1
|
Solís N, Pérez C, Ramírez M, Castro J, Rodríguez C. Clinical presentation and microbiological characteristics of community-acquired Staphylococcus aureus bacteraemia at a tertiary hospital in Costa Rica. J Med Microbiol 2024; 73. [PMID: 39234813 DOI: 10.1099/jmm.0.001883] [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] [Indexed: 09/06/2024] Open
Abstract
Introduction. Staphylococcus aureus is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.Gap statement and aim. To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54 S. aureus CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.Methodology. Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.Results. Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for mecA, with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLSB antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.Conclusions. Our findings broaden our understanding of S. aureus infections in a largely understudied region and can enhance patient management and treatment strategies.
Collapse
Affiliation(s)
- Natalia Solís
- Department of Haematology, Hospital San Juan de Dios, San José, Costa Rica
| | - Cristian Pérez
- Clinical Laboratory, Hospital Nacional de Niños, San José, Costa Rica
| | - Manuel Ramírez
- Department of Infectious Diseases, Hospital San Juan de Dios, San José, Costa Rica
| | - José Castro
- Department of Biostatistics, Caja Costarricense del Seguro Social, San José, Costa Rica
| | - César Rodríguez
- Faculty of Microbiology and Research Center for Tropical Diseases (CIET), Universidad de Costa Rica, San José, Costa Rica
| |
Collapse
|
2
|
Kumar NR, Balraj TA, Shivashankar KK, Jayaram TC, Prashant A. Inflammaging in Multidrug-Resistant Sepsis of Geriatric ICU Patients and Healthcare Challenges. Geriatrics (Basel) 2024; 9:45. [PMID: 38667512 PMCID: PMC11049875 DOI: 10.3390/geriatrics9020045] [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: 01/19/2024] [Revised: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Multidrug-resistant sepsis (MDR) is a pressing concern in intensive care unit (ICU) settings, specifically among geriatric patients who experience age-related immune system changes and comorbidities. The aim of this review is to explore the clinical impact of MDR sepsis in geriatric ICU patients and shed light on healthcare challenges associated with its management. We conducted a comprehensive literature search using the National Center for Biotechnology Information (NCBI) and Google Scholar search engines. Our search incorporated keywords such as "multidrug-resistant sepsis" OR "MDR sepsis", "geriatric ICU patients" OR "elderly ICU patients", and "complications", "healthcare burdens", "diagnostic challenges", and "healthcare challenges" associated with MDR sepsis in "ICU patients" and "geriatric/elderly ICU patients". This review explores the specific risk factors contributing to MDR sepsis, the complexities of diagnostic challenges, and the healthcare burden faced by elderly ICU patients. Notably, the elderly population bears a higher burden of MDR sepsis (57.5%), influenced by various factors, including comorbidities, immunosuppression, age-related immune changes, and resource-limited ICU settings. Furthermore, sepsis imposes a significant economic burden on healthcare systems, with annual costs exceeding $27 billion in the USA. These findings underscore the urgency of addressing MDR sepsis in geriatric ICU patients and the need for tailored interventions to improve outcomes and reduce healthcare costs.
Collapse
Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India;
| | - Kusuma K. Shivashankar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
| | - Tejaswini C. Jayaram
- Department of Geriatrics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India;
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India; (N.R.K.); (K.K.S.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570015, India
| |
Collapse
|
3
|
Tsai YW, Zhang B, Chou HY, Chen HJ, Hsu YC, Shiue YL. Clinical impacts of the rapid diagnostic method on positive blood cultures. Lab Med 2024; 55:179-184. [PMID: 37352545 DOI: 10.1093/labmed/lmad057] [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] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the impact of short-term incubation (STI) protocol on clinical outcomes of bloodstream infection (BSI) patients. METHODS A total of 1363 positive blood culture records from January 2019 to December 2021 were included. The main clinical outcomes included pathogen identification turnaround time (TAT), antimicrobial susceptibility testing (AST) TAT, and length of total hospital stay. RESULTS The TAT of pathogen identification and AST significantly decreased after implementing the STI protocol (2.2 vs 1.4 days and 3.4 vs 2.5 days, respectively, with P < .001 for both). Moreover, for patients with Gram-negative bacteria (GNB)-infected BSIs, the length of total hospital stay decreased from 31.9 days to 27.1 days, indicating that these patients could be discharged 5 days earlier after implementing the STI protocol (P < .01). CONCLUSION The protocol led to a significant reduction in TAT and improved clinical outcomes, particularly for GNB organisms. The findings suggest that the STI protocol can improve patient outcomes and hospital resource utilization in the management of BSIs.
Collapse
Affiliation(s)
- Ya-Wen Tsai
- Center for Integrative Medicine, Tainan City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US
| | - Hsiu-Yin Chou
- Center for Integrative Medicine, Tainan City, Taiwan
| | - Hung-Jui Chen
- Division of Infectious Diseases, Department of Internal Medicine, Tainan City, Taiwan
| | - Yu-Chi Hsu
- Information Systems Office, Chi Mei Medical Center, Tainan City, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Chotiprasitsakul D, Trirattanapikul A, Namsiripongpun W, Chaihongsa N, Santanirand P. From Epidemiology of Community-Onset Bloodstream Infections to the Development of Empirical Antimicrobial Treatment-Decision Algorithm in a Region with High Burden of Antimicrobial Resistance. Antibiotics (Basel) 2023; 12:1699. [PMID: 38136733 PMCID: PMC10740575 DOI: 10.3390/antibiotics12121699] [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: 10/21/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Antimicrobial-resistant (AMR) infections have increased in community settings. Our objectives were to study the epidemiology of community-onset bloodstream infections (BSIs), identify risk factors for AMR-BSI and mortality-related factors, and develop the empirical antimicrobial treatment-decision algorithm. All adult, positive blood cultures at the emergency room and outpatient clinics were evaluated from 08/2021 to 04/2022. AMR was defined as the resistance of organisms to an antimicrobial to which they were previously sensitive. A total of 1151 positive blood cultures were identified. There were 450 initial episodes of bacterial BSI, and 114 BSIs (25%) were AMR-BSI. Non-susceptibility to ceftriaxone was detected in 40.9% of 195 E. coli isolates and 16.4% among 67 K. pneumoniae isolates. A treatment-decision algorithm was developed using the independent risk factors for AMR-BSI: presence of multidrug-resistant organisms (MDROs) within 90 days (aOR 3.63), prior antimicrobial exposure within 90 days (aOR 1.94), and urinary source (aOR 1.79). The positive and negative predictive values were 53.3% and 83.2%, respectively. The C-statistic was 0.73. Factors significantly associated with 30-day all-cause mortality were Pitt bacteremia score (aHR 1.39), solid malignancy (aHR 2.61), and urinary source (aHR 0.30). In conclusion, one-fourth of community-onset BSI were antimicrobial-resistant, and one-third of Enterobacteriaceae were non-susceptible to ceftriaxone. Treatment-decision algorithms may reduce overly broad antimicrobial treatment.
Collapse
Affiliation(s)
- Darunee Chotiprasitsakul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (A.T.); (W.N.)
| | - Akeatit Trirattanapikul
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (A.T.); (W.N.)
| | - Warunyu Namsiripongpun
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (A.T.); (W.N.)
| | - Narong Chaihongsa
- Microbiology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.C.); (P.S.)
| | - Pitak Santanirand
- Microbiology Laboratory, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (N.C.); (P.S.)
| |
Collapse
|
5
|
Li K, Li L, Wang J. Distribution and Antibiotic Resistance Analysis of Blood Culture Pathogens in a Tertiary Care Hospital in China in the Past Four Years. Infect Drug Resist 2023; 16:5463-5471. [PMID: 37638064 PMCID: PMC10460211 DOI: 10.2147/idr.s423660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose This study aimed to investigate the antibiotic resistance patterns and clinical distribution of blood culture-positive isolates at Suining Central Hospital between 2018 and 2021. The findings of this study can provide a basis for ensuring rational and effective use of antibiotic therapy in clinical settings. Methods This retrospective study analyzed the data of 3660 non-repeating strains that tested positive for clinical blood culture, collected from the microbiology laboratory of Suining Central Hospital between January 2018 and December 2021. The identification of bacterial species and their antibiotic resistance patterns were analyzed. Results The study found that 76.7% of the bacterial strains identified were Gram-negative bacteria, while 23.3% were Gram-positive bacteria. Escherichia coli (44.8%), Klebsiella spp. (19.2%), Staphylococcus aureus (9.2%), Enterococcus spp. (5.3%), and Enterobacter spp. were the top five bacterial ratios observed. These bacteria were detected most frequently in the Digestion Center, intensive care unit (ICU), Neurology Center, Urology Department, and Hematology Department. Among the Staphylococcus spp., methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were detected at rates of 39.3% and 71.8%, respectively. However, no vancomycin- or linezolid-resistant staphylococci were identified. Enterococcus faecalis showed higher susceptibility to most antibiotic than Enterococcus faecium, except for tetracycline. The resistance rates of E. coli and Klebsiella spp. to meropenem and imipenem were low, but the resistance rates for other antibiotic were above 40%. Conclusion The results of this study show a rising incidence of bacterial antibiotic resistance in positive blood culture specimens at Suining Central Hospital. Clinicians should carefully consider the importance of blood culture antibiotic susceptibility testing to ensure effective treatment. The Department of Microbiology at Suining Central Hospital should regularly analyze the distribution of pathogenic bacteria and antibiotic resistance in blood cultures to ensure the most effective treatment possible.
Collapse
Affiliation(s)
- Kun Li
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, Sichuan, People’s Republic of China
| | - Long Li
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, Sichuan, People’s Republic of China
| | - Jie Wang
- Department of Clinical Laboratory Medicine, Suining Central Hospital, Suining, Sichuan, People’s Republic of China
| |
Collapse
|
6
|
Helmy AK, Sidkey NM, El-Badawy RE, Hegazi AG. Emergence of microbial infections in some hospitals of Cairo, Egypt: studying their corresponding antimicrobial resistance profiles. BMC Infect Dis 2023; 23:424. [PMID: 37349674 DOI: 10.1186/s12879-023-08397-4] [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: 04/01/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is one of the ten major public health threats facing humanity, especially in developing countries. Identification of the pathogens responsible for different microbial infections and antimicrobial resistance patterns are important to help clinicians to choose the correct empirical drugs and provide optimal patient care. METHODS During the period from November 2020 to January 2021, one hundred microbial isolates were collected randomly from different specimens from some hospitals in Cairo, Egypt. Sputum and chest specimens were from COVID-19 patients. Antimicrobial susceptibility testing was performed according to CLSI guidelines. RESULTS Most microbial infections were more common in males and in elderly people over 45 years of age. They were caused by Gram-negative, Gram-positive bacteria, and yeast isolates that represented 69%, 15%, and 16%, respectively. Uropathogenic Escherichia coli (35%) were the most prevalent microbial isolates and showed high resistance rates towards penicillin, ampicillin, and cefixime, followed by Klebsiella spp. (13%) and Candida spp. (16%). Of all microbial isolates, Acinetobacter spp., Serratia spp., Hafnia alvei, and Klebsiella ozaenae were extremely multidrug-resistant (MDR) and have resisted all antibiotic classes used, except for glycylcycline, in varying degrees. Acinetobacter spp., Serratia spp., and Candida spp. were secondary microbial infections in COVID-19 patients, while H. alvei was a bloodstream infection isolate and K. ozaenae was recorded in most infections. Moreover, about half of Staphylococcus aureus strains were MRSA isolates and reported low rates of resistance to glycylcycline and linezolid. In comparison, Candida spp. showed high resistance rates between 77 and 100% to azole drugs and terbinafine, while no resistance rate towards nystatin was reported. Indeed, glycylcycline, linezolid, and nystatin were considered the drugs of choice for the treatment of MDR infections. CONCLUSION The prevalence of antimicrobial resistance in some Egyptian hospitals was high among Gram-negative, Gram-positive bacteria, and candida spp. The high resistance pattern -especially in secondary microbial infections in COVID-19 patients- to most antibiotics used is a matter of great concern, portends an inevitable catastrophe, and requires continuous monitoring to avoid the evolution of new generations.
Collapse
Affiliation(s)
- Asmaa K Helmy
- Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University, Cairo, Egypt.
| | - Nagwa M Sidkey
- Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed G Hegazi
- Zoonotic Diseases Department, National Research Centre, Dokki, Giza, Egypt
| |
Collapse
|
7
|
Sinto R, Lie KC, Setiati S, Suwarto S, Nelwan EJ, Djumaryo DH, Karyanti MR, Prayitno A, Sumariyono S, Moore CE, Hamers RL, Day NPJ, Limmathurotsakul D. Blood culture utilization and epidemiology of antimicrobial-resistant bloodstream infections before and during the COVID-19 pandemic in the Indonesian national referral hospital. Antimicrob Resist Infect Control 2022; 11:73. [PMID: 35590391 PMCID: PMC9117993 DOI: 10.1186/s13756-022-01114-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background There is a paucity of data regarding blood culture utilization and antimicrobial-resistant (AMR) infections in low and middle-income countries (LMICs). In addition, there has been a concern for increasing AMR infections among COVID-19 cases in LMICs. Here, we investigated epidemiology of AMR bloodstream infections (BSI) before and during the COVID-19 pandemic in the Indonesian national referral hospital. Methods We evaluated blood culture utilization rate, and proportion and incidence rate of AMR-BSI caused by WHO-defined priority bacteria using routine hospital databases from 2019 to 2020. A patient was classified as a COVID-19 case if their SARS-CoV-2 RT-PCR result was positive. The proportion of resistance was defined as the ratio of the number of patients having a positive blood culture for a WHO global priority resistant pathogen per the total number of patients having a positive blood culture for the given pathogen. Poisson regression models were used to assess changes in rate over time. Results Of 60,228 in-hospital patients, 8,175 had at least one blood culture taken (total 17,819 blood cultures), giving a blood culture utilization rate of 30.6 per 1,000 patient-days. A total of 1,311 patients were COVID-19 cases. Blood culture utilization rate had been increasing before and during the COVID-19 pandemic (both p < 0.001), and was higher among COVID-19 cases than non-COVID-19 cases (43.5 vs. 30.2 per 1,000 patient-days, p < 0.001). The most common pathogens identified were K. pneumoniae (23.3%), Acinetobacter spp. (13.9%) and E. coli (13.1%). The proportion of resistance for each bacterial pathogen was similar between COVID-19 and non-COVID-19 cases (all p > 0.10). Incidence rate of hospital-origin AMR-BSI increased from 130.1 cases per 100,000 patient-days in 2019 to 165.5 in 2020 (incidence rate ratio 1.016 per month, 95%CI:1.016–1.017, p < 0.001), and was not associated with COVID-19 (p = 0.96). Conclusions In our setting, AMR-BSI incidence and etiology were similar between COVID-19 and non-COVID-19 cases. Incidence rates of hospital-origin AMR-BSI increased in 2020, which was likely due to increased blood culture utilization. We recommend increasing blood culture utilization and generating AMR surveillance reports in LMICs to inform local health care providers and policy makers. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01114-x.
Collapse
|
8
|
Selvam K, Ganapathy T, Najib MA, Khalid MF, Abdullah NA, Harun A, Wan Mohammad WMZ, Aziah I. Burden and Risk Factors of Melioidosis in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15475. [PMID: 36497549 PMCID: PMC9741171 DOI: 10.3390/ijerph192315475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
This scoping review aims to provide a comprehensive overview of human melioidosis in Southeast Asia as well as to highlight knowledge gaps in the prevalence and risk factors of this life-threatening disease using available evidence-based data for better diagnosis and treatment. Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was used as the guideline for this review. The literature search was conducted on 23 March 2022 through two electronic databases (PubMed and Scopus) using lists of keywords referring to the Medical Subject Headings (MeSH) thesaurus. A total of 38 articles related to human melioidosis were included from 645 screened articles. These studies were carried out between 1986 and 2019 in six Southeast Asian countries: Thailand, Cambodia, Malaysia, Myanmar, Singapore, and Vietnam. Melioidosis has been reported with a high disease prevalence among high-risk populations. Studies in Thailand (48.0%) and Cambodia (74.4%) revealed disease prevalence in patients with septic arthritis and children with suppurative parotitis, respectively. Other studies in Thailand (63.5%) and Malaysia (54.4% and 65.7%) showed a high seroprevalence of melioidosis among Tsunami survivors and military personnel, respectively. Additionally, this review documented soil and water exposure, diabetes mellitus, chronic renal failure, thalassemia, and children under the age of 15 as the main risk factors for melioidosis. Human melioidosis is currently under-reported in Southeast Asia and its true prevalence is unknown.
Collapse
Affiliation(s)
- Kasturi Selvam
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Thanasree Ganapathy
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohamad Ahmad Najib
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Muhammad Fazli Khalid
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nor Azlina Abdullah
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Azian Harun
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Aziah
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| |
Collapse
|
9
|
Al-Sunaidar KA, Aziz NA, Hassan Y, Jamshed S, Sekar M. Association of Multidrug Resistance Bacteria and Clinical Outcomes of Adult Patients with Sepsis in the Intensive Care Unit. Trop Med Infect Dis 2022; 7:tropicalmed7110365. [PMID: 36355907 PMCID: PMC9692934 DOI: 10.3390/tropicalmed7110365] [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: 08/06/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background: Multi-drug resistance organisms (MDRO) often cause increased morbidity, mortality, and length of stays (LOS). However, there is uncertainty whether the infection of MDRO increase the morbidity, mortality, and ICU-LOS. Objective: This study was performed to determine the prevalence of MDRO in the ICU, the site of infection, and the association of MDRO or site of infection with mortality. The secondary outcome was determined by ascertaining the association of MDRO or site of infection with ICU-LOS. Methods: A retrospective cohort study was performed with adult sepsis patients in the ICU. Univariate and multivariate (MVA) logistic regression with cox regression modeling were performed to compute the association of MDRO with ICU mortality. MVA modelling was performed for ICU-LOS predictors. Results: Out of 228 patients, the isolated MDRO was 97 (42.5%), of which 78% were Gram-negative bacteria. The mortality rate among those with MDRO was 85 (37.3%). The hospital acquired infection (HAI) was a significant predictor for ICU-LOS in univariate linear regression (R2 = 0.034, p = 0.005). In MVA linear regression, both Enterococcus faecalis infection and Acinetobacter baumannii (AC)-MDRO were predictors for ICU-LOS with (R2 = 0.478, p < 0.05). In the univariate cox regression, only the infection with AC-MDRO was a risk factor for ICU-mortality with [HR = 1.802 (95% CI: 1.2−2.706; p = 0.005)]. Conclusions: Identifying risk factors for MDRO addresses the appropriate administration of empirical antibiotics and allows to effectively control the source of infection, which would reduce mortality and ICU-LOS. The usage of broad-spectrum antibiotics should be limited to those with substantial risk factors for acquiring MDRO.
Collapse
Affiliation(s)
- Khalid Ahmad Al-Sunaidar
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy and Health Sciences, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh 30450, Perak, Malaysia
- Correspondence: ; Tel.: +60-11-2387-8780
| | - Noorizan Abd Aziz
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam 42300, Selangor, Malaysia
| | - Yahaya Hassan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam 42300, Selangor, Malaysia
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut 22200, Terengganu, Malaysia
| | - Mahendran Sekar
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health Sciences, Royal College of Medicine Perak, Universiti Kuala Lumpur, Ipoh 30450, Perak, Malaysia
| |
Collapse
|
10
|
Muacevic A, Adler JR, Gia Binh N, Lan Huong M, Dao XC, Thi Phuong Thuy P, Van Thanh D, Takeshita N, Quoc Anh N, Ohmagari N. The Epidemiology of Healthcare-Associated Bloodstream Infection in an Adult Intensive Care Unit: A Retrospective Cohort Study in a Single Tertiary Care Hospital in Hanoi, Vietnam. Cureus 2022; 14:e31879. [PMID: 36579254 PMCID: PMC9792326 DOI: 10.7759/cureus.31879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Healthcare-associated infections (HAIs), including bloodstream infections (BSIs) in the intensive care unit (ICU), are growing global public health problems. While high-income countries have reported the burden of HAIs precisely, low- and middle-income countries (LMICs), including Vietnam, often lack surveillance systems for HAIs. In Vietnam, few reports described HAI-associated BSIs. Therefore, in this study, we aim to clarify the characteristics of HAI-associated BSI in an adult ICU. Materials and methods We conducted a retrospective cohort study of HAI-associated BSI in the adult ICU of Bach Mai Hospital (BMH), Vietnam, between December 2013 and August 2015. For every case identified with bacteremia, we collected characteristics and laboratory findings of the case and followed the length of hospital stay and seven-day and 30-day survival. Predictors of 30-day mortality were analyzed using univariate and multivariate analyses. Results Among the 90 cases identified, the median age of the study cohort was 57 (range: 18-90) years, and 59 (65.6%) were male. Chronic heart disease was the most frequent comorbidity (n = 26, 28.9%). The pathogens isolated were mostly Candida spp. (n = 26, 26.3%) and Enterococcus spp. (n = 19, 19.2%). Among the 90 patients with confirmed HAI-associated BSI, 34 (37.8%) patients survived, while 31 (34.4%) patients died in 30 days. In multivariate analysis, chronic heart disease tended to increase with 30-day all-cause mortality (odds ratio (OR) = 3.5, 95% confidence interval (CI) = 1.0-11.9, p = 0.051). Conclusions Our retrospective cohort study is the largest investigation to describe HAI-associated BSI in an adult ICU in a tertiary care hospital in Vietnam. Improved laboratory detection and infection surveillance systems are needed to reduce HAI-associated BSI.
Collapse
|
11
|
Optimizing Meropenem in Highly Resistant Klebsiella pneumoniae Environments: Population Pharmacokinetics and Dosing Simulations in Critically Ill Patients. Antimicrob Agents Chemother 2022; 66:e0032122. [PMID: 36197095 PMCID: PMC9664861 DOI: 10.1128/aac.00321-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Critically ill patients are characterized by substantial pathophysiological changes that alter the pharmacokinetics (PK) of hydrophilic antibiotics, including carbapenems. Meropenem is a key antibiotic for multidrug-resistant Gram-negative bacilli, and such pathophysiological alterations can worsen treatment outcomes. This study aimed to determine the population PK of meropenem and to propose optimized dosing regimens for the treatment of multidrug-resistant Klebsiella pneumoniae in critically ill patients. Two plasma samples were collected from eligible patients over a dosing interval. Nonparametric population PK modeling was performed using Pmetrics. Monte Carlo simulations were applied to different dosing regimens to determine the probability of target attainment and the cumulative fraction of response, taking into account the local MIC distribution for K. pneumoniae. The targets of 40% and 100% for the fraction of time that free drug concentrations remained above the MIC (ƒT>MIC) were tested, as suggested for critically ill patients. A one-compartment PK model using data from 27 patients showed high interindividual variability. Significant PK covariates were the 8-h creatinine clearance for meropenem and the presence of an indwelling catheter for pleural, abdominal, or cerebrospinal fluid drainage for the meropenem volume of distribution. The target 100% ƒT>MIC for K. pneumoniae, with a MIC of ≤2 mg/liter, could be attained by the use of a continuous infusion of 2.0 g/day. Meropenem therapy in critically ill patients could be optimized for K. pneumoniae isolates with an MIC of ≤2 mg/liter by using a continuous infusion in settings with more than 50% isolates have a MIC of ≥32mg/L.
Collapse
|
12
|
Bray AS, Smith RD, Hudson AW, Hernandez GE, Young TM, George HE, Ernst RK, Zafar MA. MgrB-Dependent Colistin Resistance in Klebsiella pneumoniae Is Associated with an Increase in Host-to-Host Transmission. mBio 2022; 13:e0359521. [PMID: 35311534 PMCID: PMC9040857 DOI: 10.1128/mbio.03595-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/08/2022] [Indexed: 12/22/2022] Open
Abstract
Due to its high transmissibility, Klebsiella pneumoniae is one of the leading causes of nosocomial infections. Here, we studied the biological cost of colistin resistance, an antibiotic of last resort, in this opportunistic pathogen using a murine model of gut colonization and transmission. Colistin resistance in K. pneumoniae is commonly the result of the inactivation of the small regulatory protein MgrB. Without a functional MgrB, the two-component system PhoPQ is constitutively active, leading to an increase in lipid A modifications and subsequent colistin resistance. Using an isogenic mgrB deletion mutant (MgrB-), we demonstrate that the mutant's colistin resistance is not associated with a fitness defect under in vitro growth conditions. However, in our murine model of K. pneumoniae gastrointestinal (GI) colonization, the MgrB- colonizes the gut poorly, allowing us to identify a fitness cost. Moreover, the MgrB- mutant has higher survival outside the host compared with the parental strain. We attribute this enhanced survivability to dysregulation of the PhoPQ two-component system and accumulation of the master stress regulator RpoS. The enhanced survival of MgrB- may be critical for its rapid host-to-host transmission observed in our model. Together, our data using multiple clinical isolates demonstrate that MgrB-dependent colistin resistance in K. pneumoniae comes with a biological cost in gut colonization. However, this cost is mitigated by enhanced survival outside the host and consequently increases its host-to-host transmission. Additionally, it underscores the importance of considering the entire life cycle of a pathogen to determine the actual biological cost associated with antibiotic resistance. IMPORTANCE The biological cost associated with colistin resistance in Klebsiella pneumoniae was examined using a murine model of K. pneumoniae gut colonization and fecal-oral transmission. A common mutation resulting in colistin resistance in K. pneumoniae is a loss-of-function mutation of the small regulatory protein MgrB that regulates the two-component system PhoPQ. Even though colistin resistance in K. pneumoniae comes with a fitness defect in gut colonization, it increases bacterial survival outside the host enabling it to transmit more effectively to a new host. The enhanced survival is dependent upon the accumulation of RpoS and dysregulation of the PhoPQ. Hence, our study expands our understanding of the underlying molecular mechanism contributing to the transmission of colistin-resistant K. pneumoniae.
Collapse
Affiliation(s)
- Andrew S. Bray
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Richard D. Smith
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, Baltimore, Maryland, USA
- Department of Pathology, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Andrew W. Hudson
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Giovanna E. Hernandez
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Taylor M. Young
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | | | - Robert K. Ernst
- Department of Microbial Pathogenesis, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - M. Ammar Zafar
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| |
Collapse
|
13
|
Zhang X, Li Y, Tao Y, Ding Y, Shao X, Li W. Epidemiology and Drug Resistance of Neonatal Bloodstream Infection Pathogens in East China Children's Medical Center From 2016 to 2020. Front Microbiol 2022; 13:820577. [PMID: 35359735 PMCID: PMC8961284 DOI: 10.3389/fmicb.2022.820577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction To analyze the pathogen distribution and drug resistance of newborns with bloodstream infection (BSI) to help clinicians choose the appropriate empirical antibiotic therapy for clinical infection control. Methods A total of 707 neonatal BSI cases were retrospectively analyzed. The bacteria in blood culture-positive samples were cultured, identified, and analyzed for drug sensitivity by routine methods. Statistical software was used to compare and analyze the basic data, pathogenic information, and drug resistance of the main bacteria. Results The 5-year average positive rate of neonatal blood culture was 2.50%. The number of specimens submitted for inspection in 2020 significantly decreased. The top five infectious pathogens with the highest proportion were coagulase-negative Staphylococcus (67.35%), of which Staphylococcus epidermidis had the highest proportion (31.26%), followed by Escherichia coli (12.87%), Klebsiella pneumoniae (9.05%), Streptococcus agalactiae (8.63%), and Staphylococcus aureus (3.25%). Gram-positive (G+) bacteria were dominant, accounting for 69.45%. The main G+ bacteria had a higher rate of resistance to erythromycin and penicillin G. The main Gram-negative (G-) bacteria had a high resistance rate to a variety of antibacterial drugs, especially cephalosporin antibiotics. The overall resistance of K. pneumoniae was higher than that of E. coli. The top two fungi detected were Candida parapsilosis and Candida albicans. C. parapsilosis did not appear to be resistant to antibiotics, while C. albicans was resistant to multiple antibiotics. The type of microbial infection had a statistically significant difference in the positive rate among the age at delivery and wards (p < 0.05). There were significant differences in the detection of fungi among these groups (p < 0.05). The positive rate of G+ bacteria in the term newborns was significantly higher than that in the preterm newborns (p < 0.05). Preterm newborns are more susceptible to pneumonia. Conclusion G+ bacteria are the main pathogens of neonatal BSI. Preterm newborns are more likely to be infected with G- bacteria. E. coli and K. pneumoniae are the most common G- bacteria, and both have a high resistance rate to a variety of antibacterial drugs. According to the distribution characteristics and drug resistance, it is very important to select antibiotics reasonably.
Collapse
|
14
|
Nguyen Q, Nguyen TTN, Pham P, Chau V, Nguyen LPH, Nguyen TD, Ha TT, Le NTQ, Vu DT, Baker S, Thwaites GE, Rabaa MA, Pham DT. Genomic insights into the circulation of pandemic fluoroquinolone-resistant extra-intestinal pathogenic Escherichia coli ST1193 in Vietnam. Microb Genom 2021; 7. [PMID: 34904942 PMCID: PMC8767341 DOI: 10.1099/mgen.0.000733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Extra-intestinal pathogenic Escherichia coli (ExPEC) ST1193, a globally emergent fluoroquinolone-resistant clone, has become an important cause of bloodstream infections (BSIs) associated with significant morbidity and mortality. Previous studies have reported the emergence of fluoroquinolone-resistant ExPEC ST1193 in Vietnam; however, limited data exist regarding the genetic structure, antimicrobial resistance (AMR) determinants and transmission dynamics of this pandemic clone. Here, we performed genomic and phylogenetic analyses of 46 ST1193 isolates obtained from BSIs and healthy individuals in Ho Chi Minh City, Vietnam, to investigate the pathogen population structure, molecular mechanisms of AMR and potential transmission patterns. We further examined the phylogenetic structure of ST1193 isolates in a global context. We found that the endemic E. coli ST1193 population was heterogeneous and highly dynamic, largely driven by multiple strain importations. Several well-supported phylogenetic clusters (C1-C6) were identified and associated with distinct bla CTX-M variants, including bla CTXM-27 (C1-C3, C5), bla CTXM-55 (C4) and bla CTXM-15 (C6). Most ST1193 isolates were multidrug-resistant and carried an extensive array of AMR genes. ST1193 isolates also exhibited the ability to acquire further resistance while circulating in Vietnam. There were phylogenetic links between ST1193 isolates from BSIs and healthy individuals, suggesting these organisms may both establish long-term colonization in the human intestinal tract and induce infections. Our study uncovers factors shaping the population structure and transmission dynamics of multidrug-resistant ST1193 in Vietnam, and highlights the urgent need for local One Health genomic surveillance to capture new emerging ExPEC clones and to better understand the origins and transmission patterns of these pathogens.
Collapse
Affiliation(s)
- Quynh Nguyen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Phuong Pham
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vinh Chau
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Tuyen Thanh Ha
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nhi Thi Quynh Le
- The University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, Cambridge, UK
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maia A Rabaa
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Duy Thanh Pham
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
15
|
Octora M, Mertaniasih NM, Semedi BP, Koendhori EB. Predictive Score Model of Clinical Outcomes Sepsis in Intensive Care Unit Tertier Referral Hospital of Eastern Indonesia. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: This study aimed to design a predictive score model of clinical outcome sepsis and bacterial profiles of blood and sputum cultures in the intensive care unit (ICU) of a tertiary referral hospital.
METHODS: An observational retrospective study was conducted in 2017–2020 using medical record data in the ICU of Dr. Soetomo Hospital as tertiary referral hospital. The predictor of sepsis prognosis was Acute Physiology and Chronic Health Evaluation II (APACHE II), blood and sputum culture results, procalcitonin (PCT) levels, and antimicrobial resistance in blood and sputum cultures. The model was prepared by logistic regression analysis and receiver operating characteristic (ROC) curves.
RESULTS: Data from 355 subjects showed that predictor score was APACHE II, blood and sputum culture results; besides PCT levels were found to contribute significantly to predictive score of sepsis clinical output (p<0.05), while the predictor test of antimicrobial resistance in blood and sputum cultures was not significant to predictive score of sepsis clinical output (p > 0.05). The resulting scores to predict sepsis clinical outcomes include PCT level >2 ng/mL (1.61), APACHE score >20 (1), sputum culture as true pathogen (1.1), and blood culture as true pathogen (1.35). When the total score ≥3, the patient will die, while when the score <3, the patient will survive. ROC curves analysis obtained area under curve 0.859 (p < 0.05) which indicates that the equation is statistically significant in predicting the sepsis clinical outcome. Probability scores and death outcomes indicate that the higher the predictive score, the higher the probability of dying, with a score >3 the probability of dying is above 95.27%, whereas if the score is 5, the probability of dying is above 99%. The bacterial profile of blood cultures leading to mortality is predominately Gram-positive (34.4%), consisting of coagulase-negative Staphylococcus (22.9%), and Staphylococcus aureus (4.3%), while Gram-negative is only 14.7%, which consists of Enterobacteriaceae group (8.7%), Acinetobacter baumannii (4%), polymicrobial infection (2%), Burkholderia cepacia (0.8%), and Pseudomonas aeruginosa (0.4%). Sputum culture profile of patients with sepsis who died in the ICU of a tertiary referral RSUD Soetomo is dominated by Gram-negative, namely, A. baumannii (22.1%), Enterobacteriaceae group (20.6%), P. aeruginosa (11.1%), while Gram-positive is S. aureus (22.9%).
CONCLUSION: The predictive score model for sepsis clinical outcomes in the ICU of a tertiary referral hospitals can be used as a basis for determining of patient management and the profile of the bacteria that causes sepsis that results in death.
Collapse
|
16
|
Singh SR, Teo AKJ, Prem K, Ong RTH, Ashley EA, van Doorn HR, Limmathurotsakul D, Turner P, Hsu LY. Epidemiology of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Enterobacterales in the Greater Mekong Subregion: A Systematic-Review and Meta-Analysis of Risk Factors Associated With Extended-Spectrum Beta-Lactamase and Carbapenemase Isolation. Front Microbiol 2021; 12:695027. [PMID: 34899618 PMCID: PMC8661499 DOI: 10.3389/fmicb.2021.695027] [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: 04/14/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the rapid spread of extended-spectrum beta-lactamase (ESBL) producing-Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE), little is known about the extent of their prevalence in the Greater Mekong Subregion (GMS). In this systematic review, we aimed to determine the epidemiology of ESBL-E and CPE in clinically significant Enterobacterales: Escherichia coli and Klebsiella pneumoniae from the GMS (comprising of Cambodia, Laos, Myanmar, Thailand, Vietnam and Yunnan province and Guangxi Zhuang region of China). Methods: Following a list of search terms adapted to subject headings, we systematically searched databases: Medline, EMBASE, Scopus and Web of Science for articles published on and before October 20th, 2020. The search string consisted of the bacterial names, methods involved in detecting drug-resistance phenotype and genotype, GMS countries, and ESBL and carbapenemase detection as the outcomes. Meta-analyses of the association between the isolation of ESBL from human clinical and non-clinical specimens were performed using the "METAN" function in STATA 14. Results: One hundred and thirty-nine studies were included from a total of 1,513 identified studies. Despite the heterogeneity in study methods, analyzing the prevalence proportions on log-linear model scale for ESBL producing-E. coli showed a trend that increased by 13.2% (95%CI: 6.1-20.2) in clinical blood specimens, 8.1% (95%CI: 1.7-14.4) in all clinical specimens and 17.7% (95%CI: 4.9-30.4) increase in carriage specimens. Under the log-linear model assumption, no significant trend over time was found for ESBL producing K. pneumoniae and ESBL-E specimens. CPE was reported in clinical studies and carriage studies past 2010, however a trend could not be determined because of the small dataset. Twelve studies were included in the meta-analysis of risk factors associated with isolation of ESBL. Recent antibiotic exposure was the most studied variable and showed a significant positive association with ESBL-E isolation (pooled OR: 2.9, 95%CI: 2.3-3.8) followed by chronic kidney disease (pooled OR: 4.7, 95%CI: 1.8-11.9), and other co-morbidities (pooled OR: 1.6, 95%CI: 1.2-2.9). Conclusion: Data from GMS is heterogeneous with significant data-gaps, especially in community settings from Laos, Myanmar, Cambodia and Yunnan and Guangxi provinces of China. Collaborative work standardizing the methodology of studies will aid in better monitoring, surveillance and evaluation of interventions across the GMS.
Collapse
Affiliation(s)
- Shweta R. Singh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Infectious Disease Epidemiology, Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Elizabeth A. Ashley
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - H. Rogier van Doorn
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Direk Limmathurotsakul
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul Turner
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
17
|
Son TV, Manh ND, Trung NT, Quyen DT, Meyer CG, Phuong NTK, Hoan PQ, Sang VV, Nurjadi D, Velavan TP, Bang MH, Song LH. Molecular detection of bla CTX-M gene to predict phenotypic cephalosporin resistance and clinical outcome of Escherichia coli bloodstream infections in Vietnam. Ann Clin Microbiol Antimicrob 2021; 20:60. [PMID: 34481499 PMCID: PMC8418716 DOI: 10.1186/s12941-021-00466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Blood stream infections (BSI) caused by Extended Spectrum Beta-Lactamases (ESBLs) producing Enterobacteriaceae is a clinical challenge leading to high mortality, especially in developing countries. In this study, we sought to describe the epidemiology of ESBL-producing Escherichia coli strains isolated from Vietnamese individuals with BSI, to investigate the concordance of genotypic-phenotypic resistance, and clinical outcome of ESBL E. coli BSI. METHODS A total of 459 hospitalized patients with BSI were screened between October 2014 and May 2016. 115 E. coli strains from 115 BSI patients were isolated and tested for antibiotic resistance using the VITEK®2 system. The ESBL phenotype was determined by double disk diffusion method following the guideline of Clinical and Laboratory Standards Institute. Screening for beta-lactamase (ESBL and carbapenemase) genes was performed using a multiplex-PCR assay. RESULTS 58% (67/115) of the E. coli strains were ESBL-producers and all were susceptible to both imipenem and meropenem. Resistance to third-generation cephalosporin was common, 70% (81/115) were cefotaxime-resistant and 45% (52/115) were ceftazidime-resistant. blaCTX-M was the most common ESBL gene detected (70%; 80/115) The sensitivity and specificity of blaCTX-M-detection to predict the ESBL phenotype was 87% (76-93% 95% CI) and 54% (39-48% 95% CI), respectively. 28%% (22/80) of blaCTX-M were classified as non-ESBL producers by phenotypic testing for ESBL production. The detection of blaCTX-M in ESBL-negative E. coli BSI was associated with fatal clinical outcome (27%; 6/22 versus 8%; 2/26, p = 0.07). CONCLUSION A high prevalence of ESBL-producing E. coli isolates harbouring blaCTX-M was observed in BSI patients in Vietnam. The genotypic detection of blaCTX-M may have added benefit in optimizing and guiding empirical antibiotic therapy of E. coli BSI to improve clinical outcome.
Collapse
Affiliation(s)
- Trinh Van Son
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Dang Manh
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, Hanoi, Vietnam
| | - Ngo Tat Trung
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Dao Thanh Quyen
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Christian G Meyer
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | - Phan Quoc Hoan
- Central Laboratory, 108 Military Central Hospital, Hanoi, Vietnam
| | - Vu Viet Sang
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Clinical Infectious Diseases, 108 Military Central Hospital, Hanoi, Vietnam
| | - Dennis Nurjadi
- Department of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Thirumalaisamy P Velavan
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Mai Hong Bang
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Le Huu Song
- 108 Institute of Clinical and Pharmaceutical Sciences, Hanoi, Vietnam.
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
- 108 Military Central Hospital, Nr.1 Tran Hung Dao street, Hanoi, Vietnam.
| |
Collapse
|
18
|
Singhal C, Bruno JG, Kaushal A, Sharma TK. Recent Advances and a Roadmap to Aptamer-Based Sensors for Bloodstream Infections. ACS APPLIED BIO MATERIALS 2021; 4:3962-3984. [PMID: 35006817 DOI: 10.1021/acsabm.0c01358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The present review is intended to describe bloodstream infections (BSIs), the major pathogens responsible for BSIs, conventional tests and their limitations, commercially available methods used, and the aptamer and nanomaterials-based approaches developed so far for the detection of BSIs. The advantages associated with aptamers and the aptamer-based sensors, the comparison between the aptamers and the antibodies, and the various types of aptasensors developed so far for the detection of bloodstream infections have been described in detail in the present review. Also, the future outlook and roadmap toward aptamer-based sensors and the challenges associated with the aptamer development have also been concluded in this review.
Collapse
Affiliation(s)
- Chaitali Singhal
- Aptamer Technology and Diagnostic Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| | - John G Bruno
- Nanohmics, Inc., Austin, Texas 78741, United States
| | - Ankur Kaushal
- Centre of Nanotechnology, Amity University, Manesar, Gurugram, Haryana 122413, India
| | - Tarun K Sharma
- Aptamer Technology and Diagnostic Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| |
Collapse
|
19
|
Viet NT, Van Du V, Thuan ND, Van Tong H, Toan NL, Van Mao C, Van Tuan N, Pallerla SR, Nurjadi D, Velavan TP, Son HA. Maternal Vaginal Colonization and Extended-Spectrum Beta-Lactamase-Producing Bacteria in Vietnamese Pregnant Women. Antibiotics (Basel) 2021; 10:antibiotics10050572. [PMID: 34067975 PMCID: PMC8152252 DOI: 10.3390/antibiotics10050572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) resistance to commonly prescribed drugs is increasing in Vietnam. During pregnancy, ESBL-E may predispose women to reproductive tract infections and increases the risk for neonatal morbidity. Vaginal colonization and infections by Escherichia coli and Klebsiella pneumoniae are seldom studied in Vietnam. In this study, we investigated ESBL-producing Enterobacterales in the birth canal of pregnant women. Between 2016 and 2020, vaginal swabs were collected from 3104 pregnant women (mean gestational age of 31 weeks) and inoculated onto MacConkey agar plates. Colonies were subjected to direct identification and antimicrobial susceptibility testing using the VITEK®-2 automated compact system and disk diffusion. ESBL production was determined phenotypically. E. coli, Klebsiella species were identified in 30% (918/3104) of the vaginal swabs, with E. coli being the most common (73%; 667/918). ESBL-production was detected in 47% (432/918) of Enterobacterales, with frequent multidrug-resistant phenotype. The overall prevalence of carbapenem resistance was low (8%). Over 20% of Klebsiella spp. were carbapenem-resistant. Pregnant women had a high prevalence of colonization and may transmit ESBL-E to neonates at birth, an important risk factor to be considered. The high rate of ESBL-producers and carbapenem resistance in Enterobacterales in Vietnam emphasizes the need for consequent surveillance and access to molecular typing.
Collapse
Affiliation(s)
- Nguyen Thanh Viet
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 121-08, Vietnam; (N.T.V.); (H.V.T.)
| | - Vu Van Du
- National Hospital of Obstetrics and Gynecology, Hanoi 110-02, Vietnam;
| | - Nghiem Duc Thuan
- ENT Department, 103 Military Hospital, Vietnamese Military Medical University, Hanoi 121-08, Vietnam;
| | - Hoang Van Tong
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 121-08, Vietnam; (N.T.V.); (H.V.T.)
| | - Nguyen Linh Toan
- Department Post-Graduate Training Management, Vietnamese Military Medical University, Hanoi 121-08, Vietnam;
- Department of Pathophysiology, Vietnamese Military Medical University, Hanoi 121-08, Vietnam;
| | - Can Van Mao
- Department of Pathophysiology, Vietnamese Military Medical University, Hanoi 121-08, Vietnam;
| | - Nguyen Van Tuan
- Department of Rehabilitation, Vietnamese Military Medical University, Hanoi 121-08, Vietnam;
| | - Srinivas Reddy Pallerla
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Wilhelmstrasse 27, 72074 Tübingen, Germany
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany;
| | - Thirumalaisamy P. Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Wilhelmstrasse 27, 72074 Tübingen, Germany
- Vietnamese-German Centre for Medical Research (VG-CARE), Hanoi 116-10, Vietnam
- Correspondence: (T.P.V.); (H.A.S.); Tel.: +49-7071-2985981 (T.P.V.); +84-978-437-229 (H.A.S.)
| | - Ho Anh Son
- Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Hanoi 121-08, Vietnam; (N.T.V.); (H.V.T.)
- Correspondence: (T.P.V.); (H.A.S.); Tel.: +49-7071-2985981 (T.P.V.); +84-978-437-229 (H.A.S.)
| |
Collapse
|
20
|
Maheshwarappa HM, Guru P, Mundre RS, Lawrence N, Majumder S, Sigamani A, Anupama CN, Adak S. Validation of an Isothermal Amplification Platform for Microbial Identification and Antimicrobial Resistance Detection in Blood: A Prospective Study. Indian J Crit Care Med 2021; 25:299-304. [PMID: 33790511 PMCID: PMC7991769 DOI: 10.5005/jp-journals-10071-23761] [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] [Indexed: 12/05/2022] Open
Abstract
Background: Recent advances in nucleic acid amplification technique (NAAT)-based identification of pathogens in blood stream infections (BSI) have revolutionized molecular diagnostics in comparison to traditional clinical microbiology practice of blood culture. Rapid pathogen detection with point-of-care diagnostic-applicable platform is prerequisite for efficient patient management. The aim of the study is to evaluate an in-house developed, lyophilized OmiX-AMP pathogen test for the detection of top six BSI-causing bacteria along with two major antimicrobial resistance (AMR) markers of carbapenem and compare it to the traditional blood culture-based detection. Materials and methods: One hundred forty-three patients admitted to the Medical Intensive Care Unit, Narayana Hrudayalaya, Bangalore, with either suspected or proven sepsis, of either gender, of age ≥18 years were enrolled for the study. Pathogen DNA extracted from blood culture sample using OmiX pReP method was amplified at isothermal conditions and analyzed in real time using OmiX Analysis software. Results: Among the processed 143 samples, 54 were true negative, 83 were true positive, 3 were false negative, and 2 were false positive as analyzed by OmiX READ software. Gram-negative bacteria (91.3%) and gram-positive bacteria (75%) were detected with 100% specificity and 95.6% sensitivity along with the AMR marker pattern with a turnaround time of 4 hours from sample collection to results. Conclusion: OmiX-AMP pathogen test detected pathogens with 96.5% concordance in comparison to traditional blood culture. Henceforth, OmiX-AMP pathogen test could be used as a readily deployable diagnostic kit even in low-resource settings. How to cite this article: Maheshwarappa HM, Guru P, Mundre RS, Lawrence N, Majumder S, Sigamani A, et al. Validation of an Isothermal Amplification Platform for Microbial Identification and Antimicrobial Resistance Detection in Blood: A Prospective Study. Indian J Crit Care Med 2021;25(3):299–304.
Collapse
Affiliation(s)
- Harish M Maheshwarappa
- Department of Intensive Care Medicine, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Prasadini Guru
- Department of Laboratory Medicine, Microbiology and Serology, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | - Nima Lawrence
- OmiX Research and Diagnostics Laboratories, Bangalore, Karnataka, India
| | - Snehali Majumder
- Department of Clinical Research, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - Alben Sigamani
- Department of Clinical Research, Narayana Hrudayalaya, Bangalore, Karnataka, India
| | - C N Anupama
- OmiX Research and Diagnostics Laboratories, Bangalore, Karnataka, India
| | - Sudeshna Adak
- OmiX Research and Diagnostics Laboratories, Bangalore, Karnataka, India
| |
Collapse
|
21
|
Wang C, Hao W, Yu R, Wang X, Zhang J, Wang B. Analysis of Pathogen Distribution and Its Antimicrobial Resistance in Bloodstream Infections in Hospitalized Children in East China, 2015-2018. J Trop Pediatr 2020; 67:6048386. [PMID: 33367870 PMCID: PMC7948388 DOI: 10.1093/tropej/fmaa077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study analyzed the pathogen distribution in bloodstream-infected (BSI) children hospitalized in Shandong Province from 2015 to 2018, to identify prevention strategies and select empiric antimicrobial therapy for BSI in children. Blood sample data from 14 107 children from 162 hospitals of Shandong Province were obtained from the China Antimicrobial Resistance Surveillance System and analyzed with WHONET 5.6 software. The results of the blood culture test showed the growth of 70.6% Gram-positive and 29.4% Gram-negative bacteria. Of the 14 107 blood isolates, 59.3% were collected from males and 40.7% were from females. Coagulase-negative staphylococci (47.1%) were the most commonly distributed pathogens. The distribution of pathogens varied according to age group and season. All Staphylococcus isolates were susceptible to vancomycin, teicoplanin and linezolid. Clinically, significant declines in penicillin-resistant Streptococcus pneumonia and carbapenem-resistant Escherichia coli were observed during the study period; however, detection rates of carbapenem-resistant Klebsiella pneumoniae increased over time (p < 0.05). Empiric antimicrobial therapy should be prescribed according to corresponding regional pediatric antimicrobial-resistant data.
Collapse
Affiliation(s)
- Cuicui Wang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China,Correspondence: Bo Wang, Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Room 117, Renhe Building, No. 324 Jingwu Road, Huaiyin District, Jinan 250021, China. Tel: +86-531-68777020. Fax: +86-531-87030081. E-mail <>
| | - Wei Hao
- Pediatric Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Ruihua Yu
- Pediatric Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiaokang Wang
- Pediatric Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jing Zhang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Bo Wang
- Medical Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| |
Collapse
|
22
|
Rogne T, Solligård E, Burgess S, Brumpton BM, Paulsen J, Prescott HC, Mohus RM, Gustad LT, Mehl A, Åsvold BO, DeWan AT, Damås JK. Body mass index and risk of dying from a bloodstream infection: A Mendelian randomization study. PLoS Med 2020; 17:e1003413. [PMID: 33196656 PMCID: PMC7668585 DOI: 10.1371/journal.pmed.1003413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In observational studies of the general population, higher body mass index (BMI) has been associated with increased incidence of and mortality from bloodstream infection (BSI) and sepsis. On the other hand, higher BMI has been observed to be apparently protective among patients with infection and sepsis. We aimed to evaluate the causal association of BMI with risk of and mortality from BSI. METHODS AND FINDINGS We used a population-based cohort in Norway followed from 1995 to 2017 (the Trøndelag Health Study [HUNT]), and carried out linear and nonlinear Mendelian randomization analyses. Among 55,908 participants, the mean age at enrollment was 48.3 years, 26,324 (47.1%) were men, and mean BMI was 26.3 kg/m2. During a median 21 years of follow-up, 2,547 (4.6%) participants experienced a BSI, and 451 (0.8%) died from BSI. Compared with a genetically predicted BMI of 25 kg/m2, a genetically predicted BMI of 30 kg/m2 was associated with a hazard ratio for BSI incidence of 1.78 (95% CI: 1.40 to 2.27; p < 0.001) and for BSI mortality of 2.56 (95% CI: 1.31 to 4.99; p = 0.006) in the general population, and a hazard ratio for BSI mortality of 2.34 (95% CI: 1.11 to 4.94; p = 0.025) in an inverse-probability-weighted analysis of patients with BSI. Limitations of this study include a risk of pleiotropic effects that may affect causal inference, and that only participants of European ancestry were considered. CONCLUSIONS Supportive of a causal relationship, genetically predicted BMI was positively associated with BSI incidence and mortality in this cohort. Our findings contradict the "obesity paradox," where previous traditional epidemiological studies have found increased BMI to be apparently protective in terms of mortality for patients with BSI or sepsis.
Collapse
Affiliation(s)
- Tormod Rogne
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Solligård
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ben M. Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Clinic of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Julie Paulsen
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hallie C. Prescott
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
- VA Center for Clinical Management Research, Ann Arbor, Michigan, United States of America
| | - Randi M. Mohus
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lise T. Gustad
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Arne Mehl
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bjørn O. Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Andrew T. DeWan
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Jan K. Damås
- Gemini Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
23
|
Dat VQ, Toan PK, van Doorn HR, Thwaites CL, Nadjm B. Purchase and use of antimicrobials in the hospital sector of Vietnam, a lower middle-income country with an emerging pharmaceuticals market. PLoS One 2020; 15:e0240830. [PMID: 33079967 PMCID: PMC7575121 DOI: 10.1371/journal.pone.0240830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Antimicrobial use is associated with emergence of antimicrobial resistance. We report hospital antimicrobial procurement, as a surrogate for consumption in humans, expenditure and prices in public hospitals in Vietnam, a lower middle-income country with a high burden of drug resistant infections. METHOD Data on antimicrobial procurement were obtained from tender-winning bids from provincial health authorities and public hospitals with detailed bids representing 28.7% (1.68 / 5.85 billion US $) of total hospital medication spend in Vietnam. Antimicrobials were classified using the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Volume was measured in number of Defined Daily Doses (DDD). Antimicrobial prices were presented per DDD. RESULTS Expenditure on systemic antibacterials and antifungals accounted for 28.6% (US $482.6 million/US $1.68 billion) of the total drug bids. 83% of antibacterials (572,698,014 DDDs) by volume (accounting for 45.5% of the antibacterials spend) were domestically supplied. Overall, the most procured antibacterials by DDD were second generation cephalosporins, combinations of penicillins and beta-lactamase inhibitors, and penicillins with extended spectrum. For parenteral antibacterials this was third generation cephalosporins. The average price for antibacterials was US $15.6, US $0.86, US $0.4 and US $11.7 per DDD for Reserve, Watch, Access and non-recommended/unclassified group antibacterials, respectively. CONCLUSIONS Antimicrobials accounted for a substantial proportion of the funds spent for medication in public hospitals in Vietnam. The pattern of antibacterial consumption was similar to other countries. The high prices of Reserve group and non-recommended/unclassified antibacterials suggests a need for a combination of national pricing and antimicrobial stewardship policies to ensure appropriate accessibility.
Collapse
Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Hanoi Medical University Hospital, Hanoi, Vietnam
- Wellcome Africa Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Phan Khanh Toan
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Wellcome Africa Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - C. Louise Thwaites
- Wellcome Africa Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Behzad Nadjm
- Wellcome Africa Asia Programme, Oxford University Clinical Research Unit, Hanoi, Vietnam
- MRC The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| |
Collapse
|
24
|
Essential Oils of Zingiber Species from Vietnam: Chemical Compositions and Biological Activities. PLANTS 2020; 9:plants9101269. [PMID: 32993137 PMCID: PMC7601767 DOI: 10.3390/plants9101269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
Mosquito-borne diseases are a large problem in Vietnam as elsewhere. Due to environmental concerns regarding the use of synthetic insecticides as well as developing insecticidal resistance, there is a need for environmentally-benign alternative mosquito control agents. In addition, resistance of pathogenic microorganisms to antibiotics is an increasing problem. As part of a program to identify essential oils as alternative larvicidal and antimicrobial agents, the leaf, stem, and rhizome essential oils of several Zingiber species, obtained from wild-growing specimens in northern Vietnam, were acquired by hydrodistillation and investigated using gas chromatography. The mosquito larvicidal activities of the essential oils were assessed against Culex quinquefasciatus, Aedes albopictus, and Ae. aegypti, and for antibacterial activity against a selection of Gram-positive and Gram-negative bacteria, and for activity against Candida albicans. Zingiber essential oils rich in α-pinene and β-pinene showed the best larvicidal activity. Zingiber nudicarpum rhizome essential oil showed excellent antibacterial activity against Enterococcus faecalis, Staphylococcus aureus, and Bacillus cereus, with minimum inhibitory concentrations (MIC) of 2, 8, and 1 μg/mL, respectively. However, the major components, α-pinene and β-pinene, cannot explain the antibacterial activities obtained.
Collapse
|
25
|
Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
Collapse
Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
| |
Collapse
|
26
|
Genetic Characterization of Methicillin-Resistant Staphylococcus aureus Isolates from Human Bloodstream Infections: Detection of MLS B Resistance. Antibiotics (Basel) 2020; 9:antibiotics9070375. [PMID: 32635147 PMCID: PMC7400445 DOI: 10.3390/antibiotics9070375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
In this study we aimed to characterize antimicrobial resistance in methicillin-resistant Staphylococcus aureus (MRSA) isolated from bloodstream infections as well as the associated genetic lineages of the isolates. Sixteen MRSA isolates were recovered from bacteremia samples from inpatients between 2016 and 2019. The antimicrobial susceptibility of these isolates was tested by the Kirby–Bauer disk diffusion method against 14 antimicrobial agents. To determine the macrolide–lincosamide–streptogramin B (MLSB) resistance phenotype of the isolates, erythromycin-resistant isolates were assessed by double-disk diffusion (D-test). The resistance and virulence genes were screened by polymerase chain reaction (PCR). All isolates were characterized by multilocus sequence typing (MLST), spa typing, staphylococcal chromosomal cassette mec (SCCmec) typing, and accessory gene regulator (agr) typing. Isolates showed resistance to cefoxitin, penicillin, ciprofloxacin, erythromycin, fusidic acid, clindamycin, and aminoglycosides, confirmed by the presence of the blaZ, ermA, ermC, mphC, msrA/B, aac(6’)-Ie-aph(2’’)-Ia, and ant(4’)-Ia genes. Three isolates were Panton–Valentine-leukocidin-positive. Most strains (n = 12) presented an inducible MLSB phenotype. The isolates were ascribed to eight spa-types (t747, t002, t020, t1084, t008, t10682, t18526, and t1370) and four MLSTs (ST22, ST5, ST105, and ST8). Overall, most (n = 12) MRSA isolates had a multidrug-resistance profile with inducible MLSB phenotypes and belonged to epidemic MRSA clones.
Collapse
|
27
|
Chang K, Rattanavong S, Mayxay M, Keoluangkhot V, Davong V, Vongsouvath M, Luangraj M, Simpson AJH, Newton PN, Dance DAB. Bacteremia Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Vientiane, Lao PDR: A 5-Year Study. Am J Trop Med Hyg 2020; 102:1137-1143. [PMID: 32157990 PMCID: PMC7204562 DOI: 10.4269/ajtmh.19-0304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although there has been an increasing incidence of bacteremia caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) across South East Asia, there are sparse data from the Lao PDR, where laboratory capacity for antimicrobial resistance surveillance is limited. We, therefore, retrospectively reviewed bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae between 2010 and 2014 at Mahosot Hospital, Vientiane, Lao PDR. Clinical and laboratory data relating to all episodes of ESBL-E bacteremia were reviewed over the 5-year period and compared with non-ESBL-E bacteremia. Blood cultures positive for E. coli or K. pneumoniae were identified retrospectively from laboratory records. Clinical and laboratory data were extracted from research databases and case notes and analyzed using STATA. Between 2010 and 2014, we identified 360 patients with E. coli (n = 249) or K. pneumoniae (n = 111) bacteremia, representing 34.8% of all patients with clinically significant bacteremia. Seventy-two (20%) isolates produced ESBL; E. coli accounted for 15.3% (55/360) and K. pneumoniae for 4.7% (17/360), respectively. The incidence of ESBL-producing E. coli bacteremia rose during the study period. By multiple logistic analysis, reported antibiotic use in the previous week was significantly associated with ESBL positivity (P < 0.001, odds ratio 3.89). Although multiresistant, most ESBL-producing E. coli and K. pneumoniae remained susceptible to meropenem (65/65; 100%) and amikacin (64/65; 98.5%). We demonstrated an alarming increase in the incidence of ESBL-E as a cause of bacteremia in Vientiane during the study period. This has implications for empiric therapy of sepsis in Laos, and ongoing surveillance is essential.
Collapse
Affiliation(s)
- Ko Chang
- Adult Infectious Diseases Ward, Mahosot Hospital, Vientiane, Laos
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Mayfong Mayxay
- Institute of Research and Education Development (IRED), University of Health Sciences, Vientiane, Laos.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | | | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Manophab Luangraj
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Andrew J H Simpson
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Paul N Newton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - David A B Dance
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| |
Collapse
|
28
|
Hemeg HA, Almutairi AZ, Alharbi NL, Alenezi RF, Alturkostani MA, Ozbak HA, Islam FA. Blood culture contamination in a tertiary care hospital of Saudi Arabia. A one-year study. Saudi Med J 2020; 41:508-515. [PMID: 32373918 PMCID: PMC7253833 DOI: 10.15537/smj.2020.5.25052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: To monitor blood culture contamination (BCC) rates in a tertiary care hospital in Saudi Arabia. Methods: Blood cultures submitted to the Microbiology Laboratory of King Fahad Hospital, Madina, Saudi Arabia between January and December 2017 were analyzed prospectively. Positive blood cultures were either designated as true bacteremia with confirmed bloodstream infection or BCC. Results: Among 5,536 blood cultures from 2201 patients, 364 (6.6%) mirrored BCC. There was an upward trend in contamination rates in specific months. With respect to total blood cultures from respective units over a one-year period, medical ward contributed to the highest contamination rate (10.3%). Blood culture contamination rate in the wards ranged from 4.5-10.3%, with a higher contamination rate in elderly, aged 60-80 years. Staphylococcus epidermidis (S. epidermidis) was the most frequent contaminant (44.5%). Conclusion: The escalated contamination rates in September to October may be attributed to difficulty in sampling blood by the less competent nurses during annual pilgrimage season. High influx of patients and shortage of trained nurses may have resulted in increased incidence in December-January and March-April. The prevalence of skin-resident S. epidermidis may be due to improper aseptic conditions. Ours is the first report on evaluation of BCC rates in Madina and call for renewed efforts in this direction.
Collapse
Affiliation(s)
- Hassan A Hemeg
- Department of Medical Laboratories Technology, Faculty of Applied Medical Sciences, Taibah University, Madina, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | | | |
Collapse
|
29
|
Khurana S, Bhardwaj N, Kumari M, Malhotra R, Mathur P. Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: A 4-year study. J Lab Physicians 2020; 10:426-431. [PMID: 30498316 PMCID: PMC6210839 DOI: 10.4103/jlp.jlp_78_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION: Bloodstream infections (BSIs) can lead to life-threatening sepsis and are globally associated with high morbidity and mortality. Although BSIs require immediate antimicrobial treatment, their prevalence, etiology, and antimicrobial susceptibilities differ from one country to other. There is a dearth of such data from India. Here, we report the 4-year etiologic data on BSI in trauma patients admitted to a tertiary care referral hospital in New Delhi, India. MATERIALS AND METHODS: A retrospective study was conducted at the trauma center between January 2013 and December 2016. The routine microbiological data on bacterial BSI were recorded and determined retrospectively from the laboratory records. Antimicrobial susceptibility profiles were statistically analyzed. RESULTS: A total of 2017 bacterial strains isolated from blood culture samples were included for microbiological analysis. During the study, the median age of the patients varied from 30 to 35 years, with the percentage of females in the study population varying from 17% to 19%. The predominant pathogens were Gram-negative bacteria, with Acinetobacter species, followed by Klebsiella species being the most commonly isolated organisms throughout the 4 years of study. Among Gram-positive isolates, Staphylococcus species were the leading pathogens (11%–15%). CONCLUSIONS: A detailed analysis of prevalence, etiology of BSIs in India and its resistance profile is crucial for appropriate antibiotic use, clinical management, and formulation of antibiotic policies and preventive measures.
Collapse
Affiliation(s)
- Surbhi Khurana
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Bhardwaj
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Kumari
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
30
|
Wyres KL, Nguyen TNT, Lam MMC, Judd LM, van Vinh Chau N, Dance DAB, Ip M, Karkey A, Ling CL, Miliya T, Newton PN, Lan NPH, Sengduangphachanh A, Turner P, Veeraraghavan B, Vinh PV, Vongsouvath M, Thomson NR, Baker S, Holt KE. Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia. Genome Med 2020; 12:11. [PMID: 31948471 DOI: 10.1101/557785v1.full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/12/2019] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extended-spectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. METHODS We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. RESULTS K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 K-loci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae. CONCLUSIONS K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.
Collapse
Affiliation(s)
- Kelly L Wyres
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - To N T Nguyen
- Hospital of Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Margaret M C Lam
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Louise M Judd
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | | | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Abhilasha Karkey
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Patan Academy of Health Sciences, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Clare L Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amphone Sengduangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Phat Voong Vinh
- Hospital of Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Nicholas R Thomson
- London School of Hygiene and Tropical Medicine, London, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) Department of Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.
| | - Kathryn E Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
31
|
Wyres KL, Nguyen TNT, Lam MMC, Judd LM, van Vinh Chau N, Dance DAB, Ip M, Karkey A, Ling CL, Miliya T, Newton PN, Lan NPH, Sengduangphachanh A, Turner P, Veeraraghavan B, Vinh PV, Vongsouvath M, Thomson NR, Baker S, Holt KE. Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia. Genome Med 2020; 12:11. [PMID: 31948471 PMCID: PMC6966826 DOI: 10.1186/s13073-019-0706-y] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/12/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extended-spectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. METHODS We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. RESULTS K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 K-loci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae. CONCLUSIONS K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.
Collapse
Affiliation(s)
- Kelly L Wyres
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - To N T Nguyen
- Hospital of Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Margaret M C Lam
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Louise M Judd
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | | | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Abhilasha Karkey
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Patan Academy of Health Sciences, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Clare L Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, 63110, Thailand
| | - Thyl Miliya
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amphone Sengduangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Phat Voong Vinh
- Hospital of Tropical Diseases, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Nicholas R Thomson
- London School of Hygiene and Tropical Medicine, London, UK
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID) Department of Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.
| | - Kathryn E Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
32
|
Thai Son N, Thu Huong VT, Kim Lien VT, Quynh Nga DT, Hai Au TT, Thu Hang PT, Nguyet Minh HT, Binh TQ. Antimicrobial Resistance Profile and Molecular Characteristics of Staphylococcus aureus Isolates from Hospitalized Adults in Three Regions of Vietnam. Jpn J Infect Dis 2019; 73:193-200. [PMID: 31875603 DOI: 10.7883/yoken.jjid.2019.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate antimicrobial resistance profile, multidrug resistance (MDR), and molecular characteristics of pathogenic Staphylococcus aureus isolates from hospitalized Vietnamese adults. Two hundred and twenty-three pathogenic S. aureus isolates were obtained from the hospitals located in 3 regions of Vietnam. The minimum inhibitory concentrations were determined to detect the antibiotic susceptibility of the isolates. The molecular characteristics of S. aureus isolates were investigated through antibiotic-resistant genes analysis, staphylococcal cassette chromosome mec typing, pulsed-field gel electrophoresis, and multilocus sequence typing. Substantial differences among the 3 regions were found in the prevalence rates of methicillin-resistant S. aureus (north: 48.6%, central: 58.7%, south: 78.9%) and MDR (north: 65.8%, central: 79.7%, and south: 84.2%). The prevalence rates of the genes tetK/M, aacA/aphD, ermA/B/C, and mecA increased substantially from north to south. ST188-SCCmecIV and ST239-SCCmecII isolates were most commonly found in the 2 largest clusters. ST188 predominance was observed in the largest cluster in methicillin-resistant and methicillin-sensitive S. aureus isolates, including SCCmecIII and SCCmecIVa, in fatal cases. Our results revealed a high occurrence of MDR and possible north-south trend in antibiotic resistance profile, MDR patterns, and frequency of antibiotic-conferring genes among S. aureus isolates. ST188 predominance raises concerns about the global importance of host-adapted ST188 in East Asian populations.
Collapse
Affiliation(s)
- Nguyen Thai Son
- Department of Medical Microbiology, Vietnam Military Medical University
| | | | | | | | | | | | | | - Tran Quang Binh
- National Institute of Hygiene and Epidemiology.,Dinh Tien Hoang Institute of Medicine, High Tech Business Incubator Center
| |
Collapse
|
33
|
Hung PN, Quyet D, Thanh KC, Pho DC, Tien TV, Dung QA, Linh DD, Tan HT, Dinh TC, Bac ND, Nam LV. Antibiotic Resistance Profile and Diversity of Subtypes Genes in Escherichia coli Causing Bloodstream Infection in Northern Vietnam. Open Access Maced J Med Sci 2019; 7:4393-4398. [PMID: 32215101 PMCID: PMC7084042 DOI: 10.3889/oamjms.2019.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Evaluating the antibiotic susceptibility and resistance genes is essential in the clinical management of bloodstream infections (BSIs). But there are still limited studies in Northern Vietnam. AIM: The aim of the study was to determine the antibiotic resistance profile and characteristics of subtypes genes in Escherichia coli causing BSIs in Northern Vietnam. METHODS: The cross-sectional study was done in the period from December 2012 to June 2014 in two tertiary hospitals in Northern Vietnam. Tests were performed at the lab of the hospital. RESULTS: In 56 E. coli strains isolating 39.29 % produced ESBL. 100% of the isolates harbored blaTEM gene, but none of them had the blaPER gene. The prevalence of ESBL producers and ESBL non-producers in blaCTX-M gene was 81.82%, and 73.53%, in blaSHV gene was 18.18% and 35.29%. Sequencing results showed three blaTEM subtypes (blaTEM 1, 79, 82), four blaCTX-M subtypes (blaCTX-M-15, 73, 98, 161), and eight blaSHV subtypes (blaSHV 5, 7, 12, 15, 24, 33, 57, 77). Antibiotic resistance was higher in ampicillin (85.71%), trimethoprim/sulfamethoxazole (64.29%) and cephazolin (50%). Antibiotics were still highly susceptible including doripenem (96.43%), ertapenem (94.64%), amikacin (96.43%), and cefepime (89.29%). CONCLUSION: In Escherichia coli causing BSIs, antibiotic resistance was higher in ampicillin, trimethoprim/sulfamethoxazole and cephazolin. Antibiotics was highly susceptible including doripenem, ertapenem, amikacin, and cefepime.
Collapse
Affiliation(s)
- Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam.,Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Quyet
- Department of Tuberculosis and Lung Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Kieu Chi Thanh
- Department of Hospital Infection Control, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Dinh Cong Pho
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tran Viet Tien
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Quan Anh Dung
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Dieu Linh
- Faculty of Medicine, Hai Phong Medical University, 72A Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Ha The Tan
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Nguyen Duy Bac
- Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Van Nam
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| |
Collapse
|
34
|
Nam LV, Quyet D, Hung PN, Tien TV, Thanh KC, Dung QA, Linh DD, Tan HT, Bac ND, Dinh TC, Pho DC. Antibiotic Resistance Profile and Methicillin-Resistant Encoding Genes of Staphylococcus aureus Strains Isolated from Bloodstream Infection Patients in Northern Vietnam. Open Access Maced J Med Sci 2019; 7:4406-4410. [PMID: 32215103 PMCID: PMC7084013 DOI: 10.3889/oamjms.2019.871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Evaluating the antibiotic susceptibility and resistance genes is essential in the clinical management of bloodstream infections (BSIs). Nevertheless, there are still limited studies in Northern Vietnam. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) AIM: This study aimed to determine the antibiotic resistance profile and methicillin-resistant encoding genes of Staphylococcus aureus (S. aureus) causing BSIs in Northern Vietnam. METHODS: The cross-sectional study was done from December 2012 to June 2014 in two tertiary hospitals in Northern Vietnam. Tests performed at the lab of the hospital. RESULTS: In 43 S. aureus strains isolating, 53.5 % were MRSA. Distribution of gene for overall, MRSA, and MSSA strains were following mecA gene (58.1 %; 95.7%, and 15%), femA gene (48.8%, 47.8%, and 50%), femB gene (88.4%, 82.6%, and 95%). Antibiotic resistance was highest in penicillin (100%), followed by erythromycin (65.1%) and clindamycin (60.5%). Several antibiotics were susceptible (100%), including vancomycin, tigecycline, linezolid, quinupristin/dalfopristin. Quinolone group was highly sensitive, include ciprofloxacin (83.7%), levofloxacin (86%) and moxifloxacin (86%). CONCLUSION: In S. aureus causing BSIs, antibiotic resistance was higher in penicillin, erythromycin, and clindamycin. All strains were utterly susceptible to vancomycin, tigecycline, linezolid, quinupristin/dalfopristin.
Collapse
Affiliation(s)
- Le Van Nam
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Quyet
- Director of Vietnam Military Medical University, Department of Tuberculosis and Lung Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam.,Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tran Viet Tien
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Kieu Chi Thanh
- Department of Hospital Infection Control, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Quan Anh Dung
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Dieu Linh
- Faculty of Medicine, Hai Phong Medical University, 72A Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Ha The Tan
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Dinh Cong Pho
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| |
Collapse
|
35
|
Nguyen TK, Argudín MA, Deplano A, Nhung PH, Nguyen HA, Tulkens PM, Dodemont M, Van Bambeke F. Antibiotic Resistance, Biofilm Formation, and Intracellular Survival As Possible Determinants of Persistent or Recurrent Infections by Staphylococcus aureus in a Vietnamese Tertiary Hospital: Focus on Bacterial Response to Moxifloxacin. Microb Drug Resist 2019; 26:537-544. [PMID: 31825276 DOI: 10.1089/mdr.2019.0282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Resistance is notoriously high in Asia but may not entirely explain therapeutic failures. Specific modes of bacterial life, such as biofilm or intracellular survival, may also contribute to the persistent and/or recurrent character of infections. Most Staphylococcus aureus isolates form biofilm and many survive and even thrive intracellularly. We collected 36 nonduplicate S. aureus isolates (including 18 methicillin-resistant S. aureus) from patients with clinical evidence of persistent or recurrent infections in a large tertiary Vietnamese hospital. We examined their antibiotic resistance profile (minimal inhibitory concentration determination) and clonal relatedness (spa and agr typing, pulsed field gel electrophoresis profiles). We then assessed the activity of moxifloxacin in both biofilms and infected phagocytes (moxifloxacin previously proved to be one of the most active antibiotics against reference strains in these models). spa-types t189 and t437 and agr group I were the most frequent. Among the 36 isolates, 30 were multidrug resistant but 30 were recovered from patients having received an active drug. All tested isolates produced biofilm and survived inside phagocytes. At its human Cmax, moxifloxacin was inactive on biofilms made by moxifloxacin-susceptible as well as moxifloxacin-resistant isolates. It caused only a modest intracellular colony-forming unit decrease against moxifloxacin-susceptible isolates and was inactive against those resistant to moxifloxacin. While our data confirm for this collection the high resistance levels and prevalence of endemic spa- or agr- types in Asia, they show that tolerance in both biofilm and phagocytes are correlated and markedly limit moxifloxacin activity, which goes in line with the suggested role of these modes of life in persistence or recurrence of infections.
Collapse
Affiliation(s)
- Tiep Khac Nguyen
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Maria A Argudín
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Ariane Deplano
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Pham Hong Nhung
- Department of Microbiology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hoang Anh Nguyen
- The National Center for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Magali Dodemont
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| |
Collapse
|
36
|
Liu C, Yoon EJ, Kim D, Shin JH, Shin JH, Shin KS, Kim YA, Uh Y, Kim HS, Kim YR, Jeong SH. Antimicrobial resistance in South Korea: A report from the Korean global antimicrobial resistance surveillance system (Kor-GLASS) for 2017. J Infect Chemother 2019; 25:845-859. [DOI: 10.1016/j.jiac.2019.06.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 11/17/2022]
|
37
|
Evaluation of microorganisms isolated from blood cultures and their susceptibility profiles to antibiotics in five years period. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.626480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
38
|
Sivasankar P, Poongodi S, Seedevi P, Kalaimurugan D, Sivakumar M, Loganathan S. Nanoparticles from Actinobacteria: A Potential Target to Antimicrobial Therapy. Curr Pharm Des 2019; 25:2626-2636. [PMID: 31603056 DOI: 10.2174/1381612825666190709221710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022]
Abstract
Nanoparticles have gained significant importance in the past two decades, due to their multifaceted applications in the field of nanomedicine. As our ecosystems and habitats are changing due to global warming, many new diseases are emerging continuously. Treating these costs a lot of money and mostly ends up in failure. In addition, frequent use of antibiotics to control the emerging diseases has led the pathogens to develop resistance to antibiotics. Hence, the nanoparticles are targeted to treat such diseases instead of the costly antibiotics. In particular, the biosynthesized nanoparticles have received considerable attention due to their simple, eco-friendly and promising activity. To highlight, microbial mediated nanoparticles have been found to possess higher activity and thus have a promising role in antimicrobial therapy to fight against the emerging drug-resistant pathogens. In this context, this review article is aimed at highlight the role of nanoparticles in the field of nanomedicine and importance of actinobacteria in the nanoparticle synthesis and their need in antimicrobial therapy. This is a comprehensive review, focusing on the potential of actinobacteria-mediated nanoparticles in the field of nanomedicine.
Collapse
Affiliation(s)
- Palaniappan Sivasankar
- Department of Environmental Science, School of Life Sciences, Periyar University, Salem- 636011, Tamil Nadu, India
| | - Subramaniam Poongodi
- Centre of Advanced Study in Marine Biology, Faculty of Marine Sciences, Annamalai University, Parangipettai - 608 502, Tamil Nadu, India
| | - Palaniappan Seedevi
- Department of Environmental Science, School of Life Sciences, Periyar University, Salem- 636011, Tamil Nadu, India
| | - Dharman Kalaimurugan
- Department of Environmental Science, School of Life Sciences, Periyar University, Salem- 636011, Tamil Nadu, India
| | - Murugesan Sivakumar
- Department of Environmental Science, School of Life Sciences, Periyar University, Salem- 636011, Tamil Nadu, India
| | - Sivakumar Loganathan
- Department of Environmental Science, School of Life Sciences, Periyar University, Salem- 636011, Tamil Nadu, India
| |
Collapse
|
39
|
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]
|
40
|
Jacobs J, Hardy L, Semret M, Lunguya O, Phe T, Affolabi D, Yansouni C, Vandenberg O. Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance. Front Med (Lausanne) 2019; 6:205. [PMID: 31608280 PMCID: PMC6771306 DOI: 10.3389/fmed.2019.00205] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 09/03/2019] [Indexed: 12/28/2022] Open
Abstract
This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an "entry-level version" of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.
Collapse
Affiliation(s)
- Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Makeda Semret
- JD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, Canada
| | - Octavie Lunguya
- Department of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
- Service of Microbiology, Kinshasa General Hospital, Kinshasa, Democratic Republic of Congo
| | - Thong Phe
- Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia
| | - Dissou Affolabi
- Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, Benin
| | - Cedric Yansouni
- JD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, Canada
| | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Innovation and Business Development Unit, LHUB - ULB, Pôle Hospitalier Universitaire de Bruxelles (PHUB), Université Libre de Bruxelles (ULB), Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom
| |
Collapse
|
41
|
Chen SL, Ding Y, Apisarnthanarak A, Kalimuddin S, Archuleta S, Omar SFS, De PP, Koh TH, Chew KL, Atiya N, Suwantarat N, Velayuthan RD, Wong JGX, Lye DC. The higher prevalence of extended spectrum beta-lactamases among Escherichia coli ST131 in Southeast Asia is driven by expansion of a single, locally prevalent subclone. Sci Rep 2019; 9:13245. [PMID: 31519972 PMCID: PMC6744567 DOI: 10.1038/s41598-019-49467-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/24/2019] [Indexed: 01/29/2023] Open
Abstract
The ST131 multilocus sequence type (MLST) of Escherichia coli is a globally successful pathogen whose dissemination is increasing rates of antibiotic resistance. Numerous global surveys have demonstrated the pervasiveness of this clone; in some regions ST131 accounts for up to 30% of all E. coli isolates. However, many regions are underrepresented in these published surveys, including Africa, South America, and Asia. We collected consecutive bloodstream E. coli isolates from three countries in Southeast Asia; ST131 was the most common MLST type. As in other studies, the C2/H30Rx clade accounted for the majority of ST131 strains. Clinical risk factors were similar to other reported studies. However, we found that nearly all of the C2 strains in this study were closely related, forming what we denote the SEA-C2 clone. The SEA-C2 clone is enriched for strains from Asia, particularly Southeast Asia and Singapore. The SEA-C2 clone accounts for all of the excess resistance and virulence of ST131 relative to non-ST131 E. coli. The SEA-C2 strains appear to be locally circulating and dominant in Southeast Asia, despite the intuition that high international connectivity and travel would enable frequent opportunities for other strains to establish themselves.
Collapse
Affiliation(s)
- Swaine L Chen
- Genome Institute of Singapore, Agency for Science, Technology, and Research, 60 Biopolis Street, Genome #02-01, Singapore, 138672, Singapore. .,Department of Medicine, Division of Infectious Diseases, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.
| | - Ying Ding
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, 95 Phahonyothin Rd, Khlong Nueng, Khlong Luang District, Pathum Thani, 12120, Thailand
| | - Shirin Kalimuddin
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Sophia Archuleta
- Department of Medicine, Division of Infectious Diseases, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,University Medicine Cluster, Division of Infectious Diseases, National University Hospital, , 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Sharifah Faridah Syed Omar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Partha Pratim De
- Communicable Diseases Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Tse Hsien Koh
- Department of Microbiology, Division of Pathology, Singapore General Hospital, Academia, Diagnostics Tower, Level 7, 20 College Road, Singapore, 169856, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Nadia Atiya
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nuntra Suwantarat
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, 12120, Thailand
| | - Rukumani Devi Velayuthan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Joshua Guo Xian Wong
- Communicable Diseases Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - David C Lye
- Department of Medicine, Division of Infectious Diseases, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore. .,National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore, 308442, Singapore. .,Communicable Diseases Centre, Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, 308433, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 639798, Singapore.
| |
Collapse
|
42
|
Reed TAN, Krang S, Miliya T, Townell N, Letchford J, Bun S, Sar B, Osbjer K, Seng S, Chou M, By Y, Vanchinsuren L, Nov V, Chau D, Phe T, de Lauzanne A, Ly S, Turner P. Antimicrobial resistance in Cambodia: a review. Int J Infect Dis 2019; 85:98-107. [PMID: 31176035 DOI: 10.1016/j.ijid.2019.05.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Following the launch of the Global Antimicrobial Resistance Surveillance System (GLASS), antimicrobial resistance (AMR) rates in many countries remain poorly described. This review provides an overview of published AMR data from Cambodia in the context of recently initiated national human and food-animal surveillance. METHODS PubMed and the Cochrane Database of Systematic Reviews were searched for articles published from 2000 to 2018, which reported antimicrobial susceptibility testing (AST) data for GLASS specific organisms isolated from Cambodia. Articles were screened using strict inclusion/exclusion criteria. AST data was extracted, with medians and ranges of resistance rates calculated for specific bug-drug combinations. RESULTS Twenty-four papers were included for final analysis, with 20 describing isolates from human populations. Escherichia coli was the most commonly described organism, with median resistance rates from human isolates of 92.8% (n=6 articles), 46.4% (n=4), 55.4% (n=8), and 46.4% (n=5) to ampicillin, 3rd generation cephalosporins, fluoroquinolones, and gentamicin respectively. CONCLUSIONS Whilst resistance rates are high for several GLASS organisms, there were insufficient data to draw robust conclusions about the AMR situation in Cambodia. The recently implemented national AMR surveillance systems will begin to address this data gap.
Collapse
Affiliation(s)
- Thomas A N Reed
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sidonn Krang
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Thyl Miliya
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Nicola Townell
- Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Joanne Letchford
- Diagnostic Microbiology Development Program, Phnom Penh, Cambodia
| | - Sreng Bun
- United States Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Borann Sar
- United States Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | - Kristina Osbjer
- Food and Agriculture Organisation of the United Nations, Phnom Penh, Cambodia
| | - Sokerya Seng
- Food and Agriculture Organisation of the United Nations, Phnom Penh, Cambodia
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | - Youlet By
- Fondation Mérieux, Phnom Penh, Cambodia
| | | | - Vandarith Nov
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Darapheak Chau
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Thong Phe
- Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | | | - Sovann Ly
- Department of Communicable Diseases Control, Ministry of Health, Phnom Penh, Cambodia
| | - Paul Turner
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | |
Collapse
|
43
|
Ansari S, Jha RK, Mishra SK, Tiwari BR, Asaad AM. Recent advances in Staphylococcus aureus infection: focus on vaccine development. Infect Drug Resist 2019; 12:1243-1255. [PMID: 31190912 PMCID: PMC6526327 DOI: 10.2147/idr.s175014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus normally colonizes the nasal cavity and pharynx. After breaching the normal habitat, the organism is able to cause a number of infections at any site of the body. The development of antibiotic resistance has created a global challenge for treating infections. Therefore, protection by vaccines may provide valuable measures. Currently, several vaccine candidates have been prepared which are either in preclinical phase or in early clinical phase, whereas several candidates have failed to show a protective efficacy in human subjects. Approaches have also been made in the development of monoclonal or polyclonal antibodies for passive immunization to protect from S. aureus infections. Therefore, in this review we have summarized the findings of recently published scientific literature to make a concise report.
Collapse
Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Rajesh Kumar Jha
- Department of Systems and Diseases (Pharmacology), Saba University School of Medicine, Saba, Dutch Caribbean
| | - Shyam Kumar Mishra
- Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Ahmed Morad Asaad
- Department of Microbiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
44
|
Hattori H, Maeda M, Nagatomo Y, Takuma T, Niki Y, Naito Y, Sasaki T, Ishino K. Epidemiology and risk factors for mortality in bloodstream infections: A single-center retrospective study in Japan. Am J Infect Control 2018; 46:e75-e79. [PMID: 30172607 DOI: 10.1016/j.ajic.2018.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few published data are available on the morbidity and mortality of bloodstream infections (BSIs) in Japan. We sought to investigate the epidemiology of BSIs, the involvement of antimicrobial resistance, and the factors that influence patient prognosis. METHODS This single-center study retrospectively evaluated patients who were found to have positive blood cultures at a tertiary teaching hospital between January 2012 and December 2016. RESULTS A total of 2,105 patients with BSIs were included; 1,786 survived and 319 died, and the 30-day mortality rate was 15.2% over the 5-year study period. BSIs caused by yeasts were independently associated with 30-day mortality. The 30-day mortality rate of BSIs caused by extended-spectrum beta lactamase-producing gram-negative bacteria was significantly higher than that of BSIs caused by nonproducing bacteria. DISCUSSION The differences in mortality may be caused by differences in the distribution of pathogens and in the delivery of health care. CONCLUSIONS This study reported epidemiology and antimicrobial resistance data of BSIs in Japan and identified several risk factors associated with 30-day mortality. National surveillance of BSIs is required in Japan for comparison with other countries.
Collapse
Affiliation(s)
- Haruka Hattori
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan; Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan.
| | - Yasuhiro Nagatomo
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Takahiro Takuma
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yoshihito Niki
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yuika Naito
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Tadanori Sasaki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Keiko Ishino
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan
| |
Collapse
|
45
|
Dat VQ, Long NT, Hieu VN, Phuc NDH, Kinh NV, Trung NV, van Doorn HR, Bonell A, Nadjm B. Clinical characteristics, organ failure, inflammatory markers and prediction of mortality in patients with community acquired bloodstream infection. BMC Infect Dis 2018; 18:535. [PMID: 30367601 PMCID: PMC6204014 DOI: 10.1186/s12879-018-3448-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 10/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Community acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam. METHODS This was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated. RESULTS Among 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793-0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577-0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605-0.780 and AUC 0.527, 95%CI 0.424-0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p < 0.001) and infection with Enterobacteriaceae (HR = 1.722, p = 0.037) were independent risk factors for in-hospital mortality. CONCLUSIONS Organ dysfunction was common among Vietnamese patients with CABSI and associated with high case fatality. SOFA and qSOFA both need to be further validated in this setting.
Collapse
Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Thanh Long
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Vu Ngoc Hieu
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Dinh Hong Phuc
- Department of Infectious Diseases, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Van Kinh
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Nguyen Vu Trung
- National Hospital for Tropical Diseases, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Department of Microbiology, Hanoi Medical University, no 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam
| | - H. Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Ana Bonell
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Hanoi, 78 Giai Phong street, Dong Da district, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
46
|
Lee H, Yoon EJ, Kim D, Jeong SH, Won EJ, Shin JH, Kim SH, Shin JH, Shin KS, Kim YA, Uh Y, Yang JW, Kim IH, Park C, Lee KJ. Antimicrobial resistance of major clinical pathogens in South Korea, May 2016 to April 2017: first one-year report from Kor-GLASS. Euro Surveill 2018; 23:1800047. [PMID: 30352640 PMCID: PMC6199864 DOI: 10.2807/1560-7917.es.2018.23.42.1800047] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022] Open
Abstract
The Korean government established an antimicrobial resistance (AMR) surveillance system, compatible with the Global AMR Surveillance System (GLASS): Kor-GLASS. We describe results from the first year of operation of the Kor-GLASS from May 2016 to April 2017, comprising all non-duplicated clinical isolates of major pathogens from blood, urine, faeces and urethral and cervical swabs from six sentinel hospitals. Antimicrobial susceptibility tests were carried out by disk diffusion, Etest, broth microdilution and agar dilution methods. Among 67,803 blood cultures, 3,523 target pathogens were recovered. The predominant bacterial species were Escherichia coli (n = 1,536), Klebsiella pneumoniae (n = 597) and Staphylococcus aureus (n = 584). From 57,477 urine cultures, 6,394 E. coli and 1,097 K. pneumoniae were recovered. Bloodstream infections in inpatients per 10,000 patient-days (10TPD) were highest for cefotaxime-resistant E. coli with 2.1, followed by 1.6 for meticillin-resistant Sta. aureus, 1.1 for imipenem-resistant Acinetobacter baumannii, 0.8 for cefotaxime-resistant K. pneumoniae and 0.4 for vancomycin-resistant Enterococcus faecium. Urinary tract infections in inpatients were 7.7 and 2.1 per 10TPD for cefotaxime-resistant E. coli and K. pneumoniae, respectively. Kor-GLASS generated well-curated surveillance data devoid of collection bias or isolate duplication. A bacterial bank and a database for the collections are under development.
Collapse
Affiliation(s)
- Hyukmin Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
- These authors contributed equally to this study
| | - Eun-Jeong Yoon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
- These authors contributed equally to this study
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jeong Won
- Department of Laboratory Medicine, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Si Hyun Kim
- Department of Clinical Laboratory Science, Semyung University, Chungbuk, Republic of Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Republic of Korea
| | - Kyeong Seob Shin
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji Woo Yang
- National Institute of Health, Centers of Disease Control and Prevention, Cheongju, Republic of Korea
| | - Il Hwan Kim
- National Institute of Health, Centers of Disease Control and Prevention, Cheongju, Republic of Korea
| | - Chan Park
- National Institute of Health, Centers of Disease Control and Prevention, Cheongju, Republic of Korea
| | - Kwang Jun Lee
- National Institute of Health, Centers of Disease Control and Prevention, Cheongju, Republic of Korea
| |
Collapse
|
47
|
Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health 2018; 18:1121. [PMID: 30219056 PMCID: PMC6138887 DOI: 10.1186/s12889-018-6013-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on the pathogens responsible for nosocomial bloodstream infection (BSI) and their antimicrobial resistance (AMR) in Hubei province are limited. This study was conducted to determine the major pathogens causing BSI and to characterize their AMR. METHODS Data from the China Antimicrobial Resistance Surveillance System (CARSS) from 2014 to 2016 were analyzed retrospectively. RESULTS Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were the most common pathogens responsible for nosocomial BSI. Individuals aged 0-5 years and ≥ 40 years old were the major demographics at risk of infection by E. coli, K. pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae, while individuals aged 0-5 years were the major demographic at risk of infection by S. aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae and Stenotrophomonas maltophilia. The frequencies of E. coli and K. pneumoniae isolates resistant to cefotaxime were 59.1% and 24.3%, respectively, and the frequencies of resistant isolates to ceftazidime were 42.9% and 27.2%, respectively. From 2014 to 2016, the frequency of extended-spectrum β-lactamase (ESBL)-positive E. coli declined from 29.07 to 24.5%, and the frequency of ESBL-positive K. pneumoniae declined from 18.64 to 12.33%. The frequency of carbapenem-resistant (CR) E. coli was below 0.5%, but 1-10% of K. pneumoniae isolates were CR. CONCLUSIONS The emergence of methicillin-resistant S. aureus and the expansion of ESBL and fluoroquinolone resistance among Gram-negative Enterobacteriaceae increased AMR severity. Carbapenemase-producing K. pneumoniae isolates responsible for nosocomial BSI increased year over year and effective infection control measures should be taken to prevent them from spreading.
Collapse
Affiliation(s)
- Lei Tian
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhen Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| |
Collapse
|
48
|
Shrestha P, Roberts T, Homsana A, Myat TO, Crump JA, Lubell Y, Newton PN. Febrile illness in Asia: gaps in epidemiology, diagnosis and management for informing health policy. Clin Microbiol Infect 2018; 24:815-826. [PMID: 29581051 DOI: 10.1016/j.cmi.2018.03.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/12/2018] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Increasing evidence is becoming available on the aetiology and management of fevers in Asia; the importance of these fevers has increased with the decline in the incidence of malaria. AIMS To conduct a narrative review of the epidemiology and management of fevers in South and South-East Asia and to highlight gaps in our knowledge that impair evidence-based health policy decisions. SOURCES A narrative review of papers published since 2012 on developments in fever epidemiology, diagnosis and treatment in South and South-East Asia. The papers that the authors felt were pivotal, from their personal perspectives, are discussed. CONTENT We identified 100 studies. Among the 30 studies (30%)-including both children and adults-that investigated three or more pathogens, the most frequently reported fever aetiology was dengue (reported by 15, 50%), followed by leptospirosis (eight, 27%), scrub typhus (seven, 23%) and Salmonella serovar Typhi (six, 20%). Among four studies investigating three or more pathogens in children, dengue and Staphylococcus aureus were the most frequent, followed by non-typhoidal Salmonella spp, Streptococcus pneumoniae, Salmonella serovar Typhi, and Orientia tsutsugamushi. Increased awareness is needed that rickettsial pathogens are common but do not respond to cephalosporins, and that alternative therapies, such as tetracyclines, are required. IMPLICATIONS Many key gaps remain, and consensus guidelines for study design are needed to aid comparative understanding of the epidemiology of fevers. More investment in developing accurate and affordable diagnostic tests for rural Asia and independent evaluation of those already on the market are needed. Treatment algorithms, including simple biomarker assays, appropriate for empirical therapy of fevers in different areas of rural Asia should be a major aim of fever research. Enhanced antimicrobial resistance (AMR) surveillance and openly accessible databases of geography-specific AMR data would inform policy on empirical and specific therapy. More investment in innovative strategies facilitating infectious disease surveillance in remote rural communities would be an important component of poverty reduction and improving public health.
Collapse
Affiliation(s)
- P Shrestha
- Infectious Diseases Data Observatory, University of Oxford, UK
| | - T Roberts
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - A Homsana
- Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - T O Myat
- Department of Microbiology, University of Medicine 1, Yangon, Myanmar; Centre for International Health, University of Otago, Dunedin, New Zealand
| | - J A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Y Lubell
- Madihol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - P N Newton
- Infectious Diseases Data Observatory, University of Oxford, UK; Lao-Oxford-Mahosot-Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, UK.
| |
Collapse
|
49
|
Alvarez-Uria G, Gandra S, Mandal S, Laxminarayan R. Global forecast of antimicrobial resistance in invasive isolates of Escherichia coli and Klebsiella pneumoniae. Int J Infect Dis 2018; 68:50-53. [PMID: 29410253 PMCID: PMC5889426 DOI: 10.1016/j.ijid.2018.01.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 12/27/2022] Open
Abstract
We aimed to estimate global trends of antimicrobial resistance of E. coli and K. pneumoniae invasive isolates. By 2030, over half of E. coli and K. pneumoniae invasive isolates could become resistant to third generation cephalosporins. Carbapenem resistance is increasing rapidly among K. pneumoniae invasive isolates.
Objectives To project future antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae. Methods Mixed linear models were constructed from a sample of countries with AMR data in the ResistanceMap database. Inverse probability weighting methods were used to account for countries without AMR data. Results The estimated prevalence of AMR in 2015 was 64.5% (95% confidence interval (CI) 42–87%) for third-generation cephalosporin-resistant (3GCR) Escherichia coli, 5.8% (95% CI 1.8–9.7%) for carbapenem-resistant (CR) E. coli, 66.9% (95% CI 47.1–86.8%) for 3GCR Klebsiella pneumoniae, and 23.4% (95% CI 7.4–39.4%) for CR K. pneumoniae. The projected AMR prevalence in 2030 was 77% (95% CI 55–99.1%) for 3GCR E. coli, 11.8% (95% CI 3.7–19.9%) for CR E. coli, 58.2% (95% CI 50.2–66.1%) for 3GCR K. pneumoniae, and 52.8% (95% CI 16.3–89.3%) for CR K. pneumoniae. Conclusions The models suggest that third-generation cephalosporins and carbapenems could be ineffective against a sizeable proportion of infections by E. coli and K. pneumoniae in most parts of the world by 2030, supporting both the need to enhance stewardship efforts and to prioritize research and development of new antibiotics for resistant Enterobacteriaceae.
Collapse
Affiliation(s)
- Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, AP, India
| | - Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, New Delhi, India; Department of Management Science, University of Strathclyde, Glasgow, UK
| | | | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India; Department of Management Science, University of Strathclyde, Glasgow, UK; Princeton Environmental Institute, Princeton, NJ, USA.
| |
Collapse
|