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Promsuwan O, Malathum K, Ingsathit A. Epidemiology of extended-spectrum β-lactamase-producing Enterobacterales infection in kidney transplant recipients. Antimicrob Resist Infect Control 2023; 12:123. [PMID: 37950332 PMCID: PMC10636956 DOI: 10.1186/s13756-023-01308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 09/12/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Extended-spectrum b-lactamase (ESBL)-producing gram-negative bacilli (ESBL-GNB) are the most important pathogenic bacteria infecting kidney transplant patients. Kidney transplantation has been shown to be a risk factor for nosocomial ESBL-GNB bacteremia. The aims of this study were to describe the epidemiology of ESBL-GNB acquisition and to identify factors associated with ESBL-GNB infection in kidney transplant recipients, including pretransplant ESBL-GNB fecal carriage. METHODS A prospective study of patients undergoing kidney transplantation at Ramathibodi Hospital from March 1, 2019-November 30, 2020 was conducted. During this period, 66 patients who underwent kidney transplantation. Perianal swab cultures and urine cultures for ESBL-GNB were obtained from all subjects upon admission for transplantation and on Days 3, 7, 14 and 21 after surgery to determine the prevalence, incidence, and duration of admission before acquisition of the organisms. RESULTS Of the 66 patients undergoing kidney transplantation, 18 preoperative perianal swabs were detected to be positive for ESBL-GNB upon admission, representing 27.3% of the cases. The in-hospital perianal swab tests showed a significant increase to 96.8% positive ESBL-GNB cultures at the end of week 3. Approximately one-fourth (27.8%) of patients who acquired ESBL-GNB developed a postoperative symptomatic infection. The infection occurred in 13% of such patients who were not ESBL positive at first. These infections included urinary tract infections (20 cases, [30%], of which 55% were due to ESBL-GNB) and bloodstream infections (13 cases; of which 9 [69.2%] were due to ESBL-GNB). E. coli was the most common pathogen. Previous exposure to antibiotics, including surgical prophylaxis, underlying disease, duration of indwelling urinary catheters and ureteric stents, as well as other operative factors were not found to be significantly associated with the acquisition of ESBL-producing organisms in this dataset. CONCLUSIONS ESBL carriage may be a risk factor for the development of bacteremia and other serious infections among kidney transplant recipients, although a statistically significant difference could not be demonstrated owing to the small size of the sample. The high rate of ESBL acquisition suggests that more stringent infection prevention and control efforts are needed.
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Affiliation(s)
- Oranuch Promsuwan
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Kumthorn Malathum
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Atiporn Ingsathit
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Ramathibodi Excellence Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Caudell MA, Ayodo C, Ita T, Smith RM, Luvsansharav UO, Styczynski AR, Ramay BM, Kariuki S, Palmer GH, Call DR, Omulo S. Risk Factors for Colonization With Multidrug-Resistant Bacteria in Urban and Rural Communities in Kenya: An Antimicrobial Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S104-S110. [PMID: 37406050 DOI: 10.1093/cid/ciad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya. METHODS Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects. RESULTS Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization increased by 12% with increasing visits to hospitals and clinics. Furthermore, individuals who kept poultry were 57% more likely to be colonized with ESCrE than those who did not. Respondents' sex, age, use of improved toilet facilities, and residence in a rural or urban community were associated with healthcare contact patterns and/or poultry keeping and may indirectly affect ESCrE colonization. Prior antibiotic use was not significantly associated with ESCrE colonization in our analysis. CONCLUSIONS The risk factors associated with ESCrE colonization in communities include healthcare- and community-related factors, indicating that efforts to control antimicrobial resistance in community settings must include community- and hospital-level interventions.
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Affiliation(s)
- Mark A Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Charchil Ayodo
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Teresa Ita
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley R Styczynski
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brooke M Ramay
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
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Mayanja R, Muwonge A, Aruhomukama D, Katabazi FA, Bbuye M, Kigozi E, Nakimuli A, Sekikubo M, Najjuka CF, Kateete DP. Source-tracking ESBL-producing bacteria at the maternity ward of Mulago hospital, Uganda. PLoS One 2023; 18:e0286955. [PMID: 37289837 PMCID: PMC10249850 DOI: 10.1371/journal.pone.0286955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Escherichia coli, Klebsiella pneumoniae and Enterobacter (EKE) are the leading cause of mortality and morbidity in neonates in Africa. The management of EKE infections remains challenging given the global emergence of carbapenem resistance in Gram-negative bacteria. This study aimed to investigate the source of EKE organisms for neonates in the maternity environment of a national referral hospital in Uganda, by examining the phenotypic and molecular characteristics of isolates from mothers, neonates, and maternity ward. METHODS From August 2015 to August 2016, we conducted a cross-sectional study of pregnant women admitted for elective surgical delivery at Mulago hospital in Kampala, Uganda; we sampled (nose, armpit, groin) 137 pregnant women and their newborns (n = 137), as well as health workers (n = 67) and inanimate objects (n = 70 -beds, ventilator tubes, sinks, toilets, door-handles) in the maternity ward. Samples (swabs) were cultured for growth of EKE bacteria and isolates phenotypically/molecularly investigated for antibiotic sensitivity, as well as β-lactamase and carbapenemase activity. To infer relationships among the EKE isolates, spatial cluster analysis of phenotypic and genotypic susceptibility characteristics was done using the Ridom server. RESULTS Gram-negative bacteria were isolated from 21 mothers (15%), 15 neonates (11%), 2 health workers (3%), and 13 inanimate objects (19%); a total of 131 Gram-negative isolates were identified of which 104 were EKE bacteria i.e., 23 (22%) E. coli, 50 (48%) K. pneumoniae, and 31 (30%) Enterobacter. Carbapenems were the most effective antibiotics as 89% (93/104) of the isolates were susceptible to meropenem; however, multidrug resistance was prevalent i.e., 61% (63/104). Furthermore, carbapenemase production and carbapenemase gene prevalence were low; 10% (10/104) and 6% (6/104), respectively. Extended spectrum β-lactamase (ESBL) production occurred in 37 (36%) isolates though 61 (59%) carried ESBL-encoding genes, mainly blaCTX-M (93%, 57/61) implying that blaCTX-M is the ideal gene for tracking ESBL-mediated resistance at Mulago. Additionally, spatial cluster analysis revealed isolates from mothers, new-borns, health workers, and environment with similar phenotypic/genotypic characteristics, suggesting transmission of multidrug-resistant EKE to new-borns. CONCLUSION Our study shows evidence of transmission of drug resistant EKE bacteria in the maternity ward of Mulago hospital, and the dynamics in the ward are more likely to be responsible for transmission but not individual mother characteristics. The high prevalence of drug resistance genes highlights the need for more effective infection prevention/control measures and antimicrobial stewardship programs to reduce spread of drug-resistant bacteria in the hospital, and improve patient outcomes.
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Affiliation(s)
- Richard Mayanja
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Adrian Muwonge
- The Roslin Institute, College of Medicine and Veterinary Studies, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Midlothian, United Kingdom
| | - Dickson Aruhomukama
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Ashaba Katabazi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mudarshiru Bbuye
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Edgar Kigozi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine Florence Najjuka
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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Rahman Z, Liu W, Stapleton L, Kenters N, Rasmika Dewi DAP, Gudes O, Ziochos H, Khan SJ, Power K, McLaws ML, Thomas T. Wastewater-based monitoring reveals geospatial-temporal trends for antibiotic-resistant pathogens in a large urban community. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 325:121403. [PMID: 36914152 DOI: 10.1016/j.envpol.2023.121403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Antimicrobial resistance (AMR) is one of the top ten global health threats, and current surveillance programs rarely monitor it outside healthcare settings. This limits our ability to understand and manage the spread of AMR. Wastewater testing has the potential to simply, reliably and continuously survey trends in AMR outside the healthcare settings, as it captures biological material from the entire community. To establish and evaluate such a surveillance, we monitored wastewater for four clinically significant pathogens across the urban area of Greater Sydney, Australia. Untreated wastewater from 25 wastewater treatment plants (WWTPs) covering distinct catchment regions of 5.2 million residents was sampled between 2017 and 2019. Isolates for extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) were consistently detected, suggesting its endemicity in the community. Isolates for carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) were only occasionally detected. The flow normalized relative (FNR) ESBL-E load was positively correlated with the proportion of the population between 19 and 50 years of age, completion of vocational education and the average length of hospital stay. Collectively, these variables explained only a third of the variance of the FNR ESBL-E load, indicating further, yet-unidentified factors as a contributor to the distribution. About half of the variation in the FNR CRE load was explained by the average length of hospital stay, showing healthcare-related drivers. Interestingly, variation in the FNR VRE load was not correlated to healthcare-related parameters but to the number of schools per 10,000 population. Our study provides insight into how routine wastewater surveillance can be used to understand the factors driving the distribution of AMR in an urban community. Such information can help to manage and mitigate the emergence and spread of AMR in important human pathogens.
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Affiliation(s)
- Zillur Rahman
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, UNSW Sydney, Australia
| | - Weijia Liu
- School of Population Health, UNSW Sydney, Australia
| | | | | | - Dewa A P Rasmika Dewi
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, UNSW Sydney, Australia
| | - Ori Gudes
- School of Population Health, UNSW Sydney, Australia; School of Built Environment, UNSW Sydney, Australia
| | - Helen Ziochos
- Department of Microbiology and Infectious Diseases, NSW Health Pathology, Liverpool, NSW, Australia
| | - Stuart J Khan
- UNSW Global Water Institute, UNSW Sydney, Australia; School of Civil and Environmental Engineering, UNSW Sydney, Australia
| | - Kaye Power
- Sydney Water, Parramatta, NSW, Australia
| | - Mary-Louise McLaws
- School of Population Health, UNSW Sydney, Australia; UNSW Global Water Institute, UNSW Sydney, Australia
| | - Torsten Thomas
- Centre for Marine Science and Innovation, School of Biological, Earth and Environmental Sciences, UNSW Sydney, Australia.
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Althaqafi A, Yaseen M, Farahat F, Munshi A, Al-Amri A, Essack SY. Risk Factors for Infection With Multidrug-Resistant Gram-Negative Bacteria in a Tertiary Care Hospital in Saudi Arabia: A Case-Control Study. Cureus 2023; 15:e37291. [PMID: 37168219 PMCID: PMC10166184 DOI: 10.7759/cureus.37291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Background The increase in the incidence of multidrug-resistant (MDR) organisms especially Gram-negative bacteria (GNB) in healthcare facilities is a serious cause of concern. This study identified risk factors for the infection with these MDR GNB, such as Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli to inform healthcare workers about strategies for their containment. Methods A case-control study was carried out at a tertiary care hospital where 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as the ones that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. The data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios with 95% confidence intervals were calculated, and the level of significance was determined at p-value < 0.05. Results A total of 388 organisms were isolated during four months (January-April 2015) from 332 patients. Fifty-six (17%) of the patients were infected with more than one organism. Among the MDR bacteria, the most dominant MDR organism was A. baumannii (38%), followed by K. pneumoniae (31%), P. aeruginosa (20%), and E. coli (11%). Among the non-MDR organisms, the most dominant was P. aeruginosa (47%), followed by E. coli (32%), K. pneumoniae (18%), and A. baumannii (3%). Patients with MDR organisms compared with the first control group (patients with non-MDR organisms) showed that prior antibiotic use (p-value: 0.001), intensive care unit (ICU) admission (p-value: 0.001), and indwelling medical devices (p-value: 0.005) were significant risk factors for MDR infections. It was also found that the risk factors for MDR GNB infection were the same in the second control group (patients without infection): prior antibiotic use (p-value: 0.002), ICU admission (p-value: 0.001), and indwelling medical devices (p-value: 0.03). Based on the comparison of the two control groups, prolonged hospital stays of more than five days (p-value: 0.001), immunosuppressive therapy (p-value: 0.02), and over 60 years of age (p-value: 0.02) were significant risk factors for non-MDR infection. Conclusion The risk factors identified in our study provide guidance to healthcare workers for the prevention and containment of MDR GNB.
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Affiliation(s)
- Abdulhakeem Althaqafi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Muhammad Yaseen
- Infection Prevention and Control, Bradford Teaching Hospital National Health Service (NHS) Foundation Trust, Bradford, GBR
| | - Fayssal Farahat
- Public Health and Community Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Public Health and Community Medicine, Menoufia University, Menoufia, EGY
- Infection Prevention and Control, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Adeeb Munshi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Abdulfattah Al-Amri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Microbiology, King Abdullah International Medical Research Center, Jeddah, SAU
- Microbiology, King Abdulaziz Medical City, Jeddah, SAU
| | - Sabiha Y Essack
- Antimicrobial Research Unit, University of Kwazulu-Natal, Durban, ZAF
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Intestinal colonization with multidrug-resistant Enterobacterales: screening, epidemiology, clinical impact, and strategies to decolonize carriers. Eur J Clin Microbiol Infect Dis 2023; 42:229-254. [PMID: 36680641 PMCID: PMC9899200 DOI: 10.1007/s10096-023-04548-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales (Ent) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens-especially Escherichia coli and Klebsiella pneumoniae-may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR-Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR-Ent. In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR-Ent carriers.
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Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All. Pathogens 2023; 12:pathogens12010144. [PMID: 36678492 PMCID: PMC9866331 DOI: 10.3390/pathogens12010144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients' being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.
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Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana. Antibiotics (Basel) 2022; 12:antibiotics12010058. [PMID: 36671259 PMCID: PMC9855120 DOI: 10.3390/antibiotics12010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42-4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02-0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.
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Salazar-Vizcaya L, Atkinson A, Kronenberg A, Plüss-Suard C, Kouyos RD, Kachalov V, Troillet N, Marschall J, Sommerstein R. The impact of public health interventions on the future prevalence of ESBL-producing Klebsiella pneumoniae: a population based mathematical modelling study. BMC Infect Dis 2022; 22:487. [PMID: 35606726 PMCID: PMC9125893 DOI: 10.1186/s12879-022-07441-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 05/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Future prevalence of colonization with extended-spectrum betalactamase (ESBL-) producing K. pneumoniae in humans and the potential of public health interventions against the spread of these resistant bacteria remain uncertain. Methods Based on antimicrobial consumption and susceptibility data recorded during > 13 years in a Swiss region, we developed a mathematical model to assess the comparative effect of different interventions on the prevalence of colonization. Results Simulated prevalence stabilized in the near future when rates of antimicrobial consumption and in-hospital transmission were assumed to remain stable (2025 prevalence: 6.8% (95CI%:5.4–8.8%) in hospitals, 3.5% (2.5–5.0%) in the community versus 6.1% (5.0–7.5%) and 3.2% (2.3–4.2%) in 2019, respectively). When overall antimicrobial consumption was set to decrease by 50%, 2025 prevalence declined by 75% in hospitals and by 64% in the community. A 50% decline in in-hospital transmission rate led to a reduction in 2025 prevalence of 31% in hospitals and no reduction in the community. The best model fit estimated that 49% (6–100%) of observed colonizations could be attributable to sources other than human-to-human transmission within the geographical setting. Conclusions Projections suggests that overall antimicrobial consumption will be, by far, the most powerful driver of prevalence and that a large fraction of colonizations could be attributed to non-local transmissions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07441-z.
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Affiliation(s)
- Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | - Roger D Kouyos
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Viacheslav Kachalov
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Saliba R, Lomont A, Eudesson JL, Seytre D, Zahar JR, Pilmis B. Significant variation in the faecal relative abundance of carbapenemase-producing Enterobacteriaceae of colonised patients during hospitalisation: a preliminary study. Int J Antimicrob Agents 2021; 59:106479. [PMID: 34801676 DOI: 10.1016/j.ijantimicag.2021.106479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Rindala Saliba
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France; Laboratoire des pathogènes émergents, Université Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Alexandra Lomont
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Jean-Louis Eudesson
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Delphine Seytre
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France.
| | - Benoit Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Institut Micalis UMR 1319, Université Paris Saclay, INRAe, AgroParisTech, Châtenay Malabry, France; Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France
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11
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Mwandigha AM, Kamori D, Kibwana UO, Masoud S, Manyahi J, Majigo M. Fecal carriage and factors associated with extended-spectrum β-lactamase-producing Enterobacteriaceae among pregnant women at the tertiary referral hospital, Tanzania. Trop Med Health 2020; 48:84. [PMID: 33061787 PMCID: PMC7545914 DOI: 10.1186/s41182-020-00271-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Evidence indicates that fecal carriage of ESBL-E in pregnancy predisposes women to potential life-threatening urinary tract infections and subsequently increasing the risk of neonatal infections. There is limited data regarding fecal carriage of ESBL-E and associated factors among pregnant women in Tanzania. We aimed to address the gap by determining the proportion of pregnant women with ESBL-E fecal carriage and identify the related factors. Methodology A hospital-based cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 182 pregnant women at the gestational age of 37 weeks and above were enrolled. Participants’ socio-demographic, clinical, and hygienic information were collected by using a well-structured questionnaire. Rectal swabs were collected and processed for isolation of ESBL-E. The extended-spectrum β-lactamase production and antibiotic susceptibility test (AST) were performed using a double-disc synergy test and Kirby-Bauer disc diffusion method, respectively. Results A total of 117 (64.3%) pregnant women were found to carry ESBL-E. Factors such as self-prescription of antibiotic medication during pregnancy, low education level, and toilet sharing were independently associated with ESBL-E fecal carriage. Five ESBL-E species that were isolated include Escherichia coli (84.6%), Klebsiella pneumoniae (8.9%), Klebsiella oxytoca (3.3%), Citrobacter spp. (1.6%), and Enterobacter spp. (1.6%). ESBL-E isolates demonstrated high resistance to aztreonam and sulphamethoxazole-trimethoprim. Conclusion This study has revealed a relatively high fecal carriage of ESBL-E among pregnant women, suggesting that there is a need for routine screening among that population. We recommend further studies to explore comprehensively the factors associated with high fecal carriage of ESBL-E in pregnancy and the potential transmission kinetics to their newborn babies.
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Affiliation(s)
- Ambele M Mwandigha
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Upendo O Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Salim Masoud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Vink J, Edgeworth J, Bailey SL. Acquisition of MDR-GNB in hospital settings: a systematic review and meta-analysis focusing on ESBL-E. J Hosp Infect 2020; 106:419-428. [PMID: 32918969 DOI: 10.1016/j.jhin.2020.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/03/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and other multi-drug-resistant Gram-negative bacteria (MDR-GNB) have disseminated globally since their discovery in the late 20th century. Various infection prevention and control measures are in place to prevent nosocomial transmission of these organisms, but their efficacy remains disputed. New literature has emerged in recent years providing further evidence which can be used to formulate effective strategies to tackle this issue in the future. METHODS A systematic review was performed to characterize the prevalence of colonization of multi-drug-resistant organisms and subsequent acquisition of these organisms within hospital settings. A meta-analysis was performed to characterize the prevalence and acquisition of ESBL-E in Europe and North America. RESULTS Twenty-eight studies fulfilled the inclusion criteria. Escherichia coli formed the main burden of MDR-GNB colonization worldwide. Patient-to-patient transmission of ESBL-E was found to be rare, but increased transmissibility of Klebsiella pneumoniae was described over E. coli. Within European and North American healthcare settings, a meta-analysis of eight studies identified a pooled prevalence of ESBL-E on admission to hospital of 7.91% and an acquisition rate of 3.73%. DISCUSSION Low prevalence at the point of hospital admission and insufficient evidence of patient-to-patient transmission suggests that infection prevention and control measures such as universal surveillance screening and single-room isolation are unlikely to be practical or effective interventions in reducing the overall burden of ESBL-E in hospitals, in line with current European guidelines. Instead, it is argued that efforts should be placed on controlling the spread of these organisms and other MDR-GNB in the community, predominantly long-term care facilities.
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Affiliation(s)
- J Vink
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - J Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - S L Bailey
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
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13
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Alharbi HA. Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review. Crit Care Nurse 2020; 39:e1-e9. [PMID: 31961941 DOI: 10.4037/ccn2019207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E-mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. OBJECTIVE To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. METHODS This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. RESULTS Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. CONCLUSIONS Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.
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Affiliation(s)
- Homood A Alharbi
- Homood A. Alharbi is an assistant professor, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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14
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Aklilu A, Manilal A, Ameya G, Woldemariam M, Siraj M. Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase- and Carbapenemase-Producing Enterobacteriaceae and Associated Factors Among Hospitalized Patients in Arba Minch General Hospital, Arba Minch, Ethiopia. Infect Drug Resist 2020; 13:1517-1526. [PMID: 32547121 PMCID: PMC7250175 DOI: 10.2147/idr.s239092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of hospital-acquired enterobacteria that produce extended-spectrum beta-lactamases (ESBLs) is on the rise worldwide. Colonization of gastrointestinal tract by extended-spectrum beta-lactamase Enterobacteriaceae, a prominent causative agent, results in life-threatening infections. Objective To determine the rate of gastrointestinal colonization by extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae and also to elucidate the antibiotic susceptibility profile and associated risk factors among hospitalized patients in Arba Minch General Hospital, Ethiopia. Methodology A facility-based cross-sectional study was conducted in Arba Minch General Hospital from May 2018 to July 2019. Sociodemographic data and associated factors were collected using a pre-tested-structured questionnaire. Stool specimens were collected using sterile stool cups. Each sample was then inoculated onto MacConkey agar. Bacterial isolates were identified using various biochemical tests. Screening and confirmatory tests for extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae were performed using the modified Kirby–Bauer disc diffusion technique. Statistical package for Social Science was used to analyze the data. The P-value ≤0.05 was considered as statistically significant. Results A total of 421 hospitalized patients were enrolled in this study of which there were 240 (57%) females. The mean age of the study participants was 28.8 with SD of 15.7. Majority of participants were in the age range of 25–40 years 179 (42.5%). About 146 (34.7%) participants were found to be colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae. The predominant ESBL-producing isolates were Escherichia coli 62 (42.46%) followed by Klebsiella pneumoniae 60 (41.09%). Six (1.43%) carbapenemase-producing K. pneumoniae were isolated. ESBL-producing Enterobacteriaceae showed higher resistance against tetracycline (91.1%) and cotrimoxazole (93.84%). Colonization of the gastrointestinal tract by ESBL showed statistically significant association with regard to chronic diseases (p<0.001) and the administration of oral antibiotics after admission (p=0.020). Conclusion The overall colonization rate of the gastrointestinal tract by extended-spectrum beta-lactamase-producing Enterobacteriaceae was prominent. The extended-spectrum beta-lactamase-producing isolates exhibited a higher level of resistance against the commonly used antibiotics which further needs greater attention.
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Affiliation(s)
- Addis Aklilu
- Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Science, Arba Minch, Ethiopia
| | - Aseer Manilal
- Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Science, Arba Minch, Ethiopia
| | - Gemechu Ameya
- Kotebe Metropolitan University, College of Health Sciences, Department of Medical Laboratory Science, Addis Ababa, Ethiopia
| | - Melat Woldemariam
- Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Science, Arba Minch, Ethiopia
| | - Munira Siraj
- Arba Minch University, College of Medicine and Health Sciences, Department of Medical Laboratory Science, Arba Minch, Ethiopia
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Bastiaens GJH, Baarslag T, Pelgrum C, Mascini EM. Active surveillance for highly resistant microorganisms in patients with prolonged hospitalization. Antimicrob Resist Infect Control 2020; 9:8. [PMID: 31921414 PMCID: PMC6945390 DOI: 10.1186/s13756-019-0670-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
We evaluated a new hospital policy comprising active surveillance for highly resistant microorganisms (HRMO) in patients with prolonged hospitalization, including detection of nosocomial transmission after identification of HRMO carriers. Our findings raise the question of whether active surveillance should be extended from traditional risk groups to patients with prolonged hospitalization.
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Affiliation(s)
- Guido J H Bastiaens
- 1Laboratory for Medical Microbiology and Medical Immunology, Rijnstate Hospital, Pres. Kennedylaan 100, 6883 AZ Velp, The Netherlands.,2Department of Medical Microbiology & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom Baarslag
- 3Department of Infection Control, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Corinne Pelgrum
- 3Department of Infection Control, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Ellen M Mascini
- 1Laboratory for Medical Microbiology and Medical Immunology, Rijnstate Hospital, Pres. Kennedylaan 100, 6883 AZ Velp, The Netherlands.,3Department of Infection Control, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
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16
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Al-Tamimi M, Himsawi N, Abu-Raideh J, Khasawneh AI, Jazar DA, Al-Jawaldeh H, Hawamdeh H. Phenotypic and Molecular Screening of Nasal S. aureus from Adult Hospitalized Patients for Methicillin- and Vancomycin-resistance. Infect Disord Drug Targets 2020; 21:68-77. [PMID: 31916522 DOI: 10.2174/1871526520666200109143158] [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: 10/07/2019] [Revised: 11/12/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nasal carriers of Staphylococcus aureus are common and play an important role in the transmission of infections. The aim of this study is a phenotypic and molecular investigation of nasal methicillin- and vancomycin-resistant S. aureus in hospitalized patients. METHODS 202 nasal swabs were collected from patients at Prince Hamzah Hospital, Jordan, through 2016-2017. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution and Vitek 2. Methicillin resistance was confirmed by testing for the mecA gene, while vancomycin resistance was screened by testing for the vanA and vanB genes. RESULTS The mean age of participants was 50.17±18.18 years and 59.4% were females. Nasal Staphylococci was isolated in 64/202 (31.7%), S. aureus was isolated from 33 samples (16.3%), MRSA was isolated from 13 samples (6.4%) and constitutive Macrolide-lincosamidestreptogramin B (MLSB) was isolated from 12 samples (5.9%). All MRSA isolates harbored the mecA gene. All isolates were sensitive to vancomycin using E-test and the microdilution test and were negative for the vanA and vanB genes. The highest resistance rate was observed for benzylpenicillin (>90%), while the lowest resistance rate was for tobramycin (<5%) among all isolates. Nasal Staphylococci, S. aureus and MRSA colonization significantly correlate with increased number of family members and previous hospitalization (P<0.05), while nasal S. aureus significantly correlates with a history of skin infection (P=0.003). CONCLUSION Nasal colonization by mecA-mediated MRSA is common among hospitalized patients, while vanA- and vanB-mediated vancomycin resistance was not detected in any nasal isolates.
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Affiliation(s)
- Mohammad Al-Tamimi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Nisreen Himsawi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Jumana Abu-Raideh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Ashraf I Khasawneh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Deaa Abu Jazar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hussam Al-Jawaldeh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hasan Hawamdeh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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Pilmis B, Billard-Pomares T, Martin M, Clarempuy C, Lemezo C, Saint-Marc C, Bourlon N, Seytre D, Carbonnelle E, Zahar JR. Can environmental contamination be explained by particular traits associated with patients? J Hosp Infect 2019; 104:293-297. [PMID: 31870885 DOI: 10.1016/j.jhin.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about patient risk factors associated with environmental contamination. AIM To evaluate the rate of environmental contamination and to investigate individual risk factors. METHODS A prospective cohort study was conducted. Each day, five rooms occupied by patients were selected. Five critical surfaces were systematically swabbed twice a day before and after cleaning. Clinical characteristics of all patients were collected. Logisitic regression was performed to evaluate the association between environmental contamination and patients' characteristics. FINDINGS A total of 107 consecutive patients were included and 1052 environmental samples were performed. Nineteen (18%) patients were known previously colonized/infected with a multidrug-resistant organism (MDRO). Respectively, 723 (69%) and 112 (11%) samples grew with ≥1 and >2.5 cfu/cm2 bacteria, resulting in 62 (58%) contaminated rooms. Considering positive samples with at least one pathogenic bacterium, 16 (15%) rooms were contaminated. By univariate and multivariate analysis, no variables analysed were associated with the environmental contamination. Considering contaminated rooms with >2.5 cfu/cm2, three factors were protective for environmental contamination: known MDRO carriers/infected patients (odds ratio: 0.25; 95% confidence interval: 0.09-0.72; P = 0.01), patients with urinary catheter (0.19; 0.04-0.89; P = 0.03) and hospitalization in single room (0.3; 0.15-0.6; P < 0.001). CONCLUSION This study was conducted in a non-outbreak situation and showed a low rate of environmental contamination with pathogenic bacteria. Only 11% of environmental samples grew with >2.5 cfu/cm2, and they were related to non-pathogenic bacteria. No risk factors associated with environmental contamination were identified.
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Affiliation(s)
- B Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint Joseph, Paris, France; EA4043 Unité Bactéries Pathogènes et Santé, Université Paris-Sud Paris-Saclay, Chatenay-Malabry, France
| | - T Billard-Pomares
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - M Martin
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - C Clarempuy
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - C Lemezo
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - C Saint-Marc
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - N Bourlon
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - D Seytre
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - E Carbonnelle
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France
| | - J-R Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France.
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Dziri R, Talmoudi A, Barguellil F, Ouzari HI, El Asli MS, Klibi N. Huge Diversity of TEM and SHV β-Lactamases Types Among CTX-M-15-Producing Enterobacteriaceae Species in Tunisia. Microb Drug Resist 2019; 25:1149-1154. [DOI: 10.1089/mdr.2018.0445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Raoudha Dziri
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Arbia Talmoudi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Farouk Barguellil
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Hadda-Imen Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Selim El Asli
- Service of Microbiology, Military Hospital of Tunis HMPIT, Tunis, Tunisia
- Department of Microbiology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Dandachi I, Chaddad A, Hanna J, Matta J, Daoud Z. Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach. Front Microbiol 2019; 10:1941. [PMID: 31507558 PMCID: PMC6716069 DOI: 10.3389/fmicb.2019.01941] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
In the last decade, extended-spectrum cephalosporin and carbapenem resistant Gram-negative bacilli (GNB) have been extensively reported in the literature as being disseminated in humans but also in animals and the environment. These resistant organisms often cause treatment challenges due to their wide spectrum of antibiotic resistance. With the emergence of colistin resistance in animals and its subsequent detection in humans, the situation has worsened. Several studies reported the transmission of resistant organisms from animals to humans. Studies from the middle east highlight the spread of resistant organisms in hospitals and to a lesser extent in livestock and the environment. In view of the recent socio-economical conflicts that these countries are facing in addition to the constant population mobilization; we attempt in this review to highlight the gaps of the prevalence of resistance, antibiotic consumption reports, infection control measures and other risk factors contributing in particular to the spread of resistance in these countries. In hospitals, carbapenemases producers appear to be dominant. In contrast, extended spectrum beta lactamases (ESBL) and colistin resistance are becoming a serious problem in animals. This is mainly due to the continuous use of colistin in veterinary medicine even though it is now abandoned in the human sphere. In the environment, despite the small number of reports, ESBL and carbapenemases producers were both detected. This highlights the importance of the latter as a bridge between humans and animals in the transmission chain. In this review, we note that in the majority of the Middle Eastern area, little is known about the level of antibiotic consumption especially in the community and animal farms. Furthermore, some countries are currently facing issues with immigrants, poverty and poor living conditions which has been imposed by the civil war crisis. This all greatly facilitates the dissemination of resistance in all environments. In the one health concept, this work re-emphasizes the need to have global intervention measures to avoid dissemination of antibiotic resistance in humans, animals and the environment in Middle Eastern countries.
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Affiliation(s)
- Iman Dandachi
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Amer Chaddad
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jason Hanna
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jessika Matta
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Ziad Daoud
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
- Division of Clinical Microbiology, Saint George Hospital University Medical Center, Beirut, Lebanon
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Neemann K, Olateju EK, Izevbigie N, Akaba G, Olanipekun GM, Richard JC, Duru CI, Kocmich NJ, Samson KK, Rezac-Elgohary A, Anigilaje EA, Yunusa T, Megafu CON, Ajose TO, Medugu N, Meza J, Obaro S. Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study. Clin Microbiol Infect 2019; 26:463-469. [PMID: 31336200 DOI: 10.1016/j.cmi.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. METHODS A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal-neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. RESULTS A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83-28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63-17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44-16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06-0.75) requires further evaluation. CONCLUSIONS Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.
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Affiliation(s)
- K Neemann
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - E K Olateju
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - N Izevbigie
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - G Akaba
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - G M Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J C Richard
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - C I Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N J Kocmich
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - K K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Rezac-Elgohary
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - E A Anigilaje
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - T Yunusa
- Department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - C O N Megafu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - T O Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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ESBL colonization and acquisition in a hospital population: The molecular epidemiology and transmission of resistance genes. PLoS One 2019; 14:e0208505. [PMID: 30640915 PMCID: PMC6331103 DOI: 10.1371/journal.pone.0208505] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/18/2018] [Indexed: 11/25/2022] Open
Abstract
A prospective cohort study (German Clinical Trial Registry, No. 00005273) was performed to determine pre-admission colonization rates, hospital acquisition risk factors, subsequent infection rates and colonization persistence including the respective molecular epidemiology and transmission rates of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EPE). A total of 342 EPEs were isolated from rectal swabs of 1,334 patients on admission, at discharge and 6 months after hospitalization. Inclusion criteria were patients’ age > 18 years, expected length of stays > 48 hours, external referral. The EPEs were characterized by routine microbiological methods, a DNA microarray and ERIC-PCR. EPE colonization was found in 12.7 % of admitted patients, with the highest rate (23.8 %) in patients from nursing homes. During hospitalization, 8.1 % of the patients were de novo EPE colonized, and invasive procedures, antibiotic and antacid therapies were independent risk factors. Only 1/169 patients colonized on admission developed a hospital-acquired EPE infection. Escherichia coli was the predominant EPE (88.9 %), and 92.1% of the ESBL phenotypes could be related to CTX-M variants with CTX-M-1/15 group being most frequent (88.9%). A corresponding β-lactamase could not be identified in five isolates. Hospital-acquired EPE infections in patients colonized before or during hospitalization were rare. The diversity of the EPE strains was much higher than that of the underlying plasmids. In seven patients, transmission of the respective plasmid across different species could be observed indicating that the current strain-based surveillance approaches may underestimate the risk of inter-species transmission of resistance genes.
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Tfifha M, Ferjani A, Mallouli M, Mlika N, Abroug S, Boukadida J. Carriage of multidrug-resistant bacteria among pediatric patients before and during their hospitalization in a tertiary pediatric unit in Tunisia. Libyan J Med 2018; 13:1419047. [PMID: 29277142 PMCID: PMC5757224 DOI: 10.1080/19932820.2017.1419047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The pandemic spread of multidrug-resistant (MDR) bacteria (i.e., methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii) pose a threat to healthcare Worldwide. We found limited data of MDR bacteria in pediatric patients hospitalized in Tunisian tertiary healthcare.The aim of the study is to evaluate the acquisition rate of MDR acquisition during hospitalization and to explore some of the associated risk factors for both carriage and acquisition at the pediatric department, Sahloul University Hospital. During September and October 2016, newly admitted patients were screened, at admission, during care and at discharge. Risk factors for colonization were explored by multivariate analysis. Of 112 newly admitted patients, 8.92% were colonized with at least one MDR. No risk factor was identified at admission. During hospitalization, five newly acquisition MDR (4.9%) were detected and eight (7.84%) at discharge. The specie most frequently detected on admission was Escherichia coli (50%), whereas, on discharge, Escherichia coli and K. pneumoniae were the species most frequently detected (52.7%). The pediatric intensive care unit (PICU) hospitalization, the length of hospital stay (more than 3days) and age under 2 years were identified as risk factor for acquisition of MDR during hospitalization. We identified several independent risk factors for contracting MDR bacteria during hospitalization in a tertiary pediatric department. The incidence of symptomatic MDR Infection among those colonized should be under close surveillance and long-term screening for those children is required. An institutional screening program for MDR especially in PICU might be discussed in regards to cost effectiveness.
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Affiliation(s)
- Miniar Tfifha
- a Pediatric Department, Sahloul Hospital, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
| | - Asma Ferjani
- b Microbiology and Immunology Department, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
| | - Manel Mallouli
- c Faculty of Medicine , University of Sousse , Sousse , Tunisia
| | - Nesrine Mlika
- d Pediatric Department , Sahloul Hospital , Sousse , Tunisia
| | - Saoussen Abroug
- d Pediatric Department , Sahloul Hospital , Sousse , Tunisia
| | - Jalel Boukadida
- b Microbiology and Immunology Department, UR02SP13 , CHU Farhat Hached , Sousse , Tunisia
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A prospective surveillance study for multidrug-resistant bacteria colonization in hospitalized patients at a Thai University Hospital. Antimicrob Resist Infect Control 2018; 7:102. [PMID: 30167108 PMCID: PMC6102905 DOI: 10.1186/s13756-018-0393-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Colonization with multidrug-resistant (MDR) bacteria is a major risk factor for developing subsequent MDR infections. Methods We performed a prospective surveillance study in hospitalized patients at Siriraj Hospital. Nasal cavity, throat, inguinal area and rectal swabs were obtained within the first 48-h after admission, on day-5 after hospitalization and then every 7 days until discharge. Target bacteria included extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant-P.aeruginosa (CR-PA), carbapenem-resistant-A.baumannii (CR-AB) and methicillin-resistant S.aureus (MRSA). Results From January 2013–December 2014, 487 patients were enrolled. The baseline prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA at any site was 52.2%, 6.8%, 4.7% and 7.2%, respectively. After 3-week of hospitalization, the prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA increased to 71.7%, 47.2%, 18.9% and 18.9%, respectively. Multivariable analysis revealed that diabetes mellitus and recent cephalosporin exposure were the independent risk factors for baseline colonization by ESBL. The independent risk factors for CR-AB and/or CR-PA colonization were cerebrovascular diseases, previous hospitalization, transfer from another hospital/a LTCF and previous nasogastric tube use, whereas those for MRSA colonization were previous fluoroquinolone exposure and previous nasogastric tube use. Conclusions The baseline prevalence of colonization by ESBL was relatively high, whereas the baseline prevalence of colonization by CR-PA, CR-AB and MRSA was comparable to previous studies. There was an increasing trend in MDR bacteria colonization after hospitalization.
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Boldt AC, Schwab F, Rohde AM, Kola A, Bui MT, Märtin N, Kipnis M, Schröder C, Leistner R, Wiese-Posselt M, Zweigner J, Gastmeier P, Denkel LA. Admission prevalence of colonization with third-generation cephalosporin-resistant Enterobacteriaceae and subsequent infection rates in a German university hospital. PLoS One 2018; 13:e0201548. [PMID: 30067833 PMCID: PMC6070276 DOI: 10.1371/journal.pone.0201548] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022] Open
Abstract
Background Many patients admitted to a hospital are already colonized with multi-drug resistant organisms (MDRO) including third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB). The aim of our study was to determine the prevalence of rectal 3GCREB colonization at admission to a large German university hospital and to estimate infection incidences. In addition, risk factors for 3GCREB colonization were identified. Materials/Methods In 2014 and 2015, patients were screened for rectal colonization with 3GCREB and filled out a questionnaire on potential risk factors at admission to a non-intensive care unit (non-ICU). All patients were retrospectively monitored for bacterial infections. Descriptive, univariable and multivariable logistic regression analyses were conducted to identify risk factors for 3GCREB colonization at admission. Results Of 4,013 patients included, 10.3% (n = 415) were rectally colonized with 3GCREB at admission. Incidence of nosocomial infections was 3.5 (95% CI 2.0–6.1) per 100 patients rectally colonized with 3GCREB compared to 2.3 (95% CI 1.8–3.0, P = 0.213) per 100 3GCREB negative patients. Independent risk factors for 3GCREB colonization were prior colonization / infection with MDRO (OR 2.30, 95% CI 1.59–3.32), prior antimicrobial treatment (OR 1.97, 95% CI 1.59–2.45), male sex (OR 1.38, 95% CI 1.12–1.70), prior travelling outside Europe (OR 2.39, 95% CI 1.77–3.22) and places of residence in the Berlin districts Charlottenburg-Wilmersdorf (OR 1.52, 95% CI 1.06–2.18), Friedrichshain-Kreuzberg (OR 2.32, 95% CI 1.44–3.74) and Mitte (OR 1.73, 95% CI 1.26–2.36). Conclusions Admission prevalence of rectal colonization with 3GCREB was high, while infection incidence did not significantly differ between patients rectally colonized or not with 3GCREB at hospital admission. In consequence, hospitals should prioritize improvement of standard precautions including hand hygiene to prevent infections among all patients irrespective of their 3GCREB status at hospital admission.
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Affiliation(s)
- Anne-Cathérine Boldt
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Anna M. Rohde
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Minh Trang Bui
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Nayana Märtin
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marina Kipnis
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christin Schröder
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Miriam Wiese-Posselt
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Janine Zweigner
- German Center for Infection Research (DZIF), Braunschweig, Germany
- Department of Infection Control and Hospital Hygiene, University Hospital Cologne, Cologne, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Luisa A. Denkel
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- * E-mail:
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High carriage rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients admitted for surgery in Tanzanian hospitals with a low rate of endogenous surgical site infections. J Hosp Infect 2018; 100:47-53. [PMID: 29852267 DOI: 10.1016/j.jhin.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Despite the high reported rates of surgical site infections (SSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in low-income countries, including Tanzania, the role of EPE carriage in subsequent occurrence of SSIs is not known. This study investigated the rates of EPE carriage among surgical patients at the time of admission and discharge, and linked EPE genotype with SSIs. METHODS EPE were confirmed among isolates from rectal and wound/pus swabs using VITEK-2. Polymerase chain reaction and sequencing were performed to detect beta-lactamase genes. Multi-locus sequence typing was used to determine the genotypes of EPE isolates. RESULTS Among 930 patients enrolled, EPE carriage was significantly higher on discharge than admission (36.4% vs 23.7%, P<0.001). Of 272 patients who tested negative on admission, 78 (28.7%) acquired EPE during hospitalization. History of hospital stay within the previous three months was an independent predictor of EPE acquisition [hazard ratio 2, 95% confidence interval (CI) 1.04-3.98, P=0.038]. Of the 536 patients who were successfully followed-up after surgery, 78 (14.6%, 95% CI 11.6-17.5) developed SSIs. Of 57 SSIs investigated, 33 (58%) were caused by enteric Gram-negative bacteria, of which 63.6% (21/33) were EPE. Escherichia coli sequence type (ST)131 pandemic clone and Klebsiella pneumoniae ST391 predominated among wound isolates. The blaCTX-M-15 gene was detected in 37 (97.3%) of 38 ESBL isolates. Male sex was an independent predictor of SSI (odds ratio 2.92, 95% CI 1.73-4.91, P<0.001). CONCLUSION These findings warrant implementation of strict infection control measures, antimicrobial stewardship and exploration of the transmission dynamics of EPE in surgical wards.
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Pilmis B, Cattoir V, Lecointe D, Limelette A, Grall I, Mizrahi A, Marcade G, Poilane I, Guillard T, Bourgeois Nicolaos N, Zahar JR, Le Monnier A. Carriage of ESBL-producing Enterobacteriaceae in French hospitals: the PORTABLSE study. J Hosp Infect 2017; 98:247-252. [PMID: 29222035 DOI: 10.1016/j.jhin.2017.11.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Currently, contact precautions are recommended for patients colonized or infected with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Recent studies have challenged this strategy. This study aimed to assess the rate of ESBL-PE faecal carriage among hospitalized patients according to type of hospital ward, and to identify risk factors associated with carriage. METHODS A point prevalence study was conducted in five different types of hospital ward [medical, surgical, intensive care unit (ICU), after care and rehabilitation, and geriatric] in eight French hospitals. All patients included in the study provided a fresh stool sample. RESULTS In total, 554 patients were included in the study, with a median age of 73 years (range 60-82 years). The overall faecal carriage rate of ESBL-PE was 17.7%. The most frequently encountered species among ESBL-PE was Escherichia coli (71.4%), followed by Klebsiella pneumoniae (14.3%). Risk factors associated with ESBL-PE faecal carriage on univariate analysis were: living in the Paris region (P<0.01) and hospitalization on a geriatric ward (P<0.01). Interestingly, the cumulative duration of hospital stay before screening was not associated with a significantly higher prevalence of ESBL-PE carriage, regardless of ward type. The ESBL-PE colonization rate was much higher for patients hospitalized on geriatric wards (28.1%) and ICUs (21.7%) compared with those for patients hospitalized on surgical wards (14.8%), medical wards (12.8%) or aftercare and rehabilitation (11.2%). CONCLUSION The overall prevalence of ESBL-PE faecal carriage was 17.7%, with only 21% of patients identified previously as carriers. The delay between admission and screening was not associated with an increase in ESBL-PE faecal carriage.
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Affiliation(s)
- B Pilmis
- Equipe Mobile de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V Cattoir
- Laboratoire de Microbiologie, CHU de Caen, Caen, France
| | - D Lecointe
- Unité Fonctionnelle d'Hygiène Hospitalière et de Lutte contre les Infections Nosocomiales, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - A Limelette
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Reims, Hôpital Robert Debré, UFR de Médecine, EA4687, Université de Reims Champagne-Ardenne Reims, France
| | - I Grall
- Clinique de Champigny, Champigny sur Marne, France
| | - A Mizrahi
- Laboratoire de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France
| | - G Marcade
- Laboratoire de Microbiologie, Hôpital Louis Mourier, Colombes, France
| | - I Poilane
- Laboratoire de Microbiologie, Hôpital Jean Verdier, Bondy, France
| | - T Guillard
- Laboratoire de Bactériologie-Virologie-Hygiène, CHU Reims, Hôpital Robert Debré, UFR de Médecine, EA4687, Université de Reims Champagne-Ardenne Reims, France
| | - N Bourgeois Nicolaos
- EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France; Service de Bactériologie et hygiène, Hôpital Antoine Béclère, Clamart, France
| | - J-R Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Département de Microbiologie Clinique, Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, CHU Avicenne, Bobigny, France.
| | - A Le Monnier
- Laboratoire de Microbiologie clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; EA4043 Unité Bactéries pathogènes et Santé (UBaPS), Université Paris-Sud, Paris Saclay, Chatenay-Malabry, France
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Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission. Infect Control Hosp Epidemiol 2017; 38:1216-1225. [DOI: 10.1017/ice.2017.178] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVEIsolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.METHODSA 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.RESULTSA score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).CONCLUSIONA model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.Infect Control Hosp Epidemiol 2017;38:1216–1225
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Hammami S, Dahdeh C, Mamlouk K, Ferjeni S, Maamar E, Hamzaoui Z, Saidani M, Ghedira S, Houissa M, Slim A, Boutiba-Ben Boubaker I. Rectal Carriage of Extended-Spectrum Beta-Lactamase and Carbapenemase Producing Gram-Negative Bacilli in Intensive Care Units in Tunisia. Microb Drug Resist 2017; 23:695-702. [DOI: 10.1089/mdr.2016.0205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Samia Hammami
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
- Faculté des Sciences de Bizerte, Université de Carthage, Bizerte, Tunisie
| | - Chaima Dahdeh
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Kelthoum Mamlouk
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Sana Ferjeni
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Elaa Maamar
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Zeineb Hamzaoui
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Mabrouka Saidani
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
- Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis, Tunis, Tunisie
| | - Salma Ghedira
- Service de Reanimation Medico-chirurgicale–Hôpital, Charles Nicolle de Tunis, Tunis, Tunisie
| | - Mohamed Houissa
- Service de Reanimation Medico-chirurgicale–Hôpital, Charles Nicolle de Tunis, Tunis, Tunisie
| | - Amin Slim
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
- Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis, Tunis, Tunisie
| | - Ilhem Boutiba-Ben Boubaker
- LR99ES09 Laboratoire de Recherche “Résistance aux Antimicrobiens,” Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
- Laboratoire de Microbiologie, Hôpital Charles Nicolle de Tunis, Tunis, Tunisie
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Seni J, Moremi N, Matee M, van der Meer F, DeVinney R, Mshana SE, D Pitout JD. Preliminary insights into the occurrence of similar clones of extended-spectrum beta-lactamase-producing bacteria in humans, animals and the environment in Tanzania: A systematic review and meta-analysis between 2005 and 2016. Zoonoses Public Health 2017; 65:1-10. [PMID: 28834351 DOI: 10.1111/zph.12387] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Indexed: 11/26/2022]
Abstract
The emergence and spread of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) are complex and of the public health concern across the globe. This review aimed at assessing the ESBL-PE clones circulating in humans, animals and the environment to provide evidence-based insights for combating ESBL-PE using One Health approach. Systematic search from Medline/PubMed, Google Scholar and African Journals Online was carried out and retrieved nine eligible articles (of 131) based on phenotypic and genotypic detection of ESBL-PE between 2005 and 2016 in Tanzania. Analysis was performed using STATA 11.0 software to delineate the prevalence of ESBL-PE, phenotypic resistance profiles and clones circulating in the three interfaces. The overall prevalence of ESBL-PE in the three interfaces was 22.6% (95% CI: 21.1-24.2) with the predominance of Escherichia coli (E. coli) strains (51.6%). The majority of ESBL-PE were resistant to the commonly used antimicrobials such as trimethoprim-sulfamethoxazole and tetracycline/doxycycline, 38%-55% were resistant to ciprofloxacin and all were sensitive to meropenem/imipenem. ESBL-PE infections were more associated with deaths compared to non-ESBL-PE infections. Strikingly, E. coli ST38, ST131 and ST2852 were found to intersect variably across the three interfaces. The predominant allele, blaCTX-M-15, was found mostly in the conjugative IncF plasmids connoting transmission potential. The high prevalence of ESBL-PE and shared clones across the three interfaces, including the global E. coli ST131 clone, indicates wide and inter-compartmental spread that calls for One Health genomic-driven studies to track the resistome flow.
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Affiliation(s)
- J Seni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.,Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - N Moremi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - M Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es salaam, Tanzania
| | - F van der Meer
- Faculty of Veterinary Medicine: Ecosystem and Public Health, University of Calgary, Calgary, AB, Canada
| | - R DeVinney
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - J D D Pitout
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Sommerstein R, Atkinson A, Lo Priore EF, Kronenberg A, Marschall J. Characterizing non-linear effects of hospitalisation duration on antimicrobial resistance in respiratory isolates: an analysis of a prospective nationwide surveillance system. Clin Microbiol Infect 2017; 24:45-52. [PMID: 28559001 DOI: 10.1016/j.cmi.2017.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Our objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. METHODS Using prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. RESULTS In all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6-30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8-30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. CONCLUSIONS Resistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors.
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Affiliation(s)
- R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.
| | - A Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - E F Lo Priore
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - A Kronenberg
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Institute for Infectious Diseases, University of Bern, Switzerland
| | - J Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
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Kanafani ZA, Fadlallah SM, Assaf S, Anouti K, Kissoyan KAB, Sfeir J, Nawar T, Yasmin M, Matar GM. Sites of colonization in hospitalized patients with infections caused by extended-spectrum beta-lactamase organisms: a prospective cohort study. Antimicrob Resist Infect Control 2017; 6:46. [PMID: 28515902 PMCID: PMC5433240 DOI: 10.1186/s13756-017-0207-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/10/2017] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to determine whether patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms are colonized at multiple body sites. Methods This was a prospective cohort study at a tertiary care center in Beirut, Lebanon. Hospitalized patients with infections caused by ESBL-producing organisms were included. Cultures were obtained from the primary site of infection as well as from other sites (skin, nasopharynx, urine, rectum). Molecular analysis was performed on isolates to determine clonal relatedness. Results One hundred patients were included in the study. Only 22 patients had positive cultures from sites other than the primary site of infection. The most common ESBL gene was CTX-M-15 followed by TEM-1. In 11 of 22 patients, isolates collected from the same patient were 100% genetically related, while in the remaining patients, genomic relatedness ranged from 42.9% to 97.1%. Conclusions Colonization at sites other than the primary site of infection was not common among our patient population infected with ESBL-producing organisms. The dynamics of transmission of these bacterial strains should be studied in further prospective studies to determine the value of routine active surveillance and the need for expanded precautions in infected and colonized patients.
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Affiliation(s)
- Zeina A Kanafani
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Sukayna M Fadlallah
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
| | - Sarah Assaf
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Khalil Anouti
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Kohar Annie B Kissoyan
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
| | - Jad Sfeir
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Tamara Nawar
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Mohamad Yasmin
- Department of Internal Medicine, American University of Beirut, PO Box 11-0236/11D, Cairo Street, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Ghassan M Matar
- Department of Experimental Pathology, Immunology and Microbiology, American University of Beirut, Beirut, Lebanon
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Ebrahimi F, Mózes J, Monostori J, Gorácz O, Fésűs A, Majoros L, Szarka K, Kardos G. Comparison of rates of fecal colonization with extended-spectrum beta-lactamase-producing enterobacteria among patients in different wards, outpatients and medical students. Microbiol Immunol 2017; 60:285-94. [PMID: 26959958 DOI: 10.1111/1348-0421.12373] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/22/2016] [Accepted: 03/06/2016] [Indexed: 11/28/2022]
Abstract
Because asymptomatic carriage of extended-spectrum beta-lactamase (ESBL) producers is a risk factor for infection, data on colonization dynamics are important when planning infection control. This study investigated fecal colonization with ESBL producers among inpatients, outpatients and medical students and compares the characteristics of ESBL producers among these groups. Carriage rates were investigated in 5581 fecal samples; 4343 from inpatients (330, 1397, 619 and 1864 from adult ICUs [intensive care units], adult non-ICUs, pediatric ICUs and pediatric non-ICUs, respectively), 814 from outpatients and 424 from screening of medical students. ESBL producers were characterized by co-resistance, integrons carried, and aminoglycoside resistance and ESBL genes. Dynamic regression models were built to identify relationships between combinations of time series of monthly antibiotic consumption, prevalence of carriers and infected subjects. Inpatients, ICU patients and adults showed higher prevalence than outpatients, non-ICU patients or children (7.4%, 9.3% and 12.0% vs. 3.1%, 6.1% and 4.1%, respectively). Klebsiella pneumoniae was more frequent in ICU patients; dominance of CTX-M-15 producers was more marked in adult than in pediatric inpatients. ESBL carriage was shown to be a consequence of infection in adults in the time-series analysis; antibiotic consumption had little effect. The epidemiology of colonization with ESBL producers differed between pediatric ICU, adult ICU and adult non-ICU patients. In adults, carriage of ESBL producers seems to be the consequence of infection, especially in ICU patients; the main source of colonization is nosocomial acquisition. In contrast, children are less likely to acquire colonizer strains in hospitals; importation of ESBL producers by colonized children seems to be significant.
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Affiliation(s)
| | - Julianna Mózes
- Department of Medical Microbiology, University of Debrecen
| | | | - Orsolya Gorácz
- Department of Medical Microbiology, University of Debrecen.,Clinical Pharmacy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt.98, Hungary
| | - Adina Fésűs
- Department of Medical Microbiology, University of Debrecen.,Clinical Pharmacy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen Nagyerdei krt.98, Hungary
| | - László Majoros
- Department of Medical Microbiology, University of Debrecen
| | | | - Gábor Kardos
- Department of Medical Microbiology, University of Debrecen
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Çakir Erdoğan D, Cömert F, Aktaş E, Köktürk F, Külah C. Fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. in a Turkish community. Turk J Med Sci 2017; 47:172-179. [PMID: 28263486 DOI: 10.3906/sag-1512-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/24/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to determine the prevalence of fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing bacteria, enzyme types, and risk factors affecting colonization. MATERIALS AND METHODS A total of 576 stool samples from outpatients were examined between October 2012 and May 2013. Screening was done with selective EMB plates. ESBL were detected by double-disk synergy and confirmed agar strip gradient methods. Enzyme types were determined by PCR. RESULTS The prevalence of fecal carriage was found as 30% (173 of 576). Recent use of antibiotics, hospitalization and surgical operation, diabetes, crowded household populations, and old age were associated with higher carriage rates. Of the ESBL-producing bacteria, 87.5% were positive for blaCTX-M genes. Of the blaCTX-M gene-positive isolates, 95.2% were positive for blaCTX-M-1 genes; among these, 82.2% were positive for blaCTX-M-3 and 67.7% were positive for blaCTX-M-15 genes while 62.5% isolates were positive for both blaCTX-M-3 and blaCTX-M-15 genes Conclusions: A high rate (30%) of fecal carriage of ESBL bacteria was found in an adult population. The predominant beta-lactamase enzyme types were CTX-M-3 and CTX-M-15.
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Affiliation(s)
- Derya Çakir Erdoğan
- Department of Medical Microbiology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Füsun Cömert
- Department of Medical Microbiology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Elif Aktaş
- Department of Medical Microbiology, Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - Fürüzan Köktürk
- Department of Biostatistics, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Canan Külah
- Department of Medical Microbiology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
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Bar-Yoseph H, Hussein K, Braun E, Paul M. Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother 2016; 71:2729-39. [PMID: 27317444 DOI: 10.1093/jac/dkw221] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND ESBL-producing Enterobacteriaceae and carbapenem-resistant Enterobacteriaceae (CRE) are rapidly spreading worldwide. Their natural reservoir is intestinal. METHODS We carried out a systematic review and meta-analysis to estimate CRE and ESBL carriage duration and to evaluate the effect of decolonization therapy. We included cohort and comparative studies examining the natural history of CRE/ESBL colonization, examining rates of carriage following decolonization or comparing decolonization and no decolonization conducted in the healthcare setting or in the community. A comprehensive search was conducted until November 2015. We compiled carriage rates at 1, 3, 6 and 12 months with and without decolonization therapy and assessed the effect of decolonization. RESULTS Thirty-seven studies fulfilled inclusion criteria. In healthcare settings, pooled ESBL/CRE colonization rates decreased without intervention from 76.7% (95% CI = 69.3%-82.8%) at 1 month to 35.2% (95% CI = 28.2%-42.9%) at 12 months of follow-up. Following decolonization, the rate was 37.1% (95% CI = 27.5%-47.7%) at end of therapy and 57.9% (95% CI = 43.1%-71.4%) at 1 month. In two randomized trials, carriage was significantly reduced at end of therapy (risk ratio = 0.42, 95% CI = 0.25-0.65), but the effect was not significant after 1 month (risk ratio = 0.72, 95% CI = 0.48-1.05), with no longer follow-up. Heterogeneity was explained by surveillance methodology, with no differences observed between ESBLs and CREs. Among community dwellers, ESBL colonization decreased from 52.3% (95% CI = 29.5%-74.2%) at 1 month to 19.2% (95% CI = 9.7%-34.4%) at 6 months. CONCLUSIONS A significant proportion of ESBL and CRE carriers remain colonized up to 1 year in the healthcare setting. While short-term decolonization therapy reduces carriage during therapy, its longer-term effects are unclear.
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Affiliation(s)
- Haggai Bar-Yoseph
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khetam Hussein
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eyal Braun
- Department of Internal Medicine H, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Mical Paul
- Division of Infectious Disease, Rambam Health Care Campus & Bruce Rappaport School of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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Trubiano JA, Worth LJ, Thursky KA, Slavin MA. The prevention and management of infections due to multidrug resistant organisms in haematology patients. Br J Clin Pharmacol 2015; 79:195-207. [PMID: 24341410 DOI: 10.1111/bcp.12310] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/09/2013] [Indexed: 12/15/2022] Open
Abstract
Infections due to resistant and multidrug resistant (MDR) organisms in haematology patients and haematopoietic stem cell transplant recipients are an increasingly complex problem of global concern. We outline the burden of illness and epidemiology of resistant organisms such as gram-negative pathogens, vancomycin-resistant Enterococcus faecium (VRE), and Clostridium difficile in haematology cohorts. Intervention strategies aimed at reducing the impact of these organisms are reviewed: infection prevention programmes, screening and fluoroquinolone prophylaxis. The role of newer therapies (e.g. linezolid, daptomycin and tigecycline) for treatment of resistant and MDR organisms in haematology populations is evaluated, in addition to the mobilization of older agents (e.g. colistin, pristinamycin and fosfomycin) and the potential benefit of combination regimens.
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Affiliation(s)
- Jason A Trubiano
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, VIC
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First multicenter study on multidrug resistant bacteria carriage in Chinese ICUs. BMC Infect Dis 2015; 15:358. [PMID: 26290050 PMCID: PMC4545921 DOI: 10.1186/s12879-015-1105-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background The importance of multidrug-resistant organisms (MDRO) in Chinese hospitals is not clearly delineated. Thus we sought to assess the prevalence of MDRO in Chinese intensive care units (ICUs). Methods Prospective study of inpatients admitted consecutively to eight ICUs in four Chinese cities in 2009–10. Admission and weekly screenings were performed by using selective media for methicillin resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Enterobacteriaceae, Acinetobacter and Pseudomonas aeruginosa. For the two latters, resistance to ceftazidime defined MDRO. Backward logistic regression models were designed to assess factors independently associated with MDRO carriage on admission and MDRO acquisition within ICUs. Results 686 patients were included, and the MDRO prevalence rate on admission was 30.5 % (32.7 % for ESBL-positive Enterobacteriaceae, 3.2 % for MRSA). Antibiotic treatment prior to ICU admission was independently associated with carriage on admission (OR: 1.4) in multivariate analysis. A total of 104 patients acquired ≥1 MDRO in ICU (overall attack rate: 23.7 %; 14.9 % for ESBL-positive Enterobacteriaceae, and 5.1 % for MRSA). The MDRO attack rate increased from 13.2 % in the first week to 82.1 % for ICU stay > 3 weeks. Duration of antibiotic exposure (OR: 1.16; 1.1–1.2) and prior antibiotic treatment before ICU (OR: 2.1; 1.1–3.3) were associated with MDRO acquisition in multivariate analysis. The MDRO prevalence rate on ICU discharge was 51.2 % and the global prevalence density rate 71 per 1000 hospital-days. Conclusion More than one out of two patients was MDRO carrier on ICU discharge in Chinese hospitals. This is the result of the combination of a high MDRO prevalence rate on ICU admission and a high MDRO acquisition rate within ICU.
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Ludden C, Cormican M, Vellinga A, Johnson JR, Austin B, Morris D. Colonisation with ESBL-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant enterococci, and meticillin-resistant Staphylococcus aureus in a long-term care facility over one year. BMC Infect Dis 2015; 15:168. [PMID: 25887288 PMCID: PMC4399485 DOI: 10.1186/s12879-015-0880-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study examined colonisation with and characteristics of antimicrobial-resistant organisms among residents of a long-term care facility (LTCF) over one year, including strain persistence and molecular diversity among isolates of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Methods Sixty-four residents of a LTCF were recruited (51 at baseline, 13 during the year). Data on dependency levels, hospitalisations, and antimicrobial prescribing were collected. Nasal and rectal swabs and catheter urine specimens were examined quarterly, using chromogenic agars, for ESBL-producing Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae (CPE), vancomycin-resistant enterococci (VRE), and meticillin-resistant S. aureus (MRSA). All ESBL-producing E. coli (ESBL-EC) were characterised by pulsed-field gel electrophoresis (PFGE) and PCR to assess for sequence type (ST) ST131, its resistance-associated H30 and H30-Rx subclones, and blaCTX-M,blaTEM,blaSHV, and blaOXA-1. Results The overall number of residents colonised, by organism, was as follows: ESBL-EC, 35 (55%); MRSA, 17 (27%); ESBL-producing K. pneumoniae (ESBL-KP), 5 (8%); VRE, 2 (3%) and CPE, 0 (0%). All 98 ESBL-EC isolates were H30-Rx ST131, with blaCTX-M-group 1. By PFGE, a group of 91 ESBL-EC (from 33 participants) had ≥ 85% similar profiles and resembled UK epidemic strain A/ international pulsotype PFGE812. Sequential ESBL-EC from individual residents were closely related. Six ESBL-KP isolates, from five participants, had blaCTX-M-group 1 and by PFGE were closely related. Colonisation with ESBL and MRSA was associated with location within the LTCF and previous exposure to antimicrobials. Conclusions Among LTCF residents, colonisation with ESBL-EC and MRSA was common. All ESBL-EC were H30-Rx ST131, consistent with clonal dissemination.
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Affiliation(s)
- Catherine Ludden
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Martin Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland. .,Centre for Health from Environment, Ryan Institute, National University of Ireland Galway, Galway, Ireland.
| | - Akke Vellinga
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | | | - Bernie Austin
- St. Brendan's Home, Community Nursing Unit, Galway, Ireland.
| | - Dearbháile Morris
- Discipline of Bacteriology, School of Medicine, National University of Ireland Galway, Galway, Ireland.
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Micheel V, Hogan B, Rakotoarivelo RA, Rakotozandrindrainy R, Razafimanatsoa F, Razafindrabe T, Rakotondrainiarivelo JP, Crusius S, Poppert S, Schwarz NG, May J, Frickmann H, Hagen RM. Identification of nasal colonization with β-lactamase-producing Enterobacteriaceae in patients, health care workers and students in Madagascar. Eur J Microbiol Immunol (Bp) 2015; 5:116-25. [PMID: 25908994 DOI: 10.1556/eujmi-d-15-00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/07/2015] [Indexed: 12/21/2022] Open
Abstract
This study assesses the nasal occurrence of β-lactamase-producing Enterobacteriaceae both in patients in a hospital department of infectious diseases at admission and in healthy Madagascan students and health care workers. Nasal swabs from 681 students, 824 health care workers, and 169 patients were obtained in Antananarivo, Madagascar, and transferred to Germany. Screening for β-lactamase (ESBL, ampC) producing Enterobacteriaceae was performed by cultural and molecular approaches, comprising Brilliance ESBL agar, E-testing, ABCD-testing, and commercial hyplex ESBL and SuperBug ID PCR. Regarding ESBL-positive strains and strains with resistance against at least three out of the four tested bactericidal antibiotic drugs, 0.3% (five out of 1541) of the students and health care workers group showed nasal colonization, whereas colonization was observed in 7.1% (12 out of 169) of the hospitalized patients at admission. No appreciably reduced detection rates after sample storage and intercontinental transport were observed. A considerable proportion of nasal colonization with cephalosporin-resistant Enterobacteriaceae was demonstrated in Madagascan hospital patients at admission, posing a risk of developing future endogenous infections. The nasal colonization of healthy individuals was negligible. Good storage and transport stability of Enterobacteriaceae will allow for future studies even in areas difficult to access.
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Extended spectrum beta-lactamase carriage state among elderly nursing home residents in Beirut. ScientificWorldJournal 2015; 2015:987580. [PMID: 25866842 PMCID: PMC4381859 DOI: 10.1155/2015/987580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/25/2015] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. ESBL-producing Enterobacteriaceae can cause severe infections, but they are also isolated from the stool of asymptomatic subjects. Faecal carriage of such organism is poorly understood. Methods. First phase of the study was cross-sectional with prevalence and epidemiology of ESBL faecal carriage in two nursing homes in Beirut: 57 residents in the first (NH1) and 151 residents in the second (NH2). In second phase, faecal swabs from cohort of NH1 residents were examined for carriage at six-week intervals over three-month period. Residents' charts were reviewed to assess carriage risk factors. Results. Over 3 consecutive samplings at NH1, 81% of residents were at least one-time carriers with 50% at the first round, 60.4% at the second, and 74.5% at the last one. At NH2, 68.2% of residents were carriers. Constipation (in NH1) and antibiotic intake (in NH2) were significantly associated with higher ESBL faecal carriage while the length of stay at the nursing home (in NH2) was associated with less carriage. Conclusion. Faecal carriage of ESBL-producing Enterobacteriaceae is high among nursing home patients in Beirut. The rate of carriage changes rapidly and significantly over time either with multiple factors playing a possible role like outbreak spreading, antibiotic, and health care system exposure.
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Dananché C, Bénet T, Allaouchiche B, Hernu R, Argaud L, Dauwalder O, Vandenesch F, Vanhems P. Targeted screening for third-generation cephalosporin-resistant Enterobacteriaceae carriage among patients admitted to intensive care units: a quasi-experimental study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:38. [PMID: 25879192 PMCID: PMC4344746 DOI: 10.1186/s13054-015-0754-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/19/2015] [Indexed: 12/14/2022]
Abstract
Introduction Identification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; however, little is known about its effectiveness. The aim of this study was to evaluate the impact of ‘targeted screening’ at patient admission to intensive care units (ICUs) on the incidence of 3GC-RE hospital-acquired infections (HAIs) and compare it to ‘universal screening’. Methods We undertook a quasi-experimental study of two ICUs (unit A: intervention group; unit B: control group) at a university-affiliated hospital between 1 January 2008 and 31 December 2011. In unit A, patients were screened universally for 3GC-RE at admission during period 1 (1 January 2008 through 30 September 2010). During period 2 (2011 calendar year), the intervention was implemented in unit A; patients transferred from another unit or hospital were screened selectively. In unit B, all patients were screened throughout periods 1 and 2. 3GC-RE-related HAI incidence rates were expressed per 1,000 patient-days. Incidence rate ratios (IRRs) were examined by multivariate Poisson regression modelling. Results In unit A, 3GC-RE-related HAI incidence rates decreased from 5.4 (95% confidence interval (CI), 4.1 to 7.0) during period 1 to 1.3 (95% CI, 0.5 to 2.9) during period 2 (P < 0.001). No changes were observed in unit B between periods 1 and 2 (P = 0.5). In unit A, the adjusted incidence of 3GC-RE-related HAIs decreased in period 2 compared with period 1 (adjusted IRR, 0.3; 95% CI, 0.1 to 0.9; P = 0.03) independently of temporal trend, trauma and age. No changes were seen in unit B (P = 0.4). The total number of rectal swabs taken showed an 85% decrease in unit A between period 1 and 2 (P < 0.001). Conclusions Targeted screening of 3GC-RE carriers at ICU admission was not associated with an increase in 3GC-RE-related HAI incidence compared with universal screening. Total number of rectal swabs decreased significantly. These findings suggest that targeted screening may be worth assessing as an alternative to universal screening.
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Affiliation(s)
- Cédric Dananché
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France. .,Epidemiology and Public Health Group, University of Lyon 1, 8, avenue Rockefeller, 69373, Lyon, Cedex 08, France.
| | - Bernard Allaouchiche
- Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Romain Hernu
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Laurent Argaud
- Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France.
| | - Olivier Dauwalder
- Institut of Microbiology, Department of Bacteriology, East Hospital Complex, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.
| | - François Vandenesch
- Institut of Microbiology, Department of Bacteriology, East Hospital Complex, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, 5, place d'Arsonval, 69437, Lyon, Cedex 03, France. .,Epidemiology and Public Health Group, University of Lyon 1, 8, avenue Rockefeller, 69373, Lyon, Cedex 08, France.
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Platteel T, Leverstein-van Hall M, Cohen Stuart J, Thijsen S, Mascini E, van Hees B, Scharringa J, Fluit A, Bonten M. Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study. Clin Microbiol Infect 2015; 21:141-6. [DOI: 10.1016/j.cmi.2014.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/28/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Zahar JR, Lesprit P. Management of multidrug resistant bacterial endemic. Med Mal Infect 2014; 44:405-11. [PMID: 25169940 DOI: 10.1016/j.medmal.2014.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 11/18/2022]
Abstract
The fight against multi-drug resistant Gram-negative bacilli (MDRGNB), especially extended-spectrum β-lactamase producing Enterobacteriaceae, is about to be lost in our country. The emergence of new resistance mechanisms to carbapenems in these Enterobacteriaceae exposes patients to a risk of treatment failure without any other therapeutic options. This dramatic situation is paradoxical because we are well aware of the 2 major factors responsible for this situation: 1) MDRO cross-transmission, associated with a low compliance to standard precautions, especially hand hygiene, and 2) overexposure of patients to antibiotics. The implementation of a "search and isolate" policy, which was justified to control the spread of some MDRO that remained rare in the country, was not associated with a better adherence to standard precautions. The antibiotic policy and the measures implemented to control antibiotic consumptions have rarely been enforced and have shown inconsistent results. Notably, no significant decrease of antibiotic consumption has been observed. There is no excuse for these poor results, because some authors evaluating the effectiveness of programs for the control of MDRO have reported their positive effects on antimicrobial resistance without any detrimental effects. It is now urgent to deal with the 2 major factors by establishing an educational and persuasive program with quantified and opposable objectives. Firstly, we have to improve the observance of hand hygiene above 70%. Secondly, we have to define and reach a target for the reduction of antibiotic consumption both in community and in hospital settings.
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Affiliation(s)
- J-R Zahar
- Unité de prévention et de lutte contre les infections nosocomiales, université d'Angers, centre hospitalo-universitaire d'Angers, 4, rue Larrey, 49000 Angers, France.
| | - P Lesprit
- Infectiologie transversale, laboratoire de biologie, hôpital Foch, 92151 Suresnes, France
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Vehreschild MJGT, Hamprecht A, Peterson L, Schubert S, Häntschel M, Peter S, Schafhausen P, Rohde H, Lilienfeld-Toal MV, Bekeredjian-Ding I, Libam J, Hellmich M, Vehreschild JJ, Cornely OA, Seifert H. A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies. J Antimicrob Chemother 2014; 69:3387-92. [PMID: 25103492 DOI: 10.1093/jac/dku305] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) caused by enterobacteria remain a leading cause of mortality in patients with chemotherapy-induced neutropenia. The rate and type of colonization and infection with ESBL-producing Enterobacteriaceae (ESBL-E) and their mode of transmission in German cancer centres is largely unknown. METHODS We performed a prospective, observational study at five German university-based haematology departments. Participating sites screened for intestinal ESBL-E colonization within 72 h of admission, every 10 ± 2 days thereafter and before discharge. Three of the five centres performed contact isolation for patients colonized or infected with ESBL-E. Molecular characterization of resistance mechanisms and epidemiological typing of isolates by repetitive extragenic palindromic PCR (rep-PCR) and PFGE was performed to assess strain transmission between patients. RESULTS Between October 2011 and December 2012, 719 hospitalizations of 497 haematological high-risk patients comprising 20,143 patient-days were analysed. Mean duration of in-hospital stay was 36.6 days (range: 2-159 days). ESBL-E were identified from screening samples (82.8% Escherichia coli and 14.6% Klebsiella pneumoniae) in 55/497 patients (11.1%; range by centre: 5.8%-23.1%). PFGE and rep-PCR revealed only a single case of potential cross-transmission among two patients colonized with K. pneumoniae. Six episodes of BSI with ESBL-E were observed. Multivariate analysis revealed previous colonization with ESBL-E as the most important risk factor for BSI with ESBL-E (OR 52.00; 95% CI 5.71-473.89). CONCLUSIONS Even though BSI with ESBL-E is still rare in this high-risk population, colonization rates are substantial and vary considerably between centres. In-hospital transmission of ESBL-E as assessed by molecular typing was the exception.
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Affiliation(s)
- Maria J G T Vehreschild
- German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Axel Hamprecht
- German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Lisa Peterson
- German Centre for Infection Research (DZIF), Germany Med. Klinik III, University of Munich-Campus Großhadern, Munich, Germany
| | - Sören Schubert
- German Centre for Infection Research (DZIF), Germany Max von Pettenkofer-Institut, University of Munich-Campus Großhadern, Munich, Germany
| | - Maik Häntschel
- German Centre for Infection Research (DZIF), Germany Department of Oncology, Haematology, Immunology, Rheumatology and Pulmology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Philippe Schafhausen
- German Centre for Infection Research (DZIF), Germany Department of Oncology and Hematology, Hubertus Wald Tumorzentrum/University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie V Lilienfeld-Toal
- German Centre for Infection Research (DZIF), Germany Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn, Bonn, Germany Klinik für Innere Medizin II-Abteilung für Hämatologie und Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Isabelle Bekeredjian-Ding
- German Centre for Infection Research (DZIF), Germany Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Johannes Libam
- German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- German Centre for Infection Research (DZIF), Germany Department of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Jörg J Vehreschild
- German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Oliver A Cornely
- German Centre for Infection Research (DZIF), Germany 1st Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany Clinical Trials Center Cologne, ZKS Köln, BMBF 01KN1106, Medical Faculty, University of Cologne, Cologne, Germany Center for Integrated Oncology CIO Köln/Bonn and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
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Faecal carriage of extended-spectrumβ-lactamase (ESBL)-producing enterobacteria in liver disease patients from two hospitals in Egypt and France: a comparative epidemiological study. Epidemiol Infect 2014; 143:1247-55. [DOI: 10.1017/s0950268814001812] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
SUMMARYThis study aimed to assess and compare the epidemiology of faecal carriage of extended spectrumβ-lactamase-producing enterobacteria (ESBL-E) in Hepatology departments of two hospitals specializing in liver diseases, Theodor Bilharz Research Institute (TBRI) in Cairo (Egypt) and Beaujon Hospital (Bj) in Clichy (France). CTX-M groups were identified by PCR, and TEM and SHV derivatives with the check-point system. Phylogenetic groups ofE. coliwere determined by multiplex PCR, and clone ST131 by PCR of genepabB. Prevalence of ESBL-E was 77·6% (45/58) in TBRI and 6·5% (13/199) in Bj (P < 10−7). Previous hospitalization was more common (P = 0·003) in Bj patients (93%) than in TBRI patients (45%) suggesting high prevalence of ESBL-E in the Egyptian community. The presence ofE. coliB2 ST131 among ESBL-E faecalE. coliin Egypt confirms its pervasiveness in the community and raises concern regarding this highly virulent and resistant clone.
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High rates of intestinal colonisation with fluoroquinolone-resistant ESBL-harbouring Enterobacteriaceae in hospitalised patients with antibiotic-associated diarrhoea. Eur J Clin Microbiol Infect Dis 2014; 33:2215-21. [DOI: 10.1007/s10096-014-2193-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
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Are strict isolation policies based on susceptibility testing actually effective in the prevention of the nosocomial spread of multi-drug-resistant gram-negative rods? Am J Infect Control 2014; 42:739-43. [PMID: 24969125 DOI: 10.1016/j.ajic.2014.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The emergence of multi-drug-resistant gram-negative rods (MDR-GNRs) has become a worldwide problem. To limit the emergence of MDR-GNRs, a tertiary care cancer center in Japan implemented a policy that requires the pre-emptive isolation of patients with organisms that have the potential to be MDR-GNRs. METHODS A retrospective analysis was performed. Any gram-negative bacillus isolates categorized as intermediate or resistant to at least 2 classes of antimicrobials were subjected to contact precautions. The incidence of patients with MDR-GNRs was analyzed. RESULTS There was no difference between the preintervention and intervention time periods in the detection rate of nonfermenting MDR-GNR species (0.15 per 10,000 vs 0.35 per 10,000 patient-days, P = .08). There was an increase in the detection rate of multi-drug-resistant Enterobacteriaceae (0.19 per 10,000 vs 0.56 per 10,000 patient-days, P = .007), which was prominent for extended-spectrum β-lactamase (ESBL)-producing organisms (0.19 per 10,000 vs 0.50 per 10,000 patient-days, P = .02). CONCLUSIONS Our intervention kept the emergence of multi-drug-resistant non-glucose-fermenting gram-negative bacilli to a small number, but it failed to prevent an increase in ESBL producers. Policies, such as active detection and isolation, are warranted to decrease the incidence of these bacilli.
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Belas A, Salazar AS, Gama LTD, Couto N, Pomba C. Risk factors for faecal colonisation with Escherichia coli producing extended-spectrum and plasmid-mediated AmpC β-lactamases in dogs. Vet Rec 2014; 175:202. [PMID: 24943100 DOI: 10.1136/vr.101978] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of this study was to assess the prevalence and risk factors for faecal carriage of extended-spectrum β-lactamase (ESBL) and plasmidic AmpC β-lactamase (pAmpC) Escherichia coli producers in dogs. A three-month cross-sectional study was conducted and 151 rectal swabs were obtained from healthy dogs. ESBL and pAmpC genes were detected by PCR and were sequenced. Logistic regression models were used to investigate risk factors for the carriage of ESBL and pAmpC-producing E. coli. About 15 per cent of the isolates carried ESBL genes (blaCTX-M-32 n=8, blaCTX-M-15 n=5, blaCTX-M-1 n=3, blaCTX-M-9-like n=4) and 20 per cent carried pAmpC genes (blaCMY-2 n=23, blaCMY-2-like n=2). Thirteen dogs carried an E. coli isolate with both an ESBL and a pAmpC gene. One E. coli isolate harboured the human blaDHA-1 pAmpC gene, which has not been previously reported in companion animals in Europe. Dogs with a history of antimicrobial therapy in the past year had a higher risk of being carriers of ESBL-producing (P=0.003, OR =7.85) and pAmpC-producing (P=0.005, OR=6.28) E. coli. Dogs from shelter/breeders were approximately three times more likely to have an ESBL- or a pAmpC-producing E. coli than dogs from private owners. Males have a reduced risk of carrying a pAmpC-producing E. coli than females (P=0.017, OR =0.28). The knowledge of potential risk factors may help to limit the impact of resistance through implementation of effective control measures and judicious antimicrobial therapy.
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Affiliation(s)
- A Belas
- Laboratory of Antimicrobial and Biocide Resistance, Interdisciplinary Centre of Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Av. da Universidade Técnica - Polo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal
| | - A S Salazar
- Laboratory of Antimicrobial and Biocide Resistance, Interdisciplinary Centre of Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Av. da Universidade Técnica - Polo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal
| | - L T da Gama
- Laboratory of Antimicrobial and Biocide Resistance, Interdisciplinary Centre of Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Av. da Universidade Técnica - Polo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal
| | - N Couto
- Laboratory of Antimicrobial and Biocide Resistance, Interdisciplinary Centre of Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Av. da Universidade Técnica - Polo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal
| | - C Pomba
- Laboratory of Antimicrobial and Biocide Resistance, Interdisciplinary Centre of Research in Animal Health, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Av. da Universidade Técnica - Polo Universitário Alto da Ajuda, 1300-477 Lisboa, Portugal
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Nelson E, Kayega J, Seni J, Mushi MF, Kidenya BR, Hokororo A, Zuechner A, Kihunrwa A, Mshana SE. Evaluation of existence and transmission of extended spectrum beta lactamase producing bacteria from post-delivery women to neonates at Bugando Medical Center, Mwanza-Tanzania. BMC Res Notes 2014; 7:279. [PMID: 24886506 PMCID: PMC4014626 DOI: 10.1186/1756-0500-7-279] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended spectrum beta-lactamase producing bacteria (ESBL) are common causes of neonatal sepsis worldwide. Neonatal sepsis due to ESBL is associated with increased morbidity and mortality at Bugando Medical Centre (BMC). Due to limited information on the sources of these ESBL strains at BMC, this study was conducted to evaluate the existence, magnitude and transmission of ESBL from post-delivery women to neonates at BMC, Mwanza-Tanzania. RESULTS A cross-sectional study was conducted at obstetrics and neonatal wards from May to July 2013, involving post-delivery women and their neonates. Rectal swabs were collected and processed to identify the ESBL strains and their antimicrobial susceptibility patterns. Patients' data were obtained using a standardized data collection tool. We enrolled 113 women and 126 neonates with mean age of 26.5 ± 5.5 years and median gestation age [IQR] of 39 [35-40] weeks respectively. The prevalence of ESBL carriage among women and neonates were 15% (17/113) and 25.4% (32/126) respectively. The acquisition of ESBL isolates among neonates on day 1, day 3 and day 7 were 60.0% (21/35), 25.7% (9/35) and 14.3% (5/35) respectively. There was no phenotypic similarity between ESBL strains from women and their respective neonates, suggesting other sources of transmission. Neonates given antibiotics were more likely to carry ESBL than those not given [100% (32/32) versus 86% (81/94), p = 0.018]. CONCLUSION The carriage rate of ESBL strains among post-delivery women and neonates at BMC is high. Our findings suggest that neonates acquire these strains from sources other than post-delivery women and more than half acquire them on the first day of life. More studies are recommended to further explore the sources of ESBL strains among neonates.
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Affiliation(s)
| | | | - Jeremiah Seni
- Department of Microbiology/Immunology, Catholic University of Health and Allied Sciences, P,O, Box 1464, Mwanza, Tanzania.
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Bert F, Larroque B, Dondero F, Durand F, Paugam-Burtz C, Belghiti J, Moreau R, Nicolas-Chanoine MH. Risk factors associated with preoperative fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in liver transplant recipients. Transpl Infect Dis 2013; 16:84-9. [DOI: 10.1111/tid.12169] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 05/06/2013] [Accepted: 05/27/2013] [Indexed: 12/13/2022]
Affiliation(s)
- F. Bert
- Service de Microbiologie; Hôpital Beaujon; AP-HP; Clichy France
| | - B. Larroque
- Unité d'Epidémiologie et Recherche clinique; Hôpital Beaujon; AP-HP; Clichy France
| | - F. Dondero
- Service de Chirurgie digestive; Hôpital Beaujon; AP-HP; Clichy France
| | - F. Durand
- Service d'Hépatologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
| | - C. Paugam-Burtz
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
- Département d'Anesthésie-Réanimation; Hôpital Beaujon; AP-HP; Clichy France
| | - J. Belghiti
- Service de Chirurgie digestive; Hôpital Beaujon; AP-HP; Clichy France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
| | - R. Moreau
- Service d'Hépatologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
| | - M.-H. Nicolas-Chanoine
- Service de Microbiologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
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50
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Kim J, Lee JY, Kim SI, Song W, Kim JS, Jung S, Yu JK, Park KG, Park YJ. Rates of fecal transmission of extended-spectrum β-lactamase-producing and carbapenem-resistant Enterobacteriaceae among patients in intensive care units in Korea. Ann Lab Med 2013; 34:20-5. [PMID: 24422191 PMCID: PMC3885768 DOI: 10.3343/alm.2014.34.1.20] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 08/12/2013] [Accepted: 10/17/2013] [Indexed: 02/02/2023] Open
Abstract
Background We investigated the rates of fecal transmission of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) among patients admitted to intensive care units (ICUs). Methods From June to August 2012, rectal cultures were acquired from all patients at ICU admission. For patients not carrying ESBL-E or CRE at admission, follow-up cultures were performed to detect acquisition. A chromogenic assay was used to screen for ESBL-E and CRE. Bacterial species identification and antibiotic susceptibility tests were performed using the Vitek 2 system (bioMérieux, France). ESBL genotypes were determined by PCR, and clonal relatedness of the isolates was assessed by pulsed-field gel electrophoresis. Results Out of 347 ICU admissions, 98 patients were found to be carriers of ESBL-E (28.2%, 98/347). Follow-up cultures were acquired from 91 of the patients who tested negative for ESBL-E at admission; the acquisition rate in this group was 12.1% (11/91), although none was a nosocomial transmission. For CRE, the prevalence of fecal carriage was 0.3% (1/347), and the acquisition rate was 2.9% (4/140). None of the CRE isolates were carbapenemase-producers. Conclusions The high prevalence of ESBL-E carriage on admission (28.2%), coupled with rare nosocomial transmission and the very low carriage rate of CRE (0.3%), challenge the routine use of active surveillance in non-epidemic settings. Nevertheless, passive surveillance measures, such as rapid and accurate screening of clinical specimens, will be critical for controlling the spread of CRE.
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Affiliation(s)
- Jayoung Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Ji Young Lee
- Department of Infection Control, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sang Il Kim
- Division of Infectious Disease, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Seungwon Jung
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jin Kyung Yu
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Kang Gyun Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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