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Bandić Pavlović D, Pospišil M, Nađ M, Vrbanović Mijatović V, Luxner J, Zarfel G, Grisold A, Tonković D, Dobrić M, Bedenić B. Multidrug-Resistant Bacteria in Surgical Intensive Care Units: Antibiotic Susceptibility and β-Lactamase Characterization. Pathogens 2024; 13:411. [PMID: 38787264 PMCID: PMC11124292 DOI: 10.3390/pathogens13050411] [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] [Received: 04/07/2024] [Revised: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Multidrug-resistant (MDR) bacteria of the utmost importance are extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacterales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). In this study, an evaluation of MDR bacteria in surgical intensive care units in a tertiary referral hospital was conducted. The study aimed to characterize β-lactamases and other resistance traits of Gram-negative bacteria isolated in surgical intensive care units (ICUs). Disk diffusion and the broth dilution method were used for antibiotic susceptibility testing, whereas ESBL screening was performed through a double disk synergy test and an inhibitor-based test with clavulanic acid. A total of 119 MDR bacterial isolates were analysed. ESBL production was observed in half of the Proteus mirabilis, 90% of the Klebsiella pneumoniae and all of the Enterobacter cloacae and Escherichia coli isolates. OXA-48 carbapenemase, carried by the L plasmid, was detected in 34 K. pneumoniae and one E. coli and Enterobacter cloacae complex isolates, whereas NDM occurred sporadically and was identified in three K. pneumoniae isolates. OXA-48 positive isolates coharboured ESBLs belonging to the CTX-M family in all but one isolate. OXA-23 carbapenemase was confirmed in all A. baumannii isolates. The findings of this study provide valuable insight of resistance determinants of Enterobacterales and A. baumannii which will enhance surveillance and intervention strategies that are necessary to curb the ever-growing carbapenem resistance rates.
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Affiliation(s)
- Daniela Bandić Pavlović
- Department of Anesthesiology and Intensive Care, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (D.B.P.); (V.V.M.); (D.T.)
| | - Mladen Pospišil
- Department of Emergency Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Marina Nađ
- University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Vilena Vrbanović Mijatović
- Department of Anesthesiology and Intensive Care, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (D.B.P.); (V.V.M.); (D.T.)
| | - Josefa Luxner
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria; (J.L.); (G.Z.); (A.G.)
| | - Gernot Zarfel
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria; (J.L.); (G.Z.); (A.G.)
| | - Andrea Grisold
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria; (J.L.); (G.Z.); (A.G.)
| | - Dinko Tonković
- Department of Anesthesiology and Intensive Care, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (D.B.P.); (V.V.M.); (D.T.)
| | - Mirela Dobrić
- Department of Anesthesiology, Intensive Medicine and Pain Management, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia;
| | - Branka Bedenić
- Biomedical Research Center Šalata—BIMIS, Department for Clinical Microbiology and Infection Prevention and Control, University of Zagreb School of Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
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Cieślik M, Harhala M, Orwat F, Dąbrowska K, Górski A, Jończyk-Matysiak E. Two Newly Isolated Enterobacter-Specific Bacteriophages: Biological Properties and Stability Studies. Viruses 2022; 14:1518. [PMID: 35891499 PMCID: PMC9319786 DOI: 10.3390/v14071518] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
In an era of antibiotic therapy crisis caused by spreading antimicrobial resistance, and when recurrent urinary tract infections constitute a serious social and medical problem, the isolation and complex characterization of phages with a potential therapeutic application represents a promising solution. It is an inevitable, and even a necessary direction in the development of current phage research. In this paper, we present two newly isolated myoviruses that show lytic activity against multidrug-resistant clinical isolates of Enterobacter spp. (E. cloacae, E. hormaechei, and E. kobei), the genomes of which belong to a poorly represented phage group. Both phages were classified as part of the Tevenvirinae subfamily (Entb_43 was recognized as Karamvirus and Entb_45 as Kanagawavirus). Phage lytic spectra ranging from 40 to 60% were obtained. The most effective phage-to-bacteria ratios (MOI = 0.01 and MOI = 0.001) for both the phage amplification and their lytic activity against planktonic bacteria were also estimated. Complete adsorption to host cells were obtained after about 20 min for Entb_43 and 10 min for Entb_45. The phage lysates retained their initial titers even during six months of storage at both -70 °C and 4 °C, whereas storage at 37 °C caused a complete loss in their activity. We showed that phages retained their activity after incubation with solutions of silver and copper nanoparticles, which may indicate possible synergistic antibacterial activity. Moreover, a significant reduction in phage titers was observed after incubation with a disinfectant containing octenidinum dihydrochloridum and phenoxyethanol, as well as with 70% ethanol. The observed maintenance of phage activity during incubation in a urine sample, along with other described properties, may suggest a therapeutic potential of phages at the infection site after intravesical administration.
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Affiliation(s)
- Martyna Cieślik
- Bacteriophage Laboratory, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.C.); (F.O.); (A.G.)
| | - Marek Harhala
- Laboratory of Phage Molecular Biology, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.H.); (K.D.)
| | - Filip Orwat
- Bacteriophage Laboratory, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.C.); (F.O.); (A.G.)
| | - Krystyna Dąbrowska
- Laboratory of Phage Molecular Biology, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.H.); (K.D.)
| | - Andrzej Górski
- Bacteriophage Laboratory, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.C.); (F.O.); (A.G.)
- Phage Therapy Unit, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland
- Department of Clinical Immunology, Infant Jesus Hospital, The Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Ewa Jończyk-Matysiak
- Bacteriophage Laboratory, Department of Phage Therapy, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland; (M.C.); (F.O.); (A.G.)
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3
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Kearney A, Boyle MA, Curley GF, Humphreys H. Preventing infections caused by carbapenemase-producing bacteria in the intensive care unit - Think about the sink. J Crit Care 2021; 66:52-59. [PMID: 34438134 DOI: 10.1016/j.jcrc.2021.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Outbreaks caused by carbapenemase-producing bacteria (CPB) are challenging to manage in critical care settings and can be protracted due to inadvertent and ubiquitous ecological niches within the built unit environment, such as handwashing sinks. We discuss evidence from a narrative review on transmission pathways and interventions for critical care practitioners. METHODS A literature review was undertaken using Pubmed, CINAHL and Embase and included outbreaks of CPB, and equivalent bacteria in critical care units, between 1998 and May 2020. Intervention studies targeting elements of sinks that were employed in response to outbreaks in critical care units were included (n = 30). FINDINGS We found control measures included sink removal, use of physical barriers or design modification to protect patients from sinks, engineering controls to mitigate bacterial dispersal and administrative controls. A multi-disciplinary approach involving practitioners from critical care, infection prevention and control, engineering and other staff, should be involved in ongoing measures and in outbreak control activities. Ascertaining the optimal method to end CPB outbreaks in critical care is challenging due to the lack of prospective studies available. However, the literature suggests that sinks can and do serve as reservoirs of CPB near critically ill patients, and should be considered hazardous, especially when sub-optimally designed or used.
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Affiliation(s)
- A Kearney
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland.
| | - M A Boyle
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland
| | - G F Curley
- Department of Anaesthesia and Critical Care, the Royal College of Surgeons in Ireland, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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4
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Kohler P, Tijet N, Kim HC, Johnstone J, Edge T, Patel SN, Seah C, Willey B, Coleman B, Green K, Armstrong I, Katz K, Muller MP, Powis J, Poutanen SM, Richardson D, Sarabia A, Simor A, McGeer A, Melano RG. Dissemination of Verona Integron-encoded Metallo-β-lactamase among clinical and environmental Enterobacteriaceae isolates in Ontario, Canada. Sci Rep 2020; 10:18580. [PMID: 33122675 PMCID: PMC7596063 DOI: 10.1038/s41598-020-75247-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022] Open
Abstract
Surveillance data from Southern Ontario show that a majority of Verona Integron-encoded Metallo-β-lactamase (VIM)-producing Enterobacteriaceae are locally acquired. To better understand the local epidemiology, we analysed clinical and environmental blaVIM-positive Enterobacteriaceae from the area. Clinical samples were collected within the Toronto Invasive Bacterial Diseases Network (2010–2016); environmental water samples were collected in 2015. We gathered patient information on place of residence and hospital admissions prior to the diagnosis. Patients with and without plausible source of acquisition were compared regarding risk exposures. Microbiological isolates underwent whole-genome sequencing (WGS); blaVIM carrying plasmids were characterized. We identified 15 patients, thereof 11 with blaVIM-1-positive Enterobacter hormaechei within two genetic clusters based on WGS. Whereas no obvious epidemiologic link was identified among cluster I patients, those in cluster II were connected to a hospital outbreak. Except for patients with probable acquisition abroad, we did not identify any further risk exposures. Two blaVIM-1-positive E. hormaechei from environmental waters matched with the clinical clusters; plasmid sequencing suggested a common ancestor plasmid for the two clusters. These data show that both clonal spread and horizontal gene transfer are drivers of the dissemination of blaVIM-1-carrying Enterobacter hormaechei in hospitals and the aquatic environment in Southern Ontario, Canada.
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Affiliation(s)
| | | | - Hyunjin C Kim
- Sinai Health System, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Tom Edge
- Environment and Climate Change Canada, Burlington, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Irene Armstrong
- Sinai Health System, Toronto, ON, Canada.,Toronto Public Health, Toronto, ON, Canada
| | - Kevin Katz
- University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | | | - Jeff Powis
- Michael Garron Hospital, Toronto, ON, Canada
| | - Susan M Poutanen
- Sinai Health System, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | | | | | - Andrew Simor
- University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Roberto G Melano
- Public Health Ontario Laboratory, Toronto, ON, Canada. .,University of Toronto, Toronto, ON, Canada.
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5
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Iovene MR, Pota V, Galdiero M, Corvino G, Lella FMD, Stelitano D, Passavanti MB, Pace MC, Alfieri A, Franco SD, Aurilio C, Sansone P, Niyas VKM, Fiore M. First Italian outbreak of VIM-producing Serratia marcescensin an adult polyvalent intensive care unit, August-October 2018: A case report and literature review. World J Clin Cases 2019. [DOI: 10.12998/wjcc.v7.i21.3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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6
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Iovene MR, Pota V, Galdiero M, Corvino G, Di Lella FM, Stelitano D, Passavanti MB, Pace MC, Alfieri A, Di Franco S, Aurilio C, Sansone P, Niyas VKM, Fiore M. First Italian outbreak of VIM-producing Serratia marcescens in an adult polyvalent intensive care unit, August-October 2018: A case report and literature review. World J Clin Cases 2019; 7:3535-3548. [PMID: 31750335 PMCID: PMC6854422 DOI: 10.12998/wjcc.v7.i21.3535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae has become a significant public health concern as hospital outbreaks are now being frequently reported and these organisms are becoming difficult to treat with the available antibiotics.
CASE SUMMARY An outbreak of VIM-producing Serratia marcescens occurred over a period of 11 wk (August, 1 to October, 18) in patients admitted to the adult polyvalent intensive care unit of the University of Campania “Luigi Vanvitelli” located in Naples. Four episodes occurred in three patients (two patients infected, and one patient colonized). All the strains revealed the production of VIM.
CONCLUSION After three decades of carbapenem antibiotics use, the emergence of carbapenem-resistance in Enterobacteriaceae has become a significant concern and a stricter control to preserve its clinical application is mandatory. This is, to our knowledge, the first outbreak of VIM-producing Serratia marcescens in Europe. Surveillance policies must be implemented to avoid future outbreaks.
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Affiliation(s)
- Maria Rosaria Iovene
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Vincenzo Pota
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Giusy Corvino
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Federica Maria Di Lella
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Debora Stelitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Caterina Aurilio
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | | | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
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7
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Bedenić B, Slade M, Starčević LŽ, Sardelić S, Vranić-Ladavac M, Benčić A, Zujić Atalić V, Bogdan M, Bubonja-Šonje M, Tomić-Paradžik M, Tot T, Lukić-Grlić A, Drenjančević D, Varda-Brkić D, Bandić-Pavlović D, Mihaljević S, Zarfel G, Gužvinec M, Conzemius R, Barišić I, Tambić-Andraševic A. Epidemic spread of OXA-48 beta-lactamase in Croatia. J Med Microbiol 2018; 67:1031-1041. [PMID: 29927373 DOI: 10.1099/jmm.0.000777] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A dramatic increase in OXA-48 β-lactamase was observed recently not only in large hospital centres, but also in smaller suburban hospital centres in geographic areas bordering Croatia. The aim of the study was to analyse the epidemiology, the mechanisms of antibiotic resistance and the routes of spread of OXA-48 carbapenemase in Croatia. METHODS Carbapenemase and other β-lactamase and fluoroquinolone resistance genes were detected by PCR and sequencing. Whole-genome sequencing (WGS) was performed on five representative isolates. The isolates were genotyped by PFGE. RESULTS Forty-eight isolates positive for OXA-48, collected from seven hospital centres in Croatia from May 2016 to May 2017, were analysed (40 Klebsiella pneumoniae, 5 Enterobacter cloacae, 2 Escherichia coli and one Citrobacter freundii). Thirty-three isolates were ESBL positive and harboured group 1 CTX-M 1 β-lactamases. In addition to the β-lactam resistance genes detected by PCR (blaSHV-1, blaOXA-48 and blaOXA-1), WGS of five representative isolates revealed the presence of genes encoding aminoglycoside resistance, aadA2 and aph3-Ia, fluoroquinolone resistance determinants aac(6)Ib-c, oqxA and oqxB, the sulfonamide resistance gene sul1, and fosA (fosfomycin resistance). IncL plasmid was found in all isolates. Two K. pneumoniae isolates belonged to ST16, two E. cloacae to ST66 and E. coli to ST354. K. pneumoniae isolates were allocated to five clusters by PFGE which occured in different hospitals, indicating epidemic spread. CONCLUSIONS The OXA-48-positive organisms found in this study showed wide variability in antibiotic susceptibility, β-lactamase content and PFGE banding patterns. This study revealed a switch from the predominance of VIM-1 in 2012-2013 to that of OXA-48 in the 2015 to 2017.
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Affiliation(s)
- Branka Bedenić
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Mia Slade
- 3Croatian Institute of Transfusion Medicine (CITM), Croatia
| | | | | | | | - Ana Benčić
- 1School of Medicine, University of Zagreb, Croatia
| | - Vlasta Zujić Atalić
- 6Public Health Institute of Osijek-Baranja County, Osijek, Croatia.,7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | - Maja Bogdan
- 6Public Health Institute of Osijek-Baranja County, Osijek, Croatia.,7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | | | | | - Tatjana Tot
- 10Department for Microbiology, General Hospital Karlovac, Croatia
| | - Amarela Lukić-Grlić
- 1School of Medicine, University of Zagreb, Croatia.,11Children's Hospital Zagreb, Croatia
| | - Domagoj Drenjančević
- 7School of Medicine, University of Osijek, University Hospital Center Osijek, Croatia
| | | | - Daniela Bandić-Pavlović
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Slobodan Mihaljević
- 1School of Medicine, University of Zagreb, Croatia.,2University Hospital Center Zagreb, Croatia
| | - Gernot Zarfel
- 12Institute for Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Austria
| | - Marija Gužvinec
- 13University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Rick Conzemius
- 14AIT, Austrian Institute for Technology, Vienna, Austria
| | - Ivan Barišić
- 14AIT, Austrian Institute for Technology, Vienna, Austria
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8
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French CE, Coope C, Conway L, Higgins JPT, McCulloch J, Okoli G, Patel BC, Oliver I. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect 2016; 95:3-45. [PMID: 27890334 DOI: 10.1016/j.jhin.2016.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND In recent years, infections with carbapenemase-producing Enterobacteriaceae (CPE) have been increasing globally and present a major public health challenge. AIM To review the international literature: (i) to describe CPE outbreaks in acute hospital settings globally; and (ii) to identify the control measures used during these outbreaks and report on their effectiveness. METHODS A systematic search of MEDLINE and EMBASE databases, abstract lists for key conferences and reference lists of key reviews was undertaken, and information on unpublished outbreaks was sought for 2000-2015. Where relevant, risk of bias was assessed using the Newcastle-Ottawa scale. A narrative synthesis of the evidence was conducted. FINDINGS Ninety-eight outbreaks were eligible. These occurred worldwide, with 53 reports from Europe. The number of cases (CPE infection or colonization) involved in outbreaks varied widely, from two to 803. In the vast majority of outbreaks, multi-component infection control measures were used, commonly including: patient screening; contact precautions (e.g. gowns, gloves); handwashing interventions; staff education or monitoring; enhanced environmental cleaning/decontamination; cohorting of patients and/or staff; and patient isolation. Seven studies were identified as providing the best-available evidence on the effectiveness of control measures. These demonstrated that CPE outbreaks can be controlled successfully using a range of appropriate, commonly used, infection control measures. However, risk of bias was considered relatively high for these studies. CONCLUSION The findings indicate that CPE outbreaks can be controlled using combinations of existing measures. However, the quality of the evidence base is weak and further high-quality research is needed, particularly on the effectiveness of individual infection control measures.
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Affiliation(s)
- C E French
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | - C Coope
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK.
| | - L Conway
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
| | - J P T Higgins
- University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK
| | | | - G Okoli
- University of Bristol, Bristol, UK
| | | | - I Oliver
- NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol, Bristol, UK; Public Health England, Bristol, UK
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9
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Bedenić B, Sardelić S, Luxner J, Bošnjak Z, Varda-Brkić D, Lukić-Grlić A, Mareković I, Frančula-Zaninović S, Krilanović M, Šijak D, Grisold A, Zarfel G. Molecular characterization of class b carbapenemases in advanced stage of dissemination and emergence of class d carbapenemases in Enterobacteriaceae from Croatia. INFECTION GENETICS AND EVOLUTION 2016; 43:74-82. [DOI: 10.1016/j.meegid.2016.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/30/2016] [Accepted: 05/06/2016] [Indexed: 11/26/2022]
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10
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Liu J, Li GM, Lin LY, Wu XL, Huang SL, Zhou Y, Zhao ZG. Association of antibiotic resistance with SHV-12 extended-spectrum β-lactamase in Enterobacter cloacae. Exp Ther Med 2016; 11:269-276. [PMID: 26889253 DOI: 10.3892/etm.2015.2851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 08/06/2015] [Indexed: 11/05/2022] Open
Abstract
The association between antibiotic resistance and SHV-12 extended-spectrum β-lactamase (ESBL) in Enterobacter cloacae remains unknown. The aim of the present study was to investigate the prevalence of both chromosome- and plasmid-borne SHV-12 ESBL genes in Enterobacter cloacae. Transmission of the SHV-12 ESBL gene was explored, and the risk factors for antibiotic resistance in E. cloacae were analyzed. Polymerase chain reaction (PCR) results showed that 58 out of the 100 isolates carried the SHV-12 ESBL gene: 34.48% of them occurred in the chromosome, 48.28% were plasmid-borne and 17.24% appeared in both. Enterobacterial repetitive intergenic consensus-PCR tests detected 82 chromosomal genotypes. Conjugation assays showed that 70.00% of plasmid-borne SHV-12 ESBL genes were successfully transconjugated into E. coli C600 and that the antibiotic resistance phenotype of E. cloacae was partially (84%) or completely (10%) transferred. A significantly higher SHV-12 ESBL detection rate was found in patients with underlying conditions and/or complications compared with those without (P<0.05). The detection of SHV-12 ESBL-producing E. cloacae from vertical transmission varied significantly across clinical departments and age groups (P<0.05), with the highest rates in the intensive care unit and the group of patients aged ≥60 years. The present results indicate that the location and transmission efficiency of SHV-12 ESBL are closely correlated with the antibiotic resistance of E. cloacae.
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Affiliation(s)
- Jun Liu
- Laboratory of Pathogenic Biology, Guangdong Medical College, Zhanjiang, Guangdong 524023, P.R. China
| | - Guo-Ming Li
- Laboratory of Pathogenic Biology, Guangdong Medical College, Zhanjiang, Guangdong 524023, P.R. China
| | - Li-Yao Lin
- Department of Cardiothoracic Surgery, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524000, P.R. China
| | - Xia-Lei Wu
- Intensive Care Unit, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong 524000, P.R. China
| | - Shao-Long Huang
- Department of Experimental Medicine, Taiping People's Hospital of Dongguan, Dongguan, Guangdong 523095, P.R. China
| | - Yong Zhou
- Department of Experimental Medicine, Taiping People's Hospital of Dongguan, Dongguan, Guangdong 523095, P.R. China
| | - Zu-Guo Zhao
- Laboratory of Pathogenic Biology, Guangdong Medical College, Zhanjiang, Guangdong 524023, P.R. China
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11
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Clonal Dissemination of Enterobacter cloacae Harboring blaKPC-3 in the Upper Midwestern United States. Antimicrob Agents Chemother 2015; 59:7723-34. [PMID: 26438492 DOI: 10.1128/aac.01291-15] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/28/2015] [Indexed: 12/15/2022] Open
Abstract
Carbapenemase-producing, carbapenem-resistant Enterobacteriaceae, or CP-CRE, are an emerging threat to human and animal health, because they are resistant to many of the last-line antimicrobials available for disease treatment. Carbapenemase-producing Enterobacter cloacae harboring blaKPC-3 recently was reported in the upper midwestern United States and implicated in a hospital outbreak in Fargo, North Dakota (L. M. Kiedrowski, D. M. Guerrero, F. Perez, R. A. Viau, L. J. Rojas, M. F. Mojica, S. D. Rudin, A. M. Hujer, S. H. Marshall, and R. A. Bonomo, Emerg Infect Dis 20:1583-1585, 2014, http://dx.doi.org/10.3201/eid2009.140344). In early 2009, the Minnesota Department of Health began collecting and screening CP-CRE from patients throughout Minnesota. Here, we analyzed a retrospective group of CP-E. cloacae isolates (n = 34) collected between 2009 and 2013. Whole-genome sequencing and analysis revealed that 32 of the strains were clonal, belonging to the ST171 clonal complex and differing collectively by 211 single-nucleotide polymorphisms, and it revealed a dynamic clone under positive selection. The phylogeography of these strains suggests that this clone existed in eastern North Dakota and western Minnesota prior to 2009 and subsequently was identified in the Minneapolis and St. Paul metropolitan area. All strains harbored identical IncFIA-like plasmids conferring a CP-CRE phenotype and an additional IncX3 plasmid. In a single patient with multiple isolates submitted over several months, we found evidence that these plasmids had transferred from the E. cloacae clone to an Escherichia coli ST131 bacterium, rendering it as a CP-CRE. The spread of this clone throughout the upper midwestern United States is unprecedented for E. cloacae and highlights the importance of continued surveillance to identify such threats to human health.
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Guérin F. Infections à Enterobacter cloacae complex : résistance aux antibiotiques et traitement. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.antinf.2015.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Clonal distribution of multidrug-resistant Enterobacter cloacae. Diagn Microbiol Infect Dis 2015; 81:264-8. [PMID: 25680336 DOI: 10.1016/j.diagmicrobio.2015.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/15/2014] [Accepted: 01/09/2015] [Indexed: 11/22/2022]
Abstract
A multilocus sequence typing (MLST) scheme including 7 housekeeping genes was used to evaluate whether the current spread of multidrug-resistant Enterobacter cloacae isolates worldwide might be associated to specific successful clones. Fifty E. cloacae clinical isolates of worldwide origin, with various β-lactamase content, and recovered at different periods of time were studied. Forty-four sequence types were identified, highlighting a high clonal diversity with 3 main lineages. This study revealed that a precise identification of the isolates by sequencing of the chromosomal ampC gene of E. cloacae would provide a significant added value to improve the reliability of the MLST scheme.
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Lee CS, Doi Y. Therapy of Infections due to Carbapenem-Resistant Gram-Negative Pathogens. Infect Chemother 2014; 46:149-64. [PMID: 25298904 PMCID: PMC4189141 DOI: 10.3947/ic.2014.46.3.149] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 12/31/2022] Open
Abstract
The prevalence of carbapenem-resistant gram-negative bacterial pathogens (CRGNs) has increased dramatically during the last 10 years, but the optimal treatment for CRGN infections is not well established due to the relative scarcity of robust clinical data. The polymyxins remain the most consistently active agents against CRGNs in vitro. Tigecycline, based on its in vitro antibacterial spectrum, could also be considered as a therapeutic option in the treatment of infections caused by certain CRGNs. Other agents, including aminoglycosides, rifampin, trimethoprim-sulfamethoxazole, fosfomycin and fluoroquinolones, could be considered as monotherapy or combination therapy against CRGNs in appropriate contexts, as combination therapy with two or more in vitro active drugs appears to be more effective than monotherapy based on some clinical data. Several promising new agents are in late-stage clinical development, including ceftolozane-tazobactam, ceftazidime-avibactam and plazomicin. Given the shortage of adequate treatment options, containment of CRGNs should be pursued through implementation of adequate infection prevention procedures and antimicrobial stewardship to reduce the disease burden and prevent future outbreaks of CRGNs.
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Affiliation(s)
- Chang-Seop Lee
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. ; Department of Internal Medicine and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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