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Logan LK, Gandra S, Mandal S, Klein EY, Levinson J, Weinstein RA, Laxminarayan R. Multidrug- and Carbapenem-Resistant Pseudomonas aeruginosa in Children, United States, 1999-2012. J Pediatric Infect Dis Soc 2017; 6:352-359. [PMID: 27856730 PMCID: PMC5907855 DOI: 10.1093/jpids/piw064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a common cause of healthcare-associated infection. Multidrug-resistant (MDR) (>3 classes) and carbapenem-resistant (CR) P aeruginosa are significant threats globally. We used a large reference-laboratory database to study the epidemiology of P aeruginosa in children in the United States. METHODS Antimicrobial susceptibility data from the Surveillance Network were used to phenotypically identify MDR and CR P aeruginosa isolates in children aged 1 to 17 years between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of MDR and CR P aeruginosa. Isolates from infants (<1 year old) and patients with cystic fibrosis were excluded. RESULTS Among the isolates tested, the crude proportion of MDR P aeruginosa increased from 15.4% in 1999 to 26% in 2012, and the proportion of CR P aeruginosa increased from 9.4% in 1999 to 20% in 2012. The proportion of both MDR and CR P aeruginosa increased each year by 4% (odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03-1.04] and 1.04 [95% CI, 1.04-1.05], respectively). In multivariable analysis, both MDR and CR P aeruginosa were more common in the intensive care setting, among children aged 13 to 17 years, in respiratory specimens, and in the West North Central region. In addition, resistance to other antibiotic classes (aminoglycosides, fluoroquinolones, cephalosporins, and piperacillin-tazobactam) often used to treat P aeruginosa increased. CONCLUSIONS Rates of MDR and CR P aeruginosa infection in children are rising nationally. Aggressive prevention strategies, including instituting antimicrobial stewardship programs in pediatric settings, are essential for combating antimicrobial resistance.
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Affiliation(s)
- Latania K Logan
- Departments of Pediatrics
- Section of Pediatric Infectious Diseases, Rush Medical College, Rush University Medical Center, Chicago, Illinois
- Cook County Health and Hospitals System, Chicago, Illinois
| | - Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | | | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jordan Levinson
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Robert A Weinstein
- Internal Medicine, Division of Infectious Diseases
- Cook County Health and Hospitals System, Chicago, Illinois
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Public Health Foundation of India, New Delhi
- Princeton University, Princeton, New Jersey
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Oliveira VDC, Rubio FG, Almeida MTG, Nogueira MCL, Pignatari ACC. Trends of 9,416 multidrug-resistant Gram-negative bacteria. Rev Assoc Med Bras (1992) 2015; 61:244-9. [PMID: 26248247 DOI: 10.1590/1806-9282.61.03.244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/17/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE a resistance of hospital-acquired bacteria to multiple antibiotics is a major concern worldwide. The objective of this study was to investigate multidrugresistant (MDR) bacteria, clinical specimens, origin of specimen and trends, and correlate these with bacterial sensitivity and consumption of antimicrobials. METHODS 9,416 bacteria of nosocomial origin were evaluated in a tertiary hospital, from 1999 to 2008. MDR was defined for Gram-negative bacteria (GNB) as resistance to two or more classes/groups of antibiotics. RESULTS GNB MDR increased by 3.7 times over the study period (p<0.001). Acinetobacter baumannii was the most prevalent (36.2%). Over the study period, there were significant 4.8-fold and 14.6-fold increases for A. baumannii and K. pneumoniae (p<0.001), respectively. Sixty-seven percent of isolates of MDR GNB were isolated in intensive care units. The resistance of A. baumannii to carbapenems increased from 7.4 to 57.5% during the study period and concomitant with an increased consumption. CONCLUSION that decade showed prevalence of GNB and a gradual increase in MDR GNB. There was an increase in carbapenem resistance of 50.1% during the study.
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Affiliation(s)
| | - Fernando Góngora Rubio
- Department of Infectious, Parasitary and Dermatology Diseases, Famerp, São José do Rio Preto, SP, Brazil
| | | | | | - Antonio Carlos Campos Pignatari
- Special Clinical Microbiology Laboratory, Infectious Diseases Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Inacio HSM, Bomfim MRQ, França RO, Farias LM, Carvalho MAR, Serufo JC, Santos SG. Phenotypic and genotypic diversity of multidrug-resistant Pseudomonas aeruginosa Isolates from bloodstream infections recovered in the Hospitals of Belo Horizonte, Brazil. Chemotherapy 2014; 60:54-62. [PMID: 25402327 DOI: 10.1159/000365726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa commonly causes nosocomial bloodstream infections and the emergence of a variety of β-lactamases (BLs) is worrying. In 5 hospitals in Belo Horizonte, Brazil, the presence of phenotypes encoding BL genes was established and the genetic diversity of the P. aeruginosa strains recovered from bloodstream infections was analyzed. MATERIALS AND METHODS The isolates were investigated using a disk diffusion (DD) method and the Etest, for encoding metallo-β-lactamases (MBLs), oxacillinases and cephalosporinases. Genes and genetic diversity were evaluated by random amplified polymorphic DNA (RAPD) genotyping and enterobacterial repetitive intergenic consensus (ERIC)-PCR. RESULTS Twelve strains (30%) were positive for MBLs by Etest and DD, 15 were cephalosporinase-positive and 87.5% were positive for blaSPM-1 and blaVIM-1. Twenty-three strains (57.5%) were grouped into profile A, 32.5% into profile B and 10% into profile C by RAPD genotyping. ERIC-PCR revealed a varying degree of similarity between strains, ranging from 45 to 100%. CONCLUSIONS The results suggest distinct clonal populations in the 5 hospitals studied, indicating a potentially problematic epidemiological situation in Belo Horizonte, Brazil.
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Affiliation(s)
- Hanoch S M Inacio
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Liu WL, Chang PC, Chen YY, Lai CC. Impact of fluoroquinolone consumption on resistance of healthcare-associated Pseudomonas aeruginosa. J Infect 2011; 64:335-7. [PMID: 22186016 DOI: 10.1016/j.jinf.2011.11.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 11/23/2011] [Accepted: 11/25/2011] [Indexed: 11/15/2022]
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Neves MTD, Lorenzo MEPD, Almeida RAMB, Fortaleza CMCB. Antimicrobial use and incidence of multidrug-resistant Pseudomonas aeruginosa in a teaching hospital: an ecological approach. Rev Soc Bras Med Trop 2011; 43:629-32. [PMID: 21181012 DOI: 10.1590/s0037-86822010000600005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 09/15/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Multidrug-resistant Pseudomonas aeruginosa is a major threat in healthcare settings. The use of antimicrobials can influence the incidence of resistant strains by direct and indirect mechanisms. The latter can be addressed by ecological studies. METHODS Our group attempted to analyze the relation between the use of antipseudomonal drugs and the incidence of MDR-PA among 18 units from a 400-bed teaching hospital. The study had a retrospective, ecological design, comprising data from 2004 and 2005. Data on the use of four antimicrobials (amikacin, ciprofloxacin, ceftazidime and imipenem) were tested for correlation with the incidence of MDR-PA (defined as isolates resistant to the four antimicrobials of interest) in clinical cultures. Univariate and multivariate linear regression analyses were performed. RESULTS Significant correlations were determined between use and resistance for all antimicrobials in the univariate analysis: amikacin (standardized correlation coefficient = 0.73, p = 0.001); ciprofloxacin (0.71, p = 0.001); ceftazidime (0.61, p = 0.007) and imipenem (0.87, p < 0.001). In multivariate analysis, only imipenem (0.67, p = 0.01) was independently related to the incidence of multidrug-resistant strains. CONCLUSIONS These findings share similarities with those reported in individual-based observational studies, with possible implications for infection control.
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Affiliation(s)
- Mariana Tresoldi das Neves
- Department of Tropical Diseases, Botucatu School of Medicine, São Paulo State University, Botucatu, SP, Brazil
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Scheffer MC, Bazzo ML, Steindel M, Darini AL, Clímaco E, Dalla-Costa LM. Intrahospital spread of carbapenem-resistant Pseudomonas aeruginosa in a University Hospital in Florianópolis, Santa Catarina, Brazil. Rev Soc Bras Med Trop 2010; 43:367-71. [DOI: 10.1590/s0037-86822010000400006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/12/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been isolated with increasing frequency in Brazilian hospitals. Since June 2003, its detection in a teaching hospital in the city of Florianópolis, Brazil, has increased. This study aimed to investigate the minimal inhibitory concentration (MIC), presence of Metallo-β-lactamase (MβL) and a possible clonal relationship among the isolates. METHODS: The study included 29 CRPA and seven isolates with reduced susceptibility. The MIC was determined by agar-dilution. Detection of MβL was performed by Double Disk Sinergism (DDS) and Combined Disk (CD). The MβL gene was verified by PCR and nucleotide sequence analysis. Epidemiological typing was performed by pulsed-field gel electrophoresis. RESULTS: Among the 29 carbapenem-resistant isolates, polymyxin B presented 100% susceptibility and piperacillin/tazobactam 96.7%. Seventeen (62%) strains were verified as clonal (A clone) and among these, six isolates indicated phenotypically positive tests for MβL and harbored the blaSPM-1 gene. The first CRPA isolates were unrelated to clone A, harbored blaIMP-16 and were phenotypically positive only by CD. CONCLUSIONS: The spread of a high-level of resistance clone suggests cross transmission as an important dissemination mechanism and has contributed to the increased rate of resistance to carbapenems. This study emphasizes the need for continuous surveillance and improved strategies.
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Livermore DM, Hope R, Brick G, Lillie M, Reynolds R. Non-susceptibility trends among Pseudomonas aeruginosa and other non-fermentative Gram-negative bacteria from bacteraemias in the UK and Ireland, 2001-06. J Antimicrob Chemother 2008; 62 Suppl 2:ii55-63. [PMID: 18819980 DOI: 10.1093/jac/dkn352] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pseudomonas and Acinetobacter spp. are important opportunists, notorious for resistance. Pseudomonas spp. are collected in the British Society for Antimicrobial Chemotherapy (BSAC) bacteraemia surveillance, with Acinetobacter spp. and Stenotrophomonas maltophilia well represented in the 'other Gram-negatives' group. METHODS Data for collected isolates were reviewed together with LabBase bacteraemia reports to the Health Protection Agency (HPA). Isolates with unusual resistances were subjected to molecular investigation. RESULTS From 2001 to 2006, the BSAC surveillance collected 1226 Pseudomonas aeruginosa, 240 Acinetobacter spp.-125 of them Acinetobacter calcoaceticus/baumannii (Acb) complex-and 165 S. maltophilia. Among P. aeruginosa, non-susceptibility rates to beta-lactams and gentamicin fluctuated, without trend, below 10%; those to ciprofloxacin ranged from 16% to 22%. One P. aeruginosa isolate from 2001 had VIM-2 metallo-beta-lactamase. For Acb, the BSAC data indicated frequent non-susceptibility, except to imipenem, where only five non-susceptible isolates were collected, all after 2003, four of them belonging to the OXA-23 clone 1 lineage which is prevalent in Southeast England. Reports to the HPA indicated rising imipenem non-susceptibility in Acb (P < 0.0001). Co-trimoxazole retained near-universal activity against S. maltophilia. Among new antibiotics, doripenem MICs were </=4 mg/L for most imipenem-resistant P. aeruginosa but >/=16 mg/L for Acb OXA-23 clone 1. Ceftobiprole had higher MICs than ceftazidime for P. aeruginosa, but 81% of the isolates were inhibited at </=4 mg/L. Tigecycline had activity against most Acb, including OXA-23 clone 1, and also against S. maltophilia. CONCLUSIONS Most P. aeruginosa from bacteraemias in the UK and Ireland remain relatively susceptible by international standards; in contrast, multiresistance is widespread in Acb, with imipenem non-susceptibility emerging.
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Affiliation(s)
- David M Livermore
- Health Protection Agency Centre for Infections, 61 C olindale Avenue, London NW9 5EQ, UK.
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Farra A, Islam S, Strålfors A, Sörberg M, Wretlind B. Role of outer membrane protein OprD and penicillin-binding proteins in resistance of Pseudomonas aeruginosa to imipenem and meropenem. Int J Antimicrob Agents 2008; 31:427-33. [PMID: 18375104 DOI: 10.1016/j.ijantimicag.2007.12.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 12/13/2007] [Accepted: 12/13/2007] [Indexed: 10/22/2022]
Abstract
The main mechanism of imipenem resistance in Pseudomonas aeruginosa is via downregulation of the gene for OprD porin. In a previous study, it was shown that the level of resistance did not parallel with the degree of downregulation of the porin gene, thus arguing for the existence of other resistance mechanisms. Penicillin-binding protein (PBP) 2 and PBP3 are involved in carbapenem resistance in Escherichia coli. The genes for PBPs were sequenced in three imipenem-resistant clinical strains and these strains were conjugated with two susceptible P. aeruginosa PA0 strains, selecting for auxotrophic markers. In all the clinical and resistant isolates there was no obvious elevation of AmpC cephalosporinase. The active sites of PBP1b (ponB), PBP2 (pbpA), PBP3 (pbpB) and PBP6 (dacC) had no mutations in any of the examined strains. Production of oprD mRNA was significantly lower in clinical strains and transconjugants after selection for the proB marker (PA4565 at 5113kb). The clinical strains had alterations in OprD that were not found in transconjugants. Our findings suggest that PBPs do not play a role in imipenem resistance in the clinical strains examined here, but that a regulatory gene for oprD contributing to carbapenem resistance is located close to the proB gene.
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Affiliation(s)
- Anna Farra
- Division of Internal Medicine, Department of Infectious Diseases, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
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Mendes RE, Castanheira M, Toleman MA, Sader HS, Jones RN, Walsh TR. Characterization of an integron carrying blaIMP-1 and a new aminoglycoside resistance gene, aac(6')-31, and its dissemination among genetically unrelated clinical isolates in a Brazilian hospital. Antimicrob Agents Chemother 2007; 51:2611-4. [PMID: 17470660 PMCID: PMC1913225 DOI: 10.1128/aac.00838-06] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Seven bla(IMP-1)-harboring Acinetobacter sp. isolates and one Pseudomonas putida clinical isolate were recovered from hospitalized patients. All isolates possessed a class 1 integron, named In86, carrying the same cassette array [bla(IMP1), aac(6')-31, and aadA1], which was plasmid located in five of the isolates. This report describes the ability of nonfermentative nosocomial pathogens to acquire and disseminate antimicrobial resistance determinants.
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Affiliation(s)
- Rodrigo E Mendes
- Laboratório Especial de Microbiologia Clínica and Laboratório ALERTA, Division of Infectious Disease, Federal University of São Paulo, São Paulo, Brazil.
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