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Ahmed S, Shree N, Narula AS, Nirala PK, Majid H, Garg A, Nayeem U, Khan MA. The prevalence of multidrug resistance in uropathogens of patients admitted in the intensive care unit of a tertiary care hospital. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03108-5. [PMID: 38643454 DOI: 10.1007/s00210-024-03108-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50-65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings.
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Affiliation(s)
- Shaista Ahmed
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Neetu Shree
- Department of Microbiology, Hamdard Institute of Medical Sciences & Research, New Delhi, 110062, India
| | - Ajit Singh Narula
- Department of Nephrology, Fortis Escort Heart Institute and Research Centre, New Delhi, 110025, India
| | - Purushottam Kr Nirala
- Department of Nephrology, Fortis Escort Heart Institute and Research Centre, New Delhi, 110025, India
| | - Haya Majid
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Aakriti Garg
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, 110062, India
| | - Uzma Nayeem
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India
| | - Mohd Ashif Khan
- Department of Translational and Clinical Research, School of Chemical and Life Science, Jamia Hamdard, New Delhi, 110062, India.
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High Prevalence of Drug-Resistant Gram-Negative Bacteria: A Hospital-Based Cross-Sectional Study in Tehran, in 2017. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2020. [DOI: 10.5812/archcid.93637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garg VK, Mishra S, Gupta N, Garg R, Sachidanand B, Vinod K, Gautam H, Kapil A, Bhatnagar S. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients Admitted in the Intensive Care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J Crit Care Med 2019; 23:67-72. [PMID: 31086449 PMCID: PMC6487614 DOI: 10.5005/jp-journals-10071-23119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Cancer patients in intensive care unit (ICU) are vulnerable for developing multidrug resistant nosocomial infections. The antimicrobial resistance due to inappropriate use of antibiotics results in significant morbidity and mortality in these cancer patients. The present retrospective study was done to describe the antimicrobial sensitivity pattern of common organisms in isolates of clinical samples of patients admitted in ICU at our tertiary care cancer center. MATERIALS AND METHODS The study was carried out at ICU of a regional tertiary care cancer center for a period of 1 year from October 2016 to September 2017. All clinical samples were collected and processed for culture and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines. RESULTS A total of 644 specimens were collected. Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp. were most commonly encountered. In positive bacterial cultures, majority were Gram-negative isolates (84.14 %). Klebsiella was the most common gram-negative isolate (34.78%) and Enterococcus spp. were the most common Gram-positive isolates (61.53%). A high level of resistance to various antibiotics was noted among Gram-negative bacteria compared to Gram-positive isolates. Majority of the Gram-negative isolates were sensitive to Imipenem, Meropenem, and Colistin sensitivity among Gram-negative isolates was 100%. Linezolid, Teicoplanin and Vancomycin were most sensitive antimicrobials against the Gram-positive bacteria. CONCLUSION Regular monitoring of the pattern of resistance of bacteriological isolates in cancer patients is critical to develop antibiotic policy to combat these infections and reduce morbidity and mortality. HOW TO CITE THIS ARTICLE Garg VK, Seema M et al. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients admitted in the Intensive-care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J of Crit Care Med 2019;23(2):67-72.
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Affiliation(s)
- Vishnu Kumar Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
- Seema Mishra, Department of Oncoanesthesia and Palliative Medicine, IRCH, All India Institute of Medical Sciences, New Delhi, India, Phone: 9899061105, e-mail:
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bharti Sachidanand
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumar Vinod
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Hamishehkar H, Shadmehr P, Mahmoodpoor A, Mashayekhi SO, Entezari-Maleki T. Antimicrobial susceptibility patterns among bacteria isolated from intensive care units of the largest teaching hospital at the northwest of Iran. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000300006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | - Taher Entezari-Maleki
- Tabriz University of Medical Sciences, Iran; Tabriz University of Medical Sciences, Iran
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Eraksoy H, Basustaoglu A, Korten V, Kurt H, Ozturk R, Ulusoy S, Yaman A, Yuce A, Zarakolu P. Susceptibility of Bacterial Isolates From Turkey - A Report From the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program. J Chemother 2013; 19:650-7. [DOI: 10.1179/joc.2007.19.6.650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kizilca O, Siraneci R, Yilmaz A, Hatipoglu N, Ozturk E, Kiyak A, Ozkok D. Risk factors for community-acquired urinary tract infection caused by ESBL-producing bacteria in children. Pediatr Int 2012; 54:858-62. [PMID: 22882781 DOI: 10.1111/j.1442-200x.2012.03709.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 07/08/2012] [Accepted: 08/03/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the risk factors of antimicrobial resistance in children with urinary tract infection caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria. METHODS A total of 344 patients diagnosed with urinary tract infection (UTI) between January 2008 and December 2009 were enrolled in this retrospective study. Causative microorganisms were ESBL-producing bacteria in 148 patients and non-ESBL-producing bacteria in 196 patients. There was no difference between the two groups regarding distribution of age, sex and length of follow up. RESULTS The most frequent causative agent was Escherichia coli, of which 41.4% were ESBL producing. Among Klebsiella species, 53.2% were ESBL producing. The proportion of ESBL-producing bacteria that were resistant to antibiotics was 83.1% for trimethoprim/sulfamethoxazole, 18.2% for nitrofurantoin, 47.3% for quinolones, and 39.9% for aminoglycosides. For non-ESBL-producing bacteria, the resistance rate was 62.2% for trimethoprim/sulfamethoxazole, 4.6% for nitrofurantoin, 9.7% for quinolones, and 9.7% for aminoglycosides. Age <1 year, high UTI recurrence rate, long duration of prophylaxis, use of cephalosporins for prophylaxis, hospitalization within the previous 3 months and clean intermittent catheterization were found to be significant risk factors for ESBL-producing bacteria (P < 0.05). Logistic regression analysis identified age <1 year and high recurrence UTI rate to be independent risk factors, increasing the risk 1.74-fold and 2.25-fold, respectively. CONCLUSIONS Recognition of the risk factors for ESBL-producing bacteria may be helpful to determine new policies in the management of UTI. Recurrence of UTI should be prevented especially in the first year of life, and prophylactic cephalosporins should be avoided.
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Affiliation(s)
- Ozgur Kizilca
- Department of Pediatrics, Bakirkoy Maternity and Children's Hospital, Istanbul, Turkey
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Grover N, Sahni AK, Bhattacharya S. Therapeutic challenges of ESBLS and AmpC beta-lactamase producers in a tertiary care center. Med J Armed Forces India 2012; 69:4-10. [PMID: 24532926 DOI: 10.1016/j.mjafi.2012.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 02/28/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Resistance to broad-spectrum beta lactams mediated by extended spectrum beta lactamases (ESBLs) and AmpC beta lactamases (AmpC βLs) enzymes is an increasing problem worldwide. Determination of their prevalence is essential to formulate an effective antibiotic policy and hospital infection control measures. Present study was undertaken to determine the prevalence of ESBL and AmpC βL producers in ICU of a tertiary care center. METHODS A total of 262 clinical isolates comprising of Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis that were recovered from various clinical specimens over a one year period, were studied. Antibiogram profile was determined to conventionally used antibiotics, along with recommended tests for detection of ESBL and AmpC βL production. RESULTS 40.07% (105/262) were found to be ESBL producers, 14.8% (39/262) were AmpC bL producers. The coexistence of ESBL and AmpC βL producers was detected in 9.9% (26/262) of the isolates. CONCLUSION Screening of multidrug resistant bacteria especially belonging to the Enterobacteriaceae poses considerable therapeutic challenges in critical care patients because of the production of ESBL and AmpC βL. Strategies to keep a check on the emergence of such drug resistant microbes by hospital environmental surveillance and laboratory monitoring should form an important aspect of Hospital Infection control policy guidelines.
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Affiliation(s)
- Naveen Grover
- Associate Professor, Dept of Microbiology, AFMC, Pune 411040, India
| | - A K Sahni
- Prof & HOD, Dept of Microbiology, AFMC, Pune 411040, India
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Senturk E, Senturk Z, Sen S, Ture M, Avkan N. Mortality and associated factors in a thoracic surgery ICU. J Bras Pneumol 2011; 37:367-74. [PMID: 21755193 DOI: 10.1590/s1806-37132011000300014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 05/09/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess mortality and identify mortality risk factors in patients admitted to a thoracic surgery ICU. METHODS We retrospectively evaluated 141 patients admitted to the thoracic surgery ICU of the Denizli State Hospital, located in the city of Denizli, Turkey, between January of 2006 and August of 2008. We collected data regarding gender, age, reason for admission, invasive interventions and operations, invasive mechanical ventilation, infections, and length of ICU stay. RESULTS Of the 141 patients, 103 (73.0%) were male, and 38 (23.0%) were female. The mean age was 52.1 years (range, 12-92 years), and the mortality rate was 16.3%. The most common reason for admission was trauma. Mortality was found to correlate with advanced age (p < 0.05), requiring invasive mechanical ventilation (OR = 42.375; p < 0.05), prolonged ICU stay (p < 0.05), and specific reasons for admission-trauma, gunshot wound, stab wound, and malignancy (p < 0.05 for all). CONCLUSIONS Among patients in a thoracic surgery ICU, the rates of morbidity and mortality are high. Increased awareness of mortality risk factors can improve the effectiveness of treatment, which should reduce the rates of morbidity and mortality, thereby providing time savings and minimizing costs.
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Tsering DC, Das S, Adhiakari L, Pal R, Singh TS. Extended Spectrum Beta-lactamase Detection in Gram-negative Bacilli of Nosocomial Origin. J Glob Infect Dis 2011; 1:87-92. [PMID: 20300397 PMCID: PMC2840957 DOI: 10.4103/0974-777x.56247] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Resistance to third generation cephalosporins by acquisition and expression of extended spectrum beta lactamase (ESBL) enzymes among gram-negative bacilli is on a rise. The presence of ESBL producing organisms significantly affects the course and outcome of an infection and poses a challenge to infection management worldwide. MATERIALS AND METHODS In the period from June 2007 to 2008, we collected 1489 samples from patients suspected of nosocomial infection. The isolates were identified based on colony morphology and biochemical reaction. Gram negative bacilli resistant to third generation cephalosporins were tested for ESBL by double disc synergy test (DDST- a screening test)and then phenotypic confirmatory test. Antimicrobial susceptibility testing was done by modified Kirby Bauer disc diffusion method. RESULTS From the sample of 238 gram-negative bacilli, we isolated Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, Morganella morganii and Enterobacter cloacae. Following both methods, 34% isolates were ESBL-positive. The ESBL producing isolates were significantly resistant (p < 0.01) to ampicillin, piperacillin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole, tetracycline, ciprofloxacin and gentamicin as compared to non-ESBL producers. Multidrug resistance was significantly (p < 0.01) higher (69.14%) in ESBL positive isolates than non-ESBL isolates (21.66%). CONCLUSION High prevalence of ESBL in our hospital cannot be ignored. ESBL producers can be detected by DDST and phenotypic confirmatory test with equal efficacy. The sensitivity of screening test improved with the use of more than one antibiotic and addition of one or two antibiotics would not increase cost and labor. We recommend DDST using multiple antibiotics in all microbiology units as a routine screening test.
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Affiliation(s)
- Dechen C Tsering
- Department of Microbiology, Sikkim-Manipal Institute of Medical Sciences(SMIMS) and Central Referral Hospital (CRH), Gangtok, Sikkim, India
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Kallel H, Mahjoubi F, Dammak H, Bahloul M, Hamida CB, Chelly H, Rekik N, Hammami A, Bouaziz M. Correlation between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in a medical-surgical intensive care unit. Indian J Crit Care Med 2010; 12:18-23. [PMID: 19826586 PMCID: PMC2760919 DOI: 10.4103/0972-5229.40945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Multiple surveillance programmes have reported a decline in antibiotic susceptibility of P. aeruginosa. Aim: Our study aimed to study the relationship between the use of antipseudomonal drugs and the development of resistance of P. aerogenosa to these drugs. Setting and Design: Our study is retrospective. It was conducted in a medical surgical intensive care unit during a five-year period (January 1st, 1999 to December 31, 2003), which was divided into 20 quarters. We had monitored the use of antipseudomonal agents and the resistance rates of P. aeruginosa to these drugs. Statistical Methods: The associations between use and resistance were quantified using non-partial and partial correlation coefficients according to Pearson and Spearman. Results: Over the study period, the most frequently used antipseudomonal agent was Imipenem (152 ± 46 DDD/1000 patients-day) and the resistance rate of P. aeruginosa to Imipenem was 44.3 ± 9.5% (range, 30 and 60%). In addition, Imipenem use correlated significantly with development of resistance to Imipenem in the same (P < 0.05) and in the following quarter (P < 0.05); and Ciprofloxacin use correlated significantly with resistance to Ciprofloxacin in the following quarter (P < 0.05). However, use of Ceftazidime or Amikacine had no apparent association with development of resistance. Conclusion: We conclude that the extensive use of imipenem or ciprofloxacin in intensive care units may lead to the emergence of imipenem- and ciprofloxacin-resistant strains of P. aeruginosa and that antibiotic prescription policy has a significant impact on P. aeruginosa resistance rates in an intensive care unit.
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Affiliation(s)
- Hatem Kallel
- Service de Réanimation Polyvalente, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax - Tunisia.
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Ashour HM, El-Sharif A. Species distribution and antimicrobial susceptibility of gram-negative aerobic bacteria in hospitalized cancer patients. J Transl Med 2009; 7:14. [PMID: 19228413 PMCID: PMC2654854 DOI: 10.1186/1479-5876-7-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/19/2009] [Indexed: 01/10/2023] Open
Abstract
Background Nosocomial infections pose significant threats to hospitalized patients, especially the immunocompromised ones, such as cancer patients. Methods This study examined the microbial spectrum of gram-negative bacteria in various infection sites in patients with leukemia and solid tumors. The antimicrobial resistance patterns of the isolated bacteria were studied. Results The most frequently isolated gram-negative bacteria were Klebsiella pneumonia (31.2%) followed by Escherichia coli (22.2%). We report the isolation and identification of a number of less-frequent gram negative bacteria (Chromobacterium violacum, Burkholderia cepacia, Kluyvera ascorbata, Stenotrophomonas maltophilia, Yersinia pseudotuberculosis, and Salmonella arizona). Most of the gram-negative isolates from Respiratory Tract Infections (RTI), Gastro-intestinal Tract Infections (GITI), Urinary Tract Infections (UTI), and Bloodstream Infections (BSI) were obtained from leukemic patients. All gram-negative isolates from Skin Infections (SI) were obtained from solid-tumor patients. In both leukemic and solid-tumor patients, gram-negative bacteria causing UTI were mainly Escherichia coli and Klebsiella pneumoniae, while gram-negative bacteria causing RTI were mainly Klebsiella pneumoniae. Escherichia coli was the main gram-negative pathogen causing BSI in solid-tumor patients and GITI in leukemic patients. Isolates of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, and Acinetobacter species were resistant to most antibiotics tested. There was significant imipenem -resistance in Acinetobacter (40.9%), Pseudomonas (40%), and Enterobacter (22.2%) species, and noticeable imipinem-resistance in Klebsiella (13.9%) and Escherichia coli (8%). Conclusion This is the first study to report the evolution of imipenem-resistant gram-negative strains in Egypt. Mortality rates were higher in cancer patients with nosocomial Pseudomonas infections than any other bacterial infections. Policies restricting antibiotic consumption should be implemented to avoid the evolution of newer generations of antibiotic resistant-pathogens.
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Affiliation(s)
- Hossam M Ashour
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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Nicasio AM, Kuti JL, Nicolau DP. The current state of multidrug-resistant gram-negative bacilli in North America. Pharmacotherapy 2008; 28:235-49. [PMID: 18225969 DOI: 10.1592/phco.28.2.235] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although much of today's media focuses on multidrug-resistant gram-positive bacteria such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus, resistance within gram-negative bacilli continues to rise, occasionally creating situations in which few or no antibiotics that retain activity are available. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella sp are emerging threats nationally. Although carbapenems are considered the antibiotic class of choice to treat ESBL-producing Enterobacteriaceae, the ability of these organisms to produce carbapenemases has now become apparent in some regions throughout the United States. Although still rare, Klebsiella sp that produce KPC-2 retain susceptibility only to tigecycline, polymyxins, and occasionally aminoglycosides. Multidrug resistance among Pseudomonas aeruginosa and Acinetobacter sp has always been apparent across many hospitals in the United States. Recent surveillance indicates increasing resistance to all currently available antibiotics, including carbapenems, cephalosporins, penicillins, fluoroquinolones, and aminoglycosides. Against many strains, only polymyxins retain activity; however, resistance has also been reported to these agents. Fortunately, resistance mechanisms such as metallo-beta-lactamases are still rare in the United States. As no new antibiotics with novel mechanisms against many of these gram-negative bacilli are expected to be developed in the foreseeable future, careful and conservative use of agents combined with good infection control practices is required.
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Affiliation(s)
- Anthony M Nicasio
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
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Antimicrobial resistance pattern of Gram-negative bacilli of nosocomial origin at 2 university hospitals in Iran. Diagn Microbiol Infect Dis 2007; 60:301-5. [PMID: 18036759 DOI: 10.1016/j.diagmicrobio.2007.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 09/26/2007] [Accepted: 10/10/2007] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to investigate the antimicrobial resistance pattern among common Gram-negative bacilli isolated from patients with nosocomial infection. A total of 200 samples of common Gram-negative bacilli (Klebsiella, Pseudomonas, Acinetobacter, and Escherichia coli) were collected from 2 university hospitals in Iran during a 1.5-year period from June 2004 to December 2005. All samples were examined for the antimicrobial activity of imipenem, cefepime, ciprofloxacin, ceftriaxone, and ceftazidime using E-test methods. The most frequent pathogens were Klebsiella spp. (38.5%) followed by Pseudomonas aeruginosa (28.5%), Acinetobacter spp. (20.5%), and E. coli (12.5%). The most active antibiotic was imipenem (84%). The susceptibility of the studied microorganisms was 25% for cefepime, 24% for ciprofloxacin, 20.5% for ceftazidime, and 11.8% for ceftriaxone. The susceptibility rates of Klebsiella to imipenem, cefepime, ciprofloxacin, ceftazidime, and ceftriaxone were 90.9%, 20.8%, 18.2%, 10.4%, and 5.2%, respectively. Likewise, these rates were 88%, 19%, 17%, 21%, and 21% for E. coli. Among Acinetobacter spp., the susceptibility rates were 77% for imipenem and 21% for ciprofloxacin. Among Pseudomonas, the rates were 75% for imipenem and 39% for ciprofloxacin. The antibiotics resistance among Gram-negative bacilli was widespread, so an antibiotic policy is urgently needed to delay the resistance development.
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Falagas ME, Karveli EA, Siempos II, Vardakas KZ. Acinetobacter infections: a growing threat for critically ill patients. Epidemiol Infect 2007; 136:1009-19. [PMID: 17892629 PMCID: PMC2870905 DOI: 10.1017/s0950268807009478] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There has been increasing concern regarding the rise of Acinetobacter infections in critically ill patients. We extracted information regarding the relative frequency of Acinetobacter pneumonia and bacteraemia in intensive-care-unit (ICU) patients and the antimicrobial resistance of Acinetobacter isolates from studies identified in electronic databases. Acinetobacter infections most frequently involve the respiratory tract of intubated patients and Acinetobacter pneumonia has been more common in critically ill patients in Asian (range 4-44%) and European (0-35%) hospitals than in United States hospitals (6-11%). There is also a gradient in Europe regarding the proportion of ICU-acquired pneumonias caused by Acinetobacter with low numbers in Scandinavia, and gradually rising in Central and Southern Europe. A higher proportion of Acinetobacter isolates were resistant to aminoglycosides and piperacillin/tazobactam in Asian and European countries than in the United States. The data suggest that Acinetobacter infections are a growing threat affecting a considerable proportion of critically ill patients, especially in Asia and Europe.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
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Abstract
Extended-spectrum beta-lactamases (ESBLs) are a rapidly evolving group of beta-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these beta-lactamases. This extends the spectrum of beta-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli. In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.
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Affiliation(s)
- David L Paterson
- Infectious Disease Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Kolayli F, Gacar G, Karadenizli A, Sanic A, Vahaboglu H. PER-1 is still widespread in Turkish hospitals among Pseudomonas aeruginosa and Acinetobacter spp. FEMS Microbiol Lett 2005; 249:241-5. [PMID: 16006075 DOI: 10.1016/j.femsle.2005.06.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Revised: 06/08/2005] [Accepted: 06/09/2005] [Indexed: 11/25/2022] Open
Abstract
PER-1 type beta-lactamases were screened among ceftazidime-resistant clinical isolates of Acinetobacter spp. and Pseudomonas aeruginosa. A total of 176 non-repetitive isolates (84 Acinetobacter spp. and 92 P. aeruginosa) were collected during a three month surveillance period. Isolates were obtained from seven intensive care units of seven university hospitals. All strains were screened for bla(PER-1) alleles by PCR. Of the strains, 31% and 55.4% of Acinetobacter spp. and P. aeruginosa were positive for bla(PER-1) type genes, respectively.
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Affiliation(s)
- Fetiye Kolayli
- Mikrobiyoloji ve Klinik Mikrobiyoloji AD, Kocaeli Universitesi, Turkey
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17
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Aktaş Z, Poirel L, Salcioğlu M, Ozcan PE, Midilli K, Bal C, Anğ O, Nordmann P. PER-1- and OXA-10-like beta-lactamases in ceftazidime-resistant Pseudomonas aeruginosa isolates from intensive care unit patients in Istanbul, Turkey. Clin Microbiol Infect 2005; 11:193-8. [PMID: 15715716 DOI: 10.1111/j.1469-0691.2004.01067.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The presence of PER-1- and OXA-10-like beta-lactamases was investigated by PCR in 49 ceftazidime-resistant Pseudomonas aeruginosa isolates from patients hospitalised in the 24-bed general intensive care unit of the Istanbul Faculty of Medicine during a 12-month period between February 1999 and February 2000. The clonal relatedness of the isolates was investigated by random amplified polymorphic DNA (RAPD) analysis, and the sequences of the PER-1 and OXA genes from all isolates were determined. The rates of resistance of the isolates to imipenem, aztreonam and cefepime were 98%, 92% and 96%, respectively, and to piperacillin and piperacillin-tazobactam were 41% and 37%, respectively. Using the double-disk synergy test, 37% (18/49) of the isolates were identified as extended-spectrum beta-lactamase producers. The PER-1 gene was identified in 86% (42/49) and the OXA-10 gene in 55% (27/49) of the ceftazidime-resistant isolates. Of isolates carrying the PER-1 gene, 48% (20/42) also carried the OXA-10 gene. The respective nucleotide sequences were identical for each isolate. Sixteen RAPD patterns were detected among the PER-1-positive isolates, but 60% (25/42) of the PER-1-positive isolates belonged to two distinct patterns, while the remainder exhibited a wide clonal diversity. The results indicated that the prevalence of PER-1- and OXA-10-like beta-lactamases remains high among ceftazidime-resistant P. aeruginosa isolates in Turkey.
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Affiliation(s)
- Z Aktaş
- Department of Microbiology and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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18
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Kizirgil A, Demirdag K, Ozden M, Bulut Y, Yakupogullari Y, Toraman ZA. In vitro activity of three different antimicrobial agents against ESBL producing Escherichia coli and Klebsiella pneumoniae blood isolates. Microbiol Res 2005; 160:135-40. [PMID: 15881830 DOI: 10.1016/j.micres.2004.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Extended spectrum beta-lactamases (ESBLs) usually associated with multiple drug resistance, including beta-lactam and non-beta-lactam antibiotics. This resistance can cause Limitation in the choice of drugs appropriate for using in clinical practice, especially in life-threatening infections. In this study we aimed to investigate in vitro activity of meropenem, ciprofloxacine and amikacin against ESBL-producing and non-producing blood isolates of Escherichia coli and Klebsiella pneumoniae strains. Fifty-eight E. coli (21 ESBL-producing, 37 non-ESBL producing) and 99 K. pneumoniae (54 ESBL-producing, 45 non-ESBL producing) strains were included in the study. The presence of ESBL was investigated by double disk synergy test and E-test methods. Antibiotic susceptibility test was done by microdilution method according to NCCLS guideline. In vitro susceptibilities of ESBL producing E. coli and K. pneumoniae strains were found as 100% for meropenem, 33.3% and 25.9% for ciprofloxacine, 94.5% and 83.3% for amikacin. It was observed that; meropenem was equally active agent in both ESBL-producing and non-producing strains, and its activity was not affected by ESBL production. Whereas amikacin activity was minimally affected and ciprofloxacine activity was markedly decreased by ESBL production. In conclusion, meropenem seems to be better choice of antibiotic should be used for ESBL positive life-threatening infections, because of remaining highest activity.
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Affiliation(s)
- Ahmet Kizirgil
- Medical Faculty, Microbiology and Clinical Microbiology Department, Firat University, 23200 Elazig, Turkey.
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19
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Kaiser AM, Schultsz C, Kruithof GJ, Debets-Ossenkopp Y, Vandenbroucke-Grauls C. Carriage of resistant microorganisms in repatriates from foreign hospitals to The Netherlands. Clin Microbiol Infect 2004; 10:972-9. [PMID: 15521999 DOI: 10.1111/j.1469-0691.2004.01000.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a prospective survey conducted between May 1998 and September 2001, the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and gentamicin-resistant Gram-negative bacilli (GGNB) was determined in 1167 patients repatriated from foreign hospitals to The Netherlands. Swab specimens, demographic data and clinical data were obtained during transfer of the patients from the foreign hospitals. The total prevalence of carriage of resistant microorganisms was 18.2%. MRSA was carried by 2.7% of all patients, and by 4.7% of the patients repatriated to a Dutch hospital. Antimicrobial treatment (adjusted odds ratio (OR) 3.4; 95% confidence interval (CI) 1.2-9.7), length of stay in a foreign hospital of > 14 days (adjusted OR 5.4; 95% CI 2.3-12) and artificial ventilation (adjusted OR 8.5; 95% CI 1.8-41) were risk factors for carriage of MRSA. VRE and GGNB were isolated from 2.7% and 14.1% of the patients, respectively. Transfer from Asia, and southern, southeastern and eastern Europe, were risk factors for carriage of GGNB. These carriage rates were high compared to those found in patients in Dutch hospitals, where the rates are < 1% for MRSA, 2% for VRE, and 4.5% for GGNB. The highest risk of acquisition of GGNB was associated with the country from where the patient was repatriated, rather than with the antimicrobial treatment received by the individual patient in the foreign hospital.
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Affiliation(s)
- A M Kaiser
- VU University Medical Centre, Medical Microbiology and Infection Control, Amsterdam, The Netherlands
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20
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Abstract
Bacteria of the genus Acinetobacter are ubiquitous in nature. These organisms were invariably susceptible to many antibiotics in the 1970s. Since that time, acinetobacters have emerged as multiresistant opportunistic nosocomial pathogens. The taxonomy of the genus Acinetobacter underwent extensive revision in the mid-1980s, and at least 32 named and unnamed species have now been described. Of these, Acinetobacter baumannii and the closely related unnamed genomic species 3 and 13 sensu Tjernberg and Ursing (13TU) are the most relevant clinically. Multiresistant strains of these species causing bacteraemia, pneumonia, meningitis, urinary tract infections and surgical wound infections have been isolated from hospitalised patients worldwide. This review provides an overview of the antimicrobial susceptibilities of Acinetobacter spp. in Europe, as well as the main mechanisms of antimicrobial resistance, and summarises the remaining treatment options for multiresistant Acinetobacter infections.
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Affiliation(s)
- M Van Looveren
- Department of Medical Microbiology, University Hospital Antwerp, UA, Antwerp, Belgium.
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21
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Braunstein A, Papo N, Shai Y. In vitro activity and potency of an intravenously injected antimicrobial peptide and its DL amino acid analog in mice infected with bacteria. Antimicrob Agents Chemother 2004; 48:3127-9. [PMID: 15273131 PMCID: PMC478488 DOI: 10.1128/aac.48.8.3127-3129.2004] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report that intravenous injection (3 mg/kg of body weight twice daily) of a diastereomer (containing 33% D amino acids) of an antimicrobial peptide, K6L9 (LKLLKKLLKKLLKLL-NH2), but not the all-L-amino-acid parental peptide, cures neutropenic mice infected with gentamicin-sensitive Pseudomonas aeruginosa and gentamicin-resistant Acinetobacter baumannii bacteria. Various biophysical experiments suggest a membranolytic-like effect.
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Affiliation(s)
- Amir Braunstein
- Department of Biological Chemistry, The Weizmann Institute of Science, Rehovot, Israel
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22
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Karsligil T, Balci I, Zer Y. Antibacterial sensitivity of Acinetobacter strains isolated from nosocomial infections. J Int Med Res 2004; 32:436-41. [PMID: 15303777 DOI: 10.1177/147323000403200414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acinetobacter species can cause many types of hospital-acquired infection and play an important role in nosocomial pneumonia in intensive care units, skin and wound infections, and meningitis. They are of increasing importance because of their ability to rapidly develop resistance to the major groups of antibiotics. We aimed to determine the antibiotic sensitivity of Acinetobacter strains isolated from, and determined to be the cause of, hospital-acquired infections. A total of 156 cultures of Acinetobacter (strains of A. baumannii [136; 87.2%] and A. iwoffii [20; 12.8%]), were isolated from clinical samples taken from patients in different units of our hospital. Conventional bacterial identification methods and the Sceptor system were used. In the antibiotic sensitivity tests, A. baumannii was susceptible to imipenem (90.4%), norfloxacin (84.5%) and ciprofloxacin (65.4%), and A. iwoffii to amikacin (80.0%), ticarcillin/clavulanic acid (70.0%) and imipenem (60.0%).
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Affiliation(s)
- T Karsligil
- Department of Microbiology and Clinical Microbiology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey.
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23
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Hasdemir UO, Chevalier J, Nordmann P, Pagès JM. Detection and prevalence of active drug efflux mechanism in various multidrug-resistant Klebsiella pneumoniae strains from Turkey. J Clin Microbiol 2004; 42:2701-6. [PMID: 15184455 PMCID: PMC427859 DOI: 10.1128/jcm.42.6.2701-2706.2004] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prevalence of active drug efflux pump and porin alterations was investigated in Turkish nosocomial strains of Klebsiella pneumoniae exhibiting a multidrug-resistant phenotype. MICs of various antibiotics, including quinolones, chloramphenicol, tetracycline, and beta-lactams, for those strains were determined either with or without the efflux pump inhibitor phenylalanine arginine beta-naphthylamide (PAbetaN). Thirty-nine percent of the strains exhibited a PAbetaN-modulated resistance for quinolones, chloramphenicol, and tetracycline. In these strains, a significant increase of chloramphenicol accumulation was gained in the presence of the efflux pump inhibitor PAbetaN or with the energy uncoupler carbonyl cyanide m-chlorophenylhydrazone. Moreover, high-level expression of the membrane fusion protein AcrA, which was immunodetected in most of those isolates, suggests that the AcrAB/TolC efflux machinery contributed to their antibiotic resistance. Studies of K. pneumoniae porins indicated that the majority of the strains, including extended-spectrum beta-lactamase producers and efflux-positive ones, presented an alteration in their sorbitol-sensitive porin (OmpK35) expression. This is the first report showing the prominent role of active drug efflux in the antibiotic resistance of nosocomial K. pneumoniae strains from Turkey.
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Affiliation(s)
- Ufuk Over Hasdemir
- Department of Microbiology, School of Medicine, Marmara University, Istanbul, Turkey
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24
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Aktas O, Ozbek A. Prevalence and in-vitro antimicrobial susceptibility patterns of Acinetobacter strains isolated from patients in intensive care units. J Int Med Res 2003; 31:272-80. [PMID: 12964502 DOI: 10.1177/147323000303100404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fifty-six Acinetobacter species strains (49 Acinetobacter baumanii, 5 Acinetobacter calcoaceticus, 2 Acinetobacter iwoffii) were detected using both conventional methods and gas chromatography of bacterial fatty acids with the MIDI Sherlock Microbial Identification System. The susceptibilities of these strains to 16 antimicrobial agents were investigated by the disc-diffusion method according to the National Committee for Clinical Laboratory Standards. The production of extended-spectrum beta-lactamases (ESBLs) and inducible beta-lactamases (IBLs) by the strains were investigated by the double-disc-synergy and disc-approximation methods, respectively. Imipenem was the most effective agent for Acinetobacter baumanii strains (95.9% of strains were sensitive), while meropenem and netilmicin showed moderate activity (87.7% and 79.6% of strains, respectively, responded). Acinetobacter baumanii strains were less sensitive to cefoperazone-sulbactam (53.1%), ofloxacin (51.0%), ciprofloxacin (42.8%), and amikacin (36.7%). Acinetobacter calcoaceticus and Acinetobacter iwoffii strains were sensitive to imipenem, meropenem and netilmicin. IBLs and ESBLs were produced, respectively, by 8.9% and 7.1% of all bacterial strains. The strains isolated were sufficiently sensitive to imipenem, but not to ofloxacin or ciprofloxacin, and were very resistant to amikacin.
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Affiliation(s)
- O Aktas
- Department of Microbiology and Clinical Microbiology, Medical School, Ataturk University, Erzurum, Turkey
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25
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Hoogkamp-Korstanje JAA, Roelofs-Willemse J. Antimicrobial resistance in Gram-negative bacteria from Intensive Care Units and Urology Services. A nationwide study in The Netherlands 1995-2000. Int J Antimicrob Agents 2003; 21:547-56. [PMID: 12791468 DOI: 10.1016/s0924-8579(03)00080-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A nationwide 6-year surveillance of resistance in Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Pseudomonas aeruginosa from clinical specimens of patients from ten Intensive Care Units and ten Urology Services was started in 1995. MICs of amoxycillin, amoxycillin/clavulanate, trimethoprim, cotrimoxazole, norfloxacin, ciprofloxacin, cefaclor, ceftazidime, imipenem and gentamicin were determined by broth microdilution. Intensive Care Units had higher resistance levels of amoxycillin/clavulanate, cefaclor and ceftazidime (P<0.005) and lower resistance levels of nitrofurantoin, trimethoprim, cotrimoxazole and quinolones (P<0.01) than Urology Services. Changes in MIC distributions in time and development of resistant clusters were observed for nitrofurantoin (E. coli), amoxycillin (E. coli, P. mirabilis), amoxycillin/clavulanate (E. coli) and for quinolones (E. coli). The overall resistance level of ceftazidime and gentamicin was <5%, but this fluctuated with the appearance and disappearance of resistant clones in some Intensive Care Units. Quinolone resistance among P. aeruginosa from Intensive Care Units fluctuated between 7 and 14%.
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Affiliation(s)
- J A A Hoogkamp-Korstanje
- Laboratory for Medical Microbiology, University Hospital St. Radboud, Geert Grooteplein 24, 6500 HB, Nijmegen, The Netherlands.
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26
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Turner PJ, Greenhalgh JM. The activity of meropenem and comparators against Acinetobacter strains isolated from European hospitals, 1997-2000. Clin Microbiol Infect 2003; 9:563-7. [PMID: 12848736 DOI: 10.1046/j.1469-0691.2003.00591.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In vitro susceptibilities to meropenem and comparators of Acinetobacter strains isolated from serious infections in 37 European hospital centers participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program (1997-2000) were tested. There were 635 Acinetobacter strains collected: 490 A. baumannii; 51 A. calcoaceticus var. lwoffii; and 94 other Acinetobacter strains. Overall, meropenem and imipenem were the most effective agents tested. Resistance to the antimicrobials was: 14%, meropenem; 16%, imipenem; 39%, piperacillin-tazobactam; 41%, tobramycin; 45%, ceftazidime; and 53%, ciprofloxacin. Thus, the carbapenems have useful activity against Acinetobacter spp. and represent a viable choice for treating infections caused by these organisms.
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Affiliation(s)
- P J Turner
- Antibiotic Development and Technical Support Group, AstraZeneca, Alderley House, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK.
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27
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Larson EL, Gomez-Duarte C, Lee LV, Della-Latta P, Kain DJ, Keswick BH. Microbial flora of hands of homemakers. Am J Infect Control 2003; 31:72-9. [PMID: 12665739 DOI: 10.1067/mic.2003.33] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES AND METHODS Because of increasing concern about antimicrobial resistance in the community, aerobic flora of hands of 224 healthy homemakers in northern Manhattan, New York, were examined. RESULTS Mean log colony-forming unit counts before and after handwashing were 5.72 and 5.69, respectively, P =.60; mean number of species identified/sample was 3.6 before washing and 3.3 after (P =.02). After handwashing gram-negative bacteria were isolated from 75.1% of subjects; yeast from 32.9%; and Staphylococcus aureus from 18.5%, 1 of which (2.4%) was oxacillin-resistant. Generally, these community isolates were more sensitive than isolates from inpatients in the local hospital, although community isolates of Pseudomonas aeruginosa were significantly more resistant than inpatient isolates for 4/10 agents tested. CONCLUSIONS Hands of healthy persons in the community were usually colonized with gram-negative bacteria, a single handwash had little impact on microbial counts, and hands of healthy adults may increasingly become one reservoir for antimicrobial resistance.
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28
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Abstract
This article describes the current organization of infection control in Turkey in regard to regulations, functions and responsibilities of infection control committees and the national NosoLINE project. Also, incidence and prevalence of hospital infections and antimicrobial resistance in Turkey are reported.
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Affiliation(s)
- H Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Medical School, Samsun, Turkey.
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29
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Leblebicioglu H, Gunaydin M, Esen S, Tuncer I, Findik D, Ural O, Saltoslu N, Yaman A, Tasova Y. Surveillance of antimicrobial resistance in gram-negative isolates from intensive care units in Turkey: analysis of data from the last 5 years. J Chemother 2002; 14:140-6. [PMID: 12017368 DOI: 10.1179/joc.2002.14.2.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A multicenter antimicrobial surveillance program was established in Turkey in 1995 to monitor the predominant Gram-negative pathogens from intensive care units (ICUs) and antimicrobial resistance patterns of these isolates. Sixteen hospitals participated in the study and a total of 1479 isolates from 1,100 patients were collected. The isolates were tested for their susceptibility against 13 antibiotics by E-test method. Minimum inhibitory concentrations (MICs) for each isolate were determined for imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin. The most common isolates were Pseudomonas spp. (28.2%), Escherichia coli (19.2%) and Klebsiella spp. (19.1%). We found very high resistance rates to all major antibiotics that are used to treat serious infections. Although imipenem is the most active agent, it had an overall susceptibility rate of 68%. Half of the tested Klebsiella spp. strains were found to produce ESBL. This is a very high rate when compared with the literature. Cross-resistance among species was also investigated. 52% of ciprofloxacin-resistant strains were also resistant to imipenem, 80% to ceftazidime, 97% to ceftriaxone, 86% to amikacin and 19% of imipenem-resistant strains were susceptible to ceftazidime and 18% to amikacin. When susceptibilities of the years 1995 and 1999 were compared, the most interesting finding was the decrease in resistance to 3rd generation cephalosporins. In conclusion, this national clinical isolate database shows that resistance rates are high, the change over years is not predictable and continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.
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Affiliation(s)
- H Leblebicioglu
- Dept of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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30
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Garcia-Rodriguez JA, Jones RN. Antimicrobial resistance in gram-negative isolates from European intensive care units: data from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme. J Chemother 2002; 14:25-32. [PMID: 11892895 DOI: 10.1179/joc.2002.14.1.25] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Susceptibility data were collected for 6243 gram-negative isolates from 29 European ICUs participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme (1997-2000). The most commonly isolated bacteria were Pseudomonas aeruginosa (22.5%), Escherichia coli (19.8%), Klebsiella pneumoniae (10.4%), and Enterobacter cloacae (7.7%). The incidence of extended-spectrum beta-lactamase-producers was higher in Turkish, Russian and Italian ICUs (27.9-39.6%) than in other countries (2.5-10.8%). The frequency of AmpC-cephalosporin hyper-producers was 16.8-55.4%. Meropenem was more active against Proteus mirabilis than imipenem (99.0% versus 88.8% susceptibility, respectively). Against Acinetobacter baumannii, meropenem (79.6% susceptible) and imipenem (82.2%) were more active than comparators (34.3-51.6%). Meropenem and imipenem exhibited good activity against P. aeruginosa (76.1% and 68.2%, respectively; but with inter-country variation). Ciprofloxacin resistance in E. coli and K. pneumoniae increased and needs close monitoring. Meropenem (98.2-99.8% susceptibility) and imipenem (88.8-99.4%) remained potent against important species of gram-negative bacteria from European ICUs actively using meropenem.
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31
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Extended Spectrum Beta-lactamases in Gram-negative Sepsis. Intensive Care Med 2002. [DOI: 10.1007/978-1-4757-5551-0_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Abstract
Extended-spectrum beta-lactamases mediate resistance to cephalosporin antibiotics and were first discovered in Europe in the early 1980s. They have become a widespread problem, particularly in Klebsiella pneumoniae, but increasingly in non-typhoid Salmonella species. Traditionally, extended-spectrum beta-lactamases have been derivatives of TEM and SHV parent enzymes. The last year, however, has seen an explosion of developments in extended-spectrum beta-lactamases of non-TEM, non-SHV lineage in Europe. The CTX-M type extended-spectrum beta-lactamases have become particularly widespread. At the same time, European clinical microbiology laboratories have become more aware of the pressing need for detection methods given increasing awareness of the lack of reliability of cephalosporins in the treatment of extended-spectrum beta-lactamase producers.
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Affiliation(s)
- D L Paterson
- Infectious Disease Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213-2582, USA.
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33
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Gönüllü N, Aktaş Z, Salcioglu M, Bal C, Ang O. Comparative in vitro activities of five quinolone antibiotics, including gemifloxacin, against clinical isolates. Clin Microbiol Infect 2001; 7:499-503. [PMID: 11678934 DOI: 10.1046/j.1198-743x.2001.00297.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The in vitro activities of ciprofloxacin, ofloxacin, norfloxacin, levofloxacin and gemifloxacin against 343 clinical isolates were compared. Gemifloxacin showed the greatest activity, with MIC90 values as low as 0.03-0.25 mg/L against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus and Klebsiella pneumoniae, while methicillin-resistant Staphylococcus aureus, Enterococcus spp., Pseudomonas spp., Acinetobacter spp., Escherichia coli and Enterobacter spp. strains exhibited low rates of susceptibility to all five fluoroquinolones.
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Affiliation(s)
- N Gönüllü
- Institute for Experimental Medical Research, University of Istanbul, Istanbul, Turkey
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34
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Köseoğlu O, Kocagöz S, Gür D, Akova M. Nosocomial bloodstream infections in a Turkish university hospital: study of Gram-negative bacilli and their sensitivity patterns. Int J Antimicrob Agents 2001; 17:477-81. [PMID: 11397618 DOI: 10.1016/s0924-8579(01)00325-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Treatment of nosocomial bacteraemia is usually governed by the surveillance results of the particular unit. Such results are especially important when antimicrobial resistance rates are high. Multiresistant isolates including Gram-negatives producing extended-spectrum beta-lactamases have been frequently reported in tertiary care units in Turkey. In this study, antimicrobial susceptibilities of Gram-negative blood isolates (n=348) were determined by microbroth dilution tests. The results showed carbapenems (meropenem and imipenem) to be uniformly more potent in vitro than any other drug against the Enterobacteriaceae. Quinolone antibiotics were more active in vitro than aminoglycosides against a range of bacteria. Gram-negative bloodstream isolates were highly resistant to many antimicrobial agents in the hospital. In order to prevent hospital infection and antimicrobial resistance, surveillance of aetiological agents must be performed regularly.
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Affiliation(s)
- O Köseoğlu
- Department of Clinical Microbiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey.
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35
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Yücesoy M, Yuluğ N, Kocagöz S, Unal S, Cetin S, Calangu S. Antimicrobial resistance of gram-negative isolates from intensive care units in Turkey: comparison to previous three years. J Chemother 2000; 12:294-8. [PMID: 10949978 DOI: 10.1179/joc.2000.12.4.294] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Resistance rates to selected antibiotics of gram-negative bacteria isolated from intensive care units (ICU) of 16 Turkish hospitals during 1998 were evaluated and compared to data from the previous 3 years. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefodizime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 1,404 isolates from 1,060 patients were collected, mainly from urinary and respiratory tracts. As in the previous 3 years, Pseudomonas spp. was the most frequently isolated gram-negative species (29.7%), followed by Escherichia coli, Acinetobacter and Klebsiella spp. Imipenem was the most active in vitro agent (73.4% susceptible), followed by ciprofloxacin (60.6%), cefoperazone-sulbactam (58.7%), cefepime (56.7%), piperacillin-tazobactam (55.0%) and amikacin (54.7%). In 1996, a decline in susceptibility rates of all antibiotics was evident. With the exception of imipenem, resistance to which remained stable, rates somewhat increased in 1997. In 1998, susceptibility to imipenem and cefepime remained stable, amikacin resistance tended to increase and susceptibility rates to other antibacterials showed a favorable increase. These results may in part be due to the implementation of a surveillance program and increased understanding of the magnitude of the resistance problem.
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Affiliation(s)
- M Yücesoy
- Dokuz Eylül University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Inciralti, Izmir, Turkey.
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Siu LK, Lu PL, Hsueh PR, Lin FM, Chang SC, Luh KT, Ho M, Lee CY. Bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric oncology ward: clinical features and identification of different plasmids carrying both SHV-5 and TEM-1 genes. J Clin Microbiol 2000; 37:4020-7. [PMID: 10565924 PMCID: PMC85870 DOI: 10.1128/jcm.37.12.4020-4027.1999] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thirteen patients who had 16 episodes of bacteremia were observed between 1993 and 1997 in a pediatric oncology ward with a high background isolation rate of cefotaxime- or aztreonam-resistant gram-negative bacteria. Four blood isolates were Escherichia coli and 12 were Klebsiella pneumoniae, and these isolates harbored extended-spectrum beta-lactamases (ESBLs). All episodes of bacteremia were nosocomial, all except one of the episodes occurred in neutropenic patients, and all patients were treated with piperacillin or ceftazidime with amikacin and cefazolin prior to the onset of bacteremia. Nine of 13 patients were receiving extended-spectrum beta-lactam treatment when the bacteremias caused by ESBL producers occurred. Molecular studies revealed that four K. pneumoniae SHV-2-producing isolates from 1994 were of the same clone. Other ESBL producers, including six that carried both TEM-1 and SHV-5, five that carried SHV-5, and one that carried SHV-2 alone, were unrelated. In conclusion, SHV-5 was present in 11 of the 16 isolates and coexisted with TEM-1 in 6 isolates. Acquisition of resistance genes probably occurred under antibiotic selection pressure. This study highlights the importance of routine checks for and detection of ESBL producers. Effective therapy against ESBL producers should be considered early for children who have malignancies and neutropenia and who are septic, despite treatment with a regimen that includes an extended-spectrum beta-lactam, in a clinical setting of an increased incidence of ESBL-producing bacteria.
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Affiliation(s)
- L K Siu
- Division of Clinical Research, National Health Research Institute, National Taiwan University Hospital, Taipei, Taiwan
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