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Sharma K, Tak V, Nag VL, Bhatia PK, Kothari N. An observational study on carbapenem-resistant Enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India. Infect Prev Pract 2023; 5:100312. [PMID: 37868258 PMCID: PMC10585280 DOI: 10.1016/j.infpip.2023.100312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) are a global health problem with a growing prevalence. India has a high prevalence of CRE. CRE infections are difficult to treat, and are associated with significant morbidity and mortality. Colonisation is generally a prerequisite for infection and the prevention of CRE colonisation is key to the prevention of CRE infection. Objectives To determine the prevalence of CRE colonisation and subsequent infections in an adult intensive care unit (ICU) in India. Methods We conducted a prospective observational study in which perirectal swabs were obtained along with relevant clinical details of consenting adult patients upon ICU admission between January 2019 and August 2020. Rectal screening was performed using MacConkey agar plates with ertapenem disks and further identification was performed using conventional microbiological techniques. Ertapenem minimum inhibitory concentration (MIC) was determined using an epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and EDTA carbapenem inactivation test (eCIM) were performed to confirm carbapenem resistance using the Clinical Laboratory Standards Institute (CLSI) 2020 guidelines. Results 192 ICU patients were screened for CRE. 37 patients were found to be colonised with CRE. Klebsiella pneumoniae (N=25; 67.6%) was the most frequent CRE isolate, followed by Escherichia coli (N=11; 29.7%) and one Enterobacter species (N=1; 2.7%). 89.2% (33/37) patients developed CRE infection. Pneumonia was the most common CRE infection identified in 12/33 (36.4%) patients.during the hospital stay. The median duration of hospital stay was longer (17 days) for CRE colonised compared to CRE non-colonised patients (9 days) (P<0.001). Death occurred in 27 % (N=10/37) of CRE-colonised patients during the hospital admission. Conclusion CRE colonisation is associated with high risk of subsequent CRE infection and longer ICU and hospital admission.
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Affiliation(s)
- Kirtika Sharma
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vibhor Tak
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vijaya Lakshmi Nag
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | | | - Nikhil Kothari
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Detection of Carbapenem-resistant Enterobacteriaceae by Real-Time PCR and Assessment of Hospitalization Related Risk Factors Associated with their Fecal Carriage: A Case-control Study. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Opportunistic behavior of commensal bacteria during severe infection, especially of the intestine is always considered as a predisposing threat for the severely ill patient admitted to hospitals. A descriptive-analytical case-control study was carried out to detect the prevalence and risk factor analysis of fecal carriage of Carbapenem-resistant Enterobacteriaceae. Patients having fecal carriage of Carbapenem-resistant Enterobacteriaceae were considered as cases and patients who were without Carbapenem-resistant Enterobacteriaceae were taken as the control in a proportion of 1:4. Carbapenem-resistant Enterobacteriaceae (CRE) was confirmed by both conventional as well as molecular methods. Methods such as Combined Disk Test, mCIMtest, and RAPIDEC CarbaNP Test were used for phenotypic identification of CRE, Whereas Real-Time (RT)-PCR was used for the detection of bla-gene encoded for CRE (blaNDM1, blaVIM, blaKPC, blaIMP, and blaOXA48). All patients belonging to medicine wards were included in the study. we screened 436 patients during the study and found 160 patients suitable for our study, out of which 32 (20%) were cases and 128 (80%) were controls. We found a total number of 25 genes out of 16 isolates, where NDM 1 was identified in maximum numbers followed by KPC &VIM. Standard statistical analyses such as chi-squire and odd ratios were conducted to determine the risk factor of different variables. Stepwise multiple logistic regressions were carried out, where we found, that transfer from other wards to medicine ward, use of nebulizer and intravenous catheter, and use of multiple antibiotics were still statistically significant. Implementation of Multi-modal colonization prevention and control is the need for the present situation throughout the world.
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Agud M, de Medrano I, Mendez-Echevarria A, Sainz T, Román F, Ruiz Carrascoso G, Escosa-Garcia L, Molina Amores C, Climent FJ, Rodríguez A, Garcia-Fernandez de Villalta M, Calvo C. Risk factors for antibiotic-resistant bacteria colonisation in children with chronic complex conditions. Sci Rep 2022; 12:7223. [PMID: 35508685 PMCID: PMC9068800 DOI: 10.1038/s41598-022-11295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Abstract
To assess drug-resistant bacterial colonisation rates and associated risk factors in children with complex chronic conditions admitted to a national reference unit in Spain. Cross-sectional study that included all children admitted to our unit from September 2018 to July 2019. Rectal swabs were obtained to determine multidrug-resistant Gram-negative bacilli (MR-GNB) colonisation, and nasal swab to determine S. aureus and methicillin-resistant S. aureus (MRSA) colonisation. Medical records were reviewed. 100 children were included, with a median of four complex chronic conditions. Sixteen percent had S. aureus colonisation, including two MRSA. S. aureus colonisation was associated with technology-dependent children, while being on antibiotic prophylaxis or having undergone antibiotic therapy in the previous month were protective factors. The prevalence of MR-GNB colonisation was 27%, which was associated with immunosuppressive therapy (aOR 31; 2.02–47]; p = 0.01), antibiotic prophylaxis (aOR 4.56; 1.4–14.86; p = 0.012), previously treated skin-infections (aOR 2.9; 1.07–8.14; p = 0.03), surgery in the previous year (aOR 1.4; 1.06–1.8; p = 0.014), and hospital admission in the previous year (aOR 1.79; [1.26–2.56]; p = 0.001). The rate of S. aureus nasal colonisation in this series was not high despite the presence of chronic conditions, and few cases corresponded to MRSA. Antibiotic prophylaxis, immunosuppressive therapies, history of infections, previous surgeries, and length of admission in the previous year were risk factors for MR-GNB colonisation.
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Affiliation(s)
- Martin Agud
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Ines de Medrano
- Paediatric Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Mendez-Echevarria
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Talia Sainz
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Federico Román
- Nosocomial Infections Unit, CNM, Carlos III Health Institute, Majadahonda, Madrid, Spain
| | - Guillermo Ruiz Carrascoso
- Department of Clinical Microbiology, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Luis Escosa-Garcia
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Clara Molina Amores
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Francisco José Climent
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Aroa Rodríguez
- Children's Medically Complex Diseases Unit, La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - Cristina Calvo
- Paediatric Infectious and Tropical Diseases Department, Hospital La Paz Research Institute (IdiPAZ), CIBER Infectious Diseases (ISCIII), La Paz University Hospital, Paseo de la Castellana, 261, 28046, Madrid, Spain
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The Magnitude of Carbapenemase and ESBL Producing Enterobacteriaceae Isolates from Patients with Urinary Tract Infections at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1369:117-128. [PMID: 34914083 DOI: 10.1007/5584_2021_687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The emergence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), and carbapenemase-producing Enterobacteriaceae (CPE) is a public health concern. Therefore, this study aimed to determine the magnitude of carbapenemase and ESBL producing bacteria isolated from patients affected by Urinary Tract Infection (UTI). METHODS A cross-sectional study was conducted from December 2018 to March 2019 at Tikur Anbessa Specialized Hospital. A total of 120 Enterobacteriaceae isolates from UTI patients were collected and identified on species level using standard microbiological methods. Antimicrobial susceptibility test was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Detection of ESBL production was carried out by using ESBL ChromoSelect Agar medium and the combined disk diffusion. Production of carbapenemase was determined by using Hodge-test and modified carbapenem inactivation method as described in CLSI guidelines. RESULTS Out of the total 120 Enterobacteriaceae isolates, 74 (61.7%) were ESBL-producers, and 8 (6.7%) were carbapenemase producers. The most common ESBL producing isolate was E.coli 38 (51.4%) and the most common carbapenemase-producing isolate was K.pneumoniae five (62.5%). Most of the ESBL and carbapenemase-producing isolates were recovered from hospitalized patients 46 (62.2%) and 7 (87.5%) respectively. The rate of ESBL and CPE production was observed high among patients taking antibiotics 64.8% (59/91) and 7.7% (7/91) respectively, but no significant association was observed p > 0.05. Furthermore, about 1.7% (2/120) isolates were found both ESBL and carbapenemase producers. Significant resistances rates were observed in ESBL and CPE isolates. CONCLUSION Enterobacteriaceae isolates showed a significantly higher rate of ESBL production. A significant figure of carbapenemase production was observed among Enterobacteriaceae isolates causing UTI. The production of ESBL and CPE enhanced for an increased rate of MDR patterns. Efforts need to be made to introduce a system for tracking and detecting ESBL-PE and CPE-producing bacteria in hospitals, and monitoring dissemination of ESBL and CPE-producing Enterobacteriaceae is strongly recommended.
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Xu JJ, Gao J, Guo JH, Song LL. Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys. BMC Infect Dis 2020; 20:804. [PMID: 33121455 PMCID: PMC7597008 DOI: 10.1186/s12879-020-05542-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/23/2020] [Indexed: 01/10/2023] Open
Abstract
Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.
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Affiliation(s)
- Jiang-Jiang Xu
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jie Gao
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Jun-Hua Guo
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Li-Li Song
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
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Ramos-Castaneda JA, Ruano-Ravina A, Salinas DF, Osorio-Manrique J, Segura-Cardona AM, Lemos-Luengas EV. Factors associated with multidrug-resistant bacteria in a cohort of patients with asymptomatic bacteriuria who underwent urological surgery. Am J Infect Control 2019; 47:1479-1483. [PMID: 31331712 DOI: 10.1016/j.ajic.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the factors associated to bacterial resistance in patients with asymptomatic bacteriuria (ASB) have been studied in pregnant, fertile age women, patients with spinal cord injury, and those with urogynecological disorders, nothing is known about the factors associated with multidrug-resistant (MDR) bacteria in patients with ASB and planned urological procedures. This study therefore sought to identify the sociodemographic and clinical factors associated with MDR bacteria in a cohort of patients with ASB scheduled for urological procedures. METHODS We conducted a nested case-control study on a cohort of patients with ASB and planned urological procedures at 3 Colombian medical centers. Cases were patients with MDR bacteria and controls were patients without MDR bacteria. RESULTS A total of 184 patients were included, 41.8% (n = 77) of whom presented ASB with MDR bacteria. The factors linking ASB with MDR bacteria were: advanced age (odds ratio, 1.03; 95% confidence interval, 1.01-1.06) and hospitalization within the 3-month period before surgery (odds ratio, 2.35; 95% confidence interval, 1.08-5.21). CONCLUSIONS Bacterial resistance is frequent among patients with ASB and planned urological procedures. Advanced age and prior hospitalization should be borne in mind for patients with planned urological procedures because they are factors associated with the presence of MDR bacteria.
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Affiliation(s)
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, Universidad de Santiago de Compostela, España CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Diego F Salinas
- Infectious Diseases Unit, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia
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Oli AN, Itumo CJ, Okam PC, Ezebialu IU, Okeke KN, Ifezulike CC, Ezeobi I, Emechebe GO, Okezie UM, Adejumo SA, Okoyeh JN. Carbapenem-Resistant Enterobacteriaceae Posing a Dilemma in Effective Healthcare Delivery. Antibiotics (Basel) 2019; 8:antibiotics8040156. [PMID: 31547023 PMCID: PMC6963482 DOI: 10.3390/antibiotics8040156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
The emergence and spread of Carbapenem-resistant Enterobacteriaceae (CRE) is seriously posing threats in effective healthcare delivery. The aim of this study was to ascertain the emergence of CRE at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH) Awka. Biological samples were collected from 153 consenting patient from 5 clinics in the hospital. The isolates were identified using standard microbiological protocols. Susceptibility to meropenem was done using Kirby-Bauer disc diffusion method on Mueller Hinton Agar. A total of 153 patients were recruited in this study. About one half of those from rural, 63.64% from Sub-urban and 42.27% from urban areas had significant E. coli and Klebsiella spp infections. The male: female ratio of the Enterobacteriaceae infection was 1:1. Almost as much inpatient as outpatient study participants had the infections. The infections were observed mostly on participants with lower educational status. The unmarried individuals were most infected compared to their married counterparts. Enterobacteriaceae infection rate was 50.98%. Of this, 28.21% had CRE infection while the overall prevalence of the CRE in the studied population was 14.38% (22/153). This study shows that CRE is quickly emerging in both community and hospital environments. Klebsiella spp was the most common CRE in this hospital especially Klebsiella oxytoca. Hospitalization was a strong risk factor in the CRE infections. Rapid and accurate detection is critical for their effective management and control.
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Affiliation(s)
- Angus Nnamdi Oli
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Agulu, Nnamdi Azikiwe University, Awka 420108, Anambra State, Nigeria.
| | - Chimaobi Johnpaul Itumo
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Agulu, Nnamdi Azikiwe University, Awka 420108, Anambra State, Nigeria
| | - Princeston Chukwuemeka Okam
- Department of Pharmacology and Therapeutics, College of Health Sciences, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Nnewi 435101, Nigeria
| | - Ifeanyichukwu U Ezebialu
- Department of Obstetrics and Gynaecology, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus, Awka 420108, Anambra state, Nigeria
| | - Kenneth Nchekwube Okeke
- Department of Pediatrics, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Nnewi 435101, Anambra State, Nigeria
| | - Christian Chukwuemeka Ifezulike
- Department of Pediatrics, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus, Awka 420108, Anambra State, Nigeria
| | - Ifeanyi Ezeobi
- Department of Orthopaedic Surgery, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus, Awka 420108, Anambra State, Nigeria
| | - George Ogonna Emechebe
- Department of Pediatrics, Faculty of Clinical Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus, Awka 420108, Anambra State, Nigeria
| | - Ugochukwu Moses Okezie
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Agulu, Nnamdi Azikiwe University, Awka 420108, Anambra State, Nigeria
| | - Samson A Adejumo
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Agulu, Nnamdi Azikiwe University, Awka 420108, Anambra State, Nigeria
| | - Jude Nnaemeka Okoyeh
- Department of Biology and Clinical Laboratory Science, Division of Arts and Sciences, Neumann University, One Neumann Drive, Aston, PA 19014-1298, USA
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