSICU, mechanical ventilation of more than 5 days, emergency surgery, respiratory and cardiac comorbidities, and poor nutrition status (p < 0.05). Conclusion The MDR infection rate in our study was 17.3/1,000 patient days in pediatric patients. Also, K. pneumonia e was found to be the commonest MDR pathogen. Bloodstream was the commonest source of infection. How to cite this article Patel S, Prabhakar H, Kapoor I. Rate of Multidrug-resistance to Antimicrobial Drugs in Patients in Pediatric Neurointensive Care. Indian J Crit Care Med 2023;27(1):67-72.
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Affiliation(s)
- Swapnil Patel
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India,Indu Kapoor, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 9013439134, e-mail:
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Kuzina ES, Novikova TS, Astashkin EI, Fedyukina GN, Kislichkina AA, Kurdyumova NV, Savin IA, Ershova ON, Fursova NK. Rectal and Tracheal Carriage of Carbapenemase Genes and Class 1 and 2 Integrons in Patients in Neurosurgery Intensive Care Unit. Antibiotics (Basel) 2022; 11:886. [PMID: 35884140 PMCID: PMC9312170 DOI: 10.3390/antibiotics11070886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022] Open
Abstract
The spread of multidrug-resistant Gram-negative bacteria, which is associated with the distribution of beta-lactamase genes and class 1 and 2 integrons, is a global problem. In this study, in the Moscow neurosurgery intensive care unit (neuro-ICU), the high prevalence of the above-stated genes was found to be associated with intestinal and tracheal carriage. Seven-point prevalence surveys, which included 60 patients in the neuro-ICU, were conducted weekly in the period from Oct. to Nov. 2019. A total of 293 clinical samples were analyzed, including 146 rectal and 147 tracheal swabs; 344 Gram-negative bacteria isolates were collected. Beta-lactamase genes (n = 837) were detected in the isolates, including beta-lactamase blaTEM (n = 162), blaSHV (n = 145), cephalosporinase blaCTX-M (n = 228), carbapenemase blaNDM (n = 44), blaKPC (n = 25), blaOXA-48 (n = 126), blaOXA-51-like (n = 54), blaOXA-40-like (n = 43), blaOXA-23-like (n = 8), and blaVIM (n = 2), as well as class 1 (n = 189) and class 2 (n = 12) integrons. One extensively drug-resistant Klebsiella pneumoniae strain (sequence type ST39 and capsular type K23), simultaneously carried beta-lactamase genes, blaSHV-40 and blaTEM-1B, three carbapenemase genes, blaNDM, blaKPC, and blaOXA-48, the cephalosporinase gene blaCTX-M, and two class 1 integrons. Before this study, such heavily armed strains have not been reported, suggesting the ongoing evolution of antibiotic resistance.
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Affiliation(s)
- Ekaterina S. Kuzina
- Department of Training and Improvement of Specialists, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia;
| | - Tatiana S. Novikova
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (T.S.N.); (E.I.A.)
| | - Evgeny I. Astashkin
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (T.S.N.); (E.I.A.)
| | - Galina N. Fedyukina
- Department of Immunobiochemistry of Pathogenic Microorganisms, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia;
| | - Angelina A. Kislichkina
- Department of Culture Collection, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia;
| | - Natalia V. Kurdyumova
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (N.V.K.); (I.A.S.); (O.N.E.)
| | - Ivan A. Savin
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (N.V.K.); (I.A.S.); (O.N.E.)
| | - Olga N. Ershova
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (N.V.K.); (I.A.S.); (O.N.E.)
| | - Nadezhda K. Fursova
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (T.S.N.); (E.I.A.)
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da Silva BBO, Silva M, de Menezes FG, Troster EJ. Factors associated with multidrug-resistant bacteria in healthcare-associated infections: a pediatric intensive care unit case-control study. EINSTEIN-SAO PAULO 2022; 20:eAO6704. [PMID: 35476086 PMCID: PMC9018062 DOI: 10.31744/einstein_journal/2022ao6704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/12/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. METHODS A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. RESULTS There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p<0.001), in whom the likelihood of multidrug-resistant bacteria infection was estimated to be nine-fold higher than among non-immunosuppressed patients (OR 8.97; 95%CI 2.69-29.94). In the analysis of multiple logistic regression model, we observed that immunosuppressed patients had an 8.5-fold higher chance of multidrug-resistant bacteria infection when compared to non-immunosuppressed patients (OR 8.48; 95%CI 2.54-28.35; p=0.001). There is evidence of association between the Case Group and presence of Gram-positive (p=0.007), coagulase-negative Staphylococcus (p<0.001), and Gram-negative (p=0.041) microorganisms. CONCLUSION The immunocompromised-state variable is a factor related to healthcare-associated infections caused by multidrug-resistant bacteria, and the Case Group presented higher proportions of Gram-positive microorganisms and coagulase-negative Staphylococcus.
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Affiliation(s)
| | - Moacyr Silva
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Fernando Gatti de Menezes
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Juan Troster
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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7
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Agosta M, Bencardino D, Argentieri M, Pansani L, Sisto A, Ciofi Degli Atti ML, D’Amore C, Putignani L, Bagolan P, Iacobelli BD, Dotta A, Martini L, Di Chiara L, Magnani M, Perno CF, Andreoni F, Bernaschi P. Prevalence and Molecular Typing of Carbapenemase-Producing Enterobacterales among Newborn Patients in Italy. Antibiotics (Basel) 2022; 11:antibiotics11040431. [PMID: 35453183 PMCID: PMC9032973 DOI: 10.3390/antibiotics11040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/10/2022] Open
Abstract
The spread of carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli), is a serious public health threat in pediatric hospitals. The associated risk in newborns is due to their underdeveloped immune system and limited treatment options. The aim was to estimate the prevalence and circulation of CPE among the neonatal intensive units of a major pediatric hospital in Italy and to investigate their molecular features. A total of 124 CPE were isolated from rectal swabs of 99 newborn patients at Bambino Gesù Children’s Hospital between July 2016 and December 2019. All strains were characterized by antimicrobial susceptibility testing, detection of resistance genes, and PCR-based replicon typing (PBRT). One strain for each PBRT profile of K. pneumoniae or E. coli was characterized by multilocus-sequence typing (MLST). Interestingly, the majority of strains were multidrug-resistant and carried the blaNDM gene. A large part was characterized by a multireplicon status, and FII, A/C, FIA (15%) was the predominant. Despite the limited size of collection, MLST analysis revealed a high number of Sequence Types (STs): 14 STs among 28 K. pneumoniae and 8 STs among 11 E. coli, with the prevalence of the well-known clones ST307 and ST131, respectively. This issue indicated that some strains shared the same circulating clone. We identified a novel, so far never described, ST named ST10555, found in one E. coli strain. Our investigation showed a high heterogeneity of CPE circulating among neonatal units, confirming the need to monitor their dissemination in the hospital also through molecular methods.
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Affiliation(s)
- Marilena Agosta
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
| | - Daniela Bencardino
- Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61032 Fano, Italy; (D.B.); (M.M.); (F.A.)
| | - Marta Argentieri
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
| | - Laura Pansani
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
| | - Annamaria Sisto
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
| | - Marta Luisa Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.C.D.A.); (C.D.)
| | - Carmen D’Amore
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.C.D.A.); (C.D.)
| | - Lorenza Putignani
- Human Microbiome Unit, Department of Diagnostics and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Pietro Bagolan
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.B.); (B.D.I.)
| | - Barbara Daniela Iacobelli
- Neonatal Surgery Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (P.B.); (B.D.I.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.D.); (L.M.)
| | - Ludovica Martini
- Neonatal Intensive Care Unit, Medical and Surgical Department of the Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.D.); (L.M.)
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61032 Fano, Italy; (D.B.); (M.M.); (F.A.)
| | - Carlo Federico Perno
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
| | - Francesca Andreoni
- Department of Biomolecular Sciences, University of Urbino “Carlo Bo”, 61032 Fano, Italy; (D.B.); (M.M.); (F.A.)
| | - Paola Bernaschi
- Microbiology and Diagnostic Immunology Unit, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.A.); (M.A.); (L.P.); (A.S.); (C.F.P.)
- Correspondence: ; Tel.: +39-06-6859-2205
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Li ZL, Luo QB, Xiao SS, Lin ZH, Liu YL, Han MY, Zhong JH, Ji TX, Guo XG. Evaluation of GeneXpert vanA/vanB in the early diagnosis of vancomycin-resistant enterococci infection. PLoS Negl Trop Dis 2021; 15:e0009869. [PMID: 34748586 PMCID: PMC8575182 DOI: 10.1371/journal.pntd.0009869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/01/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Vancomycin-resistant enterococci infection is a worrying worldwide clinical problem. To evaluate the accuracy of GeneXpert vanA/vanB in the diagnosis of VRE, we conducted a systematic review in the study. METHODS Experimental data were extracted from publications until May 03 2021 related to the diagnostic accuracy of GeneXpert vanA/vanB for VRE in PubMed, Embase, Web of Science and the Cochrane Library. The accuracy of GeneXpert vanA/vanB for VRE was evaluated using summary receiver to operate characteristic curve, pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. RESULTS 8 publications were divided into 3 groups according to two golden standard references, vanA and vanB group, vanA group, vanB group, including 6 researches, 5 researches and 5 researches, respectively. The pooled sensitivity and specificity of group vanA and vanB were 0.96 (95% CI, 0.93-0.98) and 0.90 (95% CI, 0.88-0.91) respectively. The DOR was 440.77 (95% CI, 37.92-5123.55). The pooled sensitivity and specificity of group vanA were 0.86 (95% CI, 0.81-0.90) and 0.99 (95% CI, 0.99-0.99) respectively, and those of group vanB were 0.85 (95% CI, 0.63-0.97) and 0.82 (95% CI, 0.80-0.83) respectively. CONCLUSION GeneXpert vanA/vanB can diagnose VRE with high-accuracy and shows greater accuracy in diagnosing vanA.
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Affiliation(s)
- Zhuo-Lei Li
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Qi-Bing Luo
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Shan-Shan Xiao
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Ze-Hong Lin
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Pharmacy, Guangzhou Medical University School of Pharmaceutical Sciences, Guangzhou, China
| | - Ye-Ling Liu
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Meng-Yi Han
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Jing-Hua Zhong
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Tian-Xing Ji
- Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
- Department of Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
- Department of Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
- * E-mail:
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Rezk AR, Bawady SA, Omar NN. Incidence of emerging multidrug-resistant organisms and its impact on the outcome in the pediatric intensive care. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [PMCID: PMC8557963 DOI: 10.1186/s43054-021-00071-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Healthcare-associated infections (HCAI) are a worldwide threat in intensive care units particularly in the pediatric intensive care units with a major cause of morbidity and mortality among this age group. The aim of the study is to determine the prevalence and risk factors predisposing to multidrug-resistant organisms (MDROs) infections among pediatric intensive care unit (PICU) patients at Ain Shams Pediatric University Hospitals as well as determining mortality and morbidity rates along with the length of stay at PICU.
Results
Culture results revealed that of the 282 patients evaluated, only 26 (9.2%) were MDROs (half of the affected patients had Acinetobacter species (50%) and the rest of them were free, 256 (90.8%). Our study revealed that the majority of MDROs were isolated from sputum in more than half of the patients 19/32 (59.3%) followed by whole blood in 10/32 (31.2%) and urine in 3/32 (9.4%). Pulmonary system was the most common affected site and was mainly colonized by MDR Acinetobacter (71.4%) followed by MDR Klebsiella (41.6%). Regarding MDR risk factors in our PICU, multivariate logistic regression analyses showed significant relationship between MDROs and age under 1 year (odds ratio [OR] 2.4554; 95% confidence interval [95% CI] (1.072–5.625); p = 0.043) and underlying pulmonary disease (OR 2.417; 95% CI (1.014–5.761); p = 0.592). A statistically significant higher mortality was detected in patients colonized with MDROs 9/26 (34.6%) versus MDROs non-colonized patients 32/256 (12.5%) [P=0.002]. Moreover, MDROs infection has negative significant risk with discharged patients ([OR] 0.269; [95% CI] (0.111–0.656); p = 0.002). Additionally, patients infected with MDROs did have significantly greater PICU stay than those non-infected [median (IQR), 16.5 (10.7–22), 5 (4–8), P=0.00] and have longer ventilation [median (IQR), 15.5 (10–18), 3 (2–10), P=0.00].
Conclusion
Prevalence of MDROs (9.2%) was low among PICU cases at Ain Shams University Hospitals. Most common MDROs were Acinetobacter and Klebsiella followed by pseudomonas species. The frequency of gram-negative organisms is much more common than gram-positive organisms. An increasing rate of antimicrobial resistance with increasing mortality and morbidity among PICU patients is observed worldwide; even for new categories, so, strict infection control programs should be implemented.
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Ben Mabrouk A, Larbi Ammari F, Werdani A, Jemmali N, Chelli J, Mrabet HE, Rassas A, Sfar MH, El Mhamdi S, Mahjoub B. Parental self-medication with antibiotics in a Tunisian pediatric center. Therapie 2021; 77:477-485. [PMID: 34776255 DOI: 10.1016/j.therap.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/31/2021] [Accepted: 10/12/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Self-medication of antibiotics among children is a very common problem in Tunisia. Its prevalence isn't well established. The aims of this study are to evaluate parents' knowledge concerning antibiotic use, and identify the factors associated with this problem. PATIENTS AND METHODS We conducted a cross-sectional study over a one year period (between August 2019 and July 2020). Data collection was performed using a questionnaire guided interview. We included parents of children consulting or hospitalized in the pediatric department of the university hospital Taher Sfar in Mahdia. RESULTS A total of 354 parents were included with an average age of 36.4±9.2 years. The average knowledge score was 2±1.3 points. In fact, 61.6% of the parents had poor knowledge about antibiotics. The frequency of non-prescription antibiotics use among children was 20.6%. Amoxicillin was the most used antibiotic (72.6%). Sore throat, important fever and flu-like symptoms were the main symptoms justifying non-prescription antibiotic use among our pediatric population in 60.3%, 34.2% and 23.3% of cases respectively. The main reason of self-medication was the fact that the same antibiotic was once prescribed to treat the same symptoms (58.9%). The used antibiotic came from an old prescription for the same child in 57.5% of the cases and was recommended by the pharmacist in 39.7% of the cases. After multivariate analysis, the factors associated with parental self-medication with antibiotics were: the advanced parent's age, the ability to name an antibiotic and knowledge's score>2. CONCLUSION Our study confirmed that parental knowledge about antibiotic use is low. In fact, the government should from one hand, organize antibiotic delivery and prohibit off the counter sells and in the other hand promote the education of the public through different procedures to stop this major health problem.
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Affiliation(s)
- Asma Ben Mabrouk
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia.
| | - Fatma Larbi Ammari
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Amina Werdani
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Nesrine Jemmali
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Jihene Chelli
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Houcem Elomma Mrabet
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia
| | - Ahmed Rassas
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
| | - Mohamed Habib Sfar
- University Hospital Taher Sfar de Mahdia, Endocrinology and Internal medicine Department, 5100 Mahdia, Tunisia; Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia
| | - Sana El Mhamdi
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Community and Preventive Medicine Department, 5100 Mahdia, Tunisia
| | - Bahri Mahjoub
- Monastir University, Faculty of Medicine, 5019 Monastir, Tunisia; University Hospital Taher Sfar de Mahdia, Pediatric Department, 5100 Mahdia, Tunisia
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Xu Q, Zhuang H, Xie Y. Study on the related risk factors and targeted nursing effects in multi-drug resistant bacteria infections in elderly patients with stroke-associated pneumonia. Am J Transl Res 2021; 13:9860-9865. [PMID: 34540122 PMCID: PMC8430142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE to explore the related risk factors and targeted nursing effects in multi-drug resistant bacteria (MDRB) infection in elderly patients with stroke-associated pneumonia. METHODS We selected 100 elderly patients with MDRB who received SAP in the hospital encephalology department from May 2011 to November 2014, and pathogenic detection and drug susceptibility tests were performed on the specimens sent for inspection. In addition, we observed the pathogenic characteristics of MDRB, and carried out univariate and multivariate regression analysis of related risk factors. The infected patients were randomly divided into a control group and an intervention group, each with 50 cases. The control group received routine nursing care, and the intervention group received targeted nursing interventions, and the nursing effect of the two groups of patients was compared and analyzed. RESULTS A total of 112 drug-resistant bacteria were isolated from 100 SAP patients; gram-positive bacteria accounted for 22.3%, gram-negative bacteria accounted for 74.1%, fungi accounted for 3.6%. The multi-factor analysis showed that SAP type, ICU admission, gastric catheter retention, length of hospital stay, prophylactic use of antibiotics and disturbance of consciousness are risk factors associated with MDRB. The total effective rate of the control group was 50.0%, and the total effective rate of the intervention group was 74.0%, the difference between the two groups was statistically significant (P<0.05). CONCLUSION The pathogens causing MDRB in elderly SAP patients are mainly gram-negative bacteria, and there are many risk factors for developing MDRB in SAP patients, and targeted nursing measures can significantly improve the prognosis of patients with MDRB infection.
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Affiliation(s)
- Qiuyue Xu
- Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH) Haikou, Hainan, China
| | - Huiling Zhuang
- Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH) Haikou, Hainan, China
| | - Yanyun Xie
- Cadre Sanatorium of Hainan & Geriatric Hospital of Hainan (CSH) Haikou, Hainan, China
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12
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Qureshi S, Maria N, Zeeshan M, Irfan S, Qamar FN. Prevalence and risk factors associated with multi-drug resistant organisms (MDRO) carriage among pediatric patients at the time of admission in a tertiary care hospital of a developing country. A cross-sectional study. BMC Infect Dis 2021; 21:547. [PMID: 34107903 PMCID: PMC8191205 DOI: 10.1186/s12879-021-06275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/06/2021] [Indexed: 01/02/2023] Open
Abstract
Background The rise of Multidrug-resistant organisms (MDROs) poses a considerable burden on the healthcare systems, particularly in low-middle income countries like Pakistan. There is a scarcity of data on the carriage of MDRO particularly in the pediatrics population therefore, we aimed to determine MDRO carriage in pediatric patients at the time of admission to a tertiary care hospital in Karachi, Pakistan, and to identify the risk factors associated with it. Methods A cross-sectional study conducted at the pediatric department of Aga Khan University Hospital (AKUH) from May to September 2019 on 347 children aged 1–18 years. For identification of MDRO (i.e., Extended Spectrum Beta-Lactamase (ESBL) producers, Carbapenem Resistant Enterobacteriaceae (CRE), Vancomycin Resistant Enterococci (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug-resistant (MDR) Acinetobacter species and MDR Pseudomonas aeruginosa), nasal swabs and rectal swabs or stool samples were cultured on specific media within 72 h of hospitalization. Data was collected on a predesigned structured questionnaire on demographics, prior use of antibiotics for > 48 h in the last 6 months, history of vaccination in last 6 months, exposure to health care facility regardless of the time of exposure, ICU stay for > 72 h, and about the prior use of medical devices (urinary catheter, central venous lines etc.) in last 1 year. Statistical analysis was performed by Standard statistical software. Results Out of 347 participants, 237 (68.3%) were found to be MDRO carriers. Forty nine nasal swabs from 346 children (14.2%) showed growth of MRSA. The majority of the stool/rectal swabs (n = 222 of 322; 69%) collected were positive for MDRO. The most isolated species were ESBL Escherichia coli 174/222 (78.3%) followed by ESBL Enterobacter species 37/222 (16.7%) and ESBL Klebsiella pneumoniae 35/222 (15.8%). On univariate analysis, none of the risk factors showed statistically significant association with MDRO carriage. Conclusion Overall, a high prevalence of MDRO carriage was identified among admitted pediatric patients. Implementation of systematic screening may help to identify true burden of MDROs carriage in the health care settings.
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Affiliation(s)
- Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Noshi Maria
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Zeeshan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Seema Irfan
- Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
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Abera A, Tilahun M, Tekele SG, Belete MA. Prevalence, Antimicrobial Susceptibility Patterns, and Risk Factors Associated with Enterococci among Pediatric Patients at Dessie Referral Hospital, Northeastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5549847. [PMID: 33954176 PMCID: PMC8064786 DOI: 10.1155/2021/5549847] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enterococcus species, which is previously considered as medically not important, now becomes one of the leading causes of nosocomial infections. Even though it becomes the most public health concern and emerging multidrug-resistant pathogen, there is no enough data in the study area. OBJECTIVE To determine the prevalence, antimicrobial resistance pattern, and associated risk factors of enterococci infection in pediatric patients. METHODS A hospital-based cross-sectional study was conducted from February to May 2019 at Dessie Referral Hospital, Northeastern Ethiopia. A total of 403 pediatric patients were included in the study, and a pretested structured questionnaire was used to collect sociodemographic and risk factor-related data. Clinical samples such as urine, blood, wound swabs, discharges, and other body fluids were collected aseptically and inoculated on to Bile Esculin Azide Agar, and colony characteristics, Gram stain, catalase, salt, and temperature tolerance tests were employed for bacterial identification. Antimicrobial sensitivity tests were performed using the modified Kirby-Bauer disk diffusion method. Data was entered into SPSS software version 25 and descriptive statistics; bivariate and multivariate logistic regression analyses were performed. In all cases, a P value ≤ 0.05 with corresponding 95% confidence interval were considered as statistically significant. RESULT The overall prevalence of enterococci was 2.7% (11/403). Of which, the highest number of enterococci infection was recovered from urine sample (54.5%) followed by blood (27.3%), wound swab (9.1%), and other body fluids (9%). The overall multidrug resistance rate was 54.5%. Higher drug resistance pattern was observed against tetracycline, chloramphenicol, and amoxicillin/clavulanate. Having history of invasive procedure (P < 0.001), chronic illness (P < 0.001) and previous admission history of the children (P < 0.001) were statistically significant associated risk factors for pediatrics enterococci infection. CONCLUSION The prevalence of enterococci from pediatric patients in this study was relatively low compared to other studies. Significant rates of MDR and VRE were identified, and the risk of infection became high when children had a history of different chronic illnesses and history of admission and underwent invasive treatment procedures. Therefore, efforts should be made to prevent enterococci infections and spread of multidrug-resistant enterococci.
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Affiliation(s)
- Admasu Abera
- Department of Medical Laboratory Science, Debre Berhan Health Science College, Debre Berhan, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Saba Gebremichael Tekele
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Ashagrie Belete
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Girona‐Alarcón M, Fresán E, Garcia‐Garcia A, Bobillo‐Perez S, Balaguer M, Felipe A, Esteban ME, Jordan I. Device-associated multidrug-resistant bacteria surveillance in critically ill children: 10 years of experience. Acta Paediatr 2021; 110:203-209. [PMID: 32383199 DOI: 10.1111/apa.15342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
AIM Multidrug-resistant bacterial infections are a public health problem worldwide. However, most of the information available refers to adults. The main objectives were to determine the incidence, risk factors, and outcomes for device-associated infections, especially those involving multidrug-resistant bacteria. METHODS This is a prospective, observational study. Children aged ≥1 month and <18 years admitted to the paediatric intensive care unit from 2008 to 2017, with a device-associated infection microbiologically confirmed were included. Patients infected with resistant bacteria were compared with those who had a drug-susceptible infection. RESULTS The study included 213 patients. Out of all the device-associated infections, 22% (48 patients) were caused by multidrug-resistant bacteria. The most frequent were extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Cardiovascular diseases, age under 1year, comorbidity, prolonged use of invasive device, and length of stay until infection were risk factors for resistant bacteria, but not specifically for ESBL-producing bacteria. Length of stay and mortality was increased in patients with multidrug-resistant bacteria. CONCLUSION Being under 1-year-old and having a cardiovascular disease were the two major risk factors for resistant bacterial infection. ESBL-producing bacteria were the most frequent multidrug-resistant agents. However, patients with ESBL-producing bacteria did not have any additional risk factors, so they may have been colonised in the community.
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Affiliation(s)
- Mònica Girona‐Alarcón
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Elena Fresán
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Ana Garcia‐Garcia
- Immunology Department Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
| | - Sara Bobillo‐Perez
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Monica Balaguer
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Aida Felipe
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Maria Esther Esteban
- Zoology and Anthropology Section Department of Evolutionary Biology, Ecology and Environmental Sciences Faculty of Biology GREAB‐ Biological Anthropology Research Group Institut de Recerca de la Biodiversitat (IRBio) University of Barcelona Barcelona Spain
| | - Iolanda Jordan
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
- Paediatric Intensive Care Unit CIBERESP, Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
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Paredes I, Lagares A, San-Juan R, Castaño-León AM, Gómez PA, Jimenez-Roldán L, Panero I, Eiriz C, García-Perez D, Moreno LM, Perez-Nuñez A, Gonzalez-León P, Alén JAF. Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study. Acta Neurochir (Wien) 2020; 162:2857-2866. [PMID: 32720014 DOI: 10.1007/s00701-020-04508-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cranioplasty carries a high risk of surgical site infections (SSIs) for a scheduled procedure, particularly with antibiotic-resistant bacteria. METHODS The goal of this retrospective study was to measure the effect of tailored antibiotic prophylaxis on SSIs resulting from cranioplasties. The authors collected a prospective database of cranioplasties from 2009 to 2018. Risk factors for SSI were registered, as well as infection occurring during the first year postoperatively. A new protocol was initiated in 2016 consisting of antibiotic prophylaxis tailored to the colonizing flora of the skin of the scalp and decolonization of patients who were nasal carriers of methicillin-resistant S. aureus (MRSA); infection rates were compared. RESULTS One hundred nine cranioplasties were identified, 64 in the old protocol and 45 in the new protocol. Of the 109 cranioplasties, 16 (14.7%) suffered an infection, 14 (21.9%) in the old protocol group and 2 (4.4%) in the new protocol group (OR for the new protocol 0.166, 95% CI 0.036-0.772). Multiple surgeries (OR 3.44), Barthel ≤ 70 (OR 3.53), and previous infection (OR 3.9) were risk factors for SSI. Of the bacteria identified in the skin of the scalp, 22.2% were resistant to routine prophylaxis (cefazoline). Only one patient was identified as a nasal carrier of MRSA and was decolonized. CONCLUSIONS A high percentage of bacteria resistant to routine prophylaxis (cefazoline) was identified in the skin of these patients' scalps. The use of tailored antibiotic prophylaxis reduced significantly the infection rate in this particular set of patients.
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Affiliation(s)
- Igor Paredes
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain.
| | - Alfonso Lagares
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Rafael San-Juan
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Ana María Castaño-León
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Pedro-Antonio Gómez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Jimenez-Roldán
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Irene Panero
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Carla Eiriz
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Daniel García-Perez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Luis Miguel Moreno
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - Pedro Gonzalez-León
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
| | - José Antonio F Alén
- Neurosurgery Department, University Hospital 12 de Octubre, Avenida de Córdoba s/n, 28041, Madrid, Spain
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El-Shorbagi AN, Chaudhary S. Monobactams: A Unique Natural Scaffold of Four-Membered Ring Skeleton, Recent Development to Clinically Overcome Infections by Multidrug- Resistant Microbes. LETT DRUG DES DISCOV 2019. [DOI: 10.2174/1570180816666190516113202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
Monobactam antibiotics have been testified to demonstrate significant antibacterial
activity especially the treatment of infections by superbug microbes. Recently, research has
been focused on the structural modifications, and new generation of this privileged natural scaffold.
Objective:
Efforts have been made to discover the structure-antibacterial relationship of monbactams
in order to avoid the aimless work involving the ongoing generated analogues. This review aims to
summarize the current knowledge and development of monobactams as a broad-spectrum antibacterial
scaffolds. The recent structural modifications that expand the activity, especially in the infections
by resistant-strains, combinational therapies and dosing, as well as the possibility of crosshypersensitivity/
reactivity/tolerability with penicillins and cephalosporins will also be summarized
and inferred. Different approaches will be covered with emphasis on chemical methods and Structure-
Activity Relationship (SAR), in addition to the proposed mechanisms of action. Clinical investigation
of monobactams tackling various aspects will not be missed in this review.
Conclusion:
The conclusion includes the novels approaches, that could be followed to design new
research projects and reduce the pitfalls in the future development of monobactams.
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Affiliation(s)
- Abdel Nasser El-Shorbagi
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Sachin Chaudhary
- Department of Medicinal Chemistry, College of Pharmacy, University of Sharjah, Sharjah 27272, United Arab Emirates
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Oliveira PMND, Buonora SN, Souza CLP, Simões Júnior R, Silva TCD, Bom GJT, Teixeira CHDS, Silva ARAD. Surveillance of multidrug-resistant bacteria in pediatric and neonatal intensive care units in Rio de Janeiro State, Brazil. Rev Soc Bras Med Trop 2019; 52:e20190205. [PMID: 31508783 DOI: 10.1590/0037-8682-0205-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.
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Affiliation(s)
| | - Sibelle Nogueira Buonora
- Governo do Estado do Rio de Janeiro, Coordenação de Controle de Infecção Hospitalar, Rio de Janeiro, RJ, Brasil
| | | | | | | | | | | | - André Ricardo Araujo da Silva
- Universidade Federal Fluminense, Departamento Materno-Infantil, Laboratório de Ensino em Controle e Prevenção de Infecções Relacionadas à Assistência à Saúde , Niterói, RJ, Brasil
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Ahmad KS, Bibi Jaffri S. Carpogenic ZnO nanoparticles: amplified nanophotocatalytic and antimicrobial action. IET Nanobiotechnol 2019; 13:150-159. [PMID: 31051445 PMCID: PMC8676184 DOI: 10.1049/iet-nbt.2018.5006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 11/09/2023] Open
Abstract
This investigation has for the first time utilised environmental resource Prunus cerasifera seed extract phytochemicals for the green synthesis of carpogenic ZnO nanoparticles (NPs). Spherical morphology and size range of 56.57-107.70 nm at variable calcination temperatures without the use of any external reducing agent was obtained. The synthesised NPs exhibited hexagonal wurtzite geometry with an average crystal size 5.62 nm and a band gap of 3.4 eV. Carpogenic NPs were investigated for optical, compositional, morphological, and phytochemical make up via ultraviolet spectroscopy (UV-Vis), Fourier transform infrared analysis, X-ray powder diffraction, scanning electron microscopy, and gas chromatography and mass spectrometry. Carpogenic NPs degraded methyl red up to 83% with pseudo-first-order degradation kinetics (R2 = 0.88) in 18 min signifying their remediation role in environment in conformity with all principles of green chemistry. Photocatalytic assays were performed in direct solar irradiance. Nine pathogens of biomedical and agricultural significance having multi-drug resistance were inhibited in vitro via the Kirby-Bauer disc diffusion assay. The enhanced photocatalytic and antimicrobial inhibition not only makes carpogenic ZnO NPs a future photo-degradative candidate for environmental remediation but also a nanofertiliser, nanofungicide, and nanobactericide synthesised via bioinspired, biomimetic, green, and unprecedented route.
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Affiliation(s)
- Khuram Shahzad Ahmad
- Department of Environmental Sciences, Fatima Jinnah Women University, The Mall, 46000 Rawalpindi, Pakistan.
| | - Shaan Bibi Jaffri
- Department of Environmental Sciences, Fatima Jinnah Women University, The Mall, 46000 Rawalpindi, Pakistan
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Lin J, Yao Z. Maternal-Infant Correlation of Multidrug-Resistant Staphylococcus aureus Carriage: A Prospective Cohort Study. Front Pediatr 2018; 6:384. [PMID: 30568937 PMCID: PMC6290026 DOI: 10.3389/fped.2018.00384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives: We aim to assess the correlation of multidrug-resistant Staphylococcus aureus (MDR S. aureus) carriage between mothers and their newborn infants. Materials and Methods: We conducted a prospective cohort study of mothers and their newborn infants in two hospitals in Shenzhen, China, from August to November 2015. We collected demographic and clinical information from mothers and newborn infants by face-to-face questionnaires and medical datasets. Serial swabs were collected from mothers and their newborn infants for further experiments. Maternal-infant correlation was assessed using the Poisson regression model. Results: The prevalence of MDR S. aureus vaginal carriage in mothers was 4.7% (86/1834). The incidence of MDR S. aureus carriage in newborn infants was 1.3% (23/1834). The adjusted relative risk and 95% confidence interval of maternal-infant MDR S. aureus carriage was 7.63 (2.99-19.49). Six MDR S. aureus maternal-infant pairs were concordant. The phenotypic and molecular characteristics of MDR S. aureus isolates were similar between mothers and their newborn infants. Conclusion: MDR S. aureus vaginal carriage in mothers was associated with an increased risk for MDR S. aureus carriage in their newborn infants.
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Affiliation(s)
- Jialing Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenjiang Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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