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Bulens SN, Campbell D, McKay SL, Vlachos N, Burgin A, Burroughs M, Padila J, Grass JE, Jacob JT, Smith G, Muleta DB, Maloney M, Macierowski B, Wilson LE, Vaeth E, Lynfield R, O'Malley S, Snippes Vagnone PM, Dale J, Janelle SJ, Czaja CA, Johnson H, Phipps EC, Flores KG, Dumyati G, Tsay R, Beldavs ZG, Maureen Cassidy P, Hall A, Walters MS, Guh AY, Magill SS, Lutgring JD. Carbapenem-resistant Acinetobacter baumannii complex in the United States-An epidemiological and molecular description of isolates collected through the Emerging Infections Program, 2019. Am J Infect Control 2024; 52:1035-1042. [PMID: 38692307 DOI: 10.1016/j.ajic.2024.04.184] [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: 12/29/2023] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Understanding the epidemiology of carbapenem-resistant A. baumannii complex (CRAB) and the patients impacted is an important step toward informing better infection prevention and control practices and improving public health response. METHODS Active, population-based surveillance was conducted for CRAB in 9 U.S. sites from January 1 to December 31, 2019. Medical records were reviewed, isolates were collected and characterized including antimicrobial susceptibility testing and whole genome sequencing. RESULTS Among 136 incident cases in 2019, 66 isolates were collected and characterized; 56.5% were from cases who were male, 54.5% were from persons of Black or African American race with non-Hispanic ethnicity, and the median age was 63.5 years. Most isolates, 77.2%, were isolated from urine, and 50.0% were collected in the outpatient setting; 72.7% of isolates harbored an acquired carbapenemase gene (aCP), predominantly blaOXA-23 or blaOXA-24/40; however, an isolate with blaNDM was identified. The antimicrobial agent with the most in vitro activity was cefiderocol (96.9% of isolates were susceptible). CONCLUSIONS Our surveillance found that CRAB isolates in the U.S. commonly harbor an aCP, have an antimicrobial susceptibility profile that is defined as difficult-to-treat resistance, and epidemiologically are similar regardless of the presence of an aCP.
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Affiliation(s)
| | | | | | | | - Alex Burgin
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Jesse T Jacob
- Georgia Emerging Infections Program, Decatur, GA; Emory University School of Medicine, Atlanta, GA
| | - Gillian Smith
- Georgia Emerging Infections Program, Decatur, GA; Emory University School of Medicine, Atlanta, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA
| | | | | | | | - Lucy E Wilson
- Maryland Department of Health, Baltimore, MD; University of Maryland Baltimore County, Baltimore, MD
| | | | | | | | | | | | - Sarah J Janelle
- Colorado Department of Public Health and Environment, Denver, CO
| | | | - Helen Johnson
- Colorado Department of Public Health and Environment, Denver, CO
| | - Erin C Phipps
- University of New Mexico, Albuquerque, NM; New Mexico Emerging Infections Program, Santa Fe, NM
| | - Kristina G Flores
- University of New Mexico, Albuquerque, NM; New Mexico Emerging Infections Program, Santa Fe, NM
| | | | - Rebecca Tsay
- University of Rochester Medical Center, Rochester, NY
| | | | | | - Amanda Hall
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Alice Y Guh
- Centers for Disease Control and Prevention, Atlanta, GA
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Multidrug-Resistant Bacteria in a COVID-19 Hospital in Zagreb. Pathogens 2023; 12:pathogens12010117. [PMID: 36678465 PMCID: PMC9863123 DOI: 10.3390/pathogens12010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
During November to December 2020, a high rate of COVID-19-associated pneumonia with bacterial superinfections due to multidrug-resistant (MDR) pathogens was recorded in a COVID-19 hospital in Zagreb. This study analyzed the causative agents of bacterial superinfections among patients with serious forms of COVID-19. In total, 118 patients were hospitalized in the intensive care unit (ICU) of the COVID-19 hospital. Forty-six out of 118 patients (39%) developed serious bacterial infection (VAP or BSI or both) during their stay in ICU. The total mortality rate was 83/118 (70%). The mortality rate due to bacterial infection or a combination of ARDS with bacterial superinfection was 33% (40/118). Six patients had MDR organisms and 34 had XDR (extensively drug-resistant). The dominant species was Acinetobacter baumannii with all isolates (34) being carbapenem-resistant (CRAB) and positive for carbapenem-hydrolyzing oxacillinases (CHDL). One Escherichia coli causing pneumonia harboured the blaCTX-M-15 gene. It appears that the dominant resistance determinants of causative agents depend on the local epidemiology in the particular COVID center. Acinetobacter baumannii seems to easily spread in overcrowded ICUs. Croatia belongs to the 15 countries in the world with the highest mortality rate among COVID-19 patients, which could be in part attributable to the high prevalence of bacterial infections in local ICUs.
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Cruz-López F, Martínez-Meléndez A, Villarreal-Treviño L, Morfín-Otero R, Maldonado-Garza H, Garza-González E. Contamination of healthcare environment by carbapenem-resistant Acinetobacter baumannii. Am J Med Sci 2022; 364:685-694. [PMID: 35853519 DOI: 10.1016/j.amjms.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 06/12/2022] [Accepted: 07/12/2022] [Indexed: 01/25/2023]
Abstract
Acinetobacter baumannii is frequently found on floors, devices, and environmental sites in hospitals and can survive for prolonged periods and accumulate resistance determinants. The infection and presence of carbapenem-resistant A. baumannii (CRAB) in patients is associated with increased mortality, severe clinical outcomes, and longer lengths of stay at hospitals. This review addresses contamination by CRAB in corporal surfaces of patients and healthcare workers and environmental sites at healthcare-related settings. We summarized published data during the last decade on potential reservoirs for CRAB, including contamination frequency and the involved resistance mechanisms, and some measures associated with the elimination of CRAB from hospital surfaces.
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Affiliation(s)
- Flora Cruz-López
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, México
| | - Adrián Martínez-Meléndez
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, México
| | - Licet Villarreal-Treviño
- Departamento de Microbiología e Inmunología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, México
| | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara 'Fray Antonio Alcalde', e Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Héctor Maldonado-Garza
- Facultad de Medicina y Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, México
| | - Elvira Garza-González
- Facultad de Medicina y Hospital Universitario 'Dr. José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, México.
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4
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Complete Genome Sequence of an Enterobacter roggenkampii Strain with Reduced Carbapenem Susceptibility Isolated from a Home-Visit Nursing Agency. Microbiol Resour Announc 2022; 11:e0035322. [PMID: 35972254 PMCID: PMC9476973 DOI: 10.1128/mra.00353-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbapenem-resistant bacteria represent an emerging threat to global health; nursing homes may be reservoirs for these isolates, which cause life-threatening infections. Here, we present the complete genome sequence of an Enterobacter roggenkampii strain with reduced carbapenem susceptibility that was isolated from a sink in a home-visit nursing agency.
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5
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Gheorghe-Barbu I, Barbu IC, Popa LI, Pîrcălăbioru GG, Popa M, Măruțescu L, Niță-Lazar M, Banciu A, Stoica C, Gheorghe Ș, Lucaciu I, Săndulescu O, Paraschiv S, Surleac M, Talapan D, Muntean AA, Preda M, Muntean MM, Dragomirescu CC, Popa MI, Oțelea D, Chifiriuc MC. Temporo-spatial variations in resistance determinants and clonality of Acinetobacter baumannii and Pseudomonas aeruginosa strains from Romanian hospitals and wastewaters. Antimicrob Resist Infect Control 2022; 11:115. [PMID: 36104761 PMCID: PMC9476303 DOI: 10.1186/s13756-022-01156-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Romania is one of the European countries reporting very high antimicrobial resistance (AMR) rates and consumption of antimicrobials. We aimed to characterize the AMR profiles and clonality of 304 multi-drug resistant (MDR) Acinetobacter baumannii (Ab) and Pseudomonas aeruginosa (Pa) strains isolated during two consecutive years (2018 and 2019) from hospital settings, hospital collecting sewage tanks and the receiving wastewater treatment plants (WWTPs) located in the main geographical regions of Romania. Methods The strains were isolated on chromogenic media and identified by MALDI-TOF-MS. Antibiotic susceptibility testing and confirmation of ESBL- and CP- producing phenotypes and genotypes were performed. The genetic characterization also included horizontal gene transfer experiments, whole-genome sequencing (WGS), assembling, annotation and characterization.
Results Both clinical and aquatic isolates exhibited high MDR rates, especially the Ab strains isolated from nosocomial infections and hospital effluents. The phenotypic resistance profiles and MDR rates have largely varied by sampling point and geographic location. The highest MDR rates in the aquatic isolates were recorded in Galați WWTP, followed by Bucharest. The Ab strains harbored mostly blaOXA-23, blaOXA-24, blaSHV, blaTEM and blaGES, while Pa strains blaIMP, blaVIM, blaNDM, blaVEB, blaGES and blaTEM, with high variations depending on the geographical zone and the sampling point. The WGS analysis revealed the presence of antibiotic resistance genes (ARGs) to other antibiotic classes, such as aminoglycosides, tetracyclines, sulphonamides, fosfomycin, phenicols, trimethoprim-sulfamethoxazole as well as class 1 integrons. The molecular analyses highlighted: (i) The presence of epidemic clones such as ST2 for Ab and ST233 and ST357 for Pa; (ii) The relatedness between clinical and hospital wastewater strains and (iii) The possible dissemination of clinical Ab belonging to ST2 (also proved in the conjugation assays for blaOXA-23 or blaOXA-72 genes), ST79 and ST492 and of Pa strains belonging to ST357, ST640 and ST621 in the wastewaters. Conclusion Our study reveals the presence of CP-producing Ab and Pa in all sampling points and the clonal dissemination of clinical Ab ST2 strains in the wastewaters. The prevalent clones were correlated with the presence of class 1 integrons, suggesting that these isolates could be a significant reservoir of ARGs, being able to persist in the environment. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01156-1.
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6
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Hubeny J, Korzeniewska E, Buta-Hubeny M, Zieliński W, Rolbiecki D, Harnisz M. Characterization of carbapenem resistance in environmental samples and Acinetobacter spp. isolates from wastewater and river water in Poland. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 822:153437. [PMID: 35122847 DOI: 10.1016/j.scitotenv.2022.153437] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 05/29/2023]
Abstract
The aim of this study was to analyze the prevalence of carbapenem resistance genes in Acinetobacter spp. isolated from wastewater in a municipal WWTP and to determine their spread from treated wastewater to river water with the use of conventional and molecular microbiology methods (qualitative and quantitative PCR and metagenomic analysis). Samples of untreated and treated wastewater and samples of river water obtained upstream and downstream from the wastewater discharge point were collected in 3 seasons (February, June, and September) of 2019. Acinetobacter spp. isolates were obtained by the culture method on the CHROMagar™ Acinetobacter medium. Additionally, environmental DNA was extracted from the samples for metagenomic and qPCR analyses. The presence of beta-lactam resistance genes (Ambler class B and D), insertion sequence ISAba1, and class I, II, and III integron-integrase genes was determined, and the bacterial taxonomic structure and wastewater and river samples was analyzed. Out of the 301 isolates obtained on the CHROMagar™ Acinetobacter medium, 258 belonged to the genus Acinetobacter, including 21 isolates that were identified as Acinetobacter baumannii. The highest number of Acinetobacter spp. and A. baumannii isolates were obtained from wastewater and river water samples collected in June and September. The ISAba1/blaOXA-51 complex was identified in 13 isolates, which confirms the occurrence of carbapenem-resistance isolates in the analyzed samples. The number of Acinetobacter isolates carrying antibiotic resistance genes (ARGs) increased in river water samples collected downstream from the wastewater discharge point (48 out of 258 isolates - 18.6%) compared to river water samples collected upstream from the wastewater discharge point (34 out of 258 isolates - 13.2%), which suggests that WWTP is a source of pollution in the natural environment. The conducted research provides evidence that bacteria of the genus Acinetobacter may spread alarming beta-lactam resistance in the environment and, therefore, pose a serious epidemiological threat.
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Affiliation(s)
- Jakub Hubeny
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland
| | - Ewa Korzeniewska
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland
| | - Martyna Buta-Hubeny
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland
| | - Wiktor Zieliński
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland
| | - Damian Rolbiecki
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland
| | - Monika Harnisz
- Department of Water Protection Engineering and Environmental Microbiology, Faculty of Geoengineering, University of Warmia and Mazury in Olsztyn, Prawocheńskiego 1, 10-720 Olsztyn, Poland.
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7
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Mapipa Q, Digban TO, Nnolim NE, Nontongana N, Okoh AI, Nwodo UU. Molecular Characterization and Antibiotic Susceptibility Profile of Acinetobacter baumannii Recovered from Hospital Wastewater Effluents. Curr Microbiol 2022; 79:123. [PMID: 35258680 DOI: 10.1007/s00284-022-02815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
Acinetobacter baumannii (A. baumannii) plays a significant part in nosocomial infections world over and is re-emerging as a formidable pathogen due to the wide range of antibiotic resistance factors it acquires and environmental resilience. The high attendance of patients (outpatients and inpatients) into the health care facilities formed the basis for the selection of the hospitals. Consequently, this study profiled the antibiogram and antibiotic resistance genes of A. baumannii isolated from selected hospital wastewater effluents. A total of twenty-four (24) wastewater samples from three selected hospital drainages were collected and analysed presumptively by culture-dependent methods for A. baumannii. The identity confirmation of A. baumannii was done by the amplification of recA and blaoxa-51 genes. Virulence and antibiotic resistance markers were assessed using polymerase chain reaction. A total of 53 A. baumannii isolates were confirmed and the highest antibiotic resistance profile was 93% (piperacillin). Multiple antibiotic resistance index (MARI) showed a range of 0.23 and 0.46. FimH virulence gene was detected in 29 (55%) of the isolates. Tetracycline and beta-lactam resistance markers were found; 70% and 92% of the isolates possessed tetA and ampC genes. The isolates showed high level of resistance to antibiotics. The multiple antibiotic resistance index (MARI) of ≥ 0.2 indicates that some of the isolates harbour virulence and resistance traits emerging from high-risk source thereby projecting a threat to public health.
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Affiliation(s)
- Qaqamba Mapipa
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa
| | - Tennison Onoriode Digban
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa
| | - Nonso Emmanuel Nnolim
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa
| | - Nolonwabo Nontongana
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa
| | - Anthony Ifeanyi Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa
- Department of Environmental Health Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Uchechukwu U Nwodo
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice, 5700, South Africa.
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa.
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8
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Bratić V, Mihaljević S, Verzak Ž, Pleško E, Lukić A, Ćaćić M, Bedenić B. Prophylactic application of antibiotics selects extended-spectrum β-lactamase and carbapenemases producing Gram-negative bacteria in the oral cavity. Lett Appl Microbiol 2021; 73:206-219. [PMID: 33896011 DOI: 10.1111/lam.13493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022]
Abstract
Prophylactic administration of broad-spectrum antibiotics in surgery can change the oral microbiome and induce colonization of oral cavity with Gram-negative bacteria including multidrug (MDR) or extensively drug resistant (XDR) organisms which can lead to lower respiratory tract infections. The aim of the study was to analyse the Gram-negative isolates obtained from oral cavity of the mechanically ventilated patients in ICUs, after prophylactic application of antibiotics and their resistance mechanisms and to compare them with the isolates obtained from tracheal aspirates from the same patients. The antibiotic susceptibility was determined by broth dilution method. PCR was applied to detect genes encoding β-lactamases. Marked diversity of Gram-negative bacteria and resistance mechanisms was found. High resistance rates and high rate of blaCTX-M and carbapenemase encoding genes (blaVIM-1 , blaOXA-48 ) were found among Klebsiella pneumoniae. Pseudomonas aeruginosa was found to harbour blaVIM and in one strain blaPER-1 gene, whereas Acinetobacter baumannii produced OXA-23-like and OXA-24/40-like oxacillinases and was XDR in all except one case. All XDR isolates belong to international clonal lineage II (IC II). The main finding of the study is that the prophlylactic application of antibiotics in surgery intensive care units (ICUs) is associated with the colonization of oral cavity and lower respiratory tract with Gram-negative bacteria. The identity of Gram-negative bacteria in oral cavity reflected those found in endotracheal aspirates leading to conclusion that oral swab as non-invasive specimen can predict the colonization of lower respiratory tract with resistant Gram-negative organisms and the risk for development of ventilator-associated pneumonia.
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Affiliation(s)
- V Bratić
- University Hospital Center Zagreb, Zagreb, Croatia
| | - S Mihaljević
- University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, University Hospital Center, Zagreb, Croatia
| | - Ž Verzak
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - E Pleško
- School of Medicine, University of Zagreb, University Hospital Center, Zagreb, Croatia
| | - A Lukić
- Varaždin General Hospital, Varaždin, Croatia
| | - M Ćaćić
- Campus Bad Neustadt, Neustadt, Germany
| | - B Bedenić
- University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, University Hospital Center, Zagreb, Croatia
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9
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Grisold AJ, Luxner J, Bedenić B, Diab-Elschahawi M, Berktold M, Wechsler-Fördös A, Zarfel GE. Diversity of Oxacillinases and Sequence Types in Carbapenem-Resistant Acinetobacter baumannii from Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042171. [PMID: 33672170 PMCID: PMC7926329 DOI: 10.3390/ijerph18042171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii is a significant health problem worldwide. A multicenter study on A. baumannii was performed to investigate the molecular epidemiology and genetic background of carbapenem resistance of A. baumannii isolates collected from 2014–2017 in Austria. In total, 117 non-repetitive Acinetobacter spp. assigned to A. baumannii (n = 114) and A. pittii (n = 3) were collected from four centers in Austria. The isolates were uniformly resistant to piperacillin/tazobactam, ceftazidime, and carbapenems, and resistance to imipenem and meropenem was 97.4% and 98.2%, respectively. The most prominent OXA-types were OXA-58-like (46.5%) and OXA-23-like (41.2%), followed by OXA-24-like (10.5%), with notable regional differences. Carbapenem-hydrolyzing class D carbapenemases (CHDLs) were the only carbapenemases found in A.baumannii isolates in Austria since no metallo-β-lactamases (MBLs) nor KPC or GES carbapenemases were detected in any of the isolates. One-third of the isolates harbored multiple CHDLs. The population structure of A. baumannii isolates from Austria was found to be very diverse, while a total of twenty-three different sequence types (STs) were identified. The most frequent was ST195 found in 15.8%, followed by ST218 and ST231 equally found in 11.4% of isolates. Two new ST types, ST2025 and ST2026, were detected. In one A. pittii isolate, blaOXA-143-like was detected for the first time in Austria.
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Affiliation(s)
- Andrea J. Grisold
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
- Correspondence: ; Tel.: +43-316-385-73630
| | - Josefa Luxner
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
| | - Branka Bedenić
- Department of Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Michael Berktold
- Institute of Hygiene and Microbiology, Medical University Innsbruck, Schöpfstrasse 41, A-6020 Innsbruck, Austria;
| | | | - Gernot E. Zarfel
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
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10
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Bandić-Pavlović D, Zah-Bogović T, Žižek M, Bielen L, Bratić V, Hrabač P, Slačanac D, Mihaljević S, Bedenić B. Gram-negative bacteria as causative agents of ventilator-associated pneumonia and their respective resistance mechanisms. J Chemother 2020; 32:344-358. [PMID: 32729399 DOI: 10.1080/1120009x.2020.1793594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ventilator-associated pneumonia (VAP) is a serious and common complication in patients admitted to intensive care unit (ICU) and contributes to mortality. Multidrug Gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae are frequently associated with VAP in ICU. A prospective study was set up in three ICUs of the University Hospital Center Zagreb and one ICU in General Hospital Pula from September 2017 to March 2018. Antibiotic susceptibility was determined by broth microdilution method. Production of extended-spectrum β-lactamases (ESBLs) was determined by double-disk synergy test and carbapenemases by Hodge and carbapenem inactivation method (CIM). The genes encoding ESBLs, carbapenemases of class A, B and D and qnr genes were determined by PCR. In total 97 Gram-negative bacteria isolates were analyzed. P. aeruginosa demonstrated high resistance rates for imipenem and meropenem with 74% and 68% of resistant strains, respectively. Moderate resistance rates were observed for ceftazidime andpiperacillin/tazobactam, ciprofloxacin and gentamicin (44%). All except three A. baumannii isolates, were resistant to carbapenems and to all other antibiotics apart from colistin and amikacin. Eight A. baumannii isolates were positive for blaOXA-23 and 12 for blaOXA-24 genes. Four K. pneumoniae and two E. cloacae strains were ESBL positive and harboured group 1 of CTX-M β-lactamases. Three P. mirabilis strains were positive for plasmid-mediated ampC β-lactamase of CMY family. Two carbapenem-resistant K. pneumoniae harboured OXA-48 and one carbapenem-resistant E. cloacae VIM-1. A high proportion of multidrug-resistant P. aeruginosa, K. pneumoniae and extensively resistant A. baumannii was reported. Acquired resistance mechanisms, mainly production of carbapenemases and ESBLs were dominant in A. baumannii and K. pneumoniae, respectively. Resistance of P. aeruginosa isolates was more likely due to upregulation of efflux pumps or porin loss. A marked diversity of β-lactamases was identified in Enterobacteriaceae.
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Affiliation(s)
- Daniela Bandić-Pavlović
- Department of Anesthesiology, School of Medicine, University of Zagreb, Zagreb, Croatia.,Clinic for Anesthesiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Tajana Zah-Bogović
- Department of Anesthesiology, School of Medicine, University of Zagreb, Zagreb, Croatia.,Clinic for Anesthesiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marta Žižek
- Faculty of Sciences, University of Zagreb, Zagreb, Croatia
| | - Luka Bielen
- Department of Internal Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Internal Medicine, Intensive Care Unit, University Hospital Center Zagreb, Zagreb, Croatia
| | - Vesna Bratić
- Clinic for Anesthesiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Pero Hrabač
- Department of Informatics, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Domagoj Slačanac
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Slobodan Mihaljević
- Department of Anesthesiology, School of Medicine, University of Zagreb, Zagreb, Croatia.,Clinic for Anesthesiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Branka Bedenić
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia.,Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia
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11
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Jakovac S, Goić-Barišić I, Pirija M, Kovačić A, Hrenović J, Petrović T, Tutiš B, Tonkić M. Molecular Characterization and Survival of Carbapenem-Resistant Acinetobacter baumannii Isolated from Hospitalized Patients in Mostar, Bosnia and Herzegovina. Microb Drug Resist 2020; 27:383-390. [PMID: 32721271 DOI: 10.1089/mdr.2020.0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Increasingly difficult treatment of multidrug-resistant (MDR) bacteria has become a global problem of the 21st century. Within a group of multiresistant bacteria, the Acinetobacter baumannii convincingly occupies the position at the top of the group designated as ESKAPE pathogens. In this study, 61 isolates of A. baumannii were recovered from different samples originating from various departments of the University Clinical Hospital Mostar during 2018. All of the isolates were identified using conventional phenotypic methods and the VITEK® 2 Compact System, and were confirmed by MALDI-TOF mass spectrometry. The minimum inhibitory concentrations (MICs) were determined by the microbroth dilution method using MICRONAUT-S MDR MRGN-Screening and VITEK 2 Compact System. All strains were resistant to carbapenems and classified in eight different resistotypes according to their antibiotic resistance and macrorestriction pulsed-field gel electrophoresis profiles, with all belonging to IC II. One isolate displayed resistance to colistin (MIC ≥16 mg/L). The presence of blaOXA genes encoding OXA-type carbapenemases was investigated by multiplex PCR and the Eazyplex® SuperBugAcineto system and showed 100% compatibility with the detection of acquired oxacillinases. Molecular characterization of the isolates tested in this study revealed the OXA-23- and OXA-40-like groups of acquired oxacillinases. Sequencing of two PCR products of the OXA-40-like group confirmed the presence of OXA-72. Survival assays with two selected isolates of A. baumannii encoding different mechanisms of carbapenem resistance revealed that one isolate was able to survive on a fragment of white laboratory coat during 90 days of monitoring. To the best of our knowledge, this is the first article to present the results of a comprehensive phenotypic, genotypic, and molecular analysis of A. baumannii isolates from the leading clinical hospital center in the southwestern part of Bosnia and Herzegovina, including data for the survival of this pathogen on the white laboratory coats used as compulsory medical clothing.
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Affiliation(s)
- Sanja Jakovac
- Institute for Microbiological Diagnostics, University Clinical Hospital Mostar and School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ivana Goić-Barišić
- University Hospital of Split and University of Split School of Medicine, Split, Croatia
| | - Mario Pirija
- Department of Clinical Microbiology, University Hospital of Split, Split, Croatia
| | - Ana Kovačić
- Institute of Public Health of Split and Dalmatia Country, Split, Croatia
| | - Jasna Hrenović
- Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Tanja Petrović
- Institute for Microbiological Diagnostics, University Clinical Hospital Mostar and School of Medicine University of Mostar, Mostar, Bosnia and Herzegovina
| | - Borka Tutiš
- University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Marija Tonkić
- University Hospital of Split and University of Split School of Medicine, Split, Croatia
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12
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Takito S, Kusama Y, Fukuda H, Kutsuna S. Pharmacist-supported antimicrobial stewardship in a retirement home. J Infect Chemother 2020; 26:858-861. [PMID: 32360135 DOI: 10.1016/j.jiac.2020.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/21/2020] [Accepted: 04/09/2020] [Indexed: 02/09/2023]
Abstract
In an 80-bed fee-based retirement home with nursing care, the dispatched-pharmacist has provided prescription recommendations to visiting physicians based on pathogen identification using Gram staining as part of an antimicrobial stewardship program. Thus, we evaluated the effects of pharmacist-supported antimicrobial stewardship. We calculated the total number of all antimicrobials and macrolides, fluoroquinolones, and cephalosporins prescriptions per 100 residents per month at the retirement home from January 2013 to December 2017. Using log-transformed monthly resident numbers with an offset before and after the intervention, we performed Poisson regression analyses that adjusted for monthly mean age. Interrupted time series analyses (ITSA) were conducted to examine the changes in the incidence rate ratios for the baseline and slope before and after the intervention. The total number of all antimicrobial prescriptions per 100 residents per month from 2013 to 2017 was 14.10, 18.51, 10.59, 5.41, and 3.90, respectively. Although there was a significant pre-intervention increase in the total number of all antimicrobial prescriptions, the intervention was followed by a significant decrease. There was also a significant reduction in the slope. ITSA of the changes in the prescription of macrolides and fluoroquinolones showed that there were significant pre-intervention increase and followed by a significant post-intervention decrease in the slope. There was no significant change in cephalosporin prescriptions by the intervention. Our study shows that pharmacist-supported AS can reduce antimicrobial prescriptions in a retirement home. Nevertheless, further studies are needed to collect and analyse more data on similar interventions.
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Affiliation(s)
- Shigemichi Takito
- Konomi Pharmacy, Higashi-Osone-tyo, Higashi-ku, Nagoya, Aichi, 461-0022, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 1-1-3, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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13
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Lukić-Grlić A, Kos M, Žižek M, Luxner J, Grisold A, Zarfel G, Bedenić B. Emergence of Carbapenem-Hydrolyzing Oxacillinases in Acinetobacter baumannii in Children from Croatia. Chemotherapy 2019; 64:167-172. [PMID: 31707391 DOI: 10.1159/000503746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Carbapenem resistance in Acinetobacter baumannii can be mediated by carbapenemases of class A, class B metallo-β-lactamases (MBLs), and class D carbapenem-hydrolyzing oxacillinases (CHDL). The aim of the study was to investigate the antimicrobial susceptibility and β-lactamase production of carbapenem-resistant A. baumannii isolates (CRAB) from the Children's Hospital Zagreb, Croatia. METHODS A total of 12 A. baumannii isolates collected between August 2016 and March 2018 were analyzed. Antibiotic susceptibility was determined by the broth microdilution method. The presence of MBLs was explored by combined disk test with EDTA. The presence of carbapenemases of class A, B, and D was explored by PCR. The occurrence of the ISAba1 upstream of the blaOXA-51-like or blaOXA-23-like was determined by PCR mapping. Epidemiological typing was performed by determination of sequence groups (SG). Genotyping was performed by SG determination, rep-PCR, and MLST. RESULTS All CRAB were resistant to piperacillin/tazobactam, ceftazidime, cefotaxime, ceftriaxone, cefepime, imipenem, meropenem, gentamicin, and ciprofloxacin. Moderate resistance rates were observed for ampicillin/sulbactam (67%) and tigecycline (42%). The isolates were uniformly susceptible to colistin. PCR revealed the presence of genes encoding OXA-24-like CHDL in nine and OXA-23-like CHDL in three isolates. blaOXA-51 genes were preceded by ISAba1. PCR for the common MBLs in Acinetobacter was negative. All isolates belonged to SG 1 corresponding to ICL (International Clonal Lineage) II. Rep-PCR identified four major clones. CONCLUSIONS The study found OXA-24-like β-lactamase to be the dominant CHDL among children'sCRAB. The predominant spread of OXA-24-like is in contrast with the recent global dissemination of OXA-23 reported all over the world. In contrast to the previous studies in which emergency of OXA-24-like positive isolates was monoclonal, we found considerable genetic diversity of the isolates.
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Affiliation(s)
- Amarela Lukić-Grlić
- School of Medicine, University of Zagreb, Zagreb, Croatia, .,Children's Hospital Zagreb, Zagreb, Croatia,
| | - Matea Kos
- Children's Hospital Zagreb, Zagreb, Croatia
| | - Marta Žižek
- Faculty of Health Sciences, University of Zagreb, Zagreb, Croatia
| | - Josefa Luxner
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Grisold
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gernot Zarfel
- Institute of Microbiology, Hygiene and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Branka Bedenić
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital Center, Zagreb, Croatia
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14
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Bedenić B, Siroglavić M, Slade M, Šijak D, Dekić S, Musić MŠ, Godan-Hauptman A, Hrenović J. Comparison of clinical and sewage isolates of Acinetobacter baumannii from two long-term care facilities in Zagreb; mechanisms and routes of spread. Arch Microbiol 2019; 202:361-368. [DOI: 10.1007/s00203-019-01750-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022]
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15
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Kuil SD, Hidad S, Fischer JC, Harting J, Hertogh CM, Prins JM, van Leth F, de Jong MD, Schneeberger C. Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol. BMJ Open 2019; 9:e031269. [PMID: 31401614 PMCID: PMC6701568 DOI: 10.1136/bmjopen-2019-031269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Suspected urinary tract infection (UTI) ranks among the most common reasons for antibiotic use in nursing homes. However, diagnosing UTI in this setting is challenging because UTI often presents with non-specific symptomatology. Moreover asymptomatic bacteriuria is common in elderly, which complicates attribution of causality to detection of bacteria in urine. These diagnostic challenges contribute to overuse of antibiotics and emergence of antimicrobial resistance in nursing homes. Given the diagnostic challenges, there is a need for point-of-care (POC) diagnostic tests to support clinical rules for diagnosing UTI. Procalcitonin (PCT) and C reactive protein (CRP) are inflammatory blood markers that have been proven useful to support diagnosis and monitoring of (bacterial) respiratory tract infections and sepsis. While limited studies suggest their usefulness in supporting UTI diagnosis, their utility has not been studied in elderly populations for this purpose. METHODS AND ANALYSIS In a 24-month matched prospective study, 'PROGRESS' will assess and compare the sensitivity of rapid POC measurements of blood CRP and PCT levels to support clinical rules for diagnosing UTI in nursing home residents. The primary outcome measure is sensitivity of the POC tests to identify patients with true UTI based on the predefined definition, as derived from receiver operating curves. ETHICS AND DISSEMINATION This study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The study protocol is approved by the Medical Ethical Committee of Amsterdam UMC location VUmc with reference number 2017.350 and National Central Committee on Research involving Human Subjects with reference number NL62067.029.17. TRIAL REGISTRATION NUMBER NTR6467.
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Affiliation(s)
- Sacha D Kuil
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Soemeja Hidad
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Johan C Fischer
- Clinical Chemistry, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke Harting
- Public Health, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Cees Mpm Hertogh
- General Practice and Elderly Care Medicine, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Internal Medicine, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Menno D de Jong
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline Schneeberger
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
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16
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Bedenić B, Ladavac R, Vranić-Ladavac M, Barišić N, Karčić N, Sreter KB, Mihaljević S, Bielen L, Car H, Beader N. FALSE POSITIVE PHENOTYPIC DETECTION OF METALLO-BETA-LACTAMASES IN ACINETOBACTER BAUMANNII. Acta Clin Croat 2019; 58:113-118. [PMID: 31363333 PMCID: PMC6629212 DOI: 10.20471/acc.2019.58.01.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Phenotypic detection of metallo-β-lactamases (MBLs) in Acinetobacter (A.) baumannii is a serious challenge to clinical microbiologists. MBLs are inhibited by metal chelators such as ethylenediaminetetraacetic acid) (EDTA). Production of MBLs cannot be recognized based on resistance phenotype. Therefore, phenotypic tests using EDTA are recommended. The aim of this study was to investigate the sensitivity and specificity of inhibitor based tests (EDTA) for detection of MBL. A total of 172 A. baumannii strains (123 carbapenemase positive and 49 carbapenemase negative) were analyzed. Phenotypic detection of MBLs was performed by the combined disk test with EDTA (CDT-EDTA) and EPI-dilution test (EPI-DT). Both tests were positive in all 11 isolates possessing VIM-1 MBL, showing 100% sensitivity. However, false positive results were observed in strains with class D carbapenemases using both tests, i.e. all OXA-23 and OXA-24/40 producing organisms and most OXA-58 positive strains (77% with CDT-EDTA vs. 65% with EPI-DT). False positive results can occur because oxacillinases are converted to a less active state in the presence of EDTA, leading to augmentation of the inhibition zone around the carbapenem disk or reduction of carbapenem minimum inhibitory concentrations. This study showed high sensitivity but low specificity of phenotypic methods in the detection of MBLs.
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Affiliation(s)
| | - Ranko Ladavac
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Mirna Vranić-Ladavac
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Nada Barišić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Natalie Karčić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Katherina Bernadette Sreter
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Slobodan Mihaljević
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Luka Bielen
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Haris Car
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
| | - Nataša Beader
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Nephrology, Pula General Hospital, Pula, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Anesthesiology, Zagreb University Hospital Centre, Zagreb, Croatia; 7Department of Internal Medicine, Zagreb University Hospital Centre, Zagreb, Croatia; 8Zagreb Secondary Medical School, Zagreb, Croatia
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17
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Bedenić B, Cavrić G, Vranić-Ladavac M, Barišić N, Karčić N, Tot T, Presečki-Stanko A, Lukić-Grlić A, Frančula-Zaninović S, Sreter KB. COMPARISON OF TWO DIFFERENT METHODS FOR TIGECYCLINE SUSCEPTIBILITY TESTING IN ACINETOBACTER BAUMANNII. Acta Clin Croat 2018; 57:618-623. [PMID: 31168197 PMCID: PMC6544113 DOI: 10.20471/acc.2018.57.04.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – Tigecycline susceptibility testing (TST) presents a tremendous challenge for clinical microbiologists. Previous studies have shown that the Epsilometer test (E-test) and Vitek 2 automated system significantly overestimate the minimum inhibitory concentrations for tigecycline resistance compared to the broth microdilution method (BMM). This leads to very major errors or false susceptibility (i.e. the isolate is called susceptible when it is actually resistant). The aim of this study was to compare E-test against BMM for TST in carbapenem-resistant and carbapenem-susceptible Acinetobacter (A.) baumannii and to analyze changes in tigecycline susceptibility between two time periods (2009-2012 and 2013-2014), with BMM as the gold standard. Using the EUCAST criteria, the rate of resistance to tigecycline for the OXA-23 MBL-positive, OXA-23 MBL-negative and carbapenemase-negative strains for BMM was 54.5% (6/11), 29.4% (5/17) and 2.7% (1/37), respectively; the OXA-24/40 and OXA-58 producing organisms did not exhibit any resistance. With E-test, all OXA-23 MBL-positive organisms (11/11), 23.5% (4/17) of OXA-23 MBL-negative, and 4.1% of OXA-24/40 (3/74) strains displayed tigecycline resistance; there were no resistant strains among the OXA-58 and carbapenemase-negative isolates. Resistance emerged in the bacterial isolates from 2013 to 2014. Although tigecycline does not display cross-resistance, the highest rates of resistant A. baumannii isolates were observed among those producing VIM MBL, regardless of the testing method. These findings suggest that the commercial E-test does not provide reliable results for TST of A. baumannii. Further confirmation with the dilution method should be recommended, particularly in cases of serious infections.
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Affiliation(s)
- Branka Bedenić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Gordana Cavrić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Mirna Vranić-Ladavac
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Nada Barišić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Natalie Karčić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Tatjana Tot
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Aleksandra Presečki-Stanko
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Amarela Lukić-Grlić
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Sonja Frančula-Zaninović
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Katherina Bernadette Sreter
- 1Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; 2Department of Clinical and Molecular Microbiology, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Intensive Care, Merkur University Hospital, Zagreb, Croatia; 4Department of Microbiology, Public Health Institute of Istria County, Pula, Croatia; 5Department of Microbiology, Karlovac General Hospital, Karlovac, Croatia; 6Department of Clinical Microbiology, Zagreb Children's Hospital, Zagreb, Croatia; 7Zagreb Health Centre, Zagreb, Croatia; 8Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
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Liu CY, Lai CC, Chiang HT, Lu MC, Wang LF, Tsai TL, Kang MY, Jan YN, Lo YT, Ko WC, Tseng SH, Lee CM, Hsueh PR. Predominance of methicillin-resistant Staphylococcus aureus in the residents and environments of long-term care facilities in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018. [PMID: 29530709 DOI: 10.1016/j.jmii.2018.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE This study investigated the distribution and persistence of multidrug resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and multidrug-resistant Acinetobacter baumannii (MDRAB) in six long-term care facilities (LTCFs). METHODS We investigated the distribution of MDROs in residents of six LTCFs and their environments from January to December 2016 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples from the residents every three months. Multilocus sequence typing (MLST) was conducted, and genes for panton-valentine leukocidin (PVL) from MRSA isolates were determined. RESULTS A total of 521 samples were positive for MDROs, and MRSA was the most common organism (65.1%), followed by MDRAB (11.3%), carbapenem-resistant Klebsiella pneumoniae (11.1%), carbapenem-resistant Escherichia coli (4.6%), and carbapenem-resistant P. aeruginosa (2.1%, n = 11). By a linear regression model, positive MRSA isolates from the environment were found to be statistically significant and associated with the number of colonized LTCF residents (p = 0.01), while the timing of the surveillance culture was not (p = 0.227). The main MLST types associated with PVL-production were sequence type (ST) 59, (40.0%, 24/60), ST30 (21.4%, 3/14), ST8 (87.5%, 14/16), and ST45 (3.6%, 1/28). The susceptibility rates of tetracycline (96.7%), trimethoprim-sulfamethoxazole (96.7%), and ciprofloxacin (81.7%) were statistically significant and higher in MRSA ST59, compared to the rates in MRSA ST45 isolates. CONCLUSIONS MRSA was the most commonly colonized MDRO, both in the LTCF residents and in the environment, followed by MDRAB and carbapenem-resistant K. pneumoniae.
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Affiliation(s)
- Chia-Ying Liu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Min-Chi Lu
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | | | - Mei-Yu Kang
- Changhua Christian Hospital Erlin Nursing Home, Changhua, Taiwan
| | - Yi-Ni Jan
- Thanksgiving Nursing Home, Taichung, Taiwan
| | - Yi-Ting Lo
- Feng-Fung Nursing Home, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, Tainan, Taiwan
| | - Shu-Hui Tseng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Ming Lee
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan; Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Centers for Disease Control, Ministry of Health and Welfare, Taiwan.
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19
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Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2017; 58:192-198. [PMID: 29277554 DOI: 10.1016/j.meegid.2017.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/05/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
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Ladavac R, Bedenić B, Vranić-Ladavac M, Barišić N, Karčić N, Pompe K, Ferenčić A, Stojanović A, Seifert H, Katić S, Higgins PG. Emergence of different Acinetobacter baumannii clones in a Croatian hospital and correlation with antibiotic susceptibility. J Glob Antimicrob Resist 2017; 10:213-218. [PMID: 28735048 DOI: 10.1016/j.jgar.2017.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES During routine diagnostic laboratory work, the clinical microbiologist observed an increase of Acinetobacter baumannii isolates with three different carbapenem susceptibility patterns: susceptible, intermediate and resistant. Isolates belonging to the same carbapenem susceptibility phenotype exhibited identical susceptibility/resistance patterns to non-β-lactam antibiotics. This prompted us to analyse the mechanisms of carbapenem-resistance and the molecular epidemiology of the isolates. A total of 59 A. baumannii isolates were analysed and grouped according to their susceptibility to imipenem: group 1 were susceptible (N=24), group 2 were intermediate (N=8) and group 3 were resistant (N=27) to imipenem. MATERIAL AND METHODS PCR and sequencing was used to detect resistance genes. Genotyping of the isolates was performed by PFGE and MLST. RESULTS Out of 27 resistant isolates, 20 harboured blaOXA-40-like and 7 blaOXA-23-like genes. ISAba1 was found upstream of blaOXA-51 and blaOXA-23 genes. PFGE genotyping demonstrated the existence of three major A. baumannii clones in GH Pula and determination of sequence groups showed that the isolates belonged to international clones commonly associated with multidrug-resistance. MLST (performed on six isolates) showed diverse population structure of isolates belonging to the same cluster, including ST 195, ST 231, ST 775 and ST 1095. CONCLUSIONS A previous study conducted in 2009-2010 showed that reduced susceptibility to carbapenems in GH Pula was only associated with upregulation of the intrinsic OXA-51 β-lactamase. In this study a shift to isolates with acquired oxacillinases, belonging to two major clones was reported.
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Affiliation(s)
- Ranko Ladavac
- Department for Nephrology, General Hospital Pula, Pula, Croatia
| | - Branka Bedenić
- Department for Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia; Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Mirna Vranić-Ladavac
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Nada Barišić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Natalie Karčić
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Karoline Pompe
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany
| | - Antun Ferenčić
- School of Medicin, University of Rijeka, Rijeka, Croatia
| | - Aleksandar Stojanović
- Department for Microbiology, Public Health Institute of Istria County, Pula, Croatia
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Stjepan Katić
- Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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Lee CM, Lai CC, Chiang HT, Lu MC, Wang LF, Tsai TL, Kang MY, Jan YN, Lo YT, Ko WC, Tseng SH, Hsueh PR. Presence of multidrug-resistant organisms in the residents and environments of long-term care facilities in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:133-144. [PMID: 28373038 DOI: 10.1016/j.jmii.2016.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/14/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated the prevalence of multidrug-resistant organisms (MDROs) in the residents and environments of long-term care facilities (LTCFs) in Taiwan. METHODS We prospectively investigated the distribution of MDROs in residents of six LTCFs and their environments from January 2015 to December 2015 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples every 3 months for the residents: 63, 79, and 73 in the first, second, and third surveillance investigations, respectively. If MDROs, including methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa, and MDR Acinetobacter baumannii were identified, then swab specimens from environmental sources were also collected and cultured. During the study period, several infection control measures were also implemented. RESULTS The overall infection density decreased significantly from 2.69 per 1000 patient-days in the preintervention (January 2014 to December 2014) to 2.39 per 1000 patient-days during the intervention period (p < 0.001). A total of 154 samples from residents and environmental sources were positive for MDROs. Methicillin-resistant S. aureus (n = 83, 53.9%) was the predominant organism, followed by carbapenem-resistant Enterobacteriaceae (n = 35, 22.7%), MDR A. baumannii (n = 30, 19.5%), and carbapenem-resistant P. aeruginosa (n = 6, 3.9%). The rates of detection of MDROs were 27.9% (60/215) in nasal swabs, 15.8% (34/215) in rectal swabs, and 11.1% (60/542) in the environmental sources. CONCLUSIONS The distribution and persistence of MDROs varied among the different LTCFs and time periods.
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Affiliation(s)
- Chun-Ming Lee
- Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hsiu-Tzy Chiang
- Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan
| | - Min-Chi Lu
- Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | | | | | - Mei-Yu Kang
- Changhua Christian Hospital Erlin Nursing Home, Changhua, Taiwan
| | - Yi-Ni Jan
- Thanksgiving Nursing Home, Taichung, Taiwan
| | - Yi-Ting Lo
- Feng-Fung Nursing Home, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
| | - Shu-Hui Tseng
- Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Santos C, Ramalheira E, Da Silva G, Mendo S. Genetically unrelated multidrug- and carbapenem-resistant Citrobacter freundii detected in outpatients admitted to a Portuguese hospital. J Glob Antimicrob Resist 2016; 8:18-22. [PMID: 27915087 DOI: 10.1016/j.jgar.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/13/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Non-clonal, carbapenem- and multidrug-resistant Citrobacter freundii isolates were collected from unrelated outpatients admitted to a Portuguese hospital emergency department. One patient lived in a nursing home and was never hospitalised, whereas the other patient was repeatedly hospitalised in this hospital. The aim of this study was to unveil the molecular mechanisms associated with the carbapenem resistance of these isolates and to assess its potential dissemination. METHODS Isolate identification was performed by VITEK®2 and was confirmed by 16S rDNA sequencing. The clonal relationship of the isolates was evaluated by repetitive element palindromic PCR (rep-PCR). Antibiotic susceptibility was determined using the automatic VITEK®2 AES system and disk diffusion assay. β-Lactamases, porins and mobile genetic elements were characterised by PCR and sequencing. Pulsed-field gel electrophoresis (PFGE) and Southern blot hybridisation were used to determine the genetic location of integrons, and their transferability was tested by conjugation. RESULTS No genetic relatedness was found, suggesting different origins of the isolates. In isolate Cf254 a VIM-2 carbapenemase integrated in In58 was detected, located in a high-frequency conjugative IncL/M plasmid that also carried CTX-M-15 and CMY-39 genes. VIM-1 in isolate Cf872 was chromosomal. This is the first description in Portugal of VIM carbapenemases in C. freundii. Loss/alteration of porins was also detected. CONCLUSIONS Emergence of carbapenem-resistant Enterobacteria is not confined to the nosocomial environment. Community-acquired strains appear to be in circulation between inpatients and outpatients, spreading carbapenem resistance genes by horizontal gene transfer.
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Affiliation(s)
- Cátia Santos
- CESAM and Department of Biology, University of Aveiro, Campus de Santiago, 3810 Aveiro, Portugal.
| | - Elmano Ramalheira
- Centro Hospitalar do Baixo Vouga, Avenida Artur Ravara, 3810 Aveiro, Portugal
| | - Gabriela Da Silva
- Faculty of Pharmacy and Centre for Neurosciences and Cell Biology, University of Coimbra, 3000 Coimbra, Portugal
| | - Sónia Mendo
- CESAM and Department of Biology, University of Aveiro, Campus de Santiago, 3810 Aveiro, Portugal
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Goic-Barisic I, Hrenovic J, Kovacic A, Musić MŠ. Emergence of Oxacillinases in Environmental Carbapenem-Resistant Acinetobacter baumannii Associated with Clinical Isolates. Microb Drug Resist 2016; 22:559-563. [DOI: 10.1089/mdr.2015.0275] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivana Goic-Barisic
- Department of Clinical Microbiology, University Hospital Centre Split, Split, Croatia
- University of Split School of Medicine, Split, Croatia
| | - Jasna Hrenovic
- Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
| | - Ana Kovacic
- Institute of Public Health of Split and Dalmatia County, Split, Croatia
| | - Martina Šeruga Musić
- Department of Biology, Faculty of Science, University of Zagreb, Zagreb, Croatia
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Bedenić B, Beader N, Godič-Torkar K, Prahin E, Mihaljević L, Ćačić M, Vraneš J. Postantibiotic effect of colistin alone and combined with vancomycin or meropenem against Acinetobacter spp. with well defined resistance mechanisms. J Chemother 2016; 28:375-82. [DOI: 10.1179/1973947815y.0000000062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Branka Bedenić
- Department of Microbiology, School of Medicine, University of Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, Clinical Hospital Center Zagreb, Croatia
| | - Natasa Beader
- Department of Microbiology, School of Medicine, University of Zagreb, Croatia
- Department of Clinical and Molecular Microbiology, Clinical Hospital Center Zagreb, Croatia
| | - Karmen Godič-Torkar
- Department for Sanitary Engeneering, Faculty of Health Sciences, University of Ljubljana, Slovenia
| | - Esmina Prahin
- Department of Microbiology, School of Medicine, University of Zagreb, Croatia
| | - Ljiljana Mihaljević
- Department of Gynecology and Opstetrics, Clinical Hospital Center Zagreb, Croatia
| | | | - Jasmina Vraneš
- Department of Microbiology, School of Medicine, University of Zagreb, Croatia
- Department of Microbiology, Zagreb Institute of Public Health, ‘Andrija Štampar’, Croatia
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