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Jangir PK, Ogunlana L, Szili P, Czikkely M, Shaw LP, Stevens EJ, Yu Y, Yang Q, Wang Y, Pál C, Walsh TR, MacLean CR. The evolution of colistin resistance increases bacterial resistance to host antimicrobial peptides and virulence. eLife 2023; 12:e84395. [PMID: 37094804 PMCID: PMC10129329 DOI: 10.7554/elife.84395] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Antimicrobial peptides (AMPs) offer a promising solution to the antibiotic resistance crisis. However, an unresolved serious concern is that the evolution of resistance to therapeutic AMPs may generate cross-resistance to host AMPs, compromising a cornerstone of the innate immune response. We systematically tested this hypothesis using globally disseminated mobile colistin resistance (MCR) that has been selected by the use of colistin in agriculture and medicine. Here, we show that MCR provides a selective advantage to Escherichia coli in the presence of key AMPs from humans and agricultural animals by increasing AMP resistance. Moreover, MCR promotes bacterial growth in human serum and increases virulence in a Galleria mellonella infection model. Our study shows how the anthropogenic use of AMPs can drive the accidental evolution of resistance to the innate immune system of humans and animals. These findings have major implications for the design and use of therapeutic AMPs and suggest that MCR may be difficult to eradicate, even if colistin use is withdrawn.
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Affiliation(s)
- Pramod K Jangir
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Lois Ogunlana
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Petra Szili
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research NetworkSzegedHungary
- Doctoral School of Multidisciplinary Medical Sciences, University of SzegedSzegedHungary
| | - Marton Czikkely
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research NetworkSzegedHungary
| | - Liam P Shaw
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Emily J Stevens
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Yang Yu
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural UniversityGuangzhouChina
| | - Qiue Yang
- Fujian Provincial Key Laboratory of Soil Environmental Health and RegulaWon, College of Resources and Environment, Fujian Agriculture and Forestry UniversityFuzhouChina
| | - Yang Wang
- Beijing Advanced Innovation Centre for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural UniversityBeijingChina
| | - Csaba Pál
- Synthetic and Systems Biology Unit, Biological Research Centre, Eötvös Loránd Research NetworkSzegedHungary
| | - Timothy R Walsh
- Department of Biology, University of OxfordOxfordUnited Kingdom
| | - Craig R MacLean
- Department of Biology, University of OxfordOxfordUnited Kingdom
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Moghnia OH, Rotimi VO, Al-Sweih NA. Preponderance of bla KPC-Carrying Carbapenem-Resistant Enterobacterales Among Fecal Isolates From Community Food Handlers in Kuwait. Front Microbiol 2021; 12:737828. [PMID: 34721336 PMCID: PMC8552006 DOI: 10.3389/fmicb.2021.737828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) are pathogens that have been found in several countries, with a significant public health concern. Characterizing the mode of resistance and determining the prevailing clones are vital to the epidemiology of CRE in our community. This study was conducted to characterize the molecular mode of resistance and to determine the clonality of the CRE fecal isolates among community food handlers (FHs) vs. infected control patients (ICPs) in Kuwait. Fecal CRE isolates obtained from FHs and ICPs from September 2016 to September 2018 were analyzed for their resistance genes. Gene characterization was carried out by polymerase chain reaction (PCR) assays and sequencing. Clonality of isolates was established by multilocus sequence typing (MLST). Of the 681 and 95 isolates of the family Enterobacterales isolated from FHs and ICPs, 425 (62.4%) and 16 (16.8%) were Escherichia coli, and 18 (2.6%) and 69 (72.6%) were Klebsiella pneumoniae, respectively. A total of 36 isolates were CRE with a prevalence of 5.3% among FH isolates and 87 (91.6%) among the ICPs. Of these, carbapenemase genes were detected in 22 (61.1%) and 65 (74.7%) isolates, respectively (p < 0.05). The detected specific genes among FHs and ICPs were positive for blaKPC 19 (86.4%) and 35 (40.2%), and blaOXA 10 (45.5%) and 59 (67.8%), in addition to blaNDM 2 (9.1%) and 32 (36.8%), respectively. MLST assays of the E. coli and K. pneumoniae isolates revealed considerable genetic diversity and polyclonality as well as demonstrated multiple known ST types and eight novel sequence types. The study revealed a relatively high number of CRE harboring predominantly blaKPC-mediated CRE among the community FH isolates vs. predominant blaOXA genes among the ICPs. Those heterogeneous CRE isolates raise concerns and mandate more efforts toward molecular surveillance. A multinational study is recommended to monitor the spread of genes mediating CRE in the community of Arabian Peninsula countries.
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Affiliation(s)
- Ola H Moghnia
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Vincent O Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Noura A Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Moghnia OH, Rotimi VO, Al-Sweih NA. Monitoring antibiotic resistance profiles of faecal isolates of Enterobacteriaceae and the prevalence of carbapenem-resistant isolates among food handlers in Kuwait. J Glob Antimicrob Resist 2021; 25:370-376. [PMID: 33991748 DOI: 10.1016/j.jgar.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Carbapenem-resistant Enterobacteriaceae (CRE) have become one of the most challenging problems in infectious diseases worldwide. Unrecognised personnel such as food handlers (FHs) colonised with CRE serve as a reservoir for transmission. This study assessed the prevalence and susceptibility patterns of CRE isolates from FHs working in commercial eateries in the community (CFHs) and healthcare settings (HCFHs) in Kuwait over the period 2016-2018. METHODS Representative colonies from faecal samples were identified by API 20E and a VITEK®2 ID System. Susceptibility testing against 21 antibiotics was performed by Etest and agar dilution. RESULTS A total of 681 isolates of the family Enterobacteriaceae were isolated from 405 FHs, of which 425 (62.4%) were Escherichia coli and 126 (18.5%) were Klebsiella pneumoniae. The prevalence of CRE among FHs was 7.7% (31/405), comprising 32% CFHs (10/31) and 68% HCFHs (21/31). Ampicillin, tetracycline and cefalotin showed very poor activities against most isolates with resistance rates of 63.3%, 41.7% and 40.8%, respectively. The prevalence of multidrug-resistant (MDR) isolates was 30.5%, including 130 E. coli (30.6%) and 22 K. pneumoniae (17.5%). An alarming level of colistin resistance (11.3%) was noted. A significant proportion of FH isolates (13.2%) exhibited extended-spectrum β-lactamases (ESBL) phenotypes, including 80 E. coli (18.8%) and 5 K. pneumoniae (4.0%). CONCLUSION This study revealed that asymptomatic intestinal carriage of CRE, including MDR and ESBL isolates, was relatively common in our community. It is conceivable that FHs may pose a significant risk to consumers for the acquisition and spread of resistant strains.
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Affiliation(s)
- Ola H Moghnia
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Vincent O Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Noura A Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
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Moghnia OH, Rotimi VO, Al-Sweih NA. Evaluating Food Safety Compliance and Hygiene Practices of Food Handlers Working in Community and Healthcare Settings in Kuwait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1586. [PMID: 33567499 PMCID: PMC7915981 DOI: 10.3390/ijerph18041586] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
Safe food handling and proper hygiene practices performed by food handlers (FHs) in catering establishments are fundamental elements in reducing foodborne diseases. This study aimed at assessing food safety knowledge and compliance of hygiene practices of FHs within food establishments (using a structured questionnaire). A cross-sectional study was carried out from May 2016 to March 2018 on FHs working in community and healthcare settings. A total of 405 FHs, including 44.9% and 55.1%, were working in community and healthcare settings, respectively. The majority, 84.7%, were males with a ratio of 5.5:1. Most of them, 84.4%, had a high school education and above. A greater number, 44%, of FHs were in the age bracket of 29-39 years. As high as 95.6% of them underwent a regular medical check-up. Unsafe attitudes were shown by 44.9%% who used the same hand gloves while handling raw meat and fresh food. Additionally, 42% went home with their uniforms. The hygiene assessment score was 95.8%. In general, FHs have adequate knowledge and compliance with food safety practices. It is recommended that regular and ongoing training on hygienic practices and proper food safety techniques must be given to all FHs to ensure food safety.
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Affiliation(s)
| | | | - Noura A. Al-Sweih
- Department of Microbiology, Faculty of Medicine, Kuwait University, Al-Safat 24923, Kuwait; (O.H.M.); (V.O.R.)
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Prevalence of Intestinal Parasites and Gastrointestinal Carriage of Pathogenic Gram Negative Enteric Bacteria among Apparently Healthy Food Handlers of Public Hospitals, Addis Ababa, Ethiopia. Int J Microbiol 2020. [DOI: 10.1155/2020/8867033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Foodborne diseases are major public health problems in developing countries like Ethiopia. Food handlers with poor personal hygiene working in hospitals could be infected with different intestinal parasites and pathogenic enteric bacteria. Therefore, they could pose a potential risk of foodborne infection to patients and the community. Methods. An institutional based cross-sectional study conducted from March to June 2017. Besides, sociodemographic data were collected using a structured questionnaire, freshly passed stool specimens for direct wet mount smear examination, and formalin ether concentration techniques performed for the detection of parasites. For bacterial identification culture, biochemical tests and antimicrobial sensitivity (Kirby-Baure disk diffusion method) have been performed. Finally, validated data were analyzed using statistical package for social science version 20 (SPSS). Results. From 368 food handlers who participated in the study, 81% were females. 119 (32.34%) were positive for at least one intestinal parasite. The most prevalent parasite was Entamoeba histolytica/dispar 48 (13%), followed by Giardia lamblia 36 (9.78%), Taenia Species 21 (5.7%), Ascaris lumbricoide 8 (2.2%), Trichuris trichiura 5 (1.4%), and Hook worm 1 (0.3%). Regarding the prevalence of enteric bacteria 17(4.6%), food handlers were positive for Salmonella 14 (3.8%) and Shigella flexneri 3 (0.8%). No E. coli O157 : H7 was isolated. All 100% (n = 14) Salmonella isolates were resistant to ampicillin (10 µg) and erythromycin (15 µg). Similarly, 100% (n = 3) of Shigella flexneri isolates were resistant to ampicillin (10 µg) and tetracycline (30 µg). 14.3% (n = 2) Salmonella and 66.7% (n = 2) Shigella flexneri isolates were MDR. Conclusion. The study showed significant carriage of pathogenic microorganisms among food handlers. Therefore, hospital administrators and other stake holders should put measures in place to break chain of transmission routes from silent carrier to other peoples particularly patients at hospital and the community at large.
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Stoppe NDC, Silva JS, Carlos C, Sato MIZ, Saraiva AM, Ottoboni LMM, Torres TT. Worldwide Phylogenetic Group Patterns of Escherichia coli from Commensal Human and Wastewater Treatment Plant Isolates. Front Microbiol 2017; 8:2512. [PMID: 29312213 PMCID: PMC5742620 DOI: 10.3389/fmicb.2017.02512] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 12/04/2017] [Indexed: 01/01/2023] Open
Abstract
Escherichia coli is an important microorganism in the gastrointestinal tract of warm-blooded animals. Commensal populations of E. coli consist of stable genetic isolates, which means that each individual has only one phylogenetic group (phylogroup). We evaluated the frequency of human commensal E. coli phylogroups from 116 people and observed that the majority of isolates belonged to group A. We also evaluated the frequency of phylogroups in wastewater samples and found a strong positive correlation between the phylogroup distribution in wastewater and human hosts. In order to find out if some factors, such as geographical location, and climate could influence the worldwide phylogroup distribution, we performed a meta-analysis of 39 different studies and 24 countries, including different climates, living areas, and feeding habits. Unexpectedly, our results showed no substructuring patterns of phylogroups; indicating there was no correlation between phylogroup distribution and geographic location, climate, living area, feeding habits, or date of collection.
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Affiliation(s)
- Nancy de Castro Stoppe
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, Brazil.,Núcleo de Pesquisa em Biodiversidade e Computação (BioComp-USP)-Universidade de São Paulo, São Paulo, Brazil
| | - Juliana S Silva
- Núcleo de Pesquisa em Biodiversidade e Computação (BioComp-USP)-Universidade de São Paulo, São Paulo, Brazil.,Secretaria de Estado de Saúde de Mato Grosso, Cuiabá, Brazil.,Departamento de Genética e Biologia Evolutiva, Universidade de São Paulo, São Paulo, Brazil
| | - Camila Carlos
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, Brazil
| | - Maria I Z Sato
- Departamento de Análises Ambientais, Companhia Ambiental do Estado de São Paulo-CETESB, São Paulo, Brazil
| | - Antonio M Saraiva
- Núcleo de Pesquisa em Biodiversidade e Computação (BioComp-USP)-Universidade de São Paulo, São Paulo, Brazil.,Departamento de Engenharia de Computação e Sistemas Digitais, Escola Politécnica da USP, São Paulo, Brazil
| | - Laura M M Ottoboni
- Centro de Biologia Molecular e Engenharia Genética, Universidade Estadual de Campinas, Campinas, Brazil
| | - Tatiana T Torres
- Núcleo de Pesquisa em Biodiversidade e Computação (BioComp-USP)-Universidade de São Paulo, São Paulo, Brazil.,Departamento de Genética e Biologia Evolutiva, Universidade de São Paulo, São Paulo, Brazil
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Ranjbar R, Masoudimanesh M, Dehkordi FS, Jonaidi-Jafari N, Rahimi E. Shiga (Vero)-toxin producing Escherichia coli isolated from the hospital foods; virulence factors, o-serogroups and antimicrobial resistance properties. Antimicrob Resist Infect Control 2017; 6:4. [PMID: 28074125 PMCID: PMC5219770 DOI: 10.1186/s13756-016-0163-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/16/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND According to the presence of the weak, diabetic and immunosuppressive patients in hospitals, hospital foods should have a high quality and safety. Cooking a lot of foods higher than daily requirement, storage of cooked foods in an inappropriate condition and presence of nurses and servants in distribution of food to patients are the main reasons caused contamination of hospital foods. Shiga toxigenic Escherichia coli is one of the common cause of food poisoning in hospitals. The present research was carried out to study the distribution of virulence factors, O-serogroups and antibiotic resistance properties in STEC strains recovered from Iranian hospital food samples. METHODS Five-hundred and eighty raw and cooked food samples were collected and immediately transferred to the laboratory. E. coli-positive strains were subjected to PCR and disk diffusion method. RESULTS Thirty-nine out of 580 (6.72%) hospital food samples were contaminated with E. coli. Raw (20%) and cooked meat (6%) were the most commonly contaminated samples. Raw samples had the higher prevalence of E. coli (P <0.01). Samples which were collected in the summer season had the highest prevalence of bacteria (64.10%). Significant difference was seen between the prevalence of EHEC and AEEC subtypes (P <0.01). The most commonly detected virulence factors in both EHEC and AEEC subtypes were stx1 and eae. The most commonly detected serogroups were O26 (43.75%) and O157 (25%) and there were no positive results for O103, O145, O91, O113 and O128 serogroups. Aac (3)-IV (100%), CITM (100%) and tetA (62.50%) were the most commonly detected antibiotic resistance genes. STEC strains harbored the highest levels of resistance against ampicillin (93.75%), gentamycin (93.75%), tetracycline (87.50%) and ciprofloxacin (81.25%). All of the STEC strains were resistant to at least 3 antibiotics, while the prevalence of resistance against more than 12 antibiotics were 12.50%. CONCLUSIONS High presence of O157 serogroups, EHEC strains and animal-based antibiotics in cooked foods showed insufficiency of cooking time and temperature in the kitchens of hospitals. Judicious prescription of antibiotics and attentions to the principles of food safety can reduce the risk of resistant and virulent strains of STEC in hospital foods.
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Affiliation(s)
- Reza Ranjbar
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mojtaba Masoudimanesh
- Doctor Veterinary Medicine, College of Veterinary Medicine, Islamic Azad University, Shahrekord Branch, Shahrekord, Iran
| | | | | | - Ebrahim Rahimi
- Department of Food Hygiene and Public Health, College of Veterinary Medicine, Shahrekord Branch, Shahrekord, Iran
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Stewardson AJ, Renzi G, Maury N, Vaudaux C, Brossier C, Fritsch E, Pittet D, Heck M, van der Zwaluw K, Reuland EA, van de Laar T, Snelders E, Vandenbroucke-Grauls C, Kluytmans J, Edder P, Schrenzel J, Harbarth S. Extended-spectrum β-lactamase-producing Enterobacteriaceae in hospital food: a risk assessment. Infect Control Hosp Epidemiol 2014; 35:375-83. [PMID: 24602942 DOI: 10.1086/675609] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) contamination of food and colonization of food handlers in a hospital kitchen and compare retrieved ESBL-PE strains with patient isolates. DESIGN Cross-sectional study. SETTING A 2,200-bed tertiary care university hospital in Switzerland. PARTICIPANTS Food handlers. METHODS Raw and prepared food samples were obtained from the hospital kitchen, with a comparator group from local supermarkets. Fecal samples collected from food handlers and selectively pre-enriched homogenized food samples were inoculated onto selective chromogenic media. Phenotypic confirmation of ESBL production was performed using the double disk method. Representative ESBL-PE were characterized using polymerase chain reaction (PCR) and sequencing for blaCTX-M, blaSHV, and blaTEM genes, and Escherichia coli strains were typed using phylotyping, repetitive element palindromic PCR, and multilocus sequence typing. Meat samples were screened for antibiotic residues using liquid chromatography time-of-flight mass spectrometry. RESULTS Sixty (92%) of the raw chicken samples were ESBL-PE positive, including 30 (86%) of the hospital samples and all supermarket samples. No egg, beef, rabbit, or cooked chicken samples were ESBL-PE positive. No antibiotic residues were detected. Six (6.5%) of 93 food handlers were ESBL-PE carriers. ESBL-PE strains from chicken meat more commonly possessed blaCTX-M-1 and blaCTX-M-2, whereas blaCTX-M-14 and blaCTX-M-15 were predominant among strains of human origin. There was partial overlap in the sequence type of E. coli strains of chicken and human origin. No E. coli ST131 strains or blaCTX-M-15 genes were isolated from meat. CONCLUSIONS Although there is significant ESBL-PE contamination of delivered chicken meat, current preventive strategies minimize risks to food handlers, hospital staff, and patients.
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Affiliation(s)
- Andrew J Stewardson
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Ruhnke M, Arnold R, Gastmeier P. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. Lancet Oncol 2014; 15:e606-e619. [PMID: 25456379 DOI: 10.1016/s1470-2045(14)70344-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Drug-resistant Gram-negative and Gram-positive bacteria are now increasingly identified as a cause of infections in immunocompromised hosts. Bacteria identified include the multidrug-resistant (MDR) and even pandrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa, as well as carbapenem-resistant Enterobacteriaceae spp. The threat from MDR pathogens has been well-documented in the past decade with warnings about the consequences of inappropriate use of antimicrobial drugs. Resistant bacteria can substantially complicate the treatment of infections in critically ill patients and can have a substantial effect on mortality. Inappropriate antimicrobial treatment can affect morbidity, mortality, and overall health-care costs. Evidence-based data for prevention and control of MDR pathogen infections in haematology are scarce. Although not yet established a bundle of infection control and prevention measures with an anti-infective stewardship programme is an important strategy in infection control, diagnosis, and antibiotic selection with optimum regimens to ensure a successful outcome for patients.
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Affiliation(s)
- Markus Ruhnke
- Department of Hematology and Oncology, Paracelsus-Hospital Osnabrück, Germany.
| | - Renate Arnold
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Virchow Klinikum, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
| | - Petra Gastmeier
- Medical Department, Division of Haematology, Oncology and Tumour Immunology, Charité Campus Benjamin Franklin, Institute of Hygiene and Environmental Medicine, University Medicine, Berlin, Germany
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Vodovar D, Marcadé G, Raskine L, Malissin I, Mégarbane B. [Enterobacteriaceae producing extended spectrum beta-lactamase: epidemiology, risk factors, and prevention]. Rev Med Interne 2012. [PMID: 23182290 DOI: 10.1016/j.revmed.2012.10.365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multidrug-resistant bacteria are a major worldwide health public concern. It results from the growing increase in antibiotic prescriptions, which are responsible for selection pressure on bacteria. In France like in other countries, enterobacteriaceae producing extended spectrum beta-lactamase (EESBL) are the predominant multidrug-resistant bacteria. EESBL may be responsible for severe infections and require prescription of broad-spectrum antibacterial agents. The current EESBL outbreak is different from methicillin-resistant Staphylococcus aureus outbreak that occurred in the early 1980. Consistently, EESBL are isolated both in hospital and community. Moreover, standard hygiene measures appear ineffective since EESBL prevalence is still increasing. The current inability to contain EESBL outbreak is due to several factors, including the existence of a wide community- and hospital-acquired tank of EESBL, failure to follow strict rules for hygiene, and the current irrational prescription of antibiotics.
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Affiliation(s)
- D Vodovar
- Service de réanimation médicale et toxicologique, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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