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Gehlot P, P H. Unveiling the ecological landscape of bacterial β-lactam resistance in Delhi-national capital region, India: An emerging health concern. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2024; 363:121288. [PMID: 38850900 DOI: 10.1016/j.jenvman.2024.121288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/17/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Inappropriate antibiotic use not only amplifies the threat of antimicrobial resistance (AMR), moreover exacerbates the spread of resistant bacterial strains and genes in the environment, underscoring the critical need for effective research and interventions. Our aim is to assess the prevalence and resistance characteristics of β-lactam resistant bacteria (BLRB) and β-lactamase resistant bacterial genes (BLRBGs) under various environmental conditions within Delhi NCR, India. Using a culture-dependent method, we isolated 130 BLRB from 75 different environmental samples, including lakes, ponds, the Yamuna River, agricultural soil, aquatic weeds, drains, dumping yards, STPs, and gaushalas. Tests for antibiotic susceptibility were conducted in addition to phenotypic and genotypic identification of BLs and integron genes. The water and sediment samples recorded an average bacterial abundance of 3.6 × 106 CFU/mL and an average ampicillin-resistant bacterial count of 2.2 × 106 CFU/mL, which can be considered a potent reservoir of BLRB and BLRBGs. The majority of the BLRB discovered are opportunistic pathogens from the Bacillus, Aeromonas, Pseudomonas, Enterobacter, Escherichia, and Klebsiella genera, with Multiple Antibiotic Resistance (MAR) index ≥0.2 against a wide variety of β-lactams and β-lactamase (BLs) inhibitor combinations. The antibiotic resistance pattern was similar in the case of bacteria isolated from STPs. Meanwhile, bacteria isolated from other sources were diverse in their antibiotic resistance profile. Interestingly, we discovered that 10 isolates of various origins produce both Extended Spectrum BLs and Metallo BLs, as well as found harboring blaTEM, blaCTX, blaOXA, blaSHV, int-1, and int-3 genes. Enterobacter cloacae (S50/A), a common nosocomial pathogen isolated from Yamuna River sediment samples at Nizamuddin point, possesses three BLRBGs (blaTEM, blaCTX, and blaOXA) and a MAR index of 1.0, which is a major cause for concern. Therefore, identifying the source, origin and dissemination of BLRB and BLRGs in the environment is of the utmost importance for designing effective mitigation approaches to reduce a load of antimicrobial resistance factors in the environmental settings.
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Affiliation(s)
- Priyanka Gehlot
- Environmental Biotechnology Laboratory, Centre for Rural Development and Technology, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Hariprasad P
- Environmental Biotechnology Laboratory, Centre for Rural Development and Technology, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India.
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2
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Parzygnat JL, Crespo R, Koci MD, Dunn RR, Harden L, Fosnaught M, Thakur S. Widespread prevalence of plasmid-mediated blaCTX-M type extended-spectrum beta-lactamase Escherichia coli in backyard broiler production systems in the United States. PLoS One 2024; 19:e0304599. [PMID: 38829840 PMCID: PMC11146730 DOI: 10.1371/journal.pone.0304599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
Extended-spectrum beta-lactamase (ESBL) Escherichia coli (E. coli) is an emerging pathogen of high concern given its resistance to extended-spectrum cephalosporins. Broiler chicken, which is the number one consumed meat in the United States and worldwide, can be a reservoir of ESBL E. coli. Backyard poultry ownership is on the rise in the United States, yet there is little research investigating prevalence of ESBL E. coli in this setting. This study aims to identify the prevalence and antimicrobial resistance profiles (phenotypically and genotypically) of ESBL E. coli in some backyard and commercial broiler farms in the U.S. For this study ten backyard and ten commercial farms were visited at three time-points across flock production. Fecal (n = 10), litter/compost (n = 5), soil (n = 5), and swabs of feeders and waterers (n = 6) were collected at each visit and processed for E. coli. Assessment of ESBL phenotype was determined through using disk diffusion with 3rd generation cephalosporins, cefotaxime and ceftazidime, and that with clavulanic acid. Broth microdilution and whole genome sequencing were used to investigate both phenotypic and genotypic resistance profiles, respectively. ESBL E. coli was more prevalent in backyard farms with 12.95% of samples testing positive whereas 0.77% of commercial farm samples were positive. All isolates contained a blaCTX-M gene, the dominant variant being blaCTX-M-1, and its presence was entirely due to plasmids. Our study confirms concerns of growing resistance to fourth generation cephalosporin, cefepime, as roughly half (51.4%) of all isolates were found to be susceptible dose-dependent and few were resistant. Resistance to non-beta lactams, gentamicin and ciprofloxacin, was also detected in our samples. Our study identifies prevalence of blaCTX-M type ESBL E. coli in U.S. backyard broiler farms, emphasizing the need for interventions for food and production safety.
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Affiliation(s)
- Jessica L. Parzygnat
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States of America
| | - Rocio Crespo
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States of America
| | - Matthew D. Koci
- Prestage Department of Poultry Science, North Carolina State University, Raleigh, NC, United States of America
| | - Robert R. Dunn
- Department of Applied Ecology, North Carolina State University, Raleigh, NC, United States of America
| | - Lyndy Harden
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States of America
| | - Mary Fosnaught
- Prestage Department of Poultry Science, North Carolina State University, Raleigh, NC, United States of America
| | - Siddhartha Thakur
- Department of Population Health and Pathobiology, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States of America
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3
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Ryan CA, McNeal CD, Credille BC. Ceftiofur use and antimicrobial stewardship in the horse. Equine Vet J 2023; 55:944-961. [PMID: 36733237 DOI: 10.1111/evj.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
Equine practitioners require recommendations that support antimicrobial stewardship and avoid generating resistance to medically important antibiotics. This review examines current inadequacies in antimicrobial stewardship standards within the veterinary community, related to antimicrobial categorisation and prescribing practices. Resistance to cephalosporin antibiotics in horses is also described. Properties of cephalosporin antibiotics are outlined and equine-specific studies of ceftiofur, a third-generation cephalosporin antibiotic with medical importance, are detailed. Readers are provided with recommendations that encourage appropriate use of ceftiofur, citing the evidence available in horses.
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Affiliation(s)
- Clare A Ryan
- Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA
| | - Christina D McNeal
- Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA
| | - Brenton C Credille
- Department of Population Health, University of Georgia, Athens, Georgia, USA
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4
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Sule IO, Mendelsohn A, Panas RM. The Causes and Control Measures of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae in Long-Term Care Facilities: A Systematic Review and Meta-Analysis. Health Serv Res Manag Epidemiol 2022; 9:23333928221131709. [PMID: 36277608 PMCID: PMC9580105 DOI: 10.1177/23333928221131709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), infections among residents are increasing in long-term care facilities (LTCFs), resulting in a high rate of morbidity and healthcare costs. A designated infection control team is unavailable to control the disease. Methods A systematic review and meta-analysis were conducted to characterize the causes of ESBL-PE and evaluate the infection control strategies within LTCFs. Multiple regression analysis (MRA) was included as supplementary statistical analysis to identify relationships between LTCFs, geographical locations, infection control measures (ICMs), and ESBL-PE. A systematic search was conducted for studies from January 2008 to December 2018. Twenty-two of the 3106 studies met the inclusion criteria. Results The pooled prevalence for ESBL-PE among LTCFs residents was a mean difference (MD) of 15.78 (95% CI: 0.04, 31.53). Risk factors included the influence of regional areas was a standardized mean difference (SMD) of 0.61(95% CI: 0.32, 0.91) in Europe, SMD was 14.92 (95% CI: 9.17, 20.68) in Asia, and SMD was 0.51(95% CI: 0.35, 0.67) in other regions (North America and Australia). Nine of 22 studies reported ICMs were MD of 13.59 (95% CI: 5.32, 21.86). Conclusions Meta-analysis and MRA revealed a statistically significant association between LTCF and ESBL-PE among residents (p = .05). Strict adherence to infection control measures in LTCFs is needed to address this ESBL-PE prevalence among residents. The potential positive social change is promoting knowledge about vulnerable residents in LTCFs and the community factors responsible for ESBL infection.
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Affiliation(s)
- Ismaila Olatunji Sule
- Microbiology Department, NHS Western Isles, Stornoway, Isle of Lewis, Scotland,Microbiology Department, Biomedical Science Consulting Service, IG4M, Belfast, United Kingdom,Ismaila Olatunji Sule, Biomedical Science Consulting Service, IG4M, 7 Moatview Crescent. Bt16 2bg Belfast, UK.
| | - Aaron Mendelsohn
- Senior Contributing Faculty, Public Health Department, College of Health Professions, Walden University, Minneapolis, USA
| | - Raymond M Panas
- Senior Contributing Faculty, Public Health Department, College of Health Professions, Walden University, Minneapolis, USA
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Mills JP, Marchaim D. Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update. Infect Dis Clin North Am 2021; 35:969-994. [PMID: 34752228 DOI: 10.1016/j.idc.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multidrug-resistant gram-negative bacteria (MDR-GNB) pose one of the greatest challenges to health care today because of their propensity for human-to-human transmission and lack of therapeutic options. Containing the spread of MDR-GNB is challenging, and the application of multifaceted infection control bundles during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article will review the utility of various infection control measures in containing the spread of various MDR-GNB and will provide the supporting evidence for these interventions.
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Affiliation(s)
- John P Mills
- Division of Infectious Diseases, University of Michigan Medical School, F4177 University Hospital South, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5226, USA.
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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6
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The effect of EDTA in combination with some antibiotics against clinical isolates of gram negative bacteria in Mansoura, Egypt. Microb Pathog 2021; 154:104840. [PMID: 33691177 DOI: 10.1016/j.micpath.2021.104840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/10/2021] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Abstract
Extensive use of antibiotics in clinical practice has been associated with increasing frequency of resistant microorganisms. So new strategy is needed to treat the resistant pathogens. Hence this study was conducted to determine the effect of Ethylenediaminetetraacetic acid (EDTA) in increasing the inhibition effect of some antibiotics on multi-drug resistant (MDR) gram-negative bacteria. For this purpose, 40 E. coli isolates, 40 K. pneumoniae isolates and 50 P. aeruginosa isolates were collected from different University's hospitals in Mansoura, Egypt. Antibacterial susceptibility pattern against 9 different antimicrobials were studied by disc diffusion method. Also the effect of two sub-inhibitory concentrations of EDTA (1 and 2 mM) on the inhibition zones of antibiotic discs against the highly multidrug resistant (MDR) isolates was determined. Checkerboard method was used for testing the activity of gentamicin/EDTA and cefotaxime/EDTA combinations on the highly MDR isolates. Additionally, the effect of EDTA on the expression of efflux pump genes was tested by real time-PCR. Most of the clinical isolates were found to be resistant to the tested antibiotics except imipenem and high prevalence of MDR isolates was recorded. 34 isolates were selected as those showed the highest multi-drug resistance and were tested to specify their MIC for EDTA as EDTA showed strong antibacterial activity with MIC ranging 4-8 mM. The addition of sub-MIC of EDTA (1or 2 mM) to the agar plate resulted in changing the 11 tested E. coli isolates from resistant to sensitive to ceftazidime, gentamicin, rifampin, ampicillin, erythromycin and vancomycin, the tested K. pneumoniae isolates were turned also from resistant to sensitive to gentamicin and ceftazidime, additionally the tested P. aeruginosa isolates became sensitive to gentamicin, ceftazidime and ciprofloxacin. Indifference to additive activity was observed for tested combinations and MIC value of cefotaxime or gentamicin in combination with EDTA was less than antibiotic alone in the most tested isolates. Moreover, significant reduction (P < 0.01) in the expression of all tested efflux pump genes in treated E. coli, K. pneumoniae and P. aeruginosa isolates with EDTA compared to untreated isolates was observed. In conclusion, these results suggest that the combination of antibiotic especially gentamicin with EDTA may be fruitful for management of resistant gram negative infections.
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Raphael E, Chambers HF. Differential Trends in Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Infections in Four Health Care Facilities in a Single Metropolitan Area: A Retrospective Analysis. Microb Drug Resist 2020; 27:154-161. [PMID: 32589493 DOI: 10.1089/mdr.2020.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Prevalence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli) is increasing worldwide, but greatly varies geographically. We compared the prevalence of ESBL-E. coli infections at four distinct health care facilities in San Francisco, California. Methods: Antimicrobial susceptibility reports were obtained for E. coli isolates from (1) a county hospital, (2) a public skilled nursing facility, (3) a university hospital, and (4) a Veterans Affairs (VA) Medical Center. We compared change in frequency of ESBL-E. coli and antimicrobial resistance to trimethoprim-sulfamethoxazole between 2012 and 2018. Results: From 2012 to 2018, frequency of ESBL-E. coli increased in urine and nonurine isolates from the county hospital (urine: 1.1% per year, 95% confidence interval [CI]: 0.5-1.6, p < 0.01; nonurine: 1.9% per year, 95% CI: 0.9-2.9, p < 0.01) and in urine isolates from the VA hospital (0.9% per year, 95% CI: 0.3-1.4, p < 0.01). The frequency of trimethoprim-sulfamethoxazole resistance fluctuated in all facilities. Conclusions: At the skilled nursing facility, the prevalence of ESBL-E. coli was highest, but remained stable over time, while the prevalence of ESBL-E. coli increased among urine and nonurine isolates at the county hospital and urine isolates at the VA hospital. The temporal trend of ESBL-E. coli infections, even within one city, varied by health care facility.
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Affiliation(s)
- Eva Raphael
- Department of Family and Community Medicine and University of California, San Francisco, San Francisco, California, USA
| | - Henry F Chambers
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Sawatwong P, Sapchookul P, Whistler T, Gregory CJ, Sangwichian O, Makprasert S, Jorakate P, Srisaengchai P, Thamthitiwat S, Promkong C, Nanvatthanachod P, Vanaporn M, Rhodes J. High Burden of Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces. Am J Trop Med Hyg 2020; 100:943-951. [PMID: 30793684 PMCID: PMC6447101 DOI: 10.4269/ajtmh.18-0394] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bloodstream infection surveillance conducted from 2008 to 2014 in all 20 hospitals in Sa Kaeo and Nakhon Phanom provinces, Thailand, allowed us to look at disease burden, antibiotic susceptibilities, and recurrent infections caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae. Of 97,832 blood specimens, 3,338 were positive for E. coli and 1,086 for K. pneumoniae. The proportion of E. coli isolates producing ESBL significantly increased from 19% to 22% in 2008-2010 to approximately 30% from 2011 to 2014 (P-value for trend = 0.02), whereas ESBL production among K. pneumoniae cases was 27.4% with no significant trend over time. Incidence of community-onset ESBL-producing E. coli increased from 5.4 per 100,000 population in 2008 to 12.8 in 2014, with the highest rates among persons aged ≥ 70 years at 79 cases per 100,000 persons in 2014. From 2008 to 2014, community-onset ESBL-producing K. pneumoniae incidence was 2.7 per 100,000, with a rate of 12.9 among those aged ≥ 70 years. Although most (93.6% of E. coli and 87.6% of K. pneumoniae) infections were community-onset, hospital-onset infections were twice as likely to be ESBL. Population-based surveillance, as described, is vital to accurately monitor emergence and trends in antimicrobial resistance, and in guiding the development of rational antimicrobial therapy recommendations.
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Affiliation(s)
- Pongpun Sawatwong
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Patranuch Sapchookul
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Toni Whistler
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Christopher J Gregory
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia.,Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Sirirat Makprasert
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Possawat Jorakate
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Prasong Srisaengchai
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Somsak Thamthitiwat
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | | | | | - Muthita Vanaporn
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Julia Rhodes
- Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
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Gebremichael TG, Gebreyesus HH, Gebremariam A. Assessment of the Appropriateness of Ceftazidime Use in a Tertiary Teaching Hospital, Northern Ethiopia. DRUG HEALTHCARE AND PATIENT SAFETY 2020; 11:115-123. [PMID: 31908541 PMCID: PMC6930387 DOI: 10.2147/dhps.s226505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
Background Ceftazidime is nowadays one of the most commonly used antibiotics due to its high antibacterial potency, wide spectrum of activity, and low potential for toxicity. However, the global trend shows huge misuse of ceftazidime. Objective This study was conducted to assess the appropriateness of ceftazidime use and to identify areas of intervention to prevent inappropriate use in different wards of Ayder Compressive Specialized Hospital, a tertiary teaching Hospital, Mekelle-Ethiopia. Methods A facility-based prospective cross-sectional study design was steered on 327 patients who received ceftazidime during their hospitalization in the selected wards from February 1 to April 30, 2019. Results In the assessment of the appropriateness of ceftazidime use, 2,084 (70.8%) were appropriate. Appropriateness of indication was 295 (90.2%), the effectiveness of ceftazidime use was 221 (67.6%), correct dose of ceftazidime use was 264 (80.4%), and the correct frequency of ceftazidime use was 230 (70.3%). Its use was empiric in 275 participants (84.1%) and specific in 52 (15.9%) participants. The most common indication for ceftazidime use was uncomplicated pneumonia, at 112 (34.3%). One hundred and seventy-one (52.3%) participants had intervention to prevent inappropriate use of ceftazidime. Changing the drug combination (96, 29.4%), increasing the dose (13, 4%), decreasing the dose (21, 6.4%), holding the (21, 6.4%), and discontinuation of ceftazidime (20, 6.1%) were among the interventions. Conclusion This study revealed that more than one-fourth of the ceftazidime use was inappropriate. This may lead to the emergence of resistant pathogens which in turn lead to treatment failure and increased the cost of therapy. Therefore, adherence to current evidence-based guidelines and initiating antimicrobial stewardship are recommended.
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Affiliation(s)
- Teklu Gebrehiwot Gebremichael
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Hiluf Hindeya Gebreyesus
- Medical Physiology Unit, Biomedical Division, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Alem Gebremariam
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Complete Genome Sequence of a Multidrug-Resistant Strain, Escherichia coli ATCC BAA-196, as a Model for Studying Induced Antibiotic Resistance Reversion. Microbiol Resour Announc 2019; 8:8/50/e01118-19. [PMID: 31831610 PMCID: PMC6908795 DOI: 10.1128/mra.01118-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Here, we report the complete genome sequence of the multidrug-resistant Escherichiacoli strain ATCC BAA-196, a model organism used for studying possible antibiotic resistance reversion induced by FS-1, an iodine-containing complex. Two genomes, representing FS-1-treated and negative-control variants and composed of a chromosome and several plasmids, were assembled. Here, we report the complete genome sequence of the multidrug-resistant Escherichiacoli strain ATCC BAA-196, a model organism used for studying possible antibiotic resistance reversion induced by FS-1, an iodine-containing complex. Two genomes, representing FS-1-treated and negative-control variants and composed of a chromosome and several plasmids, were assembled.
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11
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Yang H, Rehman MU, Zhang S, Yang J, Li Y, Gao J, Gu L, Wang M, Jia R, Chen S, Liu M, Zhu D, Zhao X, Wu Y, Yang Q, Huan J, Zhang L, Liu Y, Tian B, Pan L, Cheng X, Cheng A. High prevalence of CTX-M belonging to ST410 and ST889 among ESBL producing E. coli isolates from waterfowl birds in China's tropical island, Hainan. Acta Trop 2019; 194:30-35. [PMID: 30853356 DOI: 10.1016/j.actatropica.2019.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 01/11/2023]
Abstract
The epidemiology and genetic characteristics of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) have been widely studied in human and veterinary settings. ESBL-producing E. coli are generally reported in pigs, poultry, and dairy farm animals. Here, we report on the prevalence and genetic characteristics of beta-lactamase producing E. coli isolated from waterfowl birds in Hainan, China. After phenotypic confirmation, genes encoding blaCTX-M, blaSHV and blaTEM were detected by polymerase chain reaction (PCR). The isolates were assigned to different phylogenetic groups, and multi-locus sequence typing (MLST). Taken as a whole, 289 (92.9%) out of 311 E. coli isolates from waterfowl birds were confirmed as ESBL phenotypes by double-disk synergy testing. Subsequent PCR analysis revealed that blaCTX-M was the predominant ESBL gene identified in 146 (46.9%) isolates, followed by the combination of blaCTX-M and blaTEM in 70 (22.5%) isolates. The majority of these positive isolates were assigned to phylogroup B2 (46.2%) followed by phylogroup A (43.6%). In addition, MLST assigned representative ESBL positive isolates (n = 40) to 18 STs, and ST410 (ST23cplx) was the most prevalent population (22.5%). The high prevalence of CTX-M and STs frequently associating with E. coli infections should be of concern as it poses threats to animal and public health. To the best of our knowledge, this is the first comprehensive study to report on the occurrence of ESBL producing E. coli from waterfowl birds in China.
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Sanchez DA, Martinez LR. Underscoring interstrain variability and the impact of growth conditions on associated antimicrobial susceptibilities in preclinical testing of novel antimicrobial drugs. Crit Rev Microbiol 2019; 45:51-64. [PMID: 30522365 PMCID: PMC6905375 DOI: 10.1080/1040841x.2018.1538934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/22/2018] [Accepted: 10/12/2018] [Indexed: 01/12/2023]
Abstract
In the era of multidrug resistant (MDR) organisms, reliable efficacy testing of novel antimicrobials during developmental stages is of paramount concern prior to introduction in clinical trials. Unfortunately, interstrain variability is often underappreciated when appraising the efficacy of innovative antimicrobials as preclinical testing of a limited number of standardized strains in unvarying conditions does not account for the vastness and potential for hyperdiversity among and within microbial populations. In this review, the importance of accounting for interstrain variability's potential to impact breadth of novel drug efficacy evaluation in the early stages of drug development will be discussed. Additionally, testing under varying microenvironmental conditions that may influence drug efficacy will be discussed. Biofilm growth, the influence of polymicrobial growth, mechanisms of antimicrobial resistance, pH, anaerobic conditions, and other virulence factors are some of critical issues that require more attention and standardization during preclinical drug efficacy evaluation. Furthermore, potential solutions for addressing this issue in pre-clinical antimicrobial development are proposed via centralization of microbial characterization and drug target databases, testing of a large number of clinical strains, inclusion of mutator strains in testing and the use of growth parameter mathematical models for testing.
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Affiliation(s)
- David A. Sanchez
- Howard University College of Medicine, Washington, DC, USA
- Brigham and Women’s Hospital, Boston, MA, USA
| | - Luis R. Martinez
- Department of Biological Sciences, The Border Biomedical Research Center, University of Texas at El Paso, TX, USA
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13
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ur Rahman S, Ali T, Ali I, Khan NA, Han B, Gao J. The Growing Genetic and Functional Diversity of Extended Spectrum Beta-Lactamases. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9519718. [PMID: 29780833 PMCID: PMC5892270 DOI: 10.1155/2018/9519718] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/31/2018] [Indexed: 11/17/2022]
Abstract
The β-lactams-a large class of diverse compounds-due to their excellent safety profile and broad antimicrobial spectrum are considered to be the most widely used therapeutic class of antibacterials prescribed in human and veterinary clinical practices. This, unfortunately, has also given rise to a continuous increased resistance globally in health care settings as well as in the community due to their permanent selective force driving diversification of the resistance mechanism. Resistance against β-lactams is increasing rapidly as novel β-lactamases, enzymes that degrade β-lactams, are being discovered each day such as recent emergence of extended spectrum β-lactamases (ESBL) that have the ability to inactivate most of the cephalosporins. The complexity and diversity of ESBL are increasing so rapidly that more than 170 variants have thus far been described for only a single genotype, the blaCTX-M -encoding ESBL. This review is to organize all the current updated literature describing genomic features, organization, and mechanism of resistance and mode of dissemination of all known ESBLs.
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Affiliation(s)
- Sadeeq ur Rahman
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, China
- Abdul Wali Khan University, Garden Campus, Khyber Pakhtunkhwa, Pakistan
| | - Tariq Ali
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Ijaz Ali
- Department of Biosciences, COMSATS Institute of Information Technology (CIIT), Bioscience Block, Chak Shahzad Campus, Park Road, Islamabad, Pakistan
| | - Nazir Ahmad Khan
- Department of Animal Nutrition, The University of Agriculture, Peshawar, Pakistan
| | - Bo Han
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jian Gao
- Department of Clinical Veterinary Medicine, College of Veterinary Medicine, China Agricultural University, Beijing, China
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14
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Babu L, Uppalapati SR, Sripathy MH, Reddy PN. Evaluation of Recombinant Multi-Epitope Outer Membrane Protein-Based Klebsiella pneumoniae Subunit Vaccine in Mouse Model. Front Microbiol 2017; 8:1805. [PMID: 28979250 PMCID: PMC5611512 DOI: 10.3389/fmicb.2017.01805] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 09/05/2017] [Indexed: 12/31/2022] Open
Abstract
Safety and protective efficacy of recombinant multi-epitope subunit vaccine (r-AK36) was evaluated in a mouse model. Recombinant AK36 protein comprised of immunodominant antigens from outer membrane proteins (Omp’s) of Klebsiella pneumoniae namely OmpA and OmpK36. r-AK36 was highly immunogenic and the hyperimmune sera reacted strongly with native OmpA and OmpK36 proteins from different K. pneumoniae strains. Hyperimmune sera showed cross-reactivity with Omp’s of other Gram-negative organisms. Humoral responses showed a Th2-type polarized immune response with IgG1 being the predominant antibody isotype. Anti-r-AK36 antibodies showed antimicrobial effect during in vitro testing with MIC values in the range of 25–50 μg/ml on different K. pneumoniae strains. The recombinant antigen elicited three fold higher proliferation of splenocytes from immunized mice compared to those with sham-immunized mice. Anti-r-AK36 antibodies also exhibited in vitro biofilm inhibition property. Subunit vaccine r-AK36 immunization promoted induction of protective cytokines IL-2 and IFN-γ in immunized mice. When r-AK36-immunized mice were challenged with 3 × LD100 dose, ∼80% of mice survived beyond the observation period. Passive antibody administration to naive mice protected them (67%) against the lethal challenge. Since the targeted OMPs are conserved among all K. pneumoniae serovars and due to the strong nature of immune responses, r-AK36 subunit vaccine could be a cost effective candidate against klebsiellosis.
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Affiliation(s)
- Litty Babu
- Department of Microbiology, Defence Food Research LaboratoryMysore, India
| | - Siva R Uppalapati
- Department of Microbiology, Defence Food Research LaboratoryMysore, India
| | - Murali H Sripathy
- Department of Microbiology, Defence Food Research LaboratoryMysore, India
| | - Prakash N Reddy
- Department of Microbiology, Defence Food Research LaboratoryMysore, India.,Department of Biotechnology, Vignan's Foundation for Science, Technology and Research UniversityGuntur, India
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15
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Padmini N, Ajilda AAK, Sivakumar N, Selvakumar G. Extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae: critical tools for antibiotic resistance pattern. J Basic Microbiol 2017; 57:460-470. [PMID: 28397262 DOI: 10.1002/jobm.201700008] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 12/24/2022]
Abstract
Drug resistance is a phenomenon where by an organism becomes fully or partially resistant to drugs or antibiotics being used against it. Antibiotic resistance poses an exacting intimidation for people with underlying medical immune conditions or weakened immune systems. Infections caused by the enzyme extended spectrum β-lactamase (ESBL) producing multi drug resistance (MDR) Enterobacteriaceae especially Escherichia coli and Klebsiella pneumoniae are resistant to a broad range of beta lactams, including third generation cephalosporins. Among all the pathogens, these two MDR E. coli and K. pneumoniae have emerged as one of the world's greatest health threats in past two decades. The nosocomial infections caused by these ESBL producing MDR E. coli and K. pneumoniae complicated the therapy and limit treatment options.
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Affiliation(s)
- Nagarajan Padmini
- Department of Microbiology, Science Campus, Alagappa University, Karaikudi, Tamil Nadu, India
| | | | - Natesan Sivakumar
- School of Biotechnology, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | - Gopal Selvakumar
- Department of Microbiology, Science Campus, Alagappa University, Karaikudi, Tamil Nadu, India
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16
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Zhu M, Yang G, Li A, Zong L, Dong Z, Lu J, Zhang K, Cheng C, Chang Q, Wu X, Ying J, Li X, Ding L, Zheng H, Yu J, Ying J, Xu T, Yi H, Li P, Li K, Wu S, Bao Q, Wang J. Identification and molecular characterization of Escherichia coli bla SHV genes in a Chinese teaching hospital. Gene 2016; 600:29-35. [PMID: 27889371 DOI: 10.1016/j.gene.2016.11.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
Abstract
Escherichia coli (E. coli) commonly reside in human intestine and most E. coli strains are harmless, but some serotypes cause serious food poisoning. This study identified and molecularly characterized blaSHV genes from 490 E. coli strains with multi-drug resistance in a hospital population. PCR and molecular cloning and southern blot were performed to assess functions and localizations of this resistant E. coli gene and the pulsed-field gel electrophoresis (PFGE) was utilized to demonstrate the clonal relatedness of the positive E. coli strains. The data showed that 4 of these 490 E. coli strains (4/499, 0.8%) carried blaSHV genes that included EC D2485 (blaSHV-5), EC D2487 (blaSHV-5), EC D2684 (blaSHV-11) and EC D2616 (blaSHV-195, a novel blaSHV). Analysis of blaSHV open-reading frame showed that blaSHV-5 had a high hydrolysis activity to the broad-spectrum penicillin (ampicillin or piperacillin), ceftazidime, ceftriaxone, cefotaxime and aztreonam. blaSHV-195 and blaSHV-11 had similar resistant characteristics with high hydrolysis activities to ampicillin and piperacillin, but low activities to cephalosporins. Moreover, the two blaSHV-5 genes were located on a transferable plasmid (23kb), whereas the other two blaSHV variants (blaSHV-11 and blaSHV-195) seemed to be located in the chromosomal material. Both EC D2485 and EC D2487 clones isolated in 2010 had the same DNA finger printing profile and they might be the siblings of clonal dissemination. The data from the current study suggest that the novel blaSHV and clonal dissemination may be developed, although blaSHV genes were infrequently identified in this hospital population. The results of the work demonstrate the necessity for molecular surveillance in tracking blaSHV-producing strains in large teaching hospital settings and emphasize the need for epidemiological monitoring.
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Affiliation(s)
- Mei Zhu
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Guangjian Yang
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Ailing Li
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Li Zong
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhaoguang Dong
- Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Junwan Lu
- School of Medicine, Lishui College, Lishui 323000, China
| | - Kaibo Zhang
- School of Medicine, Lishui College, Lishui 323000, China
| | - Cong Cheng
- School of Medicine, Lishui College, Lishui 323000, China
| | - Qingli Chang
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiuying Wu
- Wenling Women's ﹠ Children's Hospital, Wenling 317500, China
| | - Jianchao Ying
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Xianneng Li
- Wenling Women's ﹠ Children's Hospital, Wenling 317500, China
| | - Li Ding
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Haixiao Zheng
- Wenling Women's ﹠ Children's Hospital, Wenling 317500, China
| | - Junping Yu
- Wenling Women's ﹠ Children's Hospital, Wenling 317500, China
| | - Jun Ying
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Teng Xu
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Huiguang Yi
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Peizhen Li
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Kewei Li
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China
| | - Songquan Wu
- School of Medicine, Lishui College, Lishui 323000, China
| | - Qiyu Bao
- School of Laboratory Medicine and Life Science/Institute of Biomedical Informatics, Wenzhou Medical University, Wenzhou 325000, China.
| | - Junrong Wang
- Wenling Women's ﹠ Children's Hospital, Wenling 317500, China.
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17
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Adler A, Friedman ND, Marchaim D. Multidrug-Resistant Gram-Negative Bacilli: Infection Control Implications. Infect Dis Clin North Am 2016; 30:967-997. [PMID: 27660090 DOI: 10.1016/j.idc.2016.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Antimicrobial resistance is a common iatrogenic complication of both modern life and medical care. Certain multidrug resistant and extensively drug resistant Gram-negative organisms pose the biggest challenges to health care today, predominantly owing to a lack of therapeutic options. Containing the spread of these organisms is challenging, and in reality, the application of multiple control measures during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article reviews the usefulness of various infection control measures in containing the spread of multidrug-resistant Gram-negative bacilli.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Dror Marchaim
- Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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18
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Antibiogram, ESBL production and carbapenemase detection of Klebsiella spp. in hospital-acquired infection. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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John JF, Ribner BS. Antibiotic Resistance in Long-Term Care Facilities. Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30146999] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Long-term care facilities are comprised of a heterogeneous group of institutions caring for residential patients over prolonged periods of time. Included as long-term care facilities in this review are private and Veterans' Affairs (VA) nursing homes, rehabilitation centers, institutions for the developmentally disabled, and hospital wards for both long-term and intermediate care. Patients in long-term care facilities incur bacterial infections at a prevalence of 10% to 16%. These infections usually are caused by common bacterial pathogens that invade the compromised host residing within a complex physical environment. The high prevalence of institutional infections leads, in turn, to the need for multiple courses of antimicrobials or for hospitalization. This process selects strains more resistant to antibiotics, which are then available for repeated dispersal in the long-term care facility.
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20
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Cantas L, Suer K, Guler E, Imir T. High Emergence of ESBL-Producing E. coli Cystitis: Time to Get Smarter in Cyprus. Front Microbiol 2016; 6:1446. [PMID: 26793167 PMCID: PMC4710751 DOI: 10.3389/fmicb.2015.01446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/04/2015] [Indexed: 01/09/2023] Open
Abstract
Background: Widespread prevalence of extended-spectrum βeta-lactamase producing Escherichia coli (ESBL-producing E. coli) limits the infection therapeutic options and is a growing global health problem. In this study our aim was to investigate the antimicrobial resistance profile of the E. coli in hospitalized and out-patients in Cyprus. Results: During the period 2010–2014, 389 strains of E. coli were isolated from urine samples of hospitalized and out-patients in Cyprus. ESBL-producing E. coli, was observed in 53% of hospitalized and 44% in out-patients, latest one being in 2014. All ESBL-producing E. coli remained susceptible to amikacin, carbapenems except ertapenem (in-patients = 6%, out-patients = 11%). Conclusion: High emerging ESBL-producing E. coli from urine samples in hospitalized and out-patients is an extremely worrisome sign of development of untreatable infections in the near future on the island. We therefore emphasize the immediate need for establishment of optimal therapy guidelines based on the country specific surveillance programs. The need for new treatment strategies, urgent prescription habit changes and ban of over-the-counter sale of antimicrobials at each segment of healthcare services is also discussed in this research.
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Affiliation(s)
- Leon Cantas
- MicroLabHammerfest, Norway; Department of Medical Microbiology, Faculty of Medicine, Near East UniversityNicosia, Cyprus
| | - Kaya Suer
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Near East University Nicosia, Cyprus
| | - Emrah Guler
- Department of Medical Microbiology, Faculty of Medicine, Near East University Nicosia, Cyprus
| | - Turgut Imir
- Department of Medical Microbiology, Faculty of Medicine, Near East University Nicosia, Cyprus
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21
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Capkin E, Terzi E, Altinok I. Occurrence of antibiotic resistance genes in culturable bacteria isolated from Turkish trout farms and their local aquatic environment. DISEASES OF AQUATIC ORGANISMS 2015; 114:127-137. [PMID: 25993887 DOI: 10.3354/dao02852] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Antibiotic resistance and presence of the resistance genes were investigated in the bacteria isolated from water, sediment, and fish in trout farms. A total of 9 bacterial species, particularly Escherichia coli, were isolated from the water and sediment samples, and 12 species were isolated from fish. The antimicrobial test indicated the highest resistance against sulfamethoxazole and ampicillin in coliform bacteria, and against sulfamethoxazole, imipenem, and aztreonam in known pathogenic bacteria isolated from fish. The most effective antibiotics were rifampicin, chloramphenicol, and tetracycline. The multiple antibiotic resistance index was above the critical limit for almost all of the bacteria isolated. The most common antibiotic resistance gene was ampC, followed by tetA, sul2, blaCTX-M1, and blaTEM in the coliform bacteria. At least one resistance gene was found in 70.8% of the bacteria, and 66.6% of the bacteria had 2 or more resistance genes. Approximately 36.54% of the bacteria that contain plasmids were able to transfer them to other bacteria. The plasmid-mediated transferable resistance genes were ampC, blaCTX-M1, tetA, sul2, and blaTEM. These results indicate that the aquatic environment could play an important role in the development of antibiotic resistance and the dissemination of resistance genes among bacteria.
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Affiliation(s)
- Erol Capkin
- Karadeniz Technical University, Faculty of Marine Science, Department of Fisheries Technology Engineering, 61530 Surmene, Trabzon, Turkey
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22
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Apisarnthanarak A, Kiratisin P, Mundy LM. Clinical and Molecular Epidemiology of Healthcare-Associated Infections Due to Extended-Spectrumβ-Lactamase (ESBL)–Producing Strains ofEscherichia coliandKlebsiella pneumoniaeThat Harbor Multiple ESBL Genes. Infect Control Hosp Epidemiol 2015; 29:1026-34. [DOI: 10.1086/591864] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives.To characterize healthcare-associated infections due to extended-spectrumβ-lactamase (ESBL)-producing strains ofEscherichia coliandKlebsiella pneumoniaethat harbor multiple ESBL genes, as opposed to a single ESBL gene.Methods.All patients with a confirmed healthcare-associated infection due to an ESBL-producing strain ofE. coliorK. pneumoniaewere enrolled in the study. Molecular typing of isolates was performed, and the comparative risks and outcomes of patients were analyzed.Results.Among 71 patients with healthcare-associated infection due to an ESBL-producing strain ofE. coliorK. pneumoniae, the gene for CTX-M, with or without other ESBL genes, was identified in all 51 (100%) of the patients infected with anE. colistrain and in 18 (90%) of the 20 patients infected with aK. pneumoniaestrain. Of these 71 patients, 17 (24%) met the definition of healthcare-associated infection due to an ESBL-producing strain that harbored multiple genes; in multivariate analysis, previous exposure to 3 or more classes of antibiotics (adjusted odds ratio, 4.5 [95% confidence interval, 1.7-75.2]) was the sole risk factor for healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes. Isolates recovered from patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more resistant to various antibiotic classes, and, compared with patients with healthcare-associated infection due to an ESBL-producing strain that harbored a single ESBL gene, they were more likely to have ineffective initial empirical antimicrobial therapy (52% vs 94%; odds ratio, 5.1 [95% confidence interval, 1.04-14.5]).Conclusions.CTX-M ESBL is highly prevalent in Thailand. Patients with healthcare-associated infection due to an ESBL-producing strain that harbored multiple ESBL genes were more likely to have had ineffective initial empirical antimicrobial therapy, and, given that antibiotic selection pressure was the only associated risk, we suggest focused antimicrobial stewardship programs to limit the emergence and spread of healthcare-associated infection due to ESBL-producing strains in this middle-income country.
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23
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Shaikh S, Fatima J, Shakil S, Rizvi SMD, Kamal MA. Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi J Biol Sci 2014; 22:90-101. [PMID: 25561890 DOI: 10.1016/j.sjbs.2014.08.002] [Citation(s) in RCA: 345] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 08/09/2014] [Accepted: 08/10/2014] [Indexed: 12/25/2022] Open
Abstract
Antibiotic resistance is a problem of deep scientific concern both in hospital and community settings. Rapid detection in clinical laboratories is essential for the judicious recognition of antimicrobial resistant organisms. Production of extended-spectrum β-lactamases (ESBLs) is a significant resistance-mechanism that impedes the antimicrobial treatment of infections caused by Enterobacteriaceae and is a serious threat to the currently available antibiotic armory. ESBLs are classified into several groups according to their amino acid sequence homology. Proper infection control practices and barriers are essential to prevent spread and outbreaks of ESBL producing bacteria. As bacteria have developed different strategies to counter the effects of antibiotics, the identification of the resistance mechanism may help in the discovery and design of new antimicrobial agents. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Hence, more expeditious diagnostic testing of ESBL-producing bacteria and the feasible modification of guidelines for community-onset bacteremia associated with different infections are prescribed.
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Affiliation(s)
| | - Jamale Fatima
- Department of Bio-engineering, Integral University, Lucknow 226026, India
| | - Shazi Shakil
- Department of Bio-engineering, Integral University, Lucknow 226026, India
| | | | - Mohammad Amjad Kamal
- King Fahd Medical Research Center, King Abdulaziz University, P.O. Box 80216, Jeddah 21589, Saudi Arabia ; Enzymoic, 7 Peterlee Pl, Hebersham, NSW 2770, Australia
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24
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Shashwati N, Kiran T, Dhanvijay AG. Study of extended spectrum β-lactamase producing Enterobacteriaceae and antibiotic coresistance in a tertiary care teaching hospital. J Nat Sci Biol Med 2014; 5:30-5. [PMID: 24678193 PMCID: PMC3961948 DOI: 10.4103/0976-9668.127280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims: To study the prevalence of extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae and coresistance to other commonly used antibiotics from the Bhopal region of Central India. Settings and Design: A prospective study was conducted from September 2011 to August 2012 in Microbiology Department of our tertiary health care center. Materials and Methods: A total of 1044 Enterobacteriaceae isolates were recovered from various specimens. ESBL production was detected by using Clinical Laboratory Standard Institute (CLSI) that described the phenotypic confirmatory test along with routine antibiotic susceptibility testing. Statistical Analysis: Two-tailed Z-test. Results: Escherichia coli was the most common isolate (65.32%). ESBL production was confirmed in 504 (48.27%) isolates. The isolates of E. coli (50.14%) were the most common ESBL producers. Maximum ESBL isolates were obtained from urine samples (52.28%) and male patients (52.54%). Sensitivity to imipenem was 100% followed by piperacillin–tazobactam (89.28%), meropenem (87.5%), and amikacin (83.92%). Significant resistance was detected against trimethoprim–sulfomethoxazole, fluoroquinolones, and gentamicin. Conclusion: This is the only study conducted from Central India and shows high prevalence of ESBL production among Enterobacteriaceae. Imipenem seems to be more sensitive than meropenem. Piperacillin–tazobactam combination was found to be the best among the β-lactam–β-lactamase inhibitor combinations. Prevalence of ESBL producers were more in males than females.
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Affiliation(s)
- Nema Shashwati
- Department of Microbiology, L. N. Medical College and Research Centre, Bhopal, Madhya Pradesh, India
| | - Tripathi Kiran
- Department of Microbiology, L. N. Medical College and Research Centre, Bhopal, Madhya Pradesh, India
| | - A G Dhanvijay
- Department of Microbiology, L. N. Medical College and Research Centre, Bhopal, Madhya Pradesh, India
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25
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Copur-Cicek A, Ozgumus OB, Saral A, Sandalli C. Antimicrobial resistance patterns and integron carriage of Escherichia coli isolates causing community-acquired infections in Turkey. Ann Lab Med 2014; 34:139-44. [PMID: 24624350 PMCID: PMC3948827 DOI: 10.3343/alm.2014.34.2.139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/04/2013] [Accepted: 11/20/2013] [Indexed: 11/23/2022] Open
Abstract
We aimed to observe antimicrobial resistance patterns and integron carriage of Escherichia coli isolates causing community-acquired infections. Two hundred sixty-eight E. coli strains were obtained from outpatients with various infections at different polyclinics at the 82nd Year of State Hospital in Rize, Turkey. Susceptibility to antimicrobials was tested using a disk diffusion method. The presence of integrons was examined using PCR with specific primers. Positive PCR results were confirmed by sequencing. A broth mating method was used for conjugation assays. Extragenic palindromic-PCR was performed using the oligonucleotide primer BOXA1R. Resistance frequency for ampicillin, trimethoprim/sulfamethoxazole, and tetracycline was determined as 50.6%, 33.5%, and 36.8% respectively. No strains were resistant to amikacin. Seventy isolates were positive for the intI1 gene, of which 49 carried gene cassettes. Eleven isolates were positive for the intI2 gene, eight of which carried gene cassettes. Seven gene cassettes (dfrA1, dfrA5, dfrA7, dfrA17, aadA1, aadA5, and sat2) were predominantly harbored in integrons. We detected conjugative plasmids harboring integrons in two E. coli strains. Four strain clusters were yielded by BOX-PCR fingerprints showing that they were clonally related. No apparent relationship occurred among class 1 and 2 integron-carrying strains. We conclude that integrons are widespread in genetically variable E. coli strains and will continue to mediate dissemination of resistance genes in the community.
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Affiliation(s)
- Aysegul Copur-Cicek
- Department of Medical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Osman Birol Ozgumus
- Department of Medical Microbiology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Aysegul Saral
- Department of Biology, Faculty of Arts & Sciences, Artvin Coruh University, Artvin, Turkey
| | - Cemal Sandalli
- Department of Biology, Faculty of Arts & Sciences, Recep Tayyip Erdoğan University, Rize, Turkey
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26
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Cicek AC, Duzgun AO, Saral A, Sandalli C. Determination of a novel integron-located variant (bla
OXA
-320
) of Class D β-lactamase in Proteus mirabilis. J Basic Microbiol 2013; 54:1030-5. [DOI: 10.1002/jobm.201300264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 08/11/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Aysegul Copur Cicek
- Department of Medical Microbiology, Faculty of Medicine; Recep Tayyip Erdogan University; Rize Turkey
| | - Azer Ozad Duzgun
- Department of Biology, Faculty of Arts & Sciences; Giresun University; Giresun Turkey
| | - Aysegul Saral
- Department of Biology, Faculty of Arts & Sciences; Artvin Coruh University; Artvin Turkey
| | - Cemal Sandalli
- Department of Biology, Faculty of Arts & Sciences; Recep Tayyip Erdogan University; Rize Turkey
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Study of the comparative activity of piperacillin/tazobactam with currently available antibiotics against 8206 aerobic isolates. Can J Infect Dis 2012; 8:147-53. [PMID: 22514487 DOI: 10.1155/1997/632673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/1996] [Accepted: 09/30/1996] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the activity of piperacillin-tazobactam with piperacillin and other parenterally administered antibiotics against aerobic Gram-negative bacilli and Gram-positive cocci isolated from across Canada, and to determine the prevalence of resistance mediated by extended-spectrum cephalosporinases. METHODS Sixty-one laboratories participated. Disk diffusion testing was performed in accordance with methods outlined by the National Committee for Clinical Laboratory Standards. Susceptibilities were performed on 8206 strains. Escherichia coli and Klebsiella pneumoniae with reduced susceptibilities to third-generation cephalosporins were screened for extended-spectrum beta-lactamases (ESBLs). RESULTS Piperacillin-tazobactam was active against 92% of the strains, piperacillin against 81% and ticarcillin-clavulanic acid against 88%. Few differences were observed in the relative susceptibility of strains from teaching or community hospitals, from different anatomic sites or from different regions of the country. Aerobic Gram-negative bacilli tested tended to be more susceptible to all the agents than was recently reported in a similar American study. Only 43% of Enterococcus faecium were susceptible to ampicillin and 42% to piperacillin piperacillin with and without tazobactam. Only two enterococcal strains were resistant to vancomycin, and 19 had intermediate zone sizes. Of the 10 strains of E coli and eight strains of K pneumoniae with reduced susceptibility to extended spectrum cephalosporins, only one demonstrated typical ESBL activity. CONCLUSIONS Canadian aerobic Gram-positive cocci and Gram-negative bacilli remain highly susceptible to many currently available antibiotics. The findings confirm a broad spectrum of activity of piperacillin-tazobactam and indicate that the pattern of susceptibility is quite uniform from different body sites, in both teaching and community hospitals, and across the country.
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Comparative activity of several antimicrobial agents against nosocomial Gram-negative rods isolated across Canada. Can J Infect Dis 2012; 6:76-82. [PMID: 22416207 DOI: 10.1155/1995/297910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/1994] [Accepted: 10/13/1994] [Indexed: 11/17/2022] Open
Abstract
In 1992, a surveillance study was performed in Canada to determine the susceptibility of nosocomial Gram-negative rods to several wide spectrum antimicrobials. Consecutive isolates from 10 institutions, as well as additional strains of selected species of Enterobacteriaceae that are known to possess the Bush group 1 beta-lactamase, were tested for susceptibility to 12 antimicrobials. Third-generation cephalosporin resistance was found to be as high as 29% in Enterobacter cloacae that possesses the Bush group 1 beta-lactamase and less than 4% in those isolates not possessing this enzyme. Cefepime equalled or exceeded the activity of the third-generation cephalosporins against the species of Enterobacteriaceae that demonstrated resistance to the third-generation cephalosporins.
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Piper GL, Kaplan LJ. Antibiotic heterogeneity optimizes antimicrobial prescription and enables resistant pathogen control in the intensive care unit. Surg Infect (Larchmt) 2012; 13:194-202. [PMID: 22913313 DOI: 10.1089/sur.2012.121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multi-drug-resistant organisms (MDRO) complicate care increasingly on the general ward and in the emergency department, operating room, and intensive care unit (ICU). Whereas barrier precautions are important in limiting transmission of MDRO between patients, few tactics have been defined that reduce the genesis of MDRO. METHOD Review of pertinent English-language literature. RESULTS Antibiotic heterogeneity practices, as part of an overall antimicrobial drug stewardship program, offer one readily deployable means to reduce selection pressure for MDRO development in the ICU. The data underpinning this approach and data derived from its use indicate that, especially in surgical ICUs, heterogeneity of antibiotic prescribing can preserve or restore microbial ecology, reduce the prevalence of MDRO and the incidence of infections caused thereby, and facilitate the implementation and effectiveness of other antibiotic-sparing tactics, such as de-escalation. CONCLUSION Heterogeneity of antibiotic prescribing is effective in preventing the dissemination of MDRO pathogens.
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Affiliation(s)
- Greta L Piper
- Section of Trauma, Surgical Critical Care, and Surgical Emergencies, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Impact of adopting minimum inhibitory concentration as the determinant of susceptibility to cephalosporins and carbapenems in multi-drug resistant Enterobacteriaceae. Eur J Clin Microbiol Infect Dis 2012; 31:975-80. [DOI: 10.1007/s10096-011-1394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
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Fennell J, Vellinga A, Hanahoe B, Morris D, Boyle F, Higgins F, Lyons M, O'Connell K, Keady D, Cormican M. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study. BMC Infect Dis 2012; 12:116. [PMID: 22587773 PMCID: PMC3462136 DOI: 10.1186/1471-2334-12-116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022] Open
Abstract
Background Extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae infections are associated with delayed initiation of appropriate treatment, poor outcomes and increased hospital stay and expense. Although initially associated with healthcare settings, more recent international reports have shown increasing isolation of ESBLs in the community. Both hospital and community ESBL epidemiology in Ireland are poorly defined. Methods This report describes clinical and laboratory data from three hospitals over 4.5 years. All significant isolates of Enterobacteriaceae were subjected to standardized antimicrobial susceptibility testing and screening for ESBL production. Available patient data from hospital databases were reviewed. Results The database included 974 ESBL producing organisms from 464 patients. Urine and blood isolates represented 84% and 3% of isolates respectively. E. coli predominated (90.9%) followed by K. pneumoniae (5.6%). The majority of patients (n = 246, 53.0%) had been admitted to at least one of the study hospitals in the year prior to first isolation of ESBL. The overall 30-day all-cause mortality from the date of culture positivity was 9.7% and the 1 year mortality was 61.4%. A Cox regression analysis showed age over 60, male gender and previous hospital admissions were significant risk factors for death within 30 days of ESBL isolation. Numbers of ESBL-producing E. coli isolated from urine and blood cultures increased during the study. Urine isolates were more susceptible than blood isolates. Co-resistance to other classes of antimicrobial agents was more common in ESBL producers from residents of long stay facilities (LSF) compared with hospital inpatients who lived at home. Conclusions This work demonstrates a progressively increasing prevalence of ESBL Enterobacteriaceae in hospital, LSF and community specimens in a defined catchment area over a long time period . These results will improve clinician awareness of this problem and guide the development of empiric antimicrobial regimens for community acquired bloodstream and urinary tract infections.
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Affiliation(s)
- Jérôme Fennell
- Department of Medical Microbiology, Galway University Hospitals, Galway, Ireland
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Rapp RP, Urban C. Klebsiella pneumoniae carbapenemases in Enterobacteriaceae: history, evolution, and microbiology concerns. Pharmacotherapy 2012; 32:399-407. [PMID: 22488420 DOI: 10.1002/j.1875-9114.2012.01035.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Since the discovery of penicillin 80 years ago, gram-negative bacteria have become proficient at evading the lethal activity of β-lactam antibiotics, principally through the production of β-lactamases. The rapid emergence of penicillinases in both gram-positive and gram-negative bacteria led to the development of cephalosporin β-lactam antibiotics, but production of plasmid-mediated extended-spectrum cephalosporinases (or extended-spectrum β-lactamases) and AmpC enzymes resulted in resistance to this drug class. Because carbapenems were the only β-lactam agents active against such extended-spectrum β-lactamase-producing strains, appropriate and inappropriate use soon resulted in Enterobacteriaceae resistance. As a result, two distinct types of carbapenemases-the metallo-β-lactamases and Klebsiella pneumoniae carbapenemases (KPCs)-were soon identified. The KPCs comprise 10 variants that differ from one another by one to three amino acid substitutions (KPC-2 to KPC-11). The KPC-producing Enterobacteriaceae are not only multidrug resistant but are also difficult to detect routinely in the clinical microbiology laboratory. Tigecycline, polymyxins (colistin and polymyxin B), and aminoglycosides are possible candidate therapies for infections caused by KPC-producing organisms, although well-conducted clinical trials are required to fully define their roles in patient management. The shortage of new antimicrobial agents on the immediate horizon suggests that enhanced adherence with infection prevention procedures and antimicrobial stewardship programs are needed to curb patient-to-patient transmission and to reduce the selection of multidrug-resistant bacteria.
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Affiliation(s)
- Robert P Rapp
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA.
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S. Wilberger M, E. Anthony K, Rose S, McClain M, E. Bermudez L. Beta-Lactam Antibiotic Resistance among <i>Enterobacter</i> spp. Isolated from Infection in Animals. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/aim.2012.22018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ahmad TA, El-Sayed LH, Haroun M, Hussein AA, El Ashry ESH. Development of immunization trials against Klebsiella pneumoniae. Vaccine 2011; 30:2411-20. [PMID: 22100884 DOI: 10.1016/j.vaccine.2011.11.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 10/18/2011] [Accepted: 11/01/2011] [Indexed: 11/17/2022]
Abstract
Klebsiella pneumoniae is the most common cause of nosocomial respiratory tract and premature intensive care infections, and the second most frequent cause of Gram-negative bacteraemia and urinary tract infections. Drug resistant isolates remain an important hospital-acquired bacterial pathogen, add significantly to hospital stays, and are especially problematic in high impact medical areas such as intensive care units. Many investigations worldwide proved the increasing resistance of such pathogen, resulting in an average rate of 1.63 outbreak every year. A variety of preventive measures were applied to reduce such incidences. Immunotherapy and passive immunization researches as well found their way to the treatment of Klebsiella. During the last 40 years, many trials for constructing effective vaccines were followed. This up-to-date review classifies such trials and documents them in a progressive way. A following comment discusses each group benefits and defects.
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Affiliation(s)
- Tarek A Ahmad
- Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt.
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Augustine S, Bonomo RA. Taking stock of infections and antibiotic resistance in the elderly and long-term care facilities: A survey of existing and upcoming challenges. Eur J Microbiol Immunol (Bp) 2011; 1:190-7. [PMID: 24516724 DOI: 10.1556/eujmi.1.2011.3.2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/09/2011] [Indexed: 12/18/2022] Open
Abstract
Treating elderly patients with infections represents one of the greatest challenges to health-care providers. Older adults are the largest growing sector of the population and suffer excessively from infectious diseases such as pneumonia, urinary tract infections (UTIs), and skin and soft-tissue infections. Often because of disabilities, the elderly require treatment of infectious diseases in long-term care facilities (LTCFs). As a result of antibiotic use, LTCFs have become "reservoirs of resistance" and multi-drug resistant (MDR) pathogens are frequently recovered. Clinicians also need to be aware of the impairment of immune function and other emerging chronic infections (HIV, HCV) that are now present in the elderly. Despite vigilance regarding this issue, delays in diagnosis and initiation of therapy are common. This article reviews the changing landscape of infections in the elderly and the challenge these syndromes present in the context of an increasing older population that requires dedicated resources.
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Affiliation(s)
- S Augustine
- General Internal Medicine and Geriatrics Research Educational and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center Cleveland, Ohio, 44106 USA
| | - R A Bonomo
- General Internal Medicine and Geriatrics Research Educational and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center Cleveland, Ohio, 44106 USA
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Abstract
This review aims to discuss expert systems in general and how they may be used in medicine as a whole and clinical microbiology in particular (with the aid of interpretive reading). It considers rule-based systems, pattern-based systems, and data mining and introduces neural nets. A variety of noncommercial systems is described, and the central role played by the EUCAST is stressed. The need for expert rules in the environment of reset EUCAST breakpoints is also questioned. Commercial automated systems with on-board expert systems are considered, with emphasis being placed on the "big three": Vitek 2, BD Phoenix, and MicroScan. By necessity and in places, the review becomes a general review of automated system performances for the detection of specific resistance mechanisms rather than focusing solely on expert systems. Published performance evaluations of each system are drawn together and commented on critically.
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Affiliation(s)
- Trevor Winstanley
- Department of Microbiology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
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Urban C, Rahal JJ. Klebsiella and extended spectrum beta-lactamases. Int J Antimicrob Agents 2010; 8:37-43. [PMID: 18611783 DOI: 10.1016/s0924-8579(96)00355-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/1996] [Indexed: 11/18/2022]
Abstract
During the past 14 years a rapid, world-wide increase in prevalence of Klebsiella pneumoniae resistant to late generation cephalosporins has occurred. A growing number of newly identified plasmid encoded beta-lactam hydrolyzing enzymes has broadened the spectrum of primitive beta-lactamases allowing inactivation of a wide variety of beta-lactam agents. The extrachromosomal genes which code for these enzymes often exist with genes expressing resistance to several other classes of antibacterial agents, potentially arming Klebsiella pneumoniae with resistance to all therapeutically available antibiotics. More focused surveillance studies and individualized strategies within institutions are necessary to reduce this insidious trend.
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Affiliation(s)
- C Urban
- Department of Medicine, The New York Hospital Medical Center of Queens, 56-45 Main Street, Flushing, NY 11355, USA
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Utsumi M, Makimoto K, Quroshi N, Ashida N. Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature. Age Ageing 2010; 39:299-305. [PMID: 20332371 DOI: 10.1093/ageing/afq029] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND infectious outbreaks in long-term care facilities (LTCFs) tend to have a significant impact on infection rates and mortality rates of the residents. OBJECTIVES this review aimed to update the information on pathogens identified in such outbreaks and to try to explore indicators that reflect the impact of outbreaks among residents and health care workers (HCWs). METHODS MEDLINE (1966-2008) was used to identify outbreaks using the following thesaurus terms: 'Cross-Infection', 'Disease Outbreaks', 'Urinary-Tract Infections' and 'Blood-Borne Pathogens'. Elderly care facilities were identified with the following thesaurus terms: 'Long-Term Care', 'Assisted-Living Facilities', 'Homes for the Aged' and 'Nursing Homes'. Age category was limited using 'Aged'. RESULTS thirty-seven pathogens were associated with 206 outbreaks. The largest number of reported outbreaks by a single pathogen involved the influenza virus, followed by noroviruses. Among residents, the highest median attack rate for respiratory infection outbreaks was caused by Chlamydia pneumoniae (46%), followed by respiratory syncytial virus (40%). In gastrointestinal tract infection outbreaks, high median attack rates were caused by Clostridium perfringens (48%) and noroviruses (45%). Outbreaks with high median case fatality rates were caused by Group A Streptococci (50%) and Streptococcus pneumoniae (44%). High median attack rates for HCWs were caused by C. pneumoniae (41%), noroviruses (42%) and scabies (36%). CONCLUSION a variety of infectious agents were identified as the cause of outbreaks in the elderly and HCWs in LTCFs. Attack rates and case fatality rates are useful indicators for setting priorities for education and prevention of the outbreaks.
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Affiliation(s)
- Momoe Utsumi
- Graduate School of Medicine, Division of Health Science, Osaka University, 1-7 Yamadaoka, Suita City, Osaka 565-0871, Japan
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Epidemiology of an outbreak of antibiotic-resistant Klebsiella pneumoniae at a tertiary care medical center. Am J Infect Control 2009; 37:723-8. [PMID: 19501935 DOI: 10.1016/j.ajic.2009.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 02/05/2009] [Accepted: 02/06/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND In 2004, a 650-bed, tertiary care medical center experienced an outbreak of multiple antibiotic-resistant Klebsiella pneumoniae (MR-KP) that included extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing strains. METHODS Characteristics associated with MR-KP were evaluated by case-control study with variables tested by conditional regression analyses. Pulsed-field gel electrophoresis (PFGE) was used to compare the molecular relatedness of isolates. RESULTS In 2004, the incidence rate of MR-KP increased significantly compared with 2003 (relative risk [RR], 5.1; 95% confidence interval [CI]: 3.10-8.37) when only ESBL-producing K pneumoniae were present. The increase involved both ESBL-producing MR-KP and MR-KP in which ESBL production was not detected by the testing in use. Nineteen isolates were identical or closely related by PFGE. Characteristics associated with MR-KP were longer length of hospital stay (odds ratio [OR], 2.92; 95% CI: 1.17-7.30; P = .022), greater total antibiotic-days (OR, 2.81; 95% CI: 1.19-6.65; P = .018], and higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.15; 95% CI: 1.06-1.25; P = .001). When the MR-KP cases were subdivided into ESBL-producing K pneumoniae and ESBL-negative K pneumoniae, while controlling for length of stay, total antibiotic-days was significantly associated with ESBL-producing K pneumoniae (OR, 3.8; 95% CI: 1.2-12.1; P = .02). CONCLUSION Compared with patients housed on the same unit at the same time, patients with MR-KP had a longer length of stay and greater antibiotic exposure. Patients with longer length of stay and greater total antibiotic exposure should be potential targets for stringent infection control measures.
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Cephalosporin MIC distribution of extended-spectrum-{beta}-lactamase- and pAmpC-producing Escherichia coli and Klebsiella species. J Clin Microbiol 2009; 47:2419-25. [PMID: 19494061 DOI: 10.1128/jcm.00508-09] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The acquisition of beta-lactamases in members of the Enterobacteriaceae family poses a challenge to antimicrobial susceptibility testing in the clinical laboratory. We correlated the distribution of the MICs for Klebsiella spp. and Escherichia coli with the presence of extended-spectrum beta-lactamase (ESBL) and plasmid-mediated AmpC beta-lactamase (pAmpC) genes. A total of 264 isolates were subjected to cefazolin, ceftriaxone, cefotaxime, ceftazidime, cefepime, and aztreonam agar dilution MIC determination; ESBL screening and confirmatory testing by the methods of the Clinical and Laboratory Standards Institute (CLSI); and for isolates for which the MICs of extended-spectrum cephalosporins were > or =1 microg/ml or the MICs of cefpodoxime were >4 microg/ml, PCR amplification and sequencing of the ESBL and pAmpC genes. PCR was positive for 73/81 isolates (45 isolates with an ESBL gene alone, 24 isolates with a pAmpC gene alone, with 4 isolates with both genes). Compared to PCR, confirmatory testing by the CLSI method yielded a sensitivity and a specificity of 98.0 and 96.3%, respectively; there were six false-positive results and one false-negative result. No distinction in the MIC distribution was apparent between isolates with the ESBL gene and isolates with the pAmpC gene. A substantial percentage of the isolates with PCR-confirmed ESBL and/or pAmpC genes fell within the current CLSI susceptible category. For a ceftazidime, ceftriaxone, or cefotaxime MIC of > or =2 microg/ml, a dichotomy existed between isolates with and without ESBL and pAmpC genes in most cases. This suggests that the presence of the ESBL and the pAmpC enzymes may yield similar MICs of extended-spectrum cephalosporins, many of which fall within the current nonresistant categories. Lowering of the current CLSI breakpoints for cephalosporins appears to be warranted.
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Mulvey MR, Simor AE. Antimicrobial resistance in hospitals: how concerned should we be? CMAJ 2009; 180:408-15. [PMID: 19221354 DOI: 10.1503/cmaj.080239] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael R Mulvey
- Department of Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, University of Manitoba, Winnipeg, Man
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Class 1 and class 2 integrons and plasmid-mediated antibiotic resistance in coliforms isolated from ten rivers in northern Turkey. J Microbiol 2009; 47:19-27. [DOI: 10.1007/s12275-008-0206-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 10/10/2008] [Indexed: 11/25/2022]
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Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008; 6:751-63. [PMID: 18847410 DOI: 10.1586/14787210.6.5.751] [Citation(s) in RCA: 218] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Knowledge of the clinical and economic impact of antimicrobial resistance is useful to influence programs and behavior in healthcare facilities, to guide policy makers and funding agencies, to define the prognosis of individual patients and to stimulate interest in developing new antimicrobial agents and therapies. There are a variety of important issues that must be considered when designing or interpreting studies into the clinical and economic outcomes associated with antimicrobial resistance. One of the most misunderstood issues is how to measure cost appropriately. Although imperfect, existing data show that there is an association between antimicrobial resistance in Staphylococcus aureus, enterococci and Gram-negative bacilli and increases in mortality, morbidity, length of hospitalization and cost of healthcare. Patients with infections due to antimicrobial-resistant organisms have higher costs (US $6,000-30,000) than do patients with infections due to antimicrobial-susceptible organisms; the difference in cost is even greater when patients infected with antimicrobial-resistant organisms are compared with patients without infection. Given limited budgets, knowledge of the clinical and economic impact of antibiotic-resistant bacterial infections, coupled with the benefits of specific interventions targeted to reduce these infections, will allow for optimal control and improved patient safety. In this review, the authors discuss a variety of important issues that must be considered when designing or interpreting studies of the clinical and economic outcomes associated with antimicrobial resistance. Representative literature is reviewed regarding the associations between antimicrobial resistance in specific pathogens and adverse outcomes, including increased mortality, length of hospital stay and cost.
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Affiliation(s)
- Lisa L Maragakis
- The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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44
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Rice LB, Carias LL, Hutton RA, Rudin SD, Endimiani A, Bonomo RA. The KQ element, a complex genetic region conferring transferable resistance to carbapenems, aminoglycosides, and fluoroquinolones in Klebsiella pneumoniae. Antimicrob Agents Chemother 2008; 52:3427-9. [PMID: 18573935 PMCID: PMC2533511 DOI: 10.1128/aac.00493-08] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 05/30/2008] [Accepted: 06/14/2008] [Indexed: 11/20/2022] Open
Abstract
The bla(KPC-3) and qnrB19 determinants of transferable Klebsiella pneumoniae plasmid pLRM24 reside within a complex region consisting of a Tn1331 backbone into which a Tn4401-like element and qnrB19 mobilized by an adjacent ISEcp1 insertion sequence have been inserted. This novel element represents a coalescence of genes conferring multidrug resistance in K. pneumoniae.
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Affiliation(s)
- Louis B Rice
- Department of Medicine, Medical and Research Services, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
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Ding H, Yang Y, Lu Q, Wang Y, Chen Y, Deng L, Wang A, Deng Q, Zhang H, Wang C, Liu L, Xu X, Wang L, Shen X. Five-year surveillance of antimicrobial use in Chinese Pediatric Intensive Care Units. J Trop Pediatr 2008; 54:238-42. [PMID: 18222941 DOI: 10.1093/tropej/fmm118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In order to demonstrate antibiotic usage in Chinese Pediatric Intensive Care Units (PICUs), and provide some data to further study on relation of antimicrobial use and resistance. We reviewed the use of antibiotics in Chinese PICUs from 2002 to 2006. All data, including general data and antibiotic use data, were obtained from five PICUs of pediatric teaching hospitals in China. The results of antibiotic use were expressed as defined daily doses (DDDs) per 100 patient-days by WHO in this study. All 12 743 patients were included from the five PICUs in this study. Length of stay in PICUs was essentially unchanged, but the percentage of antimicrobial costs vs. drug costs dramatically decreased in this study period (p < 0.01). The percentage of empiric treatment decreased by year (from 82.2% to 70.2%). while the percentage of therapeutic treatment increased by year (from 11.2% to 24.2%) from 2002 to 2006. Total antibiotic usage decreased from 72.1 DDDs per 100 patient-days to 35.5 DDDs per 100 patient-days from 2002 to 2006 (p < 0.05). The significant increase was found in the DDDs per 100 patient-days of second generation cephalosporins in this study (p < 0.05). While usages of the some antibiotics decreased, for example penicillins, third-generation cephalosporins, and macrolides in this study period. The data of antimicrobial use were obtained from five PICUs of biggest pediatric teaching hospital in this 5-year period, which could serve as a basis of antibiotic treatment and a benchmark in future study of antibiotic use.
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Affiliation(s)
- Hui Ding
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
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Surveillance of community-based reservoirs reveals the presence of CTX-M, imported AmpC, and OXA-30 beta-lactamases in urine isolates of Klebsiella pneumoniae and Escherichia coli in a U.S. community. Antimicrob Agents Chemother 2008; 52:3814-6. [PMID: 18663030 DOI: 10.1128/aac.00877-08] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
beta-Lactamases produced by urine isolates from patients in long-term care facilities (LTCFs), outpatient, clinics, and one hospital in a U.S. community were characterized. A total of 1.3% of all Escherichia coli and Klebsiella pneumoniae isolates collected from patients in 30 LTCFs and various outpatient clinics produced extended-spectrum beta-lactamases (ESBLs) and/or imported AmpC beta-lactamases.
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47
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Kim JY, Kim MJ. Control of extended-spectrum -lactamase-producing Klebsiella pneumoniae by utilizing a computer-assisted management program to restrict third-generation cephalosporin use--authors' response. J Antimicrob Chemother 2008. [DOI: 10.1093/jac/dkn324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Esposito S, Leone S, Noviello S, Ianniello F, Marvaso A, Cuniato V, Bellitti F. Antibiotic prophylaxis in hernia repair and breast surgery: a prospective randomized study comparing piperacillin/tazobactam versus placebo. J Chemother 2008; 18:278-84. [PMID: 17129838 DOI: 10.1179/joc.2006.18.3.278] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery, its use for these clean procedures is widely adopted, albeit to a different extent in different countries, often on the personal decision of the individual surgeon. The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery.A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospective randomized clinical study. Patients were randomly assigned to receive preoperative antibiotic prophylaxis or placebo. One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v. 30 minutes prior to the surgical procedure. Using statistical univariate analysis, the following variables were correlated with a higher infection risk: age >40 years, concomitant disease, WBC <3500, surgical wound size >9cm, use of drainages, non-prophylaxis. Using multivariate analysis, no antibiotic pre-operative prophylaxis, concurrent chronic diseases, especially diabetes (risk 15 times higher), and length of intervention >45 min (risk 6 times higher) were independent predictors of infection. Finally, patients with postoperative infections had a significantly longer hospitalisation. One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair.
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Affiliation(s)
- S Esposito
- Department of Infectious Diseases, Second University of Naples, Naples, Italy.
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Al Muharrmi Z, Rafay AM, Balkhair A, Al-Tamemi S, Al Mawali A, Al Sadiri H. Extended-spectrum β-lactamase (ESBL) in Omani Children: Study of prevalence, risk factors and clinical outcomes at Sultan Qaboos University Hospital, Sultanate of Oman. Sultan Qaboos Univ Med J 2008; 8:171-177. [PMID: 21748055 PMCID: PMC3074824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 03/31/2008] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Antimicrobial resistance is a growing problem worldwide, which imposes difficulties in the selection of appropriate empirical antimicrobial therapy. This study evaluated extended-spectrum β-lactamase (ESBL) isolates in 2005 in The Department of Child Health at Sultan Qaboos University Hospital (SQUH), Oman. METHODS During the 12 month period from January 2005 to December 2005, ESBL isolates from paediatrics inpatients were identified and analysed. Risk factors for the patients who grew ESBLs were analysed. RESULTS 13.3% of E. coli and 16.6% of Klebsiella pneumoniae isolated were ESBL producers. Most of the ESBLs were from urine (46.2%) and blood (42.6%). The main risk factors for ESBL in these children were previous exposure to antimicrobials (100%), prolonged hospital stay, severe illness (92.3%) and female gender (84.6%). Sensitivity of 100% was observed to carbapenems whereas 92% of the isolates were susceptible to amikacin. The oximino-cephalosporins were 100% resistant. Klebsiella pneumoniae were 100% resistant to piperacillin-tazobactam and nitrofurantoin. E. coli was 100% resistant to trimethoprim-sulfamethoxazole and ciprofloxacin. No resistance was recorded for the following combinations: amikacin plus piperacillin-tazobactam, amikacin plus nitrofurantoin and gentamicin plus nitrofurantoin. CONCLUSION ESBL-producing organisms are becoming a major problem in Omani children. Exposure to antimicrobials and long admissions are modifiable risk factors that should be targeted for better control. Carbapenems are the most sensitive and reliable treatment options for infections caused by ESBLs. Amikacin plus piperacillin-tazobactam or nitrofurantoin are good alternatives.
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Affiliation(s)
| | | | | | - Salem Al-Tamemi
- Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al Mawali
- Medical Student, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Hilal Al Sadiri
- Medical Student, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Yao DM, Cao W, Qing ZJ. Analysis of pathogen distribution and drug resistance of nosocomial infections accompanied in patients with malignant tumor. Chin J Cancer Res 2008. [DOI: 10.1007/s11670-008-0155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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