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Wang L, Zhang L, Huang X, Xu H, Huang W. Bloodstream infection clusters for critically ill patients: analysis of two-center retrospective cohorts. BMC Infect Dis 2024; 24:306. [PMID: 38481153 PMCID: PMC10935929 DOI: 10.1186/s12879-024-09203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Bloodstream infections (BSI) are highly prevalent in hospitalized patients requiring intensive care. They are among the most serious infections and are highly associated with sepsis or septic shock, which can lead to prolonged hospital stays and high healthcare costs. This study aimed at establishing an easy-to-use nomogram for predicting the prognosis of patients with BSI. METHODS In retrospective study, records of patients with BSI admitted to the intensive care unit (ICU) over the period from Jan 1st 2016 to Dec 31st 2021 were included. We used data from two different China hospitals as development cohort and validation cohort respectively. The demographic and clinical data of patients were collected. Based on all baseline data, k-means algorithm was applied to discover the groups of BSI phenotypes with different prognostic outcomes, which was confirmed by Kaplan-Meier analysis and compared using log-rank tests. Univariate Cox regression analyses were used to estimate the risk of clusters. Random forest was used to identified discriminative predictors in clusters, which were utilized to construct nomogram based on multivariable logistic regression in the discovery cohort. For easy clinical applications, we developed a bloodstream infections clustering (BSIC) score according to the nomogram. The results were validated in the validation cohort over a similar period. RESULTS A total of 360 patients in the discovery cohort and 310 patients in the validation cohort were included in statistical analyses. Based on baseline variables, two distinct clusters with differing prognostic outcomes were identified in the discovery cohort. Population in cluster 1 was 211 with a ICU mortality of 17.1%, while population in cluster 2 was 149 with an ICU mortality of 41.6% (p < 0.001). The survival analysis also revealed a higher risk of death for cluster 2 when compared with cluster 1 (hazard ratio: 2.31 [95% CI, 1.53 to 3.51], p < 0.001), which was confirmed in validation cohort. Four independent predictors (vasoconstrictor use before BSI, mechanical ventilation (MV) before BSI, Deep vein catheterization (DVC) before BSI, and antibiotic use before BSI) were identified and used to develop a nomogram. The nomogram and BSIC score showed good discrimination with AUC of 0.96. CONCLUSION The developed score has potential applications in the identification of high-risk critically ill BSI patients.
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Affiliation(s)
- Lei Wang
- Department of Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Li Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaolong Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Hao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wei Huang
- Department of Critical Care Medicine, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China.
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Guy RL, Rudman J, Higgins H, Carter E, Henderson KL, Demirjian A, Gerver SM. Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment of Escherichia coli urinary tract specimens in England, 2015-19. JAC Antimicrob Resist 2023; 5:dlad122. [PMID: 38021038 PMCID: PMC10655056 DOI: 10.1093/jacamr/dlad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives To determine whether MDR occurs more frequently in nitrofurantoin-resistant Escherichia coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates. Methods Using routine E. coli urine isolate antibiotic susceptibility laboratory surveillance data for England, 2015-19 inclusive, the percentage of MDR or XDR phenotype was estimated for nitrofurantoin-susceptible and nitrofurantoin-resistant laboratory-reported urinary tract samples by region, patient sex and age group. Results Resistance to nitrofurantoin among E. coli urinary samples decreased slightly year on year from 2.9% in 2015 to 2.3% in 2019. Among E. coli UTIs tested for nitrofurantoin susceptibility and ≥3 additional antibiotics, the percentage that were MDR was consistently 15%-20% percentage points higher for nitrofurantoin-resistant isolates compared with nitrofurantoin-susceptible isolates. Similarly, the percentage of isolates with an XDR phenotype was higher among nitrofurantoin-resistant versus -susceptible isolates (8.7% versus 1.4%, respectively, in 2019); this disparity was greater in male patients, although variation was seen by age group in both sexes. Regional variation was also noted, with the highest MDR percentage amongst nitrofurantoin-resistant E. coli urinary samples in the London region (36.7% in 2019); the lowest was in the North East (2019: 16.9%). Conclusions MDR and XDR phenotypes occur more frequently in nitrofurantoin-resistant E. coli urinary isolates in England, compared with nitrofurantoin-susceptible isolates. However, nitrofurantoin resistance is low (<3%) overall. This latest study provides important insights into trends in nitrofurantoin resistance and MDR, which is of particular concern for patients ≥75 years old and those who are male. It also emphasises geographical heterogeneities within England in nitrofurantoin resistance and MDR.
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Affiliation(s)
- Rebecca L Guy
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
| | - Jamie Rudman
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
| | - Hannah Higgins
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
| | - Emma Carter
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
| | - Katherine L Henderson
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
| | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, SE1 7EH, UK
- Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Sarah M Gerver
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Use & Sepsis Division, United Kingdom Health Security Agency (UKHSA), Colindale, London, UK
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Sirichayanugul T, Srisawat C, Thummakomut C, Prawang A, Huynh NS, Saokaew S, Phisalprapa P, Kanchanasurakit S. Development and internal validation of simplified predictive scoring (ICU-SEPSA score) for mortality in patients with multidrug resistant infection. Front Pharmacol 2022; 13:938028. [PMID: 36120359 PMCID: PMC9472650 DOI: 10.3389/fphar.2022.938028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Mortality from multidrug-resistant (MDR) pathogens is an urgent healthcare crisis worldwide. At present we do not have any simplified screening tools to predict the risk of mortality associated with MDR infections. The aim of this study was to develop a screening tool to predict mortality in patients with multidrug-resistant organisms. Methods: A retrospective cohort study to evaluate mortality risks in patients with MDR infections was conducted at Phrae Hospital. Univariable and multivariable analyses were used to classify possible risk factors. The model performance was internally validated utilizing the mean of three measures of discrimination corrected by the optimism using a 1000-bootstrap procedure. The coefficients were transformed into item scores by dividing each coefficient with the lowest coefficient and then rounding to the most adjacent number. The area under the receiver operating characteristic curve (AuROC) was used to determine the performance of the model. Results: Between 1 October 2018 and 30 September 2020, a total of 504 patients with MDR infections were enrolled. The ICU-SEPSA score composed of eight clinical risk factors: 1) immunocompromised host, 2) chronic obstructive pulmonary disease, 3) urinary tract infection, 4) sepsis, 5) placement of endotracheal tube, 6) pneumonia, 7) septic shock, and 8) use of antibiotics within the past 3 months. The model showed good calibration (Hosmer-Lemeshow χ2 = 19.27; p-value = 0.50) and good discrimination after optimism correction (AuROC 84.6%, 95% confidence interval [Cl]: 81.0%–88.0%). The positive likelihood ratio of low risk (score ≤ 5) and high risk (score ≥ 8) were 2.07 (95% CI: 1.74–2.46) and 12.35 (95% CI: 4.90–31.13), respectively. Conclusion: A simplified predictive scoring tool wad developed to predict mortality in patients with MDR infections. Due to a single-study design of this study, external validation of the results before applying in other clinical practice settings is warranted.
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Affiliation(s)
| | - Chansinee Srisawat
- Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Chawin Thummakomut
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Abhisit Prawang
- College of Pharmacy, Rangsit University, Phathum Thani, Thailand
| | - Nina S Huynh
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, United States
| | - Surasak Saokaew
- Division of Social and Administration Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bander Sunway, Malaysia
- Biofunctional Molecule Exploratory Research Group, Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Bander Sunway, Malaysia
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- *Correspondence: Pochamana Phisalprapa, ; Sukrit Kanchanasurakit,
| | - Sukrit Kanchanasurakit
- Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Division of Pharmaceutical Care, Department of Pharmacy, Phrae Hospital, Phrae, Thailand
- *Correspondence: Pochamana Phisalprapa, ; Sukrit Kanchanasurakit,
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Transmission of NDM-5-Producing and OXA-48-Producing Escherichia coli Sequence Type 648 by International Visitors without Previous Medical Exposure. Microbiol Spectr 2021; 9:e0182721. [PMID: 34937178 PMCID: PMC8694128 DOI: 10.1128/spectrum.01827-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carbapenemase-producing Escherichia coli sequence type (ST) 648 strains were isolated from two international visitors without previous medical exposure from Southeast Asian countries in a hospital in Japan. One isolate, FUJ80154, carried blaNDM-5 in a complex class 1 integron on an IncFIB/FII plasmid; the other isolate, FUJ80155, carried two copies of blaOXA-48 on the chromosome flanked by IS1R on both sides. The core-genome based-phylogenetic analysis with publicly available genome data of E. coli ST648 carrying blaNDM-5 or blaOXA-48-like demonstrated high genetic similarity between FUJ80154 and NDM-5-prooducing E. coli ST648 strains isolated in South and Southeast Asian countries. On the other hand, no closely related isolates of FUJ80155 were identified. In the absence of prior hospitalization overseas, neither patient had qualified for routine screening of multidrug-resistant organisms, and the isolates were incidentally identified in cultures ordered at the discretion of the treating physician. IMPORTANCE Although patients with history of international hospitalization are often subject to screening for multidrug-resistant organisms, it is unclear whether patients who reside in countries where carbapenemase-producing Enterobacterales (CPE) is endemic but have no history of local hospitalization contribute to the transmission of CPE. In this study, NDM-5-producing and OXA-48-producing Escherichia coli sequence type (ST) 648, a recently recognized high-risk, multidrug-resistant clone, were detected from two overseas visitors without previous medical exposure. The findings of this study suggest that active surveillance culture on admission to hospital may be considered for travelers from countries with endemicity of carbapenem-resistant organisms even without history of local hospitalization and underscore the need to monitor cross-border transmission of high-risk clones, such as carbapenemase-producing E. coli ST648.
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Bhattarai S, Sharma BK, Subedi N, Ranabhat S, Baral MP. Burden of Serious Bacterial Infections and Multidrug-Resistant Organisms in an Adult Population of Nepal: A Comparative Analysis of Minimally Invasive Tissue Sampling Informed Mortality Surveillance of Community and Hospital Deaths. Clin Infect Dis 2021; 73:S415-S421. [PMID: 34910184 PMCID: PMC8672751 DOI: 10.1093/cid/ciab773] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bacterial diseases are the leading cause of mortality globally, and due to haphazard use of antibiotics, antimicrobial resistance has become an emerging threat. METHODS This cross-sectional observational study utilized a minimally invasive tissue sampling procedure to determine the cause of death among an adult population. Bacterial cultures (blood, cerebrospinal fluid, lung tissue) and antibiotic susceptibility were evaluated, and the results were compared between community and hospital deaths. RESULTS Of 100 deceased persons studied, 76 (76%) deaths occurred in the community and 24 (24%) in the hospital. At least 1 bacterial agent was cultured from 86 (86%) cases; of these, 74 (86%) had a bacterial disease attributed as the primary cause of death, with pneumonia (35, 47.3%), sepsis (33, 44.6%), and meningitis (3, 4.1%) most common. Of 154 bacterial isolates (76.6% from the community and 23.4% from the hospital) detected from 86 culture-positive cases, 26 (16.8%) were multidrug-resistant (MDR). Klebsiella species were the most common (13 of 26) MDR organisms. The odds of getting an MDR Klebsiella infection was 6-fold higher among hospital deaths compared with community deaths (95% confidence interval [CI], 1.37-26.40; P = .017) and almost 23-fold higher (CI, 2.45-213.54; P = .006) among cases with prior antibiotic use compared to those without. CONCLUSIONS High incidence of serious bacterial infections causing death of adults in the community, with most MDR organisms isolated from hospitalized cases, calls for robust surveillance mechanisms and infection prevention activities at the community level and evidence-driven antibiotic stewardship in healthcare settings.
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Affiliation(s)
- Suraj Bhattarai
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal
| | - Binita Koirala Sharma
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Microbiology, GMCTHRC, Pokhara, Nepal.,Department of Microbiology, Tribhuvan University Prithvi Narayan Campus, Pokhara, Nepal
| | - Nuwadatta Subedi
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Forensic Medicine, GMCTHRC, Pokhara, Nepal
| | - Sunita Ranabhat
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Pathology, GMCTHRC, Pokhara, Nepal
| | - Madan Prasad Baral
- DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal.,Department of Forensic Medicine, Pokhara Academy of Health Sciences, Western Regional Hospital, Pokhara, Nepal
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Ahmadkhosravi N, Khosravi AD, Asareh Zadegan Dezfuli A, Hashemzadeh M, Saki M, Mehr FJ, Izadpour F. Study of aerobic and anaerobic bacterial profile of nosocomial infections and their antibiotic resistance in a referral center, Southwest Iran: A three year cross-sectional study. PLoS One 2021; 16:e0259512. [PMID: 34752474 PMCID: PMC8577755 DOI: 10.1371/journal.pone.0259512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The drug resistance is expected to be the most important challenge in infection control in Iran, where there is no local report or standard drug resistance monitoring system. Therefore, this study aimed to investigate the aerobic and anaerobic bacterial profile of nosocomial infections and their antibiotic resistance in Ahvaz, southwest Iran. METHODOLOGY The gram-positive and gram-negative bacteria were identified on the basis of conventional culture and biochemical tests. The antibiotic resistance of the bacterial isolates against antibiotics was determined by the disk diffusion method. RESULTS Among total 1156 collected positive samples, E. coli and coagulase-negative staphylococci (CoNS) were the most frequent pathogenic gram negative bacteria (GNB) and gram positive bacteria (GPB) respectively. Drug susceptibility testing revealed that among GNB, P. aeruginosa was 100% resistant to amikacin, cefepime, ciprofloxacin and tetracycline. In the case of E. coli, the resistance rate was (98%) for trimethoprim sulfamethoxazole and cefepime. For GPB, S. aureus showed the highest resistance rates to amikacin (100%) and clindamycin (100%). In addition, CoNS strains showed a high level of resistance to doxycycline (100%), erythromycin (100%) and cefoxitin (97%). In Bacteroeides fragilis isolates, the highest resistance rate belonged to clindamycin (72%), and Clostridium perfringens strains showed high level of resistance to penicillin (46%). CONCLUSION The results highlighted that there are distinct factors leading to antimicrobial resistance in Ahvaz, southwest Iran. The primary contributors to the resistance development, include poor surveillance of drug-resistant infections, poor quality of available antibiotics, clinical misuse, and the ease of access to antibiotics. Moreover, similar factors such as self-medication and the lack of regulation on medication imports play a role in antibiotic resistance in the region.
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Affiliation(s)
- Nazanin Ahmadkhosravi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Azar Dokht Khosravi
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Iranian Study Group on Microbial Drug Resistance, Iran
| | - Aram Asareh Zadegan Dezfuli
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- * E-mail:
| | - Mohammad Hashemzadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Morteza Saki
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Jahangiri Mehr
- Pain Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farokh Izadpour
- Microbiology Section of Medical Laboratory, Emam Khomeini Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Ng RN, Grey LJ, Vaitekenas A, McLean SA, Rudrum JD, Laucirica DR, Poh MWP, Hillas J, Winslow SG, Iszatt JJ, Iosifidis T, Tai AS, Agudelo-Romero P, Chang BJ, Stick SM, Kicic A. Development and validation of a miniaturized bacteriophage host range screening assay against antibiotic resistant Pseudomonas aeruginosa. J Microbiol Methods 2021; 190:106346. [PMID: 34637818 DOI: 10.1016/j.mimet.2021.106346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
Antimicrobial resistance is a current global health crisis, and the increasing emergence of multidrug resistant infections has led to the resurgent interest in bacteriophages as an alternative treatment. Prior to clinical application, phage suitability is assessed, via susceptibility testing and breadth of host range to bacteriophage, however, these are both large-scale manual processes and labor-intensive. The aim of the study was to establish and validate a scaled down methodology for high-throughput screening to reduce procedural footprint. In this paper, we describe a scaled-down adapted methodology that can successfully screen bacteriophages, isolated and purified from wastewater samples. Furthermore, we describe a miniaturized host range assay against clinical Pseudomonas aeruginosa isolates using a spot test (2 μL/ drop) that was found to be both sensitive (94.6%) and specific (94.7%). It also demonstrated a positive predictive value (PPV) of 86.4% and negative predictive value (NPV) of 98%. The breadth of host range of bacteriophages that exhibited lytic activity on P. aeruginosa isolates was corroborated using the scaled down assay. The high correlation achieved in this study confirms miniaturization as the first step in future automation that could test phage diversity and efficacy as antimicrobials.
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Affiliation(s)
- Renee Nicole Ng
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lucinda Jane Grey
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Andrew Vaitekenas
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Samantha Abagail McLean
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jack Dylan Rudrum
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Daniel Rodolfo Laucirica
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Wee-Peng Poh
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Jessica Hillas
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Scott Glenn Winslow
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Joshua James Iszatt
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Thomas Iosifidis
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, Western Australia, Australia; Center for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, The University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Anna Sze Tai
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Patricia Agudelo-Romero
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Barbara Jane Chang
- The Marshall Center for Infectious Diseases Research and Training, School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Michael Stick
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia; Center for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, The University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Anthony Kicic
- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, Western Australia, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia; Center for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, The University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.
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- Wal-Yan Respiratory Research Center, Telethon Kids Institute, Perth, Western Australia, Australia; Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Lozano-Muñoz I, Wacyk J, Kretschmer C, Vásquez-Martínez Y, Martin MCS. Antimicrobial resistance in Chilean marine-farmed salmon: Improving food safety through One Health. One Health 2021; 12:100219. [PMID: 33553565 PMCID: PMC7856317 DOI: 10.1016/j.onehlt.2021.100219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
Aquaculture is seen as an essential requirement for improving food security and nutrition. Fish such as salmonids are a primary source of protein and essential nutrients. Aquaculture provide income for communities across the world and have a smaller carbon footprint than terrestrial animal-production systems. However, fish diseases are a constant threat, and the use of antibiotics is a source of concern due to its adverse impacts on the environment and human health. Chilean salmon farming has made several efforts to reduce the use of antibiotics for the eradication of piscirickettsiosis, a disease caused by the gram-negative bacteria Piscirickettsia salmonis. Excessive amounts of antibiotics continue to be used in Chilean aquaculture, playing an important role in the emerging public health crisis of antimicrobial resistance. Without doubt, P. salmonis is becoming increasingly resistant to important frontline antimicrobial classes, with severe implications for the future treatment of infectious human and animal diseases. Antimicrobial-resistant bacteria as well as antibiotic residues from salmon production are spreading in the environment, and thus both salmon food commodities and wild organisms can become a source of resistant bacteria that can be transmitted to humans as foodborne contaminants. This urgent threat needs to be addressed by implementing national strategies in compliance with international standards that include both prudent antimicrobial use in marine salmon farms and the investment towards a One Health approach, which combines human, animal and environmental health.
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Affiliation(s)
- Ivonne Lozano-Muñoz
- Laboratorio de Nutrición, Departamento de Producción Animal, Facultad de Ciencias Agronómicas, Universidad de Chile, Santa Rosa 11315, La Pintana, Santiago, Región Metropolitana CP 8820808, Chile
| | - Jurij Wacyk
- Laboratorio de Nutrición, Departamento de Producción Animal, Facultad de Ciencias Agronómicas, Universidad de Chile, Santa Rosa 11315, La Pintana, Santiago, Región Metropolitana CP 8820808, Chile
| | - Cristina Kretschmer
- Laboratorio de Nutrición, Departamento de Producción Animal, Facultad de Ciencias Agronómicas, Universidad de Chile, Santa Rosa 11315, La Pintana, Santiago, Región Metropolitana CP 8820808, Chile
| | - Yesseny Vásquez-Martínez
- Laboratorio de Virología Molecular y Control de Patógenos, Facultad de Química y Biología, Universidad de Santiago de Chile, Av. Libertador Bernardo O’higgins 3363, Santiago, Región Metropolitana CP 9170022, Chile
- Programa Centro de Investigación Biomédica Aplicada, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Av. Libertador Bernardo O’Higgins 3363, Santiago, Región Metropolitana CP 9170022, Chile
| | - Marcelo Cortez-San Martin
- Laboratorio de Virología Molecular y Control de Patógenos, Facultad de Química y Biología, Universidad de Santiago de Chile, Av. Libertador Bernardo O’higgins 3363, Santiago, Región Metropolitana CP 9170022, Chile
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9
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Kalita JM, Nag VL, Kombade S, Yedale K. Multidrug resistant superbugs in pyogenic infections: a study from Western Rajasthan, India. Pan Afr Med J 2021; 38:409. [PMID: 34381553 PMCID: PMC8325443 DOI: 10.11604/pamj.2021.38.409.25640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction the crude mortality rate due to infectious diseases in India is approximately 417 per one lakh persons and pyogenic infections are one of the significant contributor. Poor antimicrobial stewardship in India has led to an increase in multidrug resistant superbugs in both community as well as hospital settings. The aim of this study was to identify the bacterial etiology of pyogenic infections and to evaluate their antimicrobial resistance profile. Methods this is a retrospective observational study from January, 2018 to December, 2018. A total 1851 samples, collected as a part of patient care were included in this study. Specimens were subjected to culture on Blood agar and MacConkey agar and incubated at 37°C for 48 hours. Species identification was done as per standard laboratory protocol. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion according to Clinical and Laboratory Standards Institute guidelines. Results of total 1851 samples, culture was positive in 61.54%. A total 70.59%, Gram negative organisms were isolated followed by Gram positive cocci in 45.48%, yeast in 1.05%, coryneform bacteria in 0.79% and in one case, non-tubercular mycobacteria was isolated. Staphylococcus aureus (30.9%) was the predominant organism isolated. Most common multi drug resistant isolates were Klebsiella spp. (74.79%) and Acinetobacter spp. (74.32%). Conclusion this study gives an insight about the prevalence and common etiology of pyogenic infections along with their antimicrobial resistance profile in north western region of India. This study will contribute in formulating antibiotic stewardship program by selecting the antibiograms of pyogenic isolates.
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Affiliation(s)
- Jitu Mani Kalita
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarika Kombade
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kavita Yedale
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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10
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Katoziyan A, Imani Fooladi AA, Taheri RA, Vatanpour S. Multi-drug resistance of Staphylococcus aureus Strains in Baqiyatallah hospital: a Primary Step Towards Digital Health Biomonitoring Systems. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 19:321-328. [PMID: 33680033 PMCID: PMC7758007 DOI: 10.22037/ijpr.2020.112966.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the study was to evaluate the drug-resistance patterns of Staphylococcus aureus infections in Baqiyatallah hospital within 2010–2019 and to present a novel monitoring and detection system making use of molecular laboratory methods teamed with molecular delimitation analyses. This in turn is a primary step to establishment of a digital health system within Baqiyatallah hospital as a perfect pilot instance for other hospitals to follow upon. Totally, 100 patients of Baqiyatallah hospital suspicious of Staphylococcus aureus infections were sampled. Bacterial identity confirmations were done using routine biochemical test. Antibiograms were made for all the patients in this study. Consequently, bacterial total DNA was extracted and 16S rDNA gene amplified and sequenced for all patients. To uncover any cryptic strain grouping within the samples, a molecular delimitation method, i.e. automated barcode gap discovery (ABGD), was done. Our results showed Ceftaroline to be the most and Erythromycin and Oxacillin the least effective drugs. Delimitation uncovered 19 groups out of which group 19 seemed to have location-specific genetic signals in regards to susceptibility of Erythromycin and Oxacillin. Our results indicate the importance of genetic identification of bacteria with respect to their genetic patterns before antibiotic administration in order to both reduce unnecessary medicine use and to biomonitor the bacterial patterns in respect to their behavior towards general antibiotics.
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Affiliation(s)
- Ahmadreza Katoziyan
- Center of Excellence in Phylogeny of Living Organisms, School of Biology, University of Tehran, Iran.,Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramezan Ali Taheri
- Nanobiotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Saba Vatanpour
- Department of Biology, University of British Columbia, Vancouver, Canada
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11
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Broom J, Broom A, Kenny K, Chittem M. Antimicrobial overuse in India: A symptom of broader societal issues including resource limitations and financial pressures. Glob Public Health 2020; 16:1079-1087. [PMID: 33161832 DOI: 10.1080/17441692.2020.1839930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
India and the global community are facing a critical crisis of antimicrobial resistance (AMR), significantly contributed to by on-going and increasing antimicrobial misuse. Information as to what drives misuse of antimicrobials within India is essential to inform strategies to address the crisis. This papers aims to identify perceived influences on antimicrobial use in Hyderabad, India. We conducted semi-structured qualitative interviews conducted with thirty participants (15 doctors, 15 pharmacists) around their experiences of antimicrobials in Hyderabad, India. Thematic analysis was performed and four themes identified around (1) Perceptions of the problem of resistance and antimicrobial use; (2) Social pressures to prescribe/dispense; (3) Financial pressures driving antimicrobial over-use; and (4) Lack of regulation around training and qualifications. We conclude that antimicrobial use within India is embedded with, and occurs as a result of, complex social and economic factors including issues of resource limitation, structural/governance limitations and social relationships. Strategies to address misuse without acknowledging and addressing the critical driving forces of use will be unlikely to induce significant change.
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Affiliation(s)
- Jennifer Broom
- Sunshine Coast Health Institute, Birtinya, Australia.,University of Queensland, Brisbane, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Katherine Kenny
- School of Social and Political Sciences, The University of Sydney, Sydney, Australia
| | - Mahati Chittem
- Department of Liberal Arts, Indian Institute of Technology (IIT), Hyderabad, India
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12
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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13
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Gandra S, Tseng KK, Arora A, Bhowmik B, Robinson ML, Panigrahi B, Laxminarayan R, Klein EY. The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study. Clin Infect Dis 2020; 69:563-570. [PMID: 30407501 PMCID: PMC6669283 DOI: 10.1093/cid/ciy955] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens. METHODS We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes. RESULTS We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides. CONCLUSIONS This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.
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Affiliation(s)
- Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Katie K Tseng
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Anita Arora
- Fortis Healthcare Ltd., Gurgaon, Haryana, India
| | | | - Matthew L Robinson
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC.,Princeton Environmental Institute, Princeton University, New Jersey.,Department of Global Health, University of Washington, Seattle
| | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC.,Department of Emergency Medicine, Johns Hopkins School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Mamtora D, Saseedharan S, Bhalekar P, Katakdhond S. Microbiological profile and antibiotic susceptibility pattern of Gram-positive isolates at a tertiary care hospital. J Lab Physicians 2020; 11:144-148. [PMID: 31160854 PMCID: PMC6543942 DOI: 10.4103/jlp.jlp_173_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES: Gram-positive infections such as those by Staphylococcus aureus have contributed to the disease burden by increasing the morbidity and mortality rates in India. This study aims to determine the prevalence and the antibiotic susceptibility pattern of Gram-positive pathogens at a tertiary care hospital, Mumbai, Maharashtra, India. MATERIALS AND METHODS: This retrospective cross-sectional study was carried out from January, 2015 to December, 2017, at a tertiary care hospital in Mumbai, India. The clinical isolates were cultured, and identification was done using Vitek 2 culture system. The antibiotic susceptibility testing was done as per the Clinical Laboratory Standard Institute guidelines. RESULTS: Out of 2132 (29%) Gram-positive isolates, S. aureus (49%) was the most common encountered pathogen, followed by Enterococcus spp. (24.5%) and coagulase-negative Staphylococcus (16%). Majority of the S. aureus were observed in patients with skin and soft-tissue infections (61.2%) followed by those suffering from respiratory (41%) and bloodstream infections (35%). Among the infections caused by S. aureus, the prevalence of methicillin resistance was 30%. While the MRSA isolates showed lower sensitivity toward co-trimoxazole (39%), clindamycin (30%), erythromycin (23%), and ciprofloxacin (10%), they showed higher susceptibility to linezolid (98%), vancomycin (98%), and teicoplanin (98%). All the isolates were found to be sensitive to daptomycin and tigecycline. While vancomycin-resistant enterococci (VRE) formed 7.5%, the linezolid-resistant enterococcus species was as high as 4.1%. CONCLUSION: The study showed a high prevalence of MRSA and VRE, thereby emphasizing the increasing antimicrobial resistance pattern of the Gram-positive pathogens. Therefore, there is an urgent need for novel antimicrobial stewardship to restrict the ongoing resistance rate among the isolates.
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Affiliation(s)
- Dhruv Mamtora
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Sanjith Saseedharan
- Department of Critical Care Medicine, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Pallavi Bhalekar
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
| | - Surekha Katakdhond
- Department of Microbiology, S. L. Raheja Hospital, Mumbai, Maharashtra, India
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15
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A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia. Antimicrob Agents Chemother 2019; 64:AAC.01974-19. [PMID: 31636071 PMCID: PMC7187598 DOI: 10.1128/aac.01974-19] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
Community-onset bloodstream infections (CO-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CO-BSI among patients hospitalized with fever. Community-onset bloodstream infections (CO-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CO-BSI among patients hospitalized with fever. Without restriction to language or country, we searched PubMed, Web of Science, and Scopus for prospective hospital-based studies of culture-confirmed CO-BSI among febrile inpatients. We determined by study the prevalence of BSI among participants, the pathogens responsible for BSI, and the antimicrobial susceptibility patterns of pathogens causing BSI, according to place and time. Thirty-four (77.3%) of 44 eligible studies recruited 29,022 participants in Africa and Asia combined. Among participants in these two regions, the median prevalence of BSI was 12.5% (range, 2.0 to 48.4%); of 3,220 pathogens isolated, 1,119 (34.8%) were Salmonella enterica, 425 (13.2%) Streptococcus pneumoniae, and 282 (8.8%) Escherichia coli. Antimicrobial susceptibility testing was reported in 16 (36.4%) studies. When isolates collected prior to 2008 were compared to those collected in the period of 2008 through 2018, the proportions of typhoidal Salmonella and Staphylococcus aureus isolates resistant to several clinically relevant antimicrobials increased over time, while S. pneumoniae susceptibility was stable. CO-BSI remain a major cause of severe febrile illness among hospitalized patients in Africa and Asia, with S. enterica, S. pneumoniae, and E. coli predominating. There is a concerning increase in AMR among serious infections caused by community-onset pathogens. Ongoing surveillance is needed to inform empirical management and strategies to control AMR.
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16
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Marchello CS, Dale AP, Pisharody S, Crump JA. Using hospital-based studies of community-onset bloodstream infections to make inferences about typhoid fever incidence. Trop Med Int Health 2019; 24:1369-1383. [PMID: 31633858 PMCID: PMC6916262 DOI: 10.1111/tmi.13319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives Hospital-based studies of community-onset bloodstream infections (CO-BSI) are less resource-intensive to carry out than population-based incidence studies. We examined several metrics capturing the potential role of Salmonella Typhi as a cause of CO-BSI for making inferences about incidence. Methods We systematically reviewed three databases for hospital-based studies of CO-BSI. We determined, by study, the prevalence and rank order of Salmonella among pathogenic bloodstream isolates, and the prevalence ratio of Salmonella Typhi to Escherichia coli (S:E ratio). We then describe these hospital-based study metrics in relation to population-based typhoid fever incidence data from a separate systematic review. Results Forty-four studies met the inclusion criteria, of which 23 (52.3%) isolated Salmonella Typhi at least once. Among studies isolating Salmonella Typhi, the median (interquartile range) prevalence and rank order of Salmonella Typhi compared to other pathogens isolated in BSI was 8.3% (3.2–37.9%) and 3 (1–6), respectively. The median (interquartile range) S:E ratio was 1.0 (0.4–3.0). With respect to incidence, in Pemba Island, Tanzania, prevalence, rank order, S:E ratio, and incidence was 64.8%, 1, 9.2 and 110 cases per 100 000, respectively, and in Boulkiemdé, Burkina Faso, was 13.3%, 3, 2.3 and 249 cases per 100 000. Conclusions We describe considerable variation in place and time for Salmonella Typhi prevalence, rank order, and S:E ratio among hospital-based studies of CO-BSI. Data from simultaneous typhoid prevalence and incidence studies are limited. We propose that hospital-based study metrics warrant evaluation for making inference about typhoid incidence and as covariates in typhoid incidence models.
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Affiliation(s)
| | - Ariella P Dale
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | | | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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17
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High levels of drug resistance in commensal E. coli in a cohort of children from rural central India. Sci Rep 2019; 9:6682. [PMID: 31040380 PMCID: PMC6491649 DOI: 10.1038/s41598-019-43227-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/17/2019] [Indexed: 01/01/2023] Open
Abstract
The world is experiencing crisis of antibiotic resistance not only in pathogenic but also in commensal bacteria. We determine the prevalence of antibiotic resistance in commensal Escherichia coli in young children in rural setting of central India and search for its correlations with demographic and behavioral factors. At seven time points during a period of 2 years we collected stool samples from 125 children; aged 1–3 in a rural area of Madhya Pradesh. We isolated six isolates of E. coli per stool sample and subjected them to antibiotic susceptibility testing. We found resistance to ampicillin, quinolones, cephalosporins, sulfamethoxazole, co-trimoxazole, in at least one isolate from 89% to 100% of children. Extended spectrum beta lactamase producing E. coli were identified in all but one child and multidrug resistance was identified in isolates from all children. Female gender (p = 0.04) and higher wealth (p = 0.03) was significantly correlated with less antibiotic resistance. Thus, the high prevalence of antibiotic resistance in commensal E. coli in rural community from India needs urgent measures to control the growing antibiotic resistance crisis.
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18
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Itzia Azucena RC, José Roberto CL, Martin ZR, Rafael CZ, Leonardo HH, Gabriela TP, Araceli CR. Drug Susceptibility Testing and Synergistic Antibacterial Activity of Curcumin with Antibiotics against Enterotoxigenic Escherichia coli. Antibiotics (Basel) 2019; 8:antibiotics8020043. [PMID: 31003468 PMCID: PMC6627278 DOI: 10.3390/antibiotics8020043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/11/2019] [Accepted: 04/15/2019] [Indexed: 01/19/2023] Open
Abstract
Aim: This study investigated the susceptibility of Enterotoxigenic Escherichia coli to curcumin, as well as its synergistic effect with 12 antimicrobial drugs. Methods and Results: Our study shows that curcumin did not affect bacterial growth. The antimicrobial susceptibility of curcumin and antibiotic synergy were identified using disc diffusion on Mueller-Hinton agar. The strain of Enterotoxigenic Escherichia coli used was resistant to Ampicillin, Amoxicillin/Clavulanic acid, Ampicillin/Sulbactam, Ciprofloxacin, and Cefazolin. There was synergy between curcumin and the majority of antibiotics tested. Maximum synergy was observed with combinations of 330 µg/mL curcumin and Ceftazidime, followed by Cefotaxime, Amoxicillin/Clavulanic acid, Ampicillin, Aztreonam, Trimethoprim, Ciprofloxacin, Ceftriaxone, Cefazolin, Tetracycline, and Imipenem. Conclusion: Our findings indicated that curcumin might be useful as a combinatorial strategy to combat the antibiotic resistance of Enterotoxigenic Escherichia coli.
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Affiliation(s)
- Rangel-Castañeda Itzia Azucena
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico.
| | - Cruz-Lozano José Roberto
- Departamento de Química, Centro Universitario de Ciencias Exactas e Ingenierías, Universidad de Guadalajara, Blvd. Marcelino García Barragán 1421, Guadalajara 44430, Jalisco, Mexico.
| | - Zermeño-Ruiz Martin
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico.
| | - Cortes-Zarate Rafael
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico.
| | - Hernández-Hernández Leonardo
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico.
| | - Tapia-Pastrana Gabriela
- Hospital Regional de Alta Especialidad de Oaxaca, Calle Aldama S/N, 71256 San Bartolo Coyotepec, Oax, Mexico.
| | - Castillo-Romero Araceli
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Calle Sierra Mojada 950, Independencia Oriente, Guadalajara 44340, Jalisco, Mexico.
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19
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Bharadwaj R, Robinson ML, Balasubramanian U, Kulkarni V, Kagal A, Raichur P, Khadse S, Kadam D, Valvi C, Kinikar A, Kanade S, Suryavanshi N, Marbaniang I, Nelson G, Johnson J, Zenilman J, Sachs J, Gupta A, Mave V. Drug-resistant Enterobacteriaceae colonization is associated with healthcare utilization and antimicrobial use among inpatients in Pune, India. BMC Infect Dis 2018; 18:504. [PMID: 30286741 PMCID: PMC6172743 DOI: 10.1186/s12879-018-3390-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare exposure may increase drug-resistant Enterobacteriaceae colonization risk. Nascent antimicrobial stewardship efforts in low- and middle-income countries require setting-specific data. We aimed to evaluate risk factors for inpatient drug resistant Enterobacteriaceae colonization in a resource-limited setting in India. Methods Patients age ≥ 6 months admitted with ≥24 h of fever to a tertiary hospital in Pune, India were enrolled in a prospective cohort. Perirectal swabs, collected on admission and hospitalization day 3 or 4, were cultured in vancomycin- and ceftriaxone-impregnated media to assess for ceftriaxone-resistant Enterobacteriaceae (CTRE) and carbapenem-resistant Enterobacteriaceae (CPRE). Multivariable analyses assessed risk factors for drug-resistant Enterobacteriaceae colonization among participants without admission colonization. Results Admission perirectal swabs were collected on 897 participants; 87 (10%) had CTRE and 14 (1.6%) had CPRE colonization. Admission CTRE colonization was associated with recent healthcare contact (p < 0.01). Follow-up samples were collected from 620 participants, 67 (11%) had CTRE and 21 (3.4%) had CPRE colonization. Among 561 participants without enrollment CTRE colonization, 49 (9%) participants were colonized with CTRE at follow-up. Detection of CTRE colonization among participants not colonized with CTRE at admission was independently associated with empiric third generation cephalosporin treatment (adjusted odds ratio [OR] 2.9, 95% CI 1.5–5.8). Follow-up transition to CPRE colonization detection was associated with ICU admission (OR 3.0, 95% CI 1.0–8.5). Conclusions Patients who receive empiric third generation cephalosporins and are admitted to the ICU rapidly develop detectable CTRE and CPRE colonization. Improved antimicrobial stewardship and infection control measures are urgently needed upon hospital admission. Electronic supplementary material The online version of this article (10.1186/s12879-018-3390-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renu Bharadwaj
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India. .,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India.
| | | | - Usha Balasubramanian
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Priyanka Raichur
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Sandhya Khadse
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Chhaya Valvi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Byramjee-Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Savita Kanade
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Nishi Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India
| | - George Nelson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Johnson
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jonathan Sachs
- Phoenix Children's Hospital / Maricopa Medical Center, Phoenix, AZ, USA
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, Maharashtra, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Robinson ML, Kadam D, Kagal A, Khadse S, Kinikar A, Valvi C, Basavaraj A, Bharadwaj R, Marbaniang I, Kanade S, Raichur P, Sachs J, Klein E, Cosgrove S, Gupta A, Mave V. Antibiotic Utilization and the Role of Suspected and Diagnosed Mosquito-borne Illness Among Adults and Children With Acute Febrile Illness in Pune, India. Clin Infect Dis 2018; 66:1602-1609. [PMID: 29211830 PMCID: PMC5930254 DOI: 10.1093/cid/cix1059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/02/2017] [Indexed: 12/20/2022] Open
Abstract
Background Antibiotic resistance mechanisms originating in low- and middle- income countries are among the most common worldwide. Reducing unnecessary antibiotic use in India, the world's largest antibiotic consumer, is crucial to control antimicrobial resistance globally. Limited data describing factors influencing Indian clinicians to start or stop antibiotics are available. Methods Febrile adults and children admitted to a public tertiary care hospital in Pune, India, were enrolled. Antibiotic usage and clinical history were recorded. Immunoassays for mosquito-borne disease and bacterial cultures were performed by protocol and clinician-directed testing. Clinical factors were assessed for association with empiric antibiotic initiation and discontinuation by day 5 using multivariable logistic regression and propensity score-matched Cox proportional hazard models. Results Among 1486 participants, 683 (82%) adults and 614 (94%) children received empiric antibiotics. Participants suspected of having mosquito-borne disease were less likely to receive empiric antibiotics (adjusted odds ratio [AOR], 0.5; 95% confidence interval [CI], .4-.8). Empiric antibiotics were discontinued in 450 (35%) participants by day 5. Dengue or malaria testing performed before day 4 was positive in 162 (12%) participants, and was associated with antibiotic discontinuation (AOR, 1.7; 95% CI, 1.2-2.4). In a propensity score-matched model accounting for admission suspicion of mosquito-borne disease, positive dengue or malaria tests increased hazard of antibiotic discontinuation (hazard ratio, 1.6; 95% CI, 1.2-2.0). Conclusions Most patients with acute febrile illness in an Indian public hospital setting receive empiric antibiotics. Mosquito-borne disease identification is associated with reduced empiric antibiotic use and faster antibiotic discontinuation.
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Affiliation(s)
- Matthew L Robinson
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dileep Kadam
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Anju Kagal
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Sandhya Khadse
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Aarti Kinikar
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Chhaya Valvi
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Anita Basavaraj
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Renu Bharadwaj
- Byramjee-Jeejeebhoy Government Medical College, Pune, India
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Ivan Marbaniang
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Savita Kanade
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Priyanka Raichur
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
| | - Jonathan Sachs
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Eili Klein
- Department of International Health Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Center for Disease Dynamics, Economics and Policy, Washington, D.C
| | - Sara Cosgrove
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amita Gupta
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
- Department of International Health Baltimore, Maryland
| | - Vidya Mave
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Byramjee-Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Research Site, Pune, India
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21
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Robinson ML, Kadam D, Khadse S, Balasubramanian U, Raichur P, Valvi C, Marbaniang I, Kanade S, Sachs J, Basavaraj A, Bharadwaj R, Kagal A, Kulkarni V, Zenilman J, Nelson G, Manabe YC, Kinikar A, Gupta A, Mave V. Vector-Borne Disease is a Common Cause of Hospitalized Febrile Illness in India. Am J Trop Med Hyg 2018; 98:1526-1533. [PMID: 29582731 DOI: 10.4269/ajtmh.17-0571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Acute febrile illness (AFI) is a major cause of morbidity and mortality in India and other resource-limited settings, yet systematic etiologic characterization of AFI has been limited. We prospectively enrolled adults (N = 970) and children (age 6 months to 12 years, N = 755) admitted with fever from the community to Sassoon General Hospital in Pune, India, from July 2013 to December 2015. We systematically obtained a standardized clinical history, basic laboratory testing, and microbiologic diagnostics on enrolled participants. Results from additional testing ordered by treating clinicians were also recorded. A microbiological diagnosis was found in 549 (32%) participants; 211 (12%) met standardized case definitions for pneumonia and meningitis without an identified organism; 559 (32%) were assigned a clinical diagnosis in the absence of a confirmed diagnosis; and 406 (24%) had no diagnosis. Vector-borne diseases were the most common cause of AFI in adults including dengue (N = 188, 19%), malaria (N = 74, 8%), chikungunya (N = 15, 2%), and concurrent mosquito-borne infections (N = 23, 2%) occurring most frequently in the 3 months after the monsoon. In children, pneumonia was the most common cause of AFI (N = 214, 28%) and death. Bacteremia was found in 68 (4%) participants. Central nervous system infections occurred in 58 (6%) adults and 64 (8%) children. Etiology of AFI in India is diverse, highly seasonal, and difficult to differentiate on clinical grounds alone. Diagnostic strategies adapted for season and age may reduce diagnostic uncertainty and identify causative organisms in treatable, fatal causes of AFI.
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Affiliation(s)
- Matthew L Robinson
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Sandhya Khadse
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Usha Balasubramanian
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Priyanka Raichur
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Chhaya Valvi
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Savita Kanade
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Jonathan Sachs
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Anita Basavaraj
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Renu Bharadwaj
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Anju Kagal
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - George Nelson
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yukari C Manabe
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Amita Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland.,Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India.,Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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The association between infection control interventions and carbapenem-resistant Enterobacteriaceae incidence in an endemic hospital. J Hosp Infect 2017; 97:218-225. [PMID: 28743504 DOI: 10.1016/j.jhin.2017.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/18/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceae (CRE) starting in 2006. AIM To assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and CRE incidence. METHODS Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospital-days, was plotted quarterly between 2005 and 2016. IC interventions were applied at different time-points throughout this period. Data were collected on IC staffing, number of rectal surveillance cultures, and carbapenem consumption. Autocorrelated segmented linear regression analysis was used to assess the time-points at which a significant change in the CRE incidence trend occurred, and the association between the timing of IC intervention implementation and observed CRE trends was assessed. Trends between time-points were expressed as quarterly percent change (QPC) with 95% confidence intervals (CIs). FINDINGS Between 2005 and 2008, CRE incidence increased significantly (QPC: 19.7%; CI: 11.5-28.4), reaching a peak of 186.6 new acquisitions per 100,000 hospital-days. From mid-2011 until the end of follow-up, there was a significantly decreasing incidence trend (QPC: -4.5; CI: -6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments, and carbapenem restriction were required. Decreasing CRE incidence was observed with an infectious diseases/IC staffing of 1.2-1.5 per 100 beds and 20,000-36,000 yearly CRE surveillance samples. CONCLUSION A multi-faceted hospital-wide intervention programme is required to control CRE in hospital settings.
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