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Shirvani F, Hassanzadeh R, Attaran B, Ghandchi G, Abdollahi N, Gholinejad Z, Sheikhi Z, Behzad A, Fallah F, Azimi L, Safarkhani A, Karimi A, Mahdavi A, Armin S, Ghanaiee RM, Tabatabaei SR, Fahimzad SA, Alebouyeh M. The intestinal carrier status of Enterococcus spp. in children: clonal diversity and alterations in resistance phenotypes before and after admission to a pediatric intensive care unit. BMC Pediatr 2023; 23:434. [PMID: 37648974 PMCID: PMC10466818 DOI: 10.1186/s12887-023-04238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods. METHODS Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates. RESULTS The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient. CONCLUSIONS The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children.
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Affiliation(s)
- Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Romina Hassanzadeh
- Department of Microbiology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran
| | - Bahareh Attaran
- Department of Microbiology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran
| | - Ghazale Ghandchi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafiseh Abdollahi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zari Gholinejad
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sheikhi
- Pediatric Intensive Care Unit, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Behzad
- Pediatric Intensive Care Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Fallah
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Azimi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Safarkhani
- Pediatric Intensive Care Unit, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Karimi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mahdavi
- Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnaz Armin
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roxana Mansour Ghanaiee
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rafiei Tabatabaei
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Fahimzad
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Alebouyeh
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Richter SE, Miller L, Needleman J, Uslan DZ, Bell D, Watson K, Humphries R, McKinnell JA. Risk factors for development of aminoglycoside resistance among gram-negative rods. Am J Health Syst Pharm 2020; 76:1838-1847. [PMID: 31665763 DOI: 10.1093/ajhp/zxz201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Development of scoring systems to predict the risk of aminoglycoside resistance and to guide therapy is described. METHODS Infections due to aminoglycoside-resistant gram-negative rods (AR-GNRs) are increasingly common and associated with adverse outcomes; selection of effective initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. To determine risk factors for AR-GNR recovery from culture, cases of GNR infection among patients admitted to 2 institutions in a major academic hospital system during the period 2011-2016 were retrospectively analyzed. Gentamicin and tobramycin resistance (GTR-GNR) and amikacin resistance (AmR-GNR) patterns were analyzed separately. A total of 26,154 GNR isolates from 12,516 patients were analyzed, 6,699 of which were GTR, and 2,467 of which were AmR. RESULTS In multivariate analysis, risk factors for GTR-GNR were presence of weight loss, admission from another medical or long-term care facility, a hemoglobin level of <11 g/dL, receipt of any carbapenem in the prior 30 days, and receipt of any fluoroquinolone in the prior 30 days (C statistic, 0.63). Risk factors for AmR-GNR were diagnosis of cystic fibrosis, male gender, admission from another medical or long-term care facility, ventilation at any point prior to culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (C statistic, 0.74). Multinomial and ordinal models demonstrated that the risk factors for the 2 resistance patterns differed significantly. CONCLUSION A scoring system derived from the developed risk prediction models can be applied by providers to guide empirical antimicrobial therapy for treatment of GNR infections.
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Affiliation(s)
- Stefan E Richter
- Department of Cardiology, University of California, Los Angeles, and NIH BD2K Center of Excellence at UCLA, Los Angeles, CA
| | - Loren Miller
- Infectious Disease Clinical Outcome Research Unit, Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA
| | - Jack Needleman
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA
| | - Daniel Z Uslan
- Department of Infectious Disease, University of California, Los Angeles, Los Angeles, CA
| | - Douglas Bell
- Department of Internal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Karol Watson
- Department of Cardiology, University of California, Los Angeles, and NIH BD2K Center of Excellence at UCLA, Los Angeles, CA
| | - Romney Humphries
- Department of Pathology & Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, and Accelerate Diagnostics, Tucson, AZ
| | - James A McKinnell
- Infectious Disease Clinical Outcome Research Unit Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA
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Jannati E, Amirmozaffari N, Saadatmand S, Arzanlou M. Faecal carriage of high-level aminoglycoside-resistant and ampicillin-resistant Enterococcus species in healthy Iranian children. J Glob Antimicrob Resist 2019; 20:135-144. [PMID: 31295581 DOI: 10.1016/j.jgar.2019.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES High-level aminoglycoside, ampicillin and vancomycin resistance and virulence genes among enterococcal isolates collected from healthy middle-school children in Ardabil, Iran, during 2016 were investigated. METHODS Totally, 305 faecal specimens were collected. Isolates underwent antimicrobial susceptibility testing, virulence gene detection and molecular typing. RESULTS Totally, 409 enterococcal isolates were collected, comprising Enterococcus faecium (235; 57.5%), Enterococcus faecalis (56; 13.7%) and other Enterococcus spp. (118; 28.9%). Overall, 71 (17.4%), 11 (2.7%) and 10 (2.4%) isolates were identified as high-level streptomycin-resistant (HLSR), high-level gentamicin-resistant (HLGR) and ampicillin-resistant (AR), respectively. Among HLSR isolates, 40 (56.3%), 5 (7.0%) and 26 (36.6%) were E. faecium, E. faecalis and other Enterococcus spp., respectively. Among HLGR isolates 4 (36.4%) and 7 (63.6%) and among AR isolates 7 (70.0%) and 3 (30.0%) were E. faecium and other Enterococcus spp., respectively. Accordingly, 21.6%, 3.6% and 3.3% of subjects were colonised with HLSR, HLGR and AR Enterococcus spp. Carriage of HLGR, HLSR and AR isolates was associated with prior antibiotic consumption (P≤0.05). Additionally, male sex and antacid consumption were associated with AR enterococcal carriage. Moreover, 69 (97.2%), 10 (90.9%) and 9 (90.0%) of HLSR, HLGR and AR isolates were multidrug-resistant, respectively. No vancomycin-resistant enterococci were detected. ERIC-PCR revealed high genetic diversity among isolates. gelE and asa1 were major virulence genes both in E. faecalis and E. faecium. Presence of gelE was associated with HLSR and HLGR phenotypes (P≤0.05). CONCLUSION Community intestinal carriage of HLSR enterococci was high; however, carriage of HLGR and AR enterococci was low.
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Affiliation(s)
- Elham Jannati
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nour Amirmozaffari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Saadatmand
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohsen Arzanlou
- Department of Microbiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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Emerging resistance to aminoglycosides in lactic acid bacteria of food origin—an impending menace. Appl Microbiol Biotechnol 2015; 100:1137-1151. [DOI: 10.1007/s00253-015-7184-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023]
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Muruzábal-Lecumberri I, Girbau C, Canut A, Alonso R, Fernández-Astorga A. Spread of an Enterococcus faecalis sequence type 6 (CC2) clone in patients undergoing selective decontamination of the digestive tract. APMIS 2015; 123:245-51. [PMID: 25712203 DOI: 10.1111/apm.12336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 09/24/2014] [Indexed: 11/27/2022]
Abstract
Enterococcus faecalis (E. faecalis) is a common cause of nosocomial infection in immunocompromised patients. The presence and dissemination of high-risk clonal complexes, such as CC2, is an ongoing problem in hospitals. The aim of this work was to characterize 24 E. faecalis isolates from ICU patients undergoing selective decontamination of the digestive tract (SDD) by phenotypical (antimicrobial susceptibility) and genotypical (presence of virulence genes, RAPD-PCR and MLST) methods. Our results showed high prevalence of the ST6 E. faecalis clone (91.6%), especially adapted to the hospital environment, with a multidrug resistance pattern and a multitude of putative virulence genes. In addition, ST179 (4.2%) and ST191 (4.2%) were detected. By RAPD-PCR analysis, the 22 isolates identified as ST6 showed six different DNA patterns, while the two remaining isolates, ST179 and ST191, showed two additional profiles. CC2 is a known clonal complex with high adaptability to hospital environment and worldwide distribution. The high prevalence of the ST6 clone in the studied population could be related to the presence of gentamicin in the SDD mixture since most strains were gentamicin resistant. Consequently, strict surveillance should be applied for rapid detection and control of this clone to prevent future spread outside the ICU.
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Affiliation(s)
- Izaskun Muruzábal-Lecumberri
- Department of Immunology, Microbiology and Parasitology, Faculty of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria, Spain
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Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance. Clin Microbiol Rev 2013; 26:289-307. [PMID: 23554418 DOI: 10.1128/cmr.00001-13] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bacterial resistance to antibiotics is a growing clinical problem and public health threat. Antibiotic use is a known risk factor for the emergence of antibiotic resistance, but demonstrating the causal link between antibiotic use and resistance is challenging. This review describes different study designs for assessing the association between antibiotic use and resistance and discusses strengths and limitations of each. Approaches to measuring antibiotic use and antibiotic resistance are presented. Important methodological issues such as confounding, establishing temporality, and control group selection are examined.
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Pingault NM, Bowman JM, Lehmann D, Riley TV. Antimicrobial susceptibility of Moraxella catarrhalis isolated from children in Kalgoorlie–Boulder, Western Australia. Pathology 2010; 42:273-9. [DOI: 10.3109/00313021003631270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wendelbo Ø, Jureen R, Eide GE, Digranes A, Langeland N, Harthug S. Outbreak of infection with high-level gentamicin-resistant Enterococcus faecalis (HLGRE) in a Norwegian hospital. Clin Microbiol Infect 2003; 9:662-9. [PMID: 12925108 DOI: 10.1046/j.1469-0691.2003.00668.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine and characterize a suspected outbreak of high-level gentamicin-resistant Enterococcus (HLGRE) infection. METHODS Eighty-nine patients with clinical infection diagnosed during hospital stay or within 30 days after discharge in the period from June 1995 to 31 December 1999 were included in the study. One control patient was assigned for each HLGRE patient according to localization in the hospital (same ward), time of admission (+/-3 months), and age (+/-10 years). Unadjusted risk analysis and multivariate logistic regression analysis were performed. Sixty-nine HLGRE strains were subjected to PCR amplification of the genes coding for aminoglycoside-3'-O-phosphoryltransferase-III (APH(3')-III) and aminoglycoside-6'-N-acetyltransferase/2"-O-phosphoryltransferase-III (AAC(6')/APH(2")). RESULTS The gene aacA/aphD, associated with HLGRE, was detected by PCR in all isolates, and the gene aphA3, associated with high-level streptomycin, kanamycin and amikacin resistance, was detected in 56 of the 69 isolates. None of the 69 isolates was resistant to glycopeptides or ampicillin. Resistance to ciprofloxacin was found in 57 (82.6%). Pulsed-field gel electrophoresis analysis revealed 12 different genotypes, among which two major clusters dominated. CONCLUSIONS Both clonal expansion and the emergence of unique strains contributed to the increased number of infections caused by HLGRE. Urinary catheterization, duration of hospital stay and antibiotic therapy were significant risk factors for HLGRE infection.
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Affiliation(s)
- Ø Wendelbo
- Department of Medicine, Center for Clinical Research, Haukeland University Hospital, Bergen, Norway.
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Harris AD, Karchmer TB, Carmeli Y, Samore MH. Methodological principles of case-control studies that analyzed risk factors for antibiotic resistance: a systematic review. Clin Infect Dis 2001; 32:1055-61. [PMID: 11264034 DOI: 10.1086/319600] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2000] [Revised: 08/28/2000] [Indexed: 11/03/2022] Open
Abstract
Case-control studies that analyze the risk factors for antibiotic-resistant organisms have varied epidemiological methodologies, which may lead to biased estimates of antibiotic risk factors. A systematic review of case-control studies that analyzed risk factors for antibiotic-resistant organisms addressed 3 methodological principles: method of control group selection, adjustment for time at risk, and adjustment for comorbid illness. A total of 406 abstracts were reviewed. Thirty-seven studies met the inclusion and exclusion criteria and were reviewed and evaluated for the 3 methodological principles. Thirteen (35%) of 37 studies chose the preferred control group. Eleven adjusted for time at risk. Twenty-seven adjusted for comorbid illness. Future studies need to consider more closely the optimization of control group selection, adjusting for confounding caused by time at risk, and adjusting for confounding caused by comorbid illness.
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Affiliation(s)
- A D Harris
- Dept. of Epidemiology and Preventive Medicine, University of Maryland Medical System, Baltimore, MD 21201, USA.
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