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Kharaghani AA, Harzandi N, Khorsand B, Rajabnia M, Kharaghani AA, Houri H. High prevalence of Mucosa-Associated extended-spectrum β-Lactamase-producing Escherichia coli and Klebsiella pneumoniae among Iranain patients with inflammatory bowel disease (IBD). Ann Clin Microbiol Antimicrob 2023; 22:86. [PMID: 37710309 PMCID: PMC10503005 DOI: 10.1186/s12941-023-00630-x] [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: 03/19/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Several pieces of evidence suggest that certain pathobionts belonging to Enterobacterales are associated with the development and progression of inflammatory bowel diseases (IBD). Extended-spectrum β-lactamases (ESBLs) ESBLs are frequently found in the Enterobacterales members, particularly in Escherichia coli and Klebsiella spp., and might trigger antibiotic-induced perturbations of the intestinal microbiota and led to more severe disease activity in IBD. Therefore, the severity of IBD could be influenced by ESBL-producing Enterobacterales, and hence, this study aimed to investigate the presence of ESBLs and carbapenemases among mucosa-associated E. coli and Klebsiella pneumoniae isolated from colonic biopsies of Iranian patients with IBD. METHODS In this cross-sectional study, E. coli and K. pneumoniae were isolated from inflamed ileum and/or colon tissue of patients with IBD, including Ulcerative colitis (UC) and Crohn's disease (CD), during colonoscopy. Demographic data and clinical characteristics were recorded, and UC and CD disease activity and extent were evaluated according to the full Mayo score and Crohn's disease activity index (CDAI), respectively. Phenotypic and molecular detection of ESBL- and carbapenemase-producing E. coli and Klebsiella pneumoniae were carried out. Disease activity and other clinical and microbial features were compared in patients with and without gut colonization with ESBL producers. RESULTS A total of 83 IBD patients, including 67 UC and 16 CD, were enrolled in the initial analysis. Intestinal colonization with ESBL-producing E. coli and/or Klebsiella pneumoniae was found in 37 (55.2%) of UC and 9 (56.2%) of DC patients - mostly harbored E. coli containing the blaCTX-M and blaTEM genes. UC patients with intestinal colonization with ESBL-producers had more severe disease compared with patients without colonization. Moreover, 10.2% of tested E. coli and 34.8% of K. pneumoniea were recognized as potential carbapenemase producers. CONCLUSION Intestinal colonization with ESBL producers could arise disease activity in IBD patients. Further large-scale case-control studies should be performed to investigate the possible confounding factors that could contribute to this outcome.
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Affiliation(s)
- Ayda Afshari Kharaghani
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Naser Harzandi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Babak Khorsand
- Gastroenterology and Liver Disease Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Rajabnia
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Azin Afshari Kharaghani
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Hamidreza Houri
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Shahid Arabi Ave., Yemen St, Velenjak, Tehran, Iran.
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Li J, Frenette C, Loo VG. Diagnostic yield of serial SARS-CoV-2 testing in hospitalized patients. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:181-185. [PMID: 36337610 PMCID: PMC9629723 DOI: 10.3138/jammi-2022-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The detection rate of SARS-CoV-2 by polymerase chain reaction (PCR) varies depending on the time since exposure and is highest around the time of symptom onset. It is conceivable that patients who are incubating SARS-CoV-2 may screen negative at admission and develop transmissible but undetected asymptomatic or pre-symptomatic disease while in hospital. The incidence of COVID-19 in Montreal, Canada started to increase in December 2020. In anticipation of a much larger rise after the holiday period, the McGill University Health Centre implemented serial SARS-CoV-2 testing for all admitted patients on day 5 and 10 after admission, to evaluate the clinical utility of serial SARS-CoV-2 testing among patients who test negative on admission screening. METHODS We retrospectively analyzed the diagnostic yield of SARS-CoV-2 serial testing for patients admitted between January 4, 2021 and April 30, 2021. RESULTS A total of 1,505 patients underwent serial testing at day 5 and 841 patients underwent serial testing at day 10. Only 10 patients were positive on serial testing at day 5 and only 12 patients were positive on serial testing at day 10, for a yield at day 5 and day 10 of 0.7% and 1.4%, respectively. CONCLUSIONS The yield of serial SARS-CoV-2 testing was 0.7% at day 5 and 1.4% at day 10. We found that the yield of serial testing was higher when the community incidence was higher and could be considered in this situation. Policies which target repeat testing towards symptomatic or exposed individuals appear to be effective in identifying those with a positive test while admitted but testing negative upon admission.
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Affiliation(s)
- Jeremy Li
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Charles Frenette
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Vivian G Loo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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Goren I, Brom A, Yanai H, Dagan A, Segal G, Israel A. Risk of bacteremia in hospitalised patients with inflammatory bowel disease: a 9-year cohort study. United European Gastroenterol J 2019; 8:195-203. [PMID: 32213075 DOI: 10.1177/2050640619874524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease might be at increased risk of invasive bacterial infections. OBJECTIVES The objective of this study was to identify the rate of bacteremia in hospitalised patients with inflammatory bowel disease and risk factors. METHODS An observational cohort of hospitalised patients with inflammatory bowel disease, aged 16-80 years, from 2008 to 2017 in a large tertiary hospital. Patients with Charlson comorbidity index of 2 or greater were excluded. Patients with one or more positive blood culture were reviewed. Logistic regression was used to evaluate risk factors for bacteremia. RESULTS Of 5522 admitted patients, only 1.3% had bacteremia (73/5522) (39, Crohn's disease; 25, ulcerative colitis; nine, unclassified inflammatory bowel disease). The most common pathogen was Escherichia coli (19/73 patients). The mortality rate at 30 days of patients with bacteremia was 13.7% (10/73). Longer hospitalisations (mean length of stay (21.6 ± 31.0 vs. 6.4 ± 16.0 days; P < 0.0001) and older age (mean age 47.5 ± 18.0 vs. 40.2 ± 15.4 years, P < 0.0001)) were associated with an increased risk of bacteremia. In multivariate analysis, treatment with either anti-tumour necrosis factor α, purine analogues, steroids or amino salicylates was not associated with an increased risk of bacteremia. Risk was greatest among patients aged 65 years or older (relative risk 2.84, 95% confidence interval 1.6-4.8; P = 0.0001) relative to those under 65 years. CONCLUSION Age over 65 years, but not inflammatory bowel disease-related medications, is associated with an increased risk of bacteremia in hospitalised patients with inflammatory bowel disease.
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Affiliation(s)
- Idan Goren
- Division of Gastroenterology, Rabin Medical Center * , Petah Tikva, Israel
| | - Adi Brom
- Internal Medicine T, Chaim Sheba Medical Center * , Tel-Hashomer, Ramat-Gan, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center * , Petah Tikva, Israel
| | - Amir Dagan
- Rheumatology Unit, Assuta Medical Center, Ashdod, Israel
| | - Gad Segal
- Internal Medicine T, Chaim Sheba Medical Center * , Tel-Hashomer, Ramat-Gan, Israel
| | - Ariel Israel
- Clalit Jerusalem Research Center, Clalit Health Services, Jerusalem, Israel
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Reuken PA, Kruis W, Maaser C, Teich N, Büning J, Preiß JC, Schmelz R, Bruns T, Fichtner-Feigl S, Stallmach A. Microbial Spectrum of Intra-Abdominal Abscesses in Perforating Crohn's Disease: Results from a Prospective German Registry. J Crohns Colitis 2018; 12:695-701. [PMID: 29415186 DOI: 10.1093/ecco-jcc/jjy017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/02/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intra-abdominal abscesses [IAAs] are common life-threatening complications in patients with Crohn's disease [CD]. In addition to interventional drainage and surgical therapy, empirical antibiotic therapy represents a cornerstone of treatment, but contemporary data on microbial spectra and antimicrobial resistance are scarce. METHODS We recruited 105 patients with CD and IAAs from nine German centres for a prospective registry in order to characterize the microbiological spectrum, resistance profiles, antibiotic therapy and outcome. RESULTS In 92 of 105 patients, microbial investigations of abscess material revealed pathogenic microorganisms. A total of 174 pathogens were isolated, with a median of 2 pathogens per culture [range: 1-6]. Most frequently isolated pathogens were E. coli [45 patients], Streptococcus spp. [28 patients], Enterococci [27 patients], Candida [13 patients] and anaerobes [12 patients]. Resistance to third-generation cephalosporins, penicillins with beta-lactamase inhibitors and quinolones were observed in 51, 36 and 35 patients, respectively. Seven patients had multiple-drug-resistant bacteria. Thirty patients received inadequate empirical treatment, and this was more frequent in patients receiving steroids or immunosuppression [37%] than in patients without immunosuppression [10%: p = 0.001] and was associated with a longer hospital stay [21 days vs 13 days, p = 0.003]. CONCLUSION Based on antimicrobial resistance profiles, we herein report a high rate of inadequate empirical first-line therapy for IAAs in CD, especially in patients receiving immunosuppression, and this is associated with prolonged hospitalization.
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Affiliation(s)
- P A Reuken
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - W Kruis
- Klinik für Gastroenterologie, Pulmonologie und Allgemeine Innere Medizin, Evangelisches Krankenhaus Köln Kalk, University of Cologne, Cologne, Germany
| | - C Maaser
- Ambulanzzentrum Gastroenterologie, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - N Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany.,Medical Faculty, Friedrich-Schiller University, Jena, Germany
| | - J Büning
- Department of Internal Medicine I [Gastroenterology], University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - J C Preiß
- Department of Medicine I [Gastroenterology, Infectious Diseases, Rheumatology], Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - R Schmelz
- Department of Internal Medicine 1, University Hospital Carl Gustav Carus, Dresden, Germany
| | - T Bruns
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
| | - S Fichtner-Feigl
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - A Stallmach
- Department of Internal Medicine IV [Gastroenterology, Hepatology, and Infectious Diseases], Jena University Hospital, Jena, Germany
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Gut colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae may increase disease activity in biologic-naive outpatients with ulcerative colitis: an interim analysis. Eur J Gastroenterol Hepatol 2018; 30:92-100. [PMID: 29076938 DOI: 10.1097/meg.0000000000000989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Certain Enterobacteriaceae strains have been associated with the development of ulcerative colitis (UC). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are the most commonly found multi-drug-resistant (MDR) bacteria colonizing the gut in UC patients and might trigger a more severe disease activity in UC patients. OBJECTIVE The aim of this study was to evaluate whether disease activity is higher in UC patients with gut colonization with ESBL-producing Enterobacteriaceae. MATERIALS AND METHODS A cross-sectional, pilot study was carried out in a tertiary medical center in Latvia. Demographic data were collected; UC disease activity and extent were evaluated according to the full Mayo score, Montreal classification, and adapted Truelove and Witt's index. Rectal swabs with fecal biomaterial were collected, ESBL-producing Enterobacteriaceae were isolated, and bacterial plasmid genes responsible for ESBL production, blaCTX-M, blaTEM, and blaSHV, were detected. UC disease activity was compared in patients with and without gut colonization with ESBL-producing Enterobacteriaceae. RESULTS A total of 65 patients with UC were included in the initial analysis. Gut colonization with ESBL-producing Enterobacteriaceae was found in seven (11%) patients - mostly Escherichia coli [5 (71%)] containing the blaCTX-M bacterial plasmid gene. Patients with gut colonization with ESBL-producing Enterobacteriaceae had more severe disease compared with patients without gut colonization according to the full Mayo score (5.86 vs. 3.40; P=0.015), Montreal classification (moderate disease vs. clinical remission; P=0.031), and adapted Truelove and Witt's index (moderate disease vs. mild disease; P=0.008). CONCLUSION Gut colonization with ESBL-producing Enterobacteriaceae may increase UC disease activity. Further research is needed to analyze the possible confounding factors that could contribute toward this outcome.
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Blais M, Fernet M, Proulx-Boucher K, Lebouché B, Rodrigue C, Lapointe N, Otis J, Samson J. Barriers to health-care and psychological distress among mothers living with HIV in Quebec (Canada). AIDS Care 2015; 27:731-8. [PMID: 25587793 DOI: 10.1080/09540121.2014.997661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Health-care providers play a major role in providing good quality care and in preventing psychological distress among mothers living with HIV (MLHIV). The objectives of this study are to explore the impact of health-care services and satisfaction with care providers on psychological distress in MLHIV. One hundred MLHIV were recruited from community and clinical settings in the province of Quebec (Canada). Prevalence estimation of clinical psychological distress and univariate and multivariable logistic regression models were performed to predict clinical psychological distress. Forty-five percent of the participants reported clinical psychological distress. In the multivariable regression, the following variables were significantly associated with psychological distress while controlling for sociodemographic variables: resilience, quality of communication with the care providers, resources, and HIV disclosure concerns. The multivariate results support the key role of personal, structural, and medical resources in understanding psychological distress among MLHIV. Interventions that can support the psychological health of MLHIV are discussed.
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Affiliation(s)
- Martin Blais
- a Department of Sexology , Université du Québec à Montréal , Montreal , QC , Canada
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