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Pino-Otín MR, Gan C, Terrado E, Sanz MA, Ballestero D, Langa E. Antibiotic properties of Satureja montana L. hydrolate in bacteria and fungus of clinical interest and its impact in non-target environmental microorganisms. Sci Rep 2022; 12:18460. [PMID: 36323748 PMCID: PMC9630514 DOI: 10.1038/s41598-022-22419-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/14/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to analyse the microbicidal and microbiostatic activity of S. montana hydrolate L., the water-soluble fraction of the hydro-distillation process used to obtain the essential oil, on 14 Gram-positive and Gram-negative bacteria and a fungus of clinical interest. To consider whether this hydrolate is a more environmentally friendly alternative to traditional antibiotics, its effect on non-target microorganisms in the aquatic and terrestrial environment was analysed using natural soil and river microorganism communities, characterized through 16S rRNA gene sequencing. Results showed that S. montana hydrolate was especially effective (25% v/v concentration) against Pasteurella aerogenes, Streptococcus agalactiae and Acinetobacter baumannii (priority 1, WHO). It was also a microbicide for a further 7 bacterial strains and the fungus Candida albicans (50% v/v concentration). The river and soil communities exposed to the hydrolate showed a decrease in their growth, as well as a decrease in their ability to metabolize polymers and carbohydrates (soil microorganisms) and polymers, carboxylic and ketone acids (river microorganisms). Hydrolates could be an alternative to conventional antibiotics, but their impact on the environment must be taken into account.
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Affiliation(s)
- María Rosa Pino-Otín
- Universidad San Jorge, Campus Universitario Villanueva de Gállego Autovía A-23 Zaragoza-Huesca, Km. 510, Villanueva de Gállego, 50830, Zaragoza, Spain.
| | - Cristina Gan
- Universidad San Jorge, Campus Universitario Villanueva de Gállego Autovía A-23 Zaragoza-Huesca, Km. 510, Villanueva de Gállego, 50830, Zaragoza, Spain
| | - Eva Terrado
- Universidad de Zaragoza, C. de Pedro Cerbuna, 12, 50009, Zaragoza, Spain
| | - María Angeles Sanz
- CITA, Área de Laboratorios de Análisis y Asistencia Tecnológica, Avda. Montañana 930, 50059, Zaragoza, Spain
| | - Diego Ballestero
- Universidad San Jorge, Campus Universitario Villanueva de Gállego Autovía A-23 Zaragoza-Huesca, Km. 510, Villanueva de Gállego, 50830, Zaragoza, Spain
| | - Elisa Langa
- Universidad San Jorge, Campus Universitario Villanueva de Gállego Autovía A-23 Zaragoza-Huesca, Km. 510, Villanueva de Gállego, 50830, Zaragoza, Spain
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Shen X, Liu L, Yu J, Cao X, Zhan Q, Guo Y, Wang L, Yu F. Coexistence of bla NDM-1 and rmtC on a Transferrable Plasmid of a Novel ST192 Klebsiella aerogenes Clinical Isolate. Infect Drug Resist 2019; 12:3883-3891. [PMID: 31853191 PMCID: PMC6916698 DOI: 10.2147/idr.s228130] [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] [Received: 08/22/2019] [Accepted: 12/02/2019] [Indexed: 01/14/2023] Open
Abstract
Introduction The occurrence and development of antibiotic resistance are mainly caused by the spread of large plasmids carrying multiple antibiotic resistance genes. Recently, the association between 16S rRNA methyltransferase genes and β-lactamase genes carried by the same plasmid is of concern. Methods The Klebsiella aerogenes 1564 was isolated from the catheter tip of a patient in a tertiary hospital, Shanghai, China. The presence of the bla NDM-1 and rmtC genes were assessed by PCR. Complete sequence of plasmid p1564 was determined. The K. aerogenes 1564 was characterized by antimicrobial susceptibility testing, Carbapenemase phenotype confirmation testing, conjugation experiment, S1-PFGE and multilocus sequence typing (MLST). Results Herein, we found that a New Delhi Metallo-β-lactamase-1 gene (bla NDM-1) and a 16S rRNA methyltransferase gene (rmtC) coexisted on a transferrable plasmid of a carbapenem-resistant K. aerogenes clinical isolate. The K. aerogenes clinical isolate was found to belong to a novel sequence type 192 (ST192) determined by MLST. The sequencing results of the plasmid p1564 carrying bla NDM-1 gene and rmtC gene showed that the size and guanine-cytosine content of the plasmid were 136, 902 bp and 51.8%, with 164 putative ORFs and two multidrug resistance gene islands. In addition to bla NDM-1and rmtC, the plasmid contained bleomycin resistance gene (ble MBL), CMY-6β-lactamase gene (bla CMY-6), quaternary ammonium compound resistance gene (sugE), truncated quaternary ammonium compound resistance gene (qacEΔ1), aminoglycoside resistance gene (aacA4) and sulfonamide resistance gene (sul1). By comparison, p1564 has high homology with pHS36-NDM from Salmonella enterica subsp. enterica serovar Stanley reported in China, with similar size and both belonging to plasmid incompatibility group A/C. Conclusion The present study demonstrated for the first time the co-existence of rmtC and bla NDM-1 in a novel ST192 K. aerogenes. The spread of plasmids harboring both bla NDM-1 and rmtC may occur among Enterobacteriaceae in China.
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Affiliation(s)
- Xiaofei Shen
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Li Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Jingyi Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Xingwei Cao
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China
| | - Qing Zhan
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University, Nanchang 330006, People's Republic of China
| | - Yinjuan Guo
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200082, People's Republic of China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200082, People's Republic of China
| | - Liangxing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China
| | - Fangyou Yu
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200082, People's Republic of China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200082, People's Republic of China
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Does Second Place Count? Lessons from a Major Discrepancy Between Carbapenem-Resistant Klebsiella pneumoniae and Carbapenem-Resistant Enterobacter cloacae in a One-Year Follow-Up Study. Infect Control Hosp Epidemiol 2017; 38:632-634. [PMID: 28260534 DOI: 10.1017/ice.2017.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chen Z, Li H, Feng J, Li Y, Chen X, Guo X, Chen W, Wang L, Lin L, Yang H, Yang W, Wang J, Zhou D, Liu C, Yin Z. NDM-1 encoded by a pNDM-BJ01-like plasmid p3SP-NDM in clinical Enterobacter aerogenes. Front Microbiol 2015; 6:294. [PMID: 25926823 PMCID: PMC4396501 DOI: 10.3389/fmicb.2015.00294] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Abstract
A carbapenem-nonsusceptible Enterobacter aerogenes strain named 3-SP was isolated from a human case of pneumonia in a Chinese teaching hospital. NDM-1 carbapenemase is produced by a pNDM-BJ01-like conjugative plasmid designated p3SP-NDM to account for carbapenem resistance of 3-SP. p3SP-NDM was fully sequenced and compared with all publically available pNDM-BJ01-like plasmids. The genetic differences between p3SP-NDM and pNDM-BJ01 include only 18 single nucleotide polymorphisms, a 1 bp deletion and a 706 bp deletion. p3SP-NDM and pNDM-BJ01 harbor an identical Tn125 element organized as ISAba125, blaNDM−1, bleMBL, ΔtrpF, dsbC, cutA, ΔgroES, groEL, ISCR27, and ISAba125. The blaNDM−1 surrounding regions in these pNDM-BJ01-like plasmids have a conserved linear organization ISAba14-aphA6-Tn125-unknown IS, with considerable genetic differences identified within or immediately downstream of Tn125. All reported pNDM-BJ01-like plasmids are exclusively found in Acinetobacter, whereas this is the first report of identification of a pNDM-BJ01-like plasmid in Enterobacteriaceae.
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Affiliation(s)
- Zhenhong Chen
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Hongxia Li
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Jiao Feng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Yuxue Li
- The First Hospital of Shijiazhuang City Shijiazhuang, China
| | - Xin Chen
- Zhongshan School of Medicine, Sun Yat-Sen University Guangzhou, China
| | - Xuemin Guo
- Zhongshan School of Medicine, Sun Yat-Sen University Guangzhou, China
| | - Weijun Chen
- Beijing Institute of Genomics, Chinese Academy of Sciences Beijing, China
| | - Li Wang
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Lei Lin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Huiying Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Wenhui Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Jie Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
| | - Changting Liu
- Nanlou Respiratory Diseases Department, Chinese People's Liberation Army General Hospital Beijing, China
| | - Zhe Yin
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing, China
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Vandecandelaere I, Coenye T. Microbial composition and antibiotic resistance of biofilms recovered from endotracheal tubes of mechanically ventilated patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:137-55. [PMID: 25366226 DOI: 10.1007/978-3-319-11038-7_9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In critically ill patients, breathing is impaired and mechanical ventilation, using an endotracheal tube (ET) connected to a ventilator, is necessary. Although mechanical ventilation is a life-saving procedure, it is not without risk. Because of several reasons, a biofilm often forms at the distal end of the ET and this biofilm is a persistent source of bacteria which can infect the lungs, causing ventilator-associated pneumonia (VAP). There is a link between the microbial flora of ET biofilms and the microorganisms involved in the onset of VAP. Culture dependent and independent techniques were already used to identify the microbial flora of ET biofilms and also, the antibiotic resistance of microorganisms obtained from ET biofilms was determined. The ESKAPE pathogens play a dominant role in the onset of VAP and these organisms were frequently identified in ET biofilms. Also, antibiotic resistant microorganisms were frequently present in ET biofilms. Members of the normal oral flora were also identified in ET biofilms but it is thought that these organisms initiate ET biofilm formation and are not directly involved in the development of VAP.
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Affiliation(s)
- Ilse Vandecandelaere
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ottergemsesteenweg 460, 9000, Ghent, Belgium
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Tian WX, Yu S, Ibrahim M, Almonaofy AW, He L, Hui Q, Bo Z, Li B, Xie GL. Copper as an antimicrobial agent against opportunistic pathogenic and multidrug resistant Enterobacter bacteria. J Microbiol 2012; 50:586-93. [DOI: 10.1007/s12275-012-2067-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
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Vogelaers D, De Bels D, Forêt F, Cran S, Gilbert E, Schoonheydt K, Blot S. Patterns of antimicrobial therapy in severe nosocomial infections: empiric choices, proportion of appropriate therapy, and adaptation rates--a multicentre, observational survey in critically ill patients. Int J Antimicrob Agents 2010; 35:375-81. [PMID: 20122817 DOI: 10.1016/j.ijantimicag.2009.11.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/22/2009] [Accepted: 11/23/2009] [Indexed: 12/18/2022]
Abstract
This prospective, observational multicentre (n=24) study investigated relationships between antimicrobial choices and rates of empiric appropriate or adequate therapy, and subsequent adaptation of therapy in 171 ICU patients with severe nosocomial infections. Appropriate antibiotic therapy was defined as in vitro susceptibility of the causative pathogen and clinical response to the agent administered. In non-microbiologically documented infections, therapy was considered adequate in the case of favourable clinical response <5 days. Patients had pneumonia (n=127; 66 ventilator-associated), intra-abdominal infection (n=23), and bloodstream infection (n=21). Predominant pathogens were Pseudomonas aeruginosa (n=29) Escherichia coli (n=26), Staphylococcus aureus (n=22), and Enterobacter aerogenes (n=21). In 49.6% of infections multidrug-resistant (MDR) bacteria were involved, mostly extended-spectrum beta-lactamase (EBSL)-producing Enterobacteriaceae and MDR non-fermenting Gram-negative bacteria. Prior antibiotic exposure and hospitalisation in a general ward prior to ICU admission were risk factors for MDR. Empiric therapy was appropriate/adequate in 63.7% of cases. Empiric schemes were classified according to coverage of (i) ESBL-producing Enterobacteriaceae and non-fermenting Gram-negative bacteria ("meropenem-based"), (ii) non-fermenting Gram-negative bacteria (schemes with an antipseudomonal agent), and (iii) first-line agents not covering ESBL-Enterobacteriaceae nor non-fermenting Gram-negative bacteria. Meropenem-based schemes allowed for significantly higher rates of appropriate/adequate therapy (p<0.001). This benefit remained when only patients without risk factors for MDR were considered (p=0.021). In 106 patients (61%) empiric therapy was modified: in 60 cases following initial inappropriate/inadequate therapy, in 46 patients in order to refine empiric therapy. In this study reflecting real-life practice, first-line use of meropenem provided significantly higher rates of the appropriate/adequate therapy, irrespective of presence of risk factors for MDR.
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Affiliation(s)
- Dirk Vogelaers
- General Internal Medicine & Infectious Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Christiaens G, Barbier C, Warnotte J, Mutsers J. Implementation of an infection control programme to limit the spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a Belgian university hospital. J Hosp Infect 2008; 68:366-7. [PMID: 18329138 DOI: 10.1016/j.jhin.2008.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 01/10/2008] [Indexed: 11/25/2022]
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Christiaens G, Ciccarella Y, Damas P, Hayette MP, Melin P, Nys M, De Mol P. Prospective survey of digestive tract colonization with enterobacteriaceae that produce extended-spectrum β-lactamases in intensive care units. J Hosp Infect 2006; 62:386-8. [PMID: 16337030 DOI: 10.1016/j.jhin.2005.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 09/16/2005] [Indexed: 10/25/2022]
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van Belkum A, Vos MC. Prophylactic application of fluoroquinolones for selective decontamination of the gut: friend or foe. Eur J Clin Microbiol Infect Dis 2005; 24:109-10. [PMID: 15714331 DOI: 10.1007/s10096-005-1282-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Yigit H, Anderson GJ, Biddle JW, Steward CD, Rasheed JK, Valera LL, McGowan JE, Tenover FC. Carbapenem resistance in a clinical isolate of Enterobacter aerogenes is associated with decreased expression of OmpF and OmpC porin analogs. Antimicrob Agents Chemother 2002; 46:3817-22. [PMID: 12435682 PMCID: PMC132746 DOI: 10.1128/aac.46.12.3817-3822.2002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2002] [Revised: 04/09/2002] [Accepted: 08/13/2002] [Indexed: 11/20/2022] Open
Abstract
We investigated the mechanism of imipenem resistance in Enterobacter aerogenes strain 810, a clinical isolate from the United States for which the imipenem MIC was 16 micro g/ml and the meropenem MIC was 8 micro g/ml. An imipenem-susceptible revertant, strain 810-REV, was obtained after multiple passages of the strain on nonselective media. For the revertant, the imipenem MIC was =1 micro g/ml and the meropenem MIC was =0.25 micro g/ml. Cefepime MICs also decreased from 8 to 1 micro g/ml; however, the MICs of ceftazidime (>/=128 micro g/ml), cefoxitin (>/=32 micro g/ml), and cefotaxime (>/=64 micro g/ml) remained the same. The beta-lactamase and porin profiles of the parent, the revertant, and carbapenem-susceptible type strain E. aerogenes ATCC 13048 were determined. Strains 810 and 810-REV each produced two beta-lactamases with pIs of 8.2 and 5.4. The beta-lactamase activities of the parent and revertant were similar, even after induction with subinhibitory concentrations of imipenem. While 810-REV produced two major outer membrane proteins of 42 and 39 kDa that corresponded to Escherichia coli porins OmpC and OmpF, respectively, the parent strain appeared to produce similar quantities of the 39-kDa protein (OmpF) but decreased amounts of the 42-kDa protein (OmpC). When the parent strain was grown in the presence of imipenem, the 42-kDa protein was not detectable by gel electrophoresis. However, Western blot analysis of the outer membrane proteins of the parent and revertant with polyclonal antisera raised to the OmpC and OmpF analogs of Klebsiella pneumoniae (anti-OmpK36 and anti-OmpK35, respectively) showed that strain 810 expressed only the 42-kDa OmpC analog in the absence of imipenem (the 39-kDa protein was not recognized by the anti-OmpF antisera) and neither the OmpC nor the OmpF analog in the presence of imipenem. The OmpC analog is apparently down-regulated in the presence of imipenem; however, 810-REV expressed both OmpC and OmpF analogs. These data suggest that imipenem resistance in E. aerogenes 810 is primarily associated with the lack of expression of the analogs of the OmpC (42-kDa) and OmpF (39-kDa) outer membrane proteins, which also results in decreased susceptibility to meropenem and cefepime.
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Affiliation(s)
- Hesna Yigit
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
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Charles PE, Piroth L, Desbiolles N, Lequeu C, Martin L, Portier H, Chavanet P. New model of ventilator-associated pneumonia in immunocompetent rabbits. Crit Care Med 2002; 30:2278-83. [PMID: 12394956 DOI: 10.1097/00003246-200210000-00016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite the high rate of therapeutic failures in ventilator-associated pneumonia, up to now there has been no animal model specifically designed for antimicrobial evaluation. A rabbit model of ventilator-associated pneumonia is described for the first time in this study. DESIGN Prospective, randomized experimental study. SETTING An animal research laboratory. SUBJECTS Male New Zealand healthy rabbits (n = 44). INTERVENTIONS After oral intubation and an hour of mechanical ventilation, animals in the ventilator-associated pneumonia group (n = 22) were infected intrabronchially with a calibrated inoculum of. The nonventilated pneumonia group (n = 22) was composed of animals that received the same inoculum in the absence of mechanical ventilation. Rabbits from both groups were randomly killed 3, 6, 12, 24, or 48 hrs after inoculation. Pneumonia evaluation was based on histologic (macroscopic and microscopic score) and bacteriologic (bacterial count) findings. MAIN RESULTS Infected animals undergoing mechanical ventilation rapidly developed a progressive bilateral and multifocal pneumonia. Lung bacterial mean (sd) concentration was 6.48 (0.71) log10 colony-forming units (cfu) per gram of tissue at the 48th hour, whereas bacteremia occurred in most cases. In the nonventilated pneumonia group, pneumonia was less severe in terms of bacterial count (3.18 [1.86] log10 cfu/g; p <.05), and spleen cultures remained negative. In addition, microscopic examination revealed noninfectious lung injury in the ventilator-associated pneumonia group, especially hyaline membrane filling alveolar spaces. Of note, these features were never observed in the nonventilated pneumonia group. CONCLUSIONS An animal model of ventilator-associated pneumonia was obtained in immunocompetent rabbits. Histopathologic and bacteriologic features were similar to those found in humans. Obviously, pneumonia was more severe when animals underwent mechanical ventilation, especially in terms of systemic spread. Noninfectious lung injury corresponding to ventilation-induced lung injury may explain the difference. This model emphasizes the strong impact of both mechanical ventilation and infection on lung because they seem to act synergistically when causing alveolar damage. Moreover, it seems well suited to testing antimicrobial effectiveness.
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Piagnerelli M, Carlier E, Deplano A, Lejeune P, Govaerts D. Risk factors for infection and molecular typing in patients in the intensive care unit colonized with nosocomial Enterobacter aerogenes. Infect Control Hosp Epidemiol 2002; 23:452-6. [PMID: 12186211 DOI: 10.1086/502084] [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: 11/04/2022]
Abstract
OBJECTIVES To determine the frequency of colonization by Enterobacter aerogenes in patients in the intensive care unit (ICU) for more than 48 hours and to evaluate the risk factors for infection in patients colonized by this bacteria. DESIGN An 8-month prospective study. SETTING A 12-bed medical-surgical ICU in a 450-bed, university-affiliated, tertiary-care hospital in Belgium. METHOD Pulsed-field gel electrophoresis was used to determine the genotypes of E. aerogenes isolates. RESULTS We observed two major clones of E. aerogenes in the ICU. Interestingly, 87.5% of infected patients had the same genomic profile for colonization and infection. Risk factors for infection in this particular population included younger age, prolonged hospital stay, mechanical ventilation, and bronchoscopy. CONCLUSIONS Colonization is a major prerequisite for infection. The identification of risk factors for infection in colonized patients can optimize the quality of treatment in the ICU.
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Affiliation(s)
- Michael Piagnerelli
- Department of Intensive Care, André Vésale Hospital, Montigny-le-Tilleul, Belgium
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Vanhoof R, Bérin C, Carpentier M, Fagnart O, Glupczynski Y, Mans I, Nyssen HJ, Surmont I, Van Nimmen L. Comparative in vitro activity of temocillin and other antimicrobial agents against Enterobacteriaceae isolated from patients admitted to five Belgian hospitals. Acta Clin Belg 2001; 56:354-9. [PMID: 11881320 DOI: 10.1179/acb.2001.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Temocillin, a methoxy-derivative of the broad-spectrum penicillin, ticarcillin, has been introduced into clinical practice in Belgium in 1988. Since then, not many surveys of its in vitro activity have been published. This study addresses this issue in a prospective collection of 300 consecutive Gram-negative isolates originating from in-patients in five general hospitals throughout Belgium. In addition to temocillin, seven common antibiotics were tested: amoxicillin-clavulanate, piperacillin-tazobactam, cefotaxime, aztreonam, meropenem, ciprofloxacin and amikacin. Meropenem appeared to exhibit the best activity overall, whereas amoxicillin-clavulanate scored the worst. Cumulative MIC plot for two subsets of organisms are given: temocillin, meropenem and cefotaxime are the most active on E. coli and Klebsiella spp., while a significant percentage is resistant to ciprofloxacin and amoxicillin-clavulanate. In the group of inducible Enterobacteriaceae, temocillin, meropenem and amikacin are the most active drugs, while the activity of amoxicillin-clavulanate, piperacillin-tazobactam, cefotaxime and ciprofloxacin is largely decreased. Taking this well preserved in vitro activity of temocillin into account, and looking at its convenient pharmacokinetics and low cost of acquisition, this drug may prove a useful alternative in the treatment of severe nosocomial infections.
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Affiliation(s)
- R Vanhoof
- Pasteurinstituut-Brussel, Eenheid Antibiotica-onderzoek, Engelandstraat 642, B-1180 Brussel
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Comparative in vitro activity of isepamicin and other antibiotics against gram-negative bacilli from intensive care units (ICU) in Belgium. Acta Clin Belg 2001; 56:307-15. [PMID: 11774843 DOI: 10.1179/acb.2001.045] [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: 10/31/2022]
Abstract
The in vitro activity of isepamicin was compared to that of amikacin, gentamicin, cefepime, ciprofloxacin and meropenem against Gram-negative bacilli isolated from patients hospitalized in the intensive care unit (ICU) of 11 Belgian university or general hospitals between November 1998 and July 1999. The minimal inhibitory concentrations (MIC) for 1087 non-duplicate, consecutive aerobic Gram-negative isolates, including 798 Enterobacteriaceae and 289 non-fermenters, were determined by E-test for each antibiotic. Overall, isepamicin was active against 91% of all isolates and was found more active than ciprofloxacin (84% susceptibility), gentamicin (88% susceptibility), cefepime and amikacin (89% susceptibility each), but less active than meropenem (94% susceptibility). Enterobacter aerogenes isolates exhibited the highest resistance rate to ciprofloxacin (72%) while P. aeruginosa appeared the most resistant (frequently multi-resistant) pathogen. Compared to amikacin, MIC values for isepamicin were usually two- to fourfold lower for most inducible Enterobacteriacieae species and for Klebsiella spp., while they were identical for P. aeruginosa and other non-fermenters. Complete cross-susceptibility or cross-resistance between amikacin and isepamicin was observed in more than 95% of all tested isolates. On the other hand, 12% of all E. aerogenes isolates appeared resistant to amikacin and susceptible to isepamicin, while 6% of the P. aeruginosa were found to be resistant (or intermediate) to isepamicin and intermediate (or susceptible) to amikacin. No significant differences in pathogen distribution nor in resistance rates were observed between hospitals except for P. aeruginosa. Taking into account the species distribution and the prevalence of resistance to the different antibiotics tested, isepamicin appears as a suitable agent for empiric therapeutic use in severe ICU-acquired Gram-negative infections in Belgium.
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Hanberger H, Diekema D, Fluit A, Jones R, Struelens M, Spencer R, Wolff M. Surveillance of antibiotic resistance in European ICUs. J Hosp Infect 2001; 48:161-76. [PMID: 11439002 DOI: 10.1053/jhin.2001.0987] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antibiotic resistance among bacteria causing hospital-acquired infections poses a threat, particularly to patients in intensive care units (ICUs). In order to control the spread of resistant bacteria, local, regional and national resistance surveillance data must be used to develop efficient intervention strategies. In an attempt to identify national differences and the dynamics of antibiotic resistance in European ICUs, data have been merged from several networks of resistance surveillance performed during the 1990s. It should be stressed, however, that comparisons of results from different studies using different methods and different population samples must be made with caution. Antibiotic resistance across all species and drugs was, with some exceptions, highest in southern European countries and Russia, and lowest in Scandinavia. More effective strategies are needed to control the selection and spread of resistant organisms. Antibiotic intervention policies, efficient infection control measures and an overall awareness of the serious implications at public health level will contribute to the management of antibiotic resistance.
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Affiliation(s)
- H Hanberger
- Department of Infectious Diseases, University Hospital, S-581 85 Linkoping, Sweden.
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De Gheldre Y, Struelens MJ, Glupczynski Y, De Mol P, Maes N, Nonhoff C, Chetoui H, Sion C, Ronveaux O, Vaneechoutte M. National epidemiologic surveys of Enterobacter aerogenes in Belgian hospitals from 1996 to 1998. J Clin Microbiol 2001; 39:889-96. [PMID: 11230400 PMCID: PMC87846 DOI: 10.1128/jcm.39.3.889-896.2001] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two national surveys were conducted to describe the incidence and prevalence of Enterobacter aerogenes in 21 Belgian hospitals in 1996 and 1997 and to characterize the genotypic diversity and the antimicrobial resistance profiles of clinical strains of E. aerogenes isolated from hospitalized patients in Belgium in 1997 and 1998. Twenty-nine hospitals collected 10 isolates of E. aerogenes, which were typed by arbitrarily primed PCR (AP-PCR) using two primers and pulsed-field gel electrophoresis. MICs of 10 antimicrobial agents were determined by the agar dilution method. Beta-lactamases were detected by the double-disk diffusion test and characterized by isoelectric point. The median incidence of E. aerogenes colonization or infection increased from 3.3 per 1,000 admissions in 1996 to 4.2 per 1000 admissions in the first half of 1997 (P < 0.01). E. aerogenes strains (n = 260) clustered in 25 AP-PCR types. Two major types, BE1 and BE2, included 36 and 38% of strains and were found in 21 and 25 hospitals, respectively. The BE1 type was indistinguishable from a previously described epidemic strain in France. Half of the strains produced an extended-spectrum beta-lactamase, either TEM-24 (in 86% of the strains) or TEM-3 (in 14% of the strains). Over 75% of the isolates were resistant to ceftazidime, piperacillin-tazobactam, and ciprofloxacin. Over 90% of the strains were susceptible to cefepime, carbapenems, and aminoglycosides. In conclusion, these data suggest a nationwide dissemination of two epidemic multiresistant E. aerogenes strains in Belgian hospitals. TEM-24 beta-lactamase was frequently harbored by one of these epidemic strains, which appeared to be genotypically related to a TEM-24-producing epidemic strain from France, suggesting international dissemination.
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Affiliation(s)
- Y De Gheldre
- Service de Microbiologie, Laboratoire de Bacteriologie, Université Libre de Bruxelles-Hôpital Erasme, 808 route de Lennik, 1070 Brussels, Belgium.
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van Belkum A, Goessens W, van der Schee C, Lemmens-den Toom N, Vos MC, Cornelissen J, Lugtenburg E, de Marie S, Verbrugh H, Löwenberg B, Endtz H. Rapid emergence of ciprofloxacin-resistant enterobacteriaceae containing multiple gentamicin resistance-associated integrons in a Dutch hospital. Emerg Infect Dis 2001; 7:862-71. [PMID: 11747700 PMCID: PMC2631872 DOI: 10.3201/eid0705.017515] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In a hematology unit in the Netherlands, the incidence of ciprofloxacin-resistant Enterobacter cloacae and Escherichia coli increased from from 1996 to 1999. Clonal spread of single genotypes of both ciprofloxacin-resistant E. coli and Enterobacter cloacae from patient to patient was documented by pulsed-field gel electrophoresis and random amplification of polymorphic DNA. In addition, genetically heterogeneous strains were isolated regularly. Integrons associated with gentamicin resistance were detected in Enterobacter cloacae and E. coli strains. Integron-containing E. coli were detected in all hematology wards. In contrast, in Enterobacter cloacae strains two integron types were encountered only in the isolates from one ward. Although in all patients identical antibiotic regimens were used for selective decontamination, we documented clear differences with respect to the nosocomial emergence of ciprofloxacin-resistant bacterial strains and gentamicin resistance-associated integrons.
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Affiliation(s)
- A van Belkum
- Eramus University Medical Center Rotterdam, The Netherlands.
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Piagnerelli M, Kennes B, Brogniez Y, Deplano A, Govaerts D. Outbreak of nosocomial multidrug-resistant Enterobacter aerogenes in a geriatric unit: failure of isolation contact, analysis of risk factors, and use of pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 2000; 21:651-3. [PMID: 11083182 DOI: 10.1086/501704] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We describe herein an outbreak of Enterobacter aerogenes in a geriatric acute unit with failure of contact isolation that necessitated the temporary closure of the department. We emphasize the need for guidelines for the management of multiresistant bacteria.
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Affiliation(s)
- M Piagnerelli
- Department of Geriatric Medicine, CHU A. Vésale, Montigny-le-Tilleul, Belgium
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