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Nartey YA, Donkor AB, Siaw ADJ, Ekor OE, Jimah BB. Carbapenem-Resistant Acinetobacter baumannii Bloodstream Infection in a Ghanaian Patient with Unilateral Diaphragmatic Eventration and HIV Type 1 Infection. Case Rep Infect Dis 2023; 2023:9930291. [PMID: 37867582 PMCID: PMC10586909 DOI: 10.1155/2023/9930291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii infection is a critically prioritized pathogen by the World Health Organization and a cause for growing concern due to increased mortality among hospitalised patients. Phrenic nerve palsy is a rare complication of herpes zoster infection of the C3, C4, and C5 nerve roots. We present a case of bloodstream carbapenem-resistant A. baumannii infection in a Ghanaian patient with HIV type 1 infection and multiple risk factors, including unilateral diaphragmatic eventration with compression atelectasis likely secondary to phrenic nerve palsy due to herpes zoster infection, consequently leading to recurrent hospital and ICU admission. In this case, we emphasize the need for clinicians in LMICs to be aware of CRAB, in order to advocate for the availability of evidence-based medicines in resource-limited settings for appropriate treatment. In addition, we illustrate the importance of a high index of suspicion for infection with carbapenem-resistant organisms such as A. baumannii and highlight a rare and severe complication of herpes zoster infection in the form of phrenic nerve palsy and consequent diaphragmatic eventration.
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Affiliation(s)
- Yvonne Ayerki Nartey
- Department of Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Oluwayemisi Esther Ekor
- Department of Anaesthesia and Pain Management, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Bashiru Babatunde Jimah
- Department of Medical Imaging, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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2
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Phuadraksa T, Wichit S, Songtawee N, Tantimavanich S, Isarankura-Na-Ayudhya C, Yainoy S. Emergence of plasmid-mediated colistin resistance mcr-3.5 gene in Citrobacter amalonaticus and Citrobacter sedlakii isolated from healthy individual in Thailand. Front Cell Infect Microbiol 2023; 12:1067572. [PMID: 36683683 PMCID: PMC9846275 DOI: 10.3389/fcimb.2022.1067572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Citrobacter spp. are Gram-negative bacteria commonly found in environments and intestinal tracts of humans and animals. They are generally susceptible to third-generation cephalosporins, carbapenems and colistin. However, several antibiotic resistant genes have been increasingly reported in Citrobacter spp., which leads to the postulation that Citrobacter spp. could potentially be a reservoir for spreading of antimicrobial resistant genes. In this study, we characterized two colistin-resistant Citrobacter spp. isolated from the feces of a healthy individual in Thailand. Based on MALDI-TOF and ribosomal multilocus sequence typing, both strains were identified as Citrobacter sedlakii and Citrobacter amalonaticus. Genomic analysis and S1-nuclease pulsed field gel electrophoresis/DNA hybridization revealed that Citrobacter sedlakii and Citrobacter amalonaticus harbored mcr-3.5 gene on pSY_CS01 and pSY_CA01 plasmids, respectively. Both plasmids belonged to IncFII(pCoo) replicon type, contained the same genetic context (Tn3-IS1-ΔTnAs2-mcr-3.5-dgkA-IS91) and exhibited high transferring frequencies ranging from 1.03×10-4 - 4.6×10-4 CFU/recipient cell Escherichia coli J53. Colistin-MICs of transconjugants increased ≥ 16-fold suggesting that mcr-3.5 on these plasmids can be expressed in other species. However, beside mcr, other major antimicrobial resistant determinants in multidrug resistant Enterobacterales were not found in these two isolates. These findings indicate that mcr gene continued to evolve in the absence of antibiotics selective pressure. Our results also support the hypothesis that Citrobacter could be a reservoir for spreading of antimicrobial resistant genes. To the best of our knowledge, this is the first report that discovered human-derived Citrobacter spp. that harbored mcr but no other major antimicrobial resistant determinants. Also, this is the first report that described the presence of mcr gene in C. sedlakii and mcr-3 in C. amalonaticus.
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Affiliation(s)
- Thanawat Phuadraksa
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Sineewanlaya Wichit
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Napat Songtawee
- Department of Clinical Chemistry, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Srisurang Tantimavanich
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | | | - Sakda Yainoy
- Department of Clinical Microbiology and Applied Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
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3
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Chang CY, Devi Nath N, Lam K, Zaid M. Impact of an Antimicrobial Stewardship Intervention on the Appropriateness of Carbapenem Use at a Tertiary Hospital in Malaysia. Cureus 2022; 14:e31660. [DOI: 10.7759/cureus.31660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 11/21/2022] Open
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4
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Co-occurrence of mcr-2 and mcr-3 genes on chromosome of multidrug-resistant Escherichia coli isolated from healthy individuals in Thailand. Int J Antimicrob Agents 2022; 60:106662. [PMID: 36007781 DOI: 10.1016/j.ijantimicag.2022.106662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/08/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
The aim of this study was to characterize three strains of colistin-resistant E. coli isolated from feces samples of healthy individuals in Thailand. The three strains, namely, SY_EC03, SY_EC07, and SY_EC10 were identified as ST165, ST1602, and ST34. All isolates exhibited multidrug-resistant phenotype, which is mediated by accumulation of various antimicrobial resistance genes. SY_EC03 contained mcr-1.1 while SY_EC07 co-harbored mcr-2.3 and mcr-3.4, and SY_EC10 co-harbored mcr-1.1 and mcr-3.5. Genomic analysis revealed that mcr-1.1 of the two strains were located on IncI2 plasmid with genetic environment of ISApl1-mcr-1.1-PAP2, which is a composite transposon Tn6330 with single-ended. Regarding mcr-2.3, the gene was identified within the composite transposon of ISKpn71-mcr-2.3-ISSpu2-ISKpn71, which was located on a novel mobile genetic element (MGE) that was integrated into the chromosome by phage integrase. For mcr-3.4 and mcr-3.5, the genes were confirmed to locate on the chromosome by S1-PFGE/DNA hybridization. Hence, to the best of our knowledge, this is the first report on co-occurrence of mcr-2 and mcr-3 on chromosome of E. coli. More interestingly, mcr-2 was found to locate on a novel MGE, which had never been described. In addition, we also report the co-occurrence of plasmidic mcr-1.1 and chromosomal mcr-3.5 which is extremely rare. Since all these bacteria were isolated from healthy individuals and the identified STs have been found in a variety of origins, all these clones may serve as reservoir for horizontal and vertical transmission of mcr genes. Strategic action plans to control and prevent the spread of mcr genes are urgently needed.
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5
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Kong ZX, N. Karunakaran R, Abdul Jabar K, Ponnampalavanar S, Chong CW, Teh CSJ. A retrospective study on molecular epidemiology trends of carbapenem resistant Enterobacteriaceae in a teaching hospital in Malaysia. PeerJ 2022; 10:e12830. [PMID: 35223201 PMCID: PMC8877335 DOI: 10.7717/peerj.12830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 01/04/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Carbapenem resistant Enterobacteriaceae (CRE) has rapidly disseminated worldwide and has become a global threat to the healthcare system due to its resistance towards "last line" antibiotics. This study aimed to investigate the prevalence of CRE and the resistance mechanism as well as the risk factors associated with in-hospital mortality. METHODS A total of 168 CRE strains isolated from a tertiary teaching hospital from 2014-2015 were included in this study. The presence of carbapenemase genes and minimum inhibitory concentration of imipenem, meropenem and colistin were investigated. All carbapenem-resistant Klebsiella pneumoniae (K. pneumoniae) strains were characterised by PFGE. The risk factors of patients infected by CRE associated with in-hospital mortality were determined statistically. RESULTS The predominant CRE species isolated was K. pneumoniae. The carbapenemases detected were blaOXA-48, blaOXA-232, blaVIM and blaNDM of which blaOXA-48 was the predominant carbapenemase detected among 168 CRE strains. A total of 40 CRE strains harboured two different carbapenemase genes. A total of seven clusters and 48 pulsotypes were identified among 140 CRKp strains. A predominant pulsotype responsible for the transmission from 2014 to 2015 was identified. Univariate statistical analysis identified that the period between CRE isolation and start of appropriate therapy of more than 3 days was statistically associated with in-hospital mortality.
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Affiliation(s)
- Zhi Xian Kong
- Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Rina N. Karunakaran
- Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Sasheela Ponnampalavanar
- Department of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Zou D, Yao G, Shen C, Ji J, Ying C, Wang P, Liu Z, Wang J, Jin Y, Xiao Y. The Monte Carlo Simulation of Three Antimicrobials for Empiric Treatment of Adult Bloodstream Infections With Carbapenem-Resistant Enterobacterales in China. Front Microbiol 2021; 12:738812. [PMID: 34899628 PMCID: PMC8656417 DOI: 10.3389/fmicb.2021.738812] [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: 07/09/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction: The aim of this study was to predict and evaluate three antimicrobials for treatment of adult bloodstream infections (BSI) with carbapenem-resistant Enterobacterales (CRE) in China, so as to optimize the clinical dosing regimen further. Methods: Antimicrobial susceptibility data of blood isolates were obtained from the Blood Bacterial Resistance Investigation Collaborative Systems in China. Monte Carlo simulation was conducted to estimate the probability target attainment (PTA) and cumulative fraction of response (CFR) of tigecycline, polymyxin B, and ceftazidime/avibactam against CRE. Results: For the results of PTAs, tigecycline following administration of 50 mg every 12 h, 75 mg every 12 h, and 100 mg every 12 h achieved > 90% PTAs when minimum inhibitory concentration (MIC) was 0.25, 0.5, and 0.5 μg/mL, respectively; polymyxin B following administration of all tested regimens achieved > 90% PTAs when MIC was 1 μg/mL with CRE; ceftazidime/avibactam following administration of 1.25 g every 8 h, 2.5 g every 8 h achieved > 90% PTAs when MIC was 4 μg/mL, 8 μg/mL with CRE, respectively. As for CFR values of three antimicrobials, ceftazidime/avibactam achieved the lowest CFR values. The highest CFR value of ceftazidime/avibactam was 77.42%. For tigecycline and ceftazidime/avibactam, with simulated regimens daily dosing increase, the CFR values were both increased; the highest CFR of tigecycline values was 91.88%. For polymyxin B, the most aggressive dosage of 1.5 mg/kg every 12 h could provide the highest CFR values (82.69%) against CRE. Conclusion: This study suggested that measurement of MICs and individualized therapy should be considered together to achieve the optimal drug exposure. In particular, pharmacokinetic and pharmacodynamic modeling based on local antimicrobial resistance data can provide valuable guidance for clinicians for the administration of empirical antibiotic treatments for BSIs.
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Affiliation(s)
- Dongna Zou
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guangyue Yao
- Cancer Therapy and Research Center, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Chengwu Shen
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinru Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chaoqun Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Peipei Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiying Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yan Jin
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,National Clinical Research Center for Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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7
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Kirsch N, Ha J, Kang HT, Frisch T, Yoo JW, Grossman C, Oroomchi N, Shigemitsu H, Cross CL, Kioka MJ. Factors associated with the appropriate use of ultra-broad spectrum antibiotics, meropenem, for suspected healthcare-associated pneumonia. Medicine (Baltimore) 2021; 100:e27488. [PMID: 34622881 PMCID: PMC8500636 DOI: 10.1097/md.0000000000027488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/14/2021] [Indexed: 01/05/2023] Open
Abstract
Pneumonia is a common disease-causing hospitalization. When a healthcare-associated infection is suspected, antibiotics that provide coverage for multi-drug resistant (MDR) or extended-spectrum beta-lactamase (ESBL) bacteria are frequently prescribed. Limited data is available for guidance on using meropenem as a first-line empiric antimicrobial in hospitalized patients with risk factors for MDR/ESBL bacterial infections.This was a single-center, retrospective study designed and conducted to identify factors associated with positive cultures for MDR/ESBL pathogens in hospitalized patients with suspected healthcare-associated pneumonia.Of the 246 patients, 103 patients (41%) received meropenem. Among patients prescribed meropenem, MDR/ESBL pathogens were detected in only 20 patients (13%). Patients admitted from a skilled nursing facility/long-term acute care (SNF/LTAC) or with a history of a positive culture for MDR/ESBL pathogens were significantly associated with positive cultures of MDR/ESBL pathogens during the hospitalization (odds ratio [95% confidence intervals], 31.40 [5.20-189.6] in SNF/LTAC and 18.50 [2.98-115.1] in history of culture-positive MDR/ESBL pathogen). There was no significant difference in mortality between the 3 antibiotic groups.Admission from a SNF/LTAC or having a history of cultures positive for MDR/ESBL pathogens were significantly associated with a positive culture for MDR/ESBL pathogens during the subsequent admission. We did not detect significant association between meropenem use as a first-line drug and morbidity and mortality for patients admitted to the hospital with suspected healthcare-associated pneumonia, and further prospective studies with larger sample size are needed to confirm our findings.
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Affiliation(s)
- Nathan Kirsch
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Tina Frisch
- Department of Pharmacy University Medical Center, Las Vegas, NV
| | - Ji Won Yoo
- Division of Geriatrics, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Craig Grossman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Neema Oroomchi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical Dental University, Tokyo, Japan
| | - Chad L. Cross
- Department of Environmental and Occupational Health, University of Nevada, Las Vegas, NV
| | - Mutsumi John Kioka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Nevada, Las Vegas, NV
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8
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Nguyen M, Joshi SG. Carbapenem resistance in Acinetobacter baumannii, and their importance in hospital-acquired infections: a scientific review. J Appl Microbiol 2021; 131:2715-2738. [PMID: 33971055 DOI: 10.1111/jam.15130] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/30/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
Carbapenem is an important therapy for serious hospital-acquired infections and for the care of patients affected by multidrug-resistant organisms, specifically Acinetobacter baumannii; however, with the global increase of carbapenem-resistant A. baumannii, this pathogen has significantly threatened public health. Thus, there is a pressing need to better understand this pathogen in order to develop novel treatments and control strategies for dealing with A. baumannii. In this review, we discuss an overview of carbapenem, including its discovery, development, classification and biological characteristics, and its importance in hospital medicine especially in critical care units. We also describe the peculiarity of bacterial pathogen, A. baumannii, including its commonly reported virulence factors, environmental persistence and carbapenem resistance mechanisms. In closing, we discuss various control strategies for overcoming carbapenem resistance in hospitals and for limiting outbreaks. With the appearance of strains that resist carbapenem, the aim of this review is to highlight the importance of understanding this increasingly problematic healthcare-associated pathogen that creates significant concern in the field of nosocomial infections and overall public health.
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Affiliation(s)
- M Nguyen
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA
| | - S G Joshi
- Center for Surgical Infections, Drexel University School of Biomedical Engineering, Science & Health Systems, Philadelphia, PA, USA.,Institute of Molecular Medicine and Infectious Diseases, Center for Surgical Infections, Drexel University, Philadelphia, PA, USA
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9
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Jin S, Lee JY, Park JY, Jeon MJ. Xpert Carba-R assay for detection of carbapenemase-producing organisms in patients admitted to emergency rooms. Medicine (Baltimore) 2020; 99:e23410. [PMID: 33327265 PMCID: PMC7738031 DOI: 10.1097/md.0000000000023410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Carbapenemase-producing organisms (CPO) have been identified as an urgent healthcare threat. Various methods have been used for the detection of CPO using rectal swabs. Recently, an on-demand polymerase chain reaction (PCR) assay, namely, the Xpert Carba-R assay, that requires less than an hour of turnaround time, had been developed for CPO detection in clinical samples. This study focused on the use of this assay to determine the intestinal colonization rate of CPO in patients admitted to emergency rooms (ERs).A retrospective review of medical records was conducted at a tertiary hospital between July 2017 and June 2018. CPO screening using rectal swabs was performed for patients transferred from other hospitals or for those who tested positive in CPO culture tests in the previous three months. The Xpert Carba-R assay and culture tests were used as the CPO screening methods, and the results of both tests were compared.Medical records of 705 patients admitted to our hospital during the study period were reviewed. Of these, 31 (4.4%) showed positive results for CPO using the Xpert Carba-R assay, and these patients were then transferred from the ERs to isolation rooms. Fifteen of the Xpert Carba-R assay-positive patients were also positive for the culture test; hence, early detection enabled the rapid isolation of CPO-infected patients and prevented the spread of the CPO.The Xpert Carba-R assay is a rapid test to identify and guide infection control programs to contain the spread of the rectal colonization of CPO within a hospital.
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Affiliation(s)
- Sol Jin
- Department of Infectious Disease, Kosin University Gospel Hospital
| | - Jin Young Lee
- Department of Infectious Disease, Kosin University Gospel Hospital
| | - Ji Young Park
- Department of Infectious Disease, Hubhue Hospital, Busan
| | - Min Ji Jeon
- Department of Infectious Disease, Samsung Medical Center, Seoul, Republic of Korea
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10
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[Management of Carbapenem-resistant Enterobacteriaceae (CRE) infection in patients with hematological malignancies: Chinese consensus (2020)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:881-889. [PMID: 33333689 PMCID: PMC7767803 DOI: 10.3760/cma.j.issn.0253-2727.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Indexed: 12/25/2022]
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11
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Zhang S, Yang Z, Sun L, Wang Z, Sun L, Xu J, Zeng L, Sun T. Clinical Observation and Prognostic Analysis of Patients With Klebsiella pneumoniae Bloodstream Infection. Front Cell Infect Microbiol 2020; 10:577244. [PMID: 33240822 PMCID: PMC7680902 DOI: 10.3389/fcimb.2020.577244] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background and purpose The clinical prognosis of Klebsiella pneumoniae(K. pneumoniae) bloodstream infection is poor, and the prevalence of drug-resistant bacteria makes clinical anti-infective treatment more challenging. This retrospective study evaluated the epidemiological characteristics of patients with K. pneumoniae, the risk factors for drug-resistant bacterial infection and death, and analyzed treatment options. Methods Clinical data of 297 patients diagnosed with K. pneumoniae bacteremia between June 2014 and June 2019 were collected. Results Intensive care unit hospitalization history, operation history, recent antibiotic use history, mechanical ventilation, and number of days hospitalized before bloodstream infection were found to be independent risk factors for drug-resistant bacterial infection. The risk of death for carbapenem-resistant K. pneumoniae infection was 2.942 times higher than that for carbapenem-sensitive K. pneumoniae infection. For extensively drug-resistant K. pneumoniae bacteremia patients, the mortality rate of combined anti-infective therapy was lower. Conclusions Clinicians should pay attention to patients with high-risk drug-resistant bacteria infection and administer timely anti-infection treatment. The findings of this study may provide some suggestions for early identification and standardized treatment of patients with K. pneumoniae bacteremia.
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Affiliation(s)
- Shuguang Zhang
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
| | - Ziyue Yang
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
| | - Limin Sun
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
| | - Zhenhua Wang
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
| | - Liutao Sun
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China.,Department of Intensive Care Unit, Lankao People's Hospital, Kaifeng, China
| | - Jinli Xu
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China.,Emergency Department, Traditional Chinese Medicine Hospital of Sui County, Shangqiu, China
| | - Li Zeng
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
| | - Tongwen Sun
- Department of General Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Key Laboratory of Sepsis, Henan Key Laboratory of Critical Care Medicine, Zhengzhou, China
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12
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Dalmolin TV, Carneiro MDS, de Castro LP, Volpato FCZ, Wink PL, de Lima-Morales D, Barth AL. Evaluation of the susceptibility test of polymyxin B using the commercial test Policimbac®. Braz J Microbiol 2020; 51:1135-1137. [PMID: 32198730 DOI: 10.1007/s42770-020-00246-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/15/2020] [Indexed: 11/24/2022] Open
Abstract
Broth microdilution (BMD), the reference method to determine bacterial susceptibility to polymyxins, is a laborious and time-consuming technique. Policimbac® is a commercial test panel which uses lyophilized polymyxin B to determine the minimum inhibitory concentration for Gram-negative isolates. This study evaluated the performance of Policimbac® in comparison with BMD for 110 isolates. Although the Policimbac® presented a very low essential agreement, the categorical agreement with BMD was optimal. Policimbac® is an alternative approach to BMD for evaluating the susceptibility to polymyxin B.
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Affiliation(s)
- Tanise Vendruscolo Dalmolin
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Maiara Dos Santos Carneiro
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Luíza Peres de Castro
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Fabiana Caroline Zempulski Volpato
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Priscila Lamb Wink
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Daiana de Lima-Morales
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Afonso Luís Barth
- Laboratório de Pesquisa em Resistência Bacteriana-LABRESIS, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil. .,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Erdem F, Abulaila A, Aktas Z, Oncul O. In vitro evaluation of double carbapenem and colistin combinations against OXA-48, NDM carbapenemase-producing colistin-resistant Klebsiella pneumoniae strains. Antimicrob Resist Infect Control 2020; 9:70. [PMID: 32430058 PMCID: PMC7238654 DOI: 10.1186/s13756-020-00727-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Treatment of pandrug-resistant isolates often necessitates combination therapy. Checkerboard synergy and time-killing assay tests were performed to evaluate the benefits of a triple combination with meropenem, ertapenem, and colistin against 10 colistin-resistant K. pneumoniae clinical isolates harboring different β-lactamases. (blaOXA-48, blaNDM). MATERIALS AND METHODS In this study, ertapenem and meropenem (ERT/MEM), meropenem and colistin (MEM/COL), ertapenem, meropenem and colistin (ERT/MEM/COL) combinations were tested using checkerboard techniques and time-kill assays of each antibiotic alone and in combination against 10 colistin-resistant clinical K. pneumoniae isolates. An analysis of K. pneumoniae isolate B6 using a scanning electron microscope revealed morphologic changes in the cell surface after treatment with each antibiotic both alone and in combination. The whole genome of K. pneumoniae KPNB1 was sequenced using an Ion Torrent PGM sequencer. RESULTS According to the checkboard results, synergistic combinations were observed with ertapenem/meropenem (5/10 isolates), meropenem/colistin (7/10) and ertapenem/meropenem/colistin (9/10); no antagonism was observed for all combinations. For the time-kill assay results; synergism and bactericidal effects were observed with meropenem/colistin (10/10) and with ertapenem/meropenem/colistin (10/10) combinations, and an indifference effect was observed with the ertapenem and meropenem (10/10) combination. Strain number 1 was found 100% identical to Klebsiella pneumoniae subsp. pneumoniae HS11286 according to the outcomes of complete genome sequence analysis, and the strain carried the genes blaOXA-181, blaCTXM-15, blaNDM, arr-3, aac (6')-Ib-cr, rmtF, and catB1. CONCLUSION Using double carbapenem antibiotics with colistin could be a potential alternative to treat colistin and carbapenem-resistant K. pneumoniae. The present study is the first Turkish report of OXA-181-type carbapenemase causing colistin resistance.
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Affiliation(s)
- Fatma Erdem
- Department of Medical Microbiology, Adana City Trainning and Research Hospital, Dr. Mithat Ozsan Boulevard. 4522-1 Yuregir/Adana, Adana, Turkey.
| | - Ayham Abulaila
- Department of Medical Microbiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Zerrin Aktas
- Department of Medical Microbiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Oral Oncul
- Department of Infection Disease and Clinical Microbiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Malchione MD, Torres LM, Hartley DM, Koch M, Goodman JL. Carbapenem and colistin resistance in Enterobacteriaceae in Southeast Asia: Review and mapping of emerging and overlapping challenges. Int J Antimicrob Agents 2019; 54:381-399. [DOI: 10.1016/j.ijantimicag.2019.07.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 01/21/2023]
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Chen Z, Xu Z, Wu H, Chen L, Gao S, Chen Y. The impact of carbapenem-resistant Pseudomonas aeruginosa on clinical and economic outcomes in a Chinese tertiary care hospital: A propensity score-matched analysis. Am J Infect Control 2019; 47:677-682. [PMID: 30554879 DOI: 10.1016/j.ajic.2018.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study aimed to estimate the impact of carbapenem-resistant Pseudomonas aeruginosa (CRPA) on clinical and economic outcomes in a Chinese tertiary care hospital. METHODS Patients were assigned to a carbapenem-susceptible P aeruginosa group or to a CRPA group and matched using propensity score matching. In-hospital mortality, length of stay (LOS), LOS after culture, total hospital costs, daily hospital cost, and 30-day readmission were comparatively analyzed. Subgroup analysis was performed to determine the associations between the subgrouping factors and in-hospital mortality in patients with CRPA isolates. RESULTS Within the propensity-matched cohort, in-hospital mortality (12.6% vs 7.8%; P = .044), LOS (median 29.0 vs 25.5 days; P = .026), LOS after culture (median 18.5 vs 14.0 days; P = .029), total hospital costs (median $6,082.0 vs $4,954.2; P = .015), and daily hospital cost (median $236.1 vs $223.6; P = .045) were significantly higher in CRPA patients than in carbapenem-susceptible P aeruginosa patients. Subgroup analysis revealed a significant interaction between CRPA and age (P = .009). CONCLUSION Prevention and control of CRPA among hospitalized patients, especially among those over the age of 65 years, is a good measurement for the reduction of mortality and medical costs derived from CRPA infection or colonization.
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Affiliation(s)
- Zhihui Chen
- Department of Infection Control, Wenzhou People's Hospital, Wenzhou, China.
| | - Ziqin Xu
- Department of Infection Control, Wenzhou People's Hospital, Wenzhou, China
| | - Hongmei Wu
- Department of Infection Control, Wenzhou People's Hospital, Wenzhou, China
| | - Le Chen
- Department of Infection Control, Wenzhou People's Hospital, Wenzhou, China
| | - Shengchun Gao
- Department of Infection Control, Wenzhou People's Hospital, Wenzhou, China
| | - Yangfang Chen
- Laboratory of Microbiology, Wenzhou People's Hospital, Wenzhou, China
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Tóth H, Fésűs A, Kungler-Gorácz O, Balázs B, Majoros L, Szarka K, Kardos G. Utilization of Vector Autoregressive and Linear Transfer Models to Follow Up the Antibiotic Resistance Spiral in Gram-negative Bacteria From Cephalosporin Consumption to Colistin Resistance. Clin Infect Dis 2018; 69:1410-1421. [DOI: 10.1093/cid/ciy1086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Increasing antibiotic resistance may reciprocally affect consumption and lead to use of broader-spectrum alternatives; a vicious cycle that may gradually limit therapeutic options. Our aim in this study was to demonstrate this vicious cycle in gram-negative bacteria and show the utility of vector autoregressive (VAR) models for time-series analysis in explanatory and dependent roles simultaneously.
Methods
Monthly drug consumption data in defined daily doses per 100 bed-days and incidence densities of gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter baumannii) resistant to cephalosporins or to carbapenems were analyzed using VAR models. These were compared to linear transfer models used earlier.
Results
In case of all gram-negative bacteria, cephalosporin consumption led to increasing cephalosporin resistance, which provoked carbapenem use and consequent carbapenem resistance and finally increased colistin consumption, exemplifying the vicious cycle. Different species were involved in different ways. For example, cephalosporin-resistant Klebsiella spp. provoked carbapenem use less than E. coli, and the association between carbapenem resistance of P. aeruginosa and colistin use was weaker than that of A. baumannii. Colistin use led to decreased carbapenem use and decreased carbapenem resistance of P. aeruginosa but not of A. baumannii.
Conclusions
VAR models allow analysis of consumption and resistance series in a bidirectional manner. The reconstructed resistance spiral involved cephalosporin use augmenting cephalosporin resistance primarily in E. coli. This led to increased carbapenem use, provoking spread of carbapenem-resistant A. baumannii and consequent colistin use. Emergence of panresistance is fueled by such antibiotic-resistance spirals.
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Affiliation(s)
- Hajnalka Tóth
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Adina Fésűs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Orsolya Kungler-Gorácz
- Department of Medical Microbiology, Faculty of Medicine, Hungary
- Clinical Pharmacy, Faculty of Pharmacy, Clinical Center, University of Debrecen, Hungary
| | - Bence Balázs
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - László Majoros
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Krisztina Szarka
- Department of Medical Microbiology, Faculty of Medicine, Hungary
| | - Gábor Kardos
- Department of Medical Microbiology, Faculty of Medicine, Hungary
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Adam MA, Elhag WI. Prevalence of metallo-β-lactamase acquired genes among carbapenems susceptible and resistant Gram-negative clinical isolates using multiplex PCR, Khartoum hospitals, Khartoum Sudan. BMC Infect Dis 2018; 18:668. [PMID: 30558551 PMCID: PMC6296134 DOI: 10.1186/s12879-018-3581-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 12/03/2018] [Indexed: 01/11/2023] Open
Abstract
Background The increased prevalence of carbapenem-resistant Gram-negative isolates caused by Metallo-β-lactamase (MBL) is worrisome in clinical settings worldwide. The mortality rate associated with infections caused by MBLs producing organisms ranging from 18 to 67%. This study aimed to determine the prevalence of Metallo-β-lactamase genes among some Gram-negative clinical isolates (Carbapenems susceptible and resistant). Methods This paper describes a descriptive cross-sectional study carried out to detect MBL genes such as (blaVIM, blaIMP and blaNDM) by multiplex PCR mixture reaction among 200 Gram-negative clinical isolates (Citrobacter spp, Escherichia coli, Enterobacter spp, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Proteus valgaris). Khartoum hospitals during 2015 to 2016. Limitation: The study organisms were not evaluated for non-MBL carbapenemases, such as KPC and OXA-48. Results The prevalence of MBL genes by multiplex PCR assays among 200 Gram-negative clinical isolates was 72(36.1%). MBL positive genes among 100 carbapenems sensitive and 100 resistant isolates were 27(27%) and 45(45%) respectively. There was a statistically, significant association between the antimicrobial susceptibility and the presences of MBL genes (P.value = 0.008). E.coli was the predominant species possessing MBL genes 26(36.1%), with 22(30.7%) species having a combination of MBL genes. Verona integron Metallo beta-lactamase (VIM) was the most frequent genes 28(38.9%) out of 72 MBL detected genes, followed by imipenemase (IMP) was 19(26.4%), and consequently, New Delhi Metallo beta lactamase was 3(4.2%). Conclusion This study revealed a high prevalence of MBL genes in some Gram-negative isolates from Khartoum State Hospitals which were not previously established in these hospitals. Electronic supplementary material The online version of this article (10.1186/s12879-018-3581-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mudathir Abdallah Adam
- Medical Microbiology Department, Faculty of Medical Laboratory Science, Al Neelain University, Khartoum, Sudan.
| | - Wafa I Elhag
- Medical Microbiology Department, Faculty of Medical Laboratory Science, Al Neelain University, Khartoum, Sudan.
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Lim TP, Wang R, Poh GQ, Koh TH, Tan TY, Lee W, Teo JQM, Cai Y, Tan TT, Ee PLR, Kwa AL. Integrated pharmacokinetic-pharmacodynamic modeling to evaluate empiric carbapenem therapy in bloodstream infections. Infect Drug Resist 2018; 11:1591-1596. [PMID: 30310294 PMCID: PMC6166767 DOI: 10.2147/idr.s168191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB. Methods Carbapenem minimum inhibitory concentrations (MICs) were generated for non-repeat GNB-BSI obtained in 2013–2014 from two hospitals. Monte Carlo simulations were used to assess the cumulative fraction of response (CFR) of various CDRs using the percentage of time above MIC for 40% (%T > MIC of 40%) as the pharmacokinetic (PK)–pharmacodynamic (PD) parameter for efficacy. Carbapenem costs were based on patient antibiotic costs. Antibiotic cost-effectiveness was calculated as total daily drug cost/CFR. Results A total of 1,140 bloodstream isolates were collected. They comprised 116 Acinetobacter baumannii, 237 Pseudomonas aeruginosa, and 787 Enterobacteriaceae. All CDRs achieved ~40, ~80, and ≥90% CFRs against A. baumannii, P. aeruginosa, and Enterobacteriaceae, respectively. Against P. aeruginosa, MER 2 g every 8 h infused over 3 h and DOR 1 g every 8 h infused over 4 h achieved CFRs 84 and 81%, respectively. Against Enterobacteriaceae, the cost of MER 2 g every 8 h infused over 3 h was the lowest among the three carbapenems at $0.40/percentage of CFR. Conclusion This study demonstrates the utility of PK–PD modeling to formulate the optimal selection of a cost-effective empiric CDR in antibiotics guidelines and formulary inclusion. The findings support the selection of high MER doses of prolonged infusions as empiric coverage for GNB-BSI in our institutions.
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Affiliation(s)
- Tze-Peng Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore, .,SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
| | - Reyna Wang
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Gang Quan Poh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Tse-Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Thean-Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Jocelyn Qi-Min Teo
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Yiying Cai
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore,
| | - Thuan-Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Pui Lai Rachel Ee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore, .,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore, .,Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore,
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Targeted surveillance of nosocomial infection in intensive care units of 176 hospitals in Jiangsu province, China. J Hosp Infect 2017; 99:36-41. [PMID: 29051092 DOI: 10.1016/j.jhin.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Nosocomial infections (NIs) impact care and costs in hospitals across the globe. There are few data on targeted surveillance of NI in intensive care units (ICUs), and data specific to the risk factors for NI are especially limited. METHODS One hundred and seventy-six secondary and tertiary hospitals performed NI targeted surveillance in their ICUs. The data were collected and summarized by Minke software, then fed back once per quarter. FINDINGS The incidence of NI appeared to decrease, and the incidence of NI per 1000 patient-days and adjusted incidence were 25.63‰ and 7.41‰ in 2010, and 9.73‰ and 2.76‰ in 2015, respectively. The NI incidence in general hospitals was higher than in specialized hospitals. The incidence of central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) appeared to decrease, and the incidence of ventilator-associated pneumonia (VAP) decreased markedly from 20.33‰ to 2.76‰. There was no statistically significant difference among ICUs. The six most frequently found pathogen-caused NIs were Acinetobacter baumannii (AB), Klebsiella pneumoniae (KP), Pseudomonas aeruginosa (PA), Staphylococcus aureus, Candida albicans, and Escherichia coli (E. coli). The isolation rate of carbapenem-resistant Gram-negative bacilli were carbapenem-resistant AB 80.53%, carbapenem-resistant PA 39.94%, carbapenem-resistant KP (CRKP) 24.86%, and carbapenem-resistant E. coli 9.23%. The isolation rate of meticillin-resistant S. aureus (MRSA) was 66.30%. The increasing trend of CRKP was statistically significant as analysed by the regression model. CONCLUSION The incidences of VAP, CAUTI, and CLABSI were high in ICUs, and multidrug-resistant organisms were the primary pathogens of NI. The implementation of targeted surveillance may determine the risk factors of NI so that effective intervention measures can be taken to reduce the incidence of NI in ICU patients.
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Hariharan P, Bharani T, Franklyne JS, Biswas P, Solanki SS, Paul-Satyaseela M. Antibiotic susceptibility pattern of Enterobacteriaceae and non-fermenter Gram-negative clinical isolates of microbial resource orchid. J Nat Sci Biol Med 2015; 6:198-201. [PMID: 25810660 PMCID: PMC4367035 DOI: 10.4103/0976-9668.149121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Microbial resource orchid is a collection of Gram-positive and Gram-negative clinical isolates sourced from different hospitals and diagnostic laboratories in India. We determined the antibiotic susceptibility of a set of Gram-negative Enterobacteriaceae and non-fermenter clinical isolates from microbial resource orchid, collected during the period of 2002-2012 against commonly used antibiotics. MATERIALS AND METHODS A total of 247 Gram negative strains consisting of 142 Enterobacteriaceae and 105 non-fermenters from microbial resource orchid were selected for determining minimum inhibitory concentration against β-lactams, aminoglycosides, quinolone, and tetracycline by agar dilution method as per clinical and laboratory standards institute guidelines. RESULTS All the isolates had high resistance to ampicillin, piperacillin, ceftazidime, gentamicin, tetracycline, and ciprofloxacin. Pseudomonas aeruginosa showed moderate resistance to carbapenems. CONCLUSION This study demonstrated the high level of antibiotic resistance among the strains collected under microbial resource orchid and further, such data and the strains can be used in new chemical entities profiling.
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Affiliation(s)
- Periasamy Hariharan
- Department of Microbiology, Drug Discovery Research, Orchid Chemicals and Pharmaceuticals Ltd., Sholinganallur, Chennai, Tamil Nadu, India
| | - Thirunavukkarasu Bharani
- Department of Microbiology, Drug Discovery Research, Orchid Chemicals and Pharmaceuticals Ltd., Sholinganallur, Chennai, Tamil Nadu, India
| | - Jonathan Sampath Franklyne
- Department of Microbiology, Drug Discovery Research, Orchid Chemicals and Pharmaceuticals Ltd., Sholinganallur, Chennai, Tamil Nadu, India
| | - Prithwijit Biswas
- Department of Biotechnology, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
| | - Shakti S Solanki
- Department of Microbiology, Drug Discovery Research, Orchid Chemicals and Pharmaceuticals Ltd., Sholinganallur, Chennai, Tamil Nadu, India
| | - Maneesh Paul-Satyaseela
- Department of Microbiology, Drug Discovery Research, Orchid Chemicals and Pharmaceuticals Ltd., Sholinganallur, Chennai, Tamil Nadu, India
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In vitro pharmacodynamics of various antibiotics in combination against extensively drug-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother 2015; 59:2515-24. [PMID: 25691628 DOI: 10.1128/aac.03639-14] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/24/2015] [Indexed: 11/20/2022] Open
Abstract
Extensively drug-resistant (XDR) Klebsiella pneumoniae is an emerging pathogen in Singapore. With limited therapeutic options available, combination antibiotics may be the only viable option. In this study, we aimed to elucidate effective antibiotic combinations against XDR K. pneumoniae isolates. Six NDM-1-producing and two OXA-181-producing K. pneumoniae strains were exposed to 12 antibiotics alone and in combination via time-kill studies. A hollow-fiber infection model (HFIM) with pharmacokinetic validation was used to simulate clinically relevant tigecycline-plus-meropenem dosing regimens against 2 XDR K. pneumoniae isolates over 240 h. The emergence of resistance against tigecycline was quantified using drug-free and selective (tigecycline at 3× the MIC) media. The in vitro growth rates were determined and serial passages on drug-free and selective media were carried out on resistant isolates obtained at 240 h. Both the polymyxin B and tigecycline MICs ranged from 1 to 4 mg/liter. In single time-kill studies, all antibiotics alone demonstrated regrowth at 24 h, except for polymyxin B against 2 isolates. Tigecycline plus meropenem was found to be bactericidal in 50% of the isolates. For the isolates that produced OXA-181-like carbapenemases, none of the 55 tested antibiotic combinations was bactericidal. Against 2 isolates in the HFIM, tigecycline plus meropenem achieved a >90% reduction in bacterial burden for 96 h before regrowth was observed until 10(9) CFU/ml at 240 h. Phenotypically stable and resistant isolates, which were recovered from tigecycline-supplemented plates post-HFIM studies, had lower growth rates than those of their respective parent isolates, possibly implying a substantial biofitness deficit in this population. We found that tigecycline plus meropenem may be a potential antibiotic combination for XDR K. pneumoniae infections, but its efficacy was strain specific.
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Antimicrobial susceptibility among Gram-positive and Gram-negative isolates collected in Europe between 2004 and 2010. J Glob Antimicrob Resist 2014; 2:155-161. [DOI: 10.1016/j.jgar.2014.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 03/19/2014] [Accepted: 05/06/2014] [Indexed: 11/22/2022] Open
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Blondeau JM. Gram-negative superbugs: inappropriate antimicrobial therapy and mortality. Expert Rev Clin Pharmacol 2014; 6:347-9. [DOI: 10.1586/17512433.2013.811831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clock SA, Tabibi S, Alba L, Kubin CJ, Whittier S, Saiman L. In vitro activity of doripenem alone and in multi-agent combinations against extensively drug-resistant Acinetobacter baumannii and Klebsiella pneumoniae. Diagn Microbiol Infect Dis 2013; 76:343-6. [DOI: 10.1016/j.diagmicrobio.2013.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/05/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
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Activity of doripenem versus comparators in subjects with baseline bacteraemia in six pooled phase 3 clinical trials. Int J Antimicrob Agents 2013; 41:388-92. [DOI: 10.1016/j.ijantimicag.2012.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/30/2012] [Accepted: 12/24/2012] [Indexed: 11/21/2022]
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Underlying mechanisms of carbapenem resistance in extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli isolates at a tertiary care centre in Lebanon: role of OXA-48 and NDM-1 carbapenemases. Int J Antimicrob Agents 2012; 41:75-9. [PMID: 23142087 DOI: 10.1016/j.ijantimicag.2012.08.010] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 08/15/2012] [Accepted: 08/19/2012] [Indexed: 11/22/2022]
Abstract
A recent increase in carbapenem resistance among extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli isolates at a major tertiary care centre in Lebanon prompted the initiation of this study. Consecutive ESBL-producing isolates were tested for resistance to carbapenems, with initial screening by disk diffusion and Etest using ertapenem. The modified Hodge test was also performed. PCR of β-lactamase-encoding genes, including bla(NDM-1), bla(KPC), bla(OXA-48), bla(CTX-M), bla(TEM), bla(SHV), bla(CMY-2) and bla(OXA-1), as well as outer membrane porin genes (ompC and ompF) was performed. Sequencing, efflux pump inhibitor tests and random amplified polymorphic DNA (RAPD) analysis were performed. In total, 14 (2.45%) of 572 K. pneumoniae and 24 (1.07%) of 2243 E. coli were ertapenem-non-susceptible [minimum inhibitory concentration (MIC) ≥0.25 μg/mL]. Resistance to other carbapenems was variable. PCR and sequencing analysis revealed that isolates harboured different β-lactamase genes, including bla(OXA-1), bla(CTX-M-15), bla(TEM-1), bla(CMY-2), bla(OXA-48) and bla(NDM-1). In addition, K. pneumoniae lacked the outer membrane porin-encoding genes, whilst E. coli harboured them with detected mutations. CTX-M-15 was carried on a 90 kb plasmid, whilst OXA-48 was carried on a 70 kb plasmid. Efflux pump inhibition significantly decreased MICs in E. coli. RAPD analysis demonstrated genomic variability. In conclusion, carbapenem resistance in ESBL-producing K. pneumoniae and E. coli is due to the combined effect of β-lactamases with porin impermeability and/or efflux pump activity observed in these organisms, and in a number of isolates is due to the production of the carbapenemase-encoding genes bla(OXA-48) and the newly emerging bla(NDM-1).
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Effective Antibiotic Treatment Prescribed by Emergency Physicians in Patients Admitted to the Intensive Care Unit with Severe Sepsis or Septic Shock: Where is the Gap? J Emerg Med 2011; 41:573-80. [DOI: 10.1016/j.jemermed.2010.10.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 08/30/2010] [Accepted: 10/31/2010] [Indexed: 11/21/2022]
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Nosocomial and community infections due to class A extended-spectrum β-lactamase (ESBLA)-producing Escherichia coli and Klebsiella spp. in southern Brazil. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
PURPOSE OF REVIEW Management of hospital-associated infections (HAIs) has been made more challenging by the increasing proportion of immunocompromised or otherwise severely ill patients and increasing prevalence of antibiotic-resistant pathogens in this environment. This review examines strategies to optimize clinical outcomes and lower healthcare costs for patients with HAIs by focusing on patient-related, pathogen-related, and drug-related factors. RECENT FINDINGS Factors have converged to increase the risk of infection with antibiotic-resistant pathogens in the current hospital environment, including the increasing prevalence of resistant species and number of hospitalized patients with conditions increasingly susceptible to infection with drug-resistant bacteria. Although the list of bacterial pathogens associated with HAIs has been fairly constant over time, the prevalence and resistance profile of these individual species continues to evolve. Periodic antibiograms should be utilized to access local patterns of resistance within the different hospital wards. Outcomes for patients with HAIs are optimized with early empiric treatment with an appropriate regimen, selected on the basis of patient characteristics and local resistance patterns. Dosing strategies should be utilized to ensure that the efficacy of an appropriate antibiotic is optimized, by achieving the pharmacodynamic target predictive of its efficacy. Using these strategies improves quality of care and is associated with lower overall healthcare costs. SUMMARY Bacterial resistance is an increasing problem in the hospital environment, and has been associated with poorer clinical outcomes and elevated healthcare costs. By using patient characteristics, local antibiograms, and dosing strategies to achieve an optimal pharmacodynamic profile, early appropriate empiric therapy can be utilized to improve clinical outcomes, minimize the development of resistance, and reduce healthcare costs.
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Ramphal R. Optimizing the use of carbapenems in the face of increasing Gram-negative resistance. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12 Suppl 4:S1. [PMID: 18495058 PMCID: PMC2391263 DOI: 10.1186/cc6817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Reuben Ramphal
- Division of Infectious Diseases, Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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