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Awada B, Abarca J, Mumtaz S, Al-Khirbash A, Al-Sayegh H, Milupi M, Garcia AE, Al Harthy M, Al Qarshoubi I, Al Baimani K, Varghese GM. Predictors and outcomes of multi-drug-resistant gram-negative bacteremia in patients with cancer: A retrospective cohort study at a tertiary cancer center in Oman. IJID REGIONS 2024; 12:100399. [PMID: 39157419 PMCID: PMC11326951 DOI: 10.1016/j.ijregi.2024.100399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 08/20/2024]
Abstract
Objectives This study aimed to delineate the characteristics and outcomes of gram-negative bacteremia (GNB) in oncology patients; analyze the risk factors for multi-drug-resistant (MDR) GNB; and assess its impact on the recurrence of bloodstream infection (BSI), hospital stay, and 30-day mortality. Methods Data, including demographics, clinical features, common cancers, and microbiologic findings, were collected retrospectively from electronic medical records of patients admitted with solid tumors and BSI episodes between January and December 2022. Fisher's exact tests were used to determine the effect of MDR-GNB on 30-day mortality and BSI recurrence. The Wilcoxon rank-sum test assessed the differences in the length of hospital stay. Logistic regression models identified the risk factors for MDR-GNB. Results Among 1074 patients, 77 episodes of GNB bacteremia occurred in 59 individuals (47% male, median age 57.4 years). Of these, 37 (48%) were MDR-GNB. Carbapenem resistance was noted in 9.1% of GNB episodes. Previous antibiotic use was significantly associated with MDR-GNB (odds ratio 7.82; 95% confidence interval 2.52-24). MDR-GNB was linked to longer hospital stays (median 23 vs 10.5 days, P = 0.003) and higher recurrence rates than non-MDR-GNB (35.13% vs 5.0%, P <0.001). However, 30-day mortality did not significantly differ between the groups (35.14% vs 32.5%, P = 0.81). Conclusion Previous antibiotic use predicted MDR-GNB in patients with solid tumor. MDR-GNB bacteremia increased the length of hospital stay and risk of recurrence compared with non-MDR-GNB bacteremia.
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Affiliation(s)
- Bassem Awada
- Infectious Diseases, Internal Medicine Department, Sultan Qaboos Comprehensive Cancer and Research Center, Muscat, Sultanate of Oman
| | - Jorge Abarca
- Infectious Diseases, Internal Medicine Department, Sultan Qaboos Comprehensive Cancer and Research Center, Muscat, Sultanate of Oman
| | - Sumbel Mumtaz
- Medical Oncology Department, Princess Alexandra NHS trust, Harlow, United Kingdom
| | - Athar Al-Khirbash
- Pharmacy Department, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Hasan Al-Sayegh
- Research Laboratories Department, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Manyando Milupi
- Microbiology, Laboratory Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Augustin Emilio Garcia
- Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Munjid Al Harthy
- Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Issa Al Qarshoubi
- Gastroenterology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - Khalid Al Baimani
- Medical Oncology, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Sultanate of Oman
| | - George M Varghese
- Infectious Diseases, Internal Medicine Department, Sultan Qaboos Comprehensive Cancer and Research Center, Muscat, Sultanate of Oman
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Laçinel Gürlevik S, Oygar PD, Köseoğlu B, Hazırolan G, Cengiz AB, Ozsurekci Y. Is the high dose extended infusion of meropenem useful in the treatment of highly resistant gram-negative bacteria in children? J Infect Chemother 2024:S1341-321X(24)00230-7. [PMID: 39168281 DOI: 10.1016/j.jiac.2024.08.013] [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: 05/18/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES Multidrug resistant infections present a treatment challenge for clinicians. These infections have been associated with increased morbidity and mortality. Recently, there has been increasing discussion in the literature that high dose extended infusion of meropenem may be helpful. We aimed to evaluate the clinical efficacy of high dose extended infusion of meropenem in the treatment of highly resistant Gram-negative infections. METHODS This retrospective observational study was conducted between December 2014 and December 2020 at Hacettepe University Ihsan Dogramaci Children's Hospital. Clinical and microbiological data of children diagnosed with invasive multidrug and extremely drug resistant Gram-negative infections were studied. The findings of patients given high dose extended infusion of meropenem were compared with patients who received colistin or tigecycline. RESULTS Overall, 158 pediatric patients infected with multidrug and extremely drug resistant gram-negatives were enrolled; 76 treated with high-dose prolonged infusion of meropenem; 60 treated with colistin and 22 with tigecycline. The overall clinical response at the end of the treatment was 81.6 % in meropenem group, 83.3 % in colistin group and 77.3 % in tigecycline group (P = 0.821). Microbiological response at the end of the treatment was 81.1 % in meropenem group, 76.4 % in colistin group and 72.2 % in tigecycline group (P = 0.694). CONCLUSION Meropenem, with an adjusted dose (high-dose and extended), seems a crucial and robust fighting agent in the treatment of pediatric patients infected with highly-resistant Gram-negative bacteria. It may also be useful in preventing the use of the latest fighting tools such as colistin and tigecycline during the antibacterial stewardship process.
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Affiliation(s)
- Sibel Laçinel Gürlevik
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Pembe Derin Oygar
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Büşra Köseoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Gülşen Hazırolan
- Hacettepe University Faculty of Medicine, Department of Microbiology, Ankara, Turkey
| | - Ali Bülent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey.
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Aitken A, Lavery J. The specialist community practitioner district nurse's role in optimising COPD. Br J Community Nurs 2024; 29:275-281. [PMID: 38814840 DOI: 10.12968/bjcn.2024.29.6.275] [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: 06/01/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a long-term condition affecting all aspects of an individual's life. Specialist Community practitioner district nurses (SCPDN) manage patients with multiple co morbidities on their caseload, and as such require an extensive clinical knowledge base. COPD is a highly prevalent and complex disease; therefore, individualised holistic assessments are required to ensure patients receive personalised and evidence-based care. Care delivery must include an awareness of health interventions encompassing, screening, health promotion and prevention. The SCPDN's consideration of the physical, mental and social determinants which adversely affect the health of the individual with COPD is imperative to deliver high quality care to the individuals, families and communities.
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Affiliation(s)
| | - Joanna Lavery
- Senior Lecturer, Postgraduate Nursing and Advanced Practice, Liverpool John Moores University
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Abdel Hadi H, Dargham SR, Eltayeb F, Ali MOK, Suliman J, Ahmed SAM, Omrani AS, Ibrahim EB, Chen Y, Tsui CKM, Skariah S, Sultan A. Epidemiology, Clinical, and Microbiological Characteristics of Multidrug-Resistant Gram-Negative Bacteremia in Qatar. Antibiotics (Basel) 2024; 13:320. [PMID: 38666996 PMCID: PMC11047403 DOI: 10.3390/antibiotics13040320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance is a global healthcare threat with significant clinical and economic consequences peaking at secondary and tertiary care hospitals where multidrug-resistant Gram-negative bacteria (MDR GNB) lead to poor outcomes. A prospective study was conducted between January and December 2019 for all invasive bloodstream infections (BSIs) secondary to MDR GNB in Qatar identified during routine microbiological service to examine their clinical, microbiological, and genomic characteristics. Out of 3238 episodes of GNB BSIs, the prevalence of MDR GNB was 13% (429/3238). The predominant MDR pathogens were Escherichia coli (62.7%), Klebsiella pneumoniae (20.4%), Salmonella species (6.6%), and Pseudomonas aeruginosa (5.3%), while out of 245 clinically evaluated patients, the majority were adult males, with the elderly constituting almost one-third of the cohort and with highest observed risk for prolonged hospital stays. The risk factors identified included multiple comorbidities, recent healthcare contact, previous antimicrobial therapy, and admission to critical care. The in-hospital mortality rate was recorded at 25.7%, associated with multiple comorbidities, admission to critical care, and the acquisition of MDR Pseudomonas aeruginosa. Resistant pathogens demonstrated high levels of antimicrobial resistance but noticeable susceptibility to amikacin and carbapenems. Genomic analysis revealed that Escherichia coli ST131 and Salmonella enterica ST1 were the predominant clones not observed with other pathogens.
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Affiliation(s)
- Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (S.A.M.A.); (A.S.O.)
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Soha R. Dargham
- Department of Medical Education, Weill Cornell Medicine, Qatar Foundation, Doha P.O. Box 24144, Qatar;
| | - Faiha Eltayeb
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (F.E.); (E.B.I.)
| | - Mohamed O. K. Ali
- Department of Internal Medicine, University Health Truman Medical Centre, Kansas City, MO 64108, USA;
| | - Jinan Suliman
- Department of Community Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Shiema Abdalla M. Ahmed
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (S.A.M.A.); (A.S.O.)
| | - Ali S. Omrani
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (S.A.M.A.); (A.S.O.)
- College of Medicine, Qatar University, Doha P.O. Box 2713, Qatar
| | - Emad Bashir Ibrahim
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (F.E.); (E.B.I.)
- Biomedical Research Centre, Qatar University, Doha P.O. Box 2713, Qatar
| | - Yuzhou Chen
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.C.); (C.K.M.T.)
| | - Clement K. M. Tsui
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore; (Y.C.); (C.K.M.T.)
- Infectious Diseases Research Laboratory, National Centre for Infectious Diseases, Singapore 308442, Singapore
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Sini Skariah
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Doha 2713, Qatar; (S.S.); (A.S.)
| | - Ali Sultan
- Department of Microbiology and Immunology, Weill Cornell Medicine-Qatar, Doha 2713, Qatar; (S.S.); (A.S.)
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Quang HV, Nhung LTK, Thuy PTT, Quyen PC, Huy LB, Dung HS. Blood-Stream Infections: Causative Agents, Antibiotic Resistance and Associated Factors in Older Patients. Mater Sociomed 2024; 36:82-89. [PMID: 38590604 PMCID: PMC10999148 DOI: 10.5455/msm.2024.36.82-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background The rate of multi-drug antibiotic resistance in nosocomial bloodstream infections in elderly patients is increasing. This study examined the data for bloodstream infections to gain a better understanding of bacterial antibiotic resistance. Methods This was a retrospective study of 817 patients with the first positive blood culture between January 1, 2016 and December 31, 2019. Results Moyen's age was 77.4 ± 9.8 years, male (52.4%) and SOFA 5.0 ± 4. ESBL(+) rate was 78/817 (9.5%). ESBL(+) rate for Escherichia coli and Klebsiella pneumoniae was 69/141 (48.9%) and 9/52 (17.3%), respectively. The most common isolates were Escherichia coli (17.3%), Stenotrophomonas maltophilia (13.7%), and Staphylococcus species (23.1%). The rate of septic shock and mortality accounted for 22.3% and 28.9%, respectively. Escherichia coli is highly sensitive to carbapenem, and resistant (>50%) with quinolone and aminoside. Klebsiella pneumoniae and Pseudomonas aeruginosa were highly sensitive to carbapenem. Acinetobacter baumannii was resistant to meropenem (75%). Stenotrophomonas maltophilia was sensitive to quinolone (13.8 %), and highly resistant to remaining antibiotics. Methicillin-resistant Staphylococcus aureus had a low resistance rate for vancomycin, teicoplanin, and linezolid. Multivariate analysis showed that the significant factors associated with mortality were age >75; SOFA >7; respiratory infection; intensive care unit treatment and presentation with septic shock. Conclusion The mortality rate was still high, especially for antibiotic-resistant agents.
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Affiliation(s)
- Hoang-Van Quang
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le-Thi Kim Nhung
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
| | | | - Phan Chau Quyen
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le Bao Huy
- Department of Emergency Medicine, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Ho Si Dung
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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Cekin ZK, Oncul A, Bayraktar B. Bloodstream Infections Caused by Multidrug Resistant Bacteria: Clinical and Microbiological Features and Mortality. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:416-425. [PMID: 37900327 PMCID: PMC10600613 DOI: 10.14744/semb.2023.31697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/31/2023] [Indexed: 10/31/2023]
Abstract
Objectives Bloodstream infections (BSI) are associated with high morbidity and mortality. The aim of our study is to determine whether there is a relationship between certain risk factors such as the underlying disease, patient's medical history, or interventional procedures and multidrug resistant (MDR) bacterial infection and to determine the risk factors for mortality. Methods Two hundred and twenty-two outpatients and inpatients who were diagnosed with bacteremia over a 6-month period were included in the study. 232 agents from 222 patients were isolated and tested for antimicrobial susceptibility. The relationship between patients demographic and clinical data and MDR was analyzed. Results The most common microorganisms were Gram-negative bacteria (59.4%), Gram-positive bacteria (36.9%), Candida species (2.2%), and anaerobic bacteria (1.35%). The most common isolates were Escherichia coli 53 (22.8%), Staphylococcus aureus 35 (%15.1), Klebsiella pneumoniae 26 (11.2%), Pseudomonas spp. (n=17, 7.3%), Acinetobacter spp 17 (7.3%), and Enterococcus spp 14 (6%). Microorganisms with the highest antimicrobial resistance observed were 82.3% in Acinetobacter baumannii, 64.5% in coagulase-negative staphylococci, 60.3% in E. coli, 50% in K. pneumoniae, and 27.2% in Enterobacterales spp. Most patients with BSI caused by MDR bacteria were in the intensive care unit (64%). Sepsis diagnosis, urinary catheter use, history of surgery, and use of broad-spectrum antibiotics as well as risk factors for antibiotic-resistant bacteremia, coronary artery disease, inappropriate empirical therapy, healthcare-associated infections, urinary catheterization, and stay in the ICU were determined as risk factors for mortality. Conclusion Our study identified the risk factors of BSI caused by MDR bacteria and helped to reveal the relationship between these factors and mortality.
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Affiliation(s)
- Zuhal Kalayci Cekin
- Clinical Microbiology Laboratory, Bolu Izzet Baysal State Hospital, Bolu, Türkiye
| | - Ahsen Oncul
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Banu Bayraktar
- Department of Clinical Microbiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Raslan MA, Raslan SA, Shehata EM, Mahmoud AS, Lundstrom K, Barh D, Azevedo V, Sabri NA. Associations between Nutrigenomic Effects and Incidences of Microbial Resistance against Novel Antibiotics. Pharmaceuticals (Basel) 2023; 16:1093. [PMID: 37631008 PMCID: PMC10458141 DOI: 10.3390/ph16081093] [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: 05/07/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Nutrigenomics is the study of the impact of diets or nutrients on gene expression and phenotypes using high-throughput technologies such as transcriptomics, proteomics, metabolomics, etc. The bioactive components of diets and nutrients, as an environmental factor, transmit information through altered gene expression and hence the overall function and traits of the organism. Dietary components and nutrients not only serve as a source of energy but also, through their interactions with genes, regulate gut microbiome composition, the production of metabolites, various biological processes, and finally, health and disease. Antimicrobial resistance in pathogenic and probiotic microorganisms has emerged as a major public health concern due to the presence of antimicrobial resistance genes in various food products. Recent evidence suggests a correlation between the regulation of genes and two-component and other signaling systems that drive antibiotic resistance in response to diets and nutrients. Therefore, diets and nutrients may be alternatively used to overcome antibiotic resistance against novel antibiotics. However, little progress has been made in this direction. In this review, we discuss the possible implementations of nutrigenomics in antibiotic resistance against novel antibiotics.
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Affiliation(s)
- Mohamed A. Raslan
- Drug Research Centre, Cairo P.O. Box 11799, Egypt or (M.A.R.); or (S.A.R.); (E.M.S.)
| | - Sara A. Raslan
- Drug Research Centre, Cairo P.O. Box 11799, Egypt or (M.A.R.); or (S.A.R.); (E.M.S.)
| | - Eslam M. Shehata
- Drug Research Centre, Cairo P.O. Box 11799, Egypt or (M.A.R.); or (S.A.R.); (E.M.S.)
| | - Amr S. Mahmoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo P.O. Box 11566, Egypt;
| | | | - Debmalya Barh
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil; (D.B.); (V.A.)
- Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, West Bengal, India
| | - Vasco Azevedo
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil; (D.B.); (V.A.)
| | - Nagwa A. Sabri
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo P.O. Box 11566, Egypt
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Drobish IC, Barasa IK, Otieno G, Osoo MO, Thuo SK, Belknap KS, Shirk AM, McClanahan ST, Irungu E, Riunga F, Lelei F, Rudd KE, Brotherton BJ. Prevalence of Antimicrobial Resistance and Association with Patient Outcomes in a Rural Kenyan Hospital. Am J Trop Med Hyg 2023; 108:1227-1234. [PMID: 37160272 PMCID: PMC10540121 DOI: 10.4269/ajtmh.22-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/10/2023] [Indexed: 05/11/2023] Open
Abstract
Data on antimicrobial resistance (AMR) and association with outcomes in resource-variable intensive care units (ICU) are lacking. Data currently available are limited to large, urban centers. We attempted to understand this locally through a dual-purpose, retrospective study. Cohort A consisted of adult and pediatric patients who had blood, urine, or cerebrospinal fluid cultures obtained from 2016 to 2020. A total of 3,013 isolates were used to create the Kijabe Hospital's first antibiogram. Gram-negative organisms were found to be less than 50% susceptible to third- and fourth-generation cephalosporins, 67% susceptible to piperacillin-tazobactam, 87% susceptible to amikacin, and 93% susceptible to meropenem. We then evaluated the association between AMR and clinical characteristics, management, and outcomes among ICU patients (Cohort B). Demographics, vital signs, laboratory results, management data, and outcomes were obtained. Antimicrobial resistance was defined as resistance to one or more antimicrobials. Seventy-six patients were admitted to the ICU with bacteremia during this time. Forty complete paper charts were found for review. Median age was 34 years (interquartile range, 9-51), 26 patients were male (65%), and 28 patients were older than 18 years (70%). Septic shock was the most common diagnosis (n = 22, 55%). Six patients had AMR bacteremia; Escherichia coli was most common (n = 3, 50%). There was not a difference in mortality between patients with AMR versus non-AMR infections (P = 0.54). This study found a prevalence of AMR. There was no association between AMR and outcomes among ICU patients. More studies are needed to understand the impact of AMR in resource-variable settings.
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Affiliation(s)
- Ian C. Drobish
- Department of Internal Medicine, Department of Pediatrics, University of California San Diego, San Diego, California
- Critical Care Medicine Department, NIH Clinical Center; Bethesda, Maryland
| | | | - George Otieno
- Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | | | - Solomon K. Thuo
- Department of Laboratory Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | - Kaya S. Belknap
- Department of Outpatient Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | | | | | | | - Felix Riunga
- Department of Infectious Diseases, Aga Khan University Hospital, Nairobi, Kenya
| | - Faith Lelei
- Department of Family Medicine, AIC Kijabe Hospital, Kijabe, Kenya
| | - Kristina E. Rudd
- Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - B. Jason Brotherton
- Department of Pediatrics, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Internal Medicine, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Marutescu LG. Current and Future Flow Cytometry Applications Contributing to Antimicrobial Resistance Control. Microorganisms 2023; 11:1300. [PMID: 37317273 DOI: 10.3390/microorganisms11051300] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023] Open
Abstract
Antimicrobial resistance is a global threat to human health and welfare, food safety, and environmental health. The rapid detection and quantification of antimicrobial resistance are important for both infectious disease control and public health threat assessment. Technologies such as flow cytometry can provide clinicians with the early information, they need for appropriate antibiotic treatment. At the same time, cytometry platforms facilitate the measurement of antibiotic-resistant bacteria in environments impacted by human activities, enabling assessment of their impact on watersheds and soils. This review focuses on the latest applications of flow cytometry for the detection of pathogens and antibiotic-resistant bacteria in both clinical and environmental samples. Novel antimicrobial susceptibility testing frameworks embedding flow cytometry assays can contribute to the implementation of global antimicrobial resistance surveillance systems that are needed for science-based decisions and actions.
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Affiliation(s)
- Luminita Gabriela Marutescu
- Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, 91-95 Spl. Independentei, 050095 Bucharest, Romania
- Research Institute of the University of Bucharest, 050095 Bucharest, Romania
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Tawfick MM, Adulall AK, El-Kholy AA, Manakhly ARE. Mutation-based fluoroquinolone resistance in carbapenem-resistant Acinetobacter baumannii and Escherichia coli isolates causing catheter-related bloodstream infections. Int J Health Sci (Qassim) 2023; 17:18-25. [PMID: 37151743 PMCID: PMC10155246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Objective We studied the presence of mutations in the chromosomal quinolone resistance-determining regions (QRDRs) of the fluoroquinolone targets gyrA and parC genes and detected the carbapenem resistance (CR) encoding genes among Acinetobacter baumannii and Escherichia coli isolates from catheter-related bloodstream infections (CRBSIs). Methods The study included 39 non-duplicate isolates of A. baumannii (14/39, 35.9%) and E. coli (25/39, 64.1%) isolated from 128 confirmed CRBSIs cases. Antimicrobial susceptibility testing was performed, followed by an evaluation of biofilm formation using the tissue culture plate method. The carbapenemase encoding genes were detected by multiplex polymerase chain reaction (PCR). The mutations in QRDRs of gyrA and parC genes were determined by singleplex PCR amplification followed by DNA sequencing and BlastN analysis in the GenBank database. DNA and the translated amino acid sequences were analyzed using the Mega7 bioinformatics tool. Results Multidrug-resistant (MDR) E. coli and A. baumannii isolates harbored CR encoding genes and combined gyrA and parC genes mutation. The specific substitutions observed in GyrA were Cys173Arg, Cys174Gly, Asp80Val, Tyr178ASP, Tyr84Gly, Glu85Lys, Ser172Leu, and Asp176Asn, while the specific substitutions observed in the ParC amino acid sequence were point mutation 62 Arg, Phe60Leu, Ils66Val, and Gln76Lys. Point mutation 62Arg was detected in two A. baumannii isolates, whereas Ser172Leu mutation was observed in two E. coli isolates. Conclusion The presence of new single and multiple mutations in QRDR causes the emergence of MDR E. coli and A. baumannii infections in carbapenem-resistant Enterobacteriaceae in Egypt, requiring further investigation in Gram-negative bacteria.
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Affiliation(s)
- Mahmoud M. Tawfick
- Department of Microbiology and Immunology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, Nasr City, Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Abeer K. Adulall
- Department of Microbiology and Immunology, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Amani A. El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Arwa Ramadan El Manakhly
- Department of Microbiology and Immunology, Faculty of Pharmacy, Modern University for Technology and Information (MTI), Cairo, Egypt
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Priyadarshi K, Dhandapani S, Sivaradjy M, Shanmugam L, Sastry AS. Feasibility of Using Ceftazidime-Avibactam as a Therapeutic Option for Bloodstream Infections Caused by Multidrug-Resistant Enterobacterales and Pseudomonas aeruginosa Based on Its Susceptibility Profile. Cureus 2023; 15:e37002. [PMID: 37139019 PMCID: PMC10151155 DOI: 10.7759/cureus.37002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
Background In the era of increased antimicrobial resistance, there are limited therapeutic options available for the treatment of bacteremia caused by multidrug-resistant organisms (MDROs). This study aims to find out the feasibility of using ceftazidime/avibactam (CZA) as a therapeutic option for bloodstream infections caused by multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa based on its susceptibility profile. Materials and methods The isolates were routinely subjected to antimicrobial susceptibility testing (AST) by an automated AST system (VITEK-2). Those isolates found as MDR (resistant to at least one drug for ≥3 antimicrobial classes) were tested against CZA by Kirby-Bauer's disk diffusion (kb-DD) method. Results A total number of 293 MDR Enterobacterales and 31 MDR P. aeruginosa isolates were included. Of these, 87.3% of isolates were found as carbapenem-resistant (CR), whereas 12.7% of isolates were found as carbapenem susceptible. About 30.6% of MDROs were susceptible to CZA. Among carbapenem-resistant organisms (CROs), CR Klebsiella pneumoniae(33.5%) is most susceptible to CZA, compared to CR P. aeruginosa(0%)and CREscherichia coli(3.2%). Among the MDR isolates that were susceptible to CZA (30.6%), the majority had poor susceptibility against other β-lactam-β-lactamase inhibitor (BL-BLI) agents. Among all antimicrobial agents tested against CROs, colistin (96%) was found to have the best susceptibility profile. Conclusion It is observed that CZA is an acceptable therapeutic option for the treatment of bacteremia caused by MDROs, especially CROs. Therefore, it is important for the laboratories to perform the AST for CZA if the healthcare settings intend to use CZA for the management of such "difficult-to-treat" bloodstream infections.
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Karuna T, Gupta A, Vyas A, Kumar S, Sampath A, Goel P, Shukla P, Mishra V, Sharma S, Chakraborty S, Jaiswal SP, Mishra A, Gupta A, Sahu M, Tiwari S, Pal A, Nagendra M, Gautham H, Patel K, Asati S, Khadanga S. Changing Trends in Antimicrobial Susceptibility Patterns of Bloodstream Infection (BSI) in Secondary Care Hospitals of India. Cureus 2023; 15:e37800. [PMID: 37214059 PMCID: PMC10195700 DOI: 10.7759/cureus.37800] [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: 04/09/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Bloodstream infection (BSI) and subsequent sepsis are life-threatening medical conditions. The onset of antimicrobial resistance and subsequent multi-drug resistant organisms (MDRO) significantly increase healthcare-associated expenditure with adverse clinical outcomes. The present study was undertaken to identify the trends of BSI in community settings in secondary care hospitals (smaller private hospitals and district hospitals) in the state of Madhya Pradesh in Central India with the support of the Indian Council of Medical Research (ICMR) and National Health Mission, Madhya Pradesh. Methodology The present study was a prospective, longitudinal observational chart review type of study. The study was carried out at 10 secondary care hospitals (eight smaller private hospitals and two government district hospitals) nominated by the State Government as part of the ICMR Antimicrobial Resistance Surveillance and Research Network (AMRSN). The hospitals were nominated depending on the availability of a microbiology laboratory and a full-time microbiologist. Result A total of 6202 blood samples were received from patients with suspected BSI, out of which 693 samples were positive for aerobic culture. Among these, 621 (89.6%) showed bacterial growth and 72 (10.3%) grew Candida species (spp). Out of the 621 bacterial growth samples, Gram-negative bacteria were 406 (65.3%) and Gram-positive bacteria were 215 (34.6%). Among the Gram-negative isolates (406), the predominant isolate was Escherichia coli (115; 28.3%) followed by Klebsiella pneumoniae (109; 26.8%), Pseudomonas aeruginosa (61; 15%), Salmonella spp. (52; 12.8%), Acinetobacter spp. (47; 11.6%) and the other Enterobacter spp. (22; 5.4%). Among the Gram-positive isolates (215), the predominant isolate was Staphylococcus aureus (178; 82.8%) followed by Enterococcus spp. (37; 17.2%). Among the Escherichia coli, third-generation cephalosporin resistance was identified in 77.6%, piperacillin-tazobactam resistance in 45.2%, carbapenem resistance in 23.5% and colistin resistance in 16.5% of cases. Among the Klebsiella pneumoniae, third-generation cephalosporin resistance was identified in 80.7%, piperacillin-tazobactam resistance in 72.8%, carbapenem resistance in 63.3% and colistin resistance in 14% of cases. Among the Pseudomonas aeruginosa, ceftazidime resistance was identified in 61.2%, piperacillin-tazobactam resistance in 55%, carbapenem resistance in 32.8%, and colistin resistance in 38.3% of cases. Among the Acinetobacter spp., piperacillin-tazobactam resistance was identified in 72.7%, carbapenem resistance in 72.3%, and colistin resistance in 9.3% cases. While analyzing the antibiogram for Staphylococcus aureus isolates, methicillin resistance (MRSA) was seen in 70.3% of cases, followed by vancomycin resistance (VRSA) in 8% of cases and linezolid resistance in 8.1%. Among the Enterococcus spp. isolates, linezolid resistance was found in 13.5%, vancomycin resistance (VRE) in 21.6%, and teicoplanin resistance in 29.7% of cases. Conclusion In conclusion, the first-ever study to identify the risk of high-end antibiotics causing significant drug resistance in secondary and tertiary care settings has highlighted the urgent need for more randomized control studies and proactive measures from healthcare authorities and serves as a beacon for future research efforts and underscores the importance of implementing antibiograms to combat the growing threat of antibiotic resistance.
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Affiliation(s)
- T Karuna
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ayush Gupta
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Apurva Vyas
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Shweta Kumar
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ananyan Sampath
- Medical School, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pramod Goel
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Pankaj Shukla
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Vivek Mishra
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Sandeep Sharma
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | | | | | - Abhi Mishra
- Microbiology, Government Prakashchandra Sethi Hospital, Indore, IND
| | | | - Manisa Sahu
- Microbiology, Balco Medical Centre, Raipur, IND
| | | | - Anisa Pal
- Microbiology, Jabalpur Hospital and Research Centre, Jabalpur, IND
| | - Manish Nagendra
- Microbiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | | | | | - Shruti Asati
- Microbiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Sagar Khadanga
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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The relationship between renal functions and multi-drug resistant organisms in patients with ventilator-associated pneumonia. MARMARA MEDICAL JOURNAL 2023. [DOI: 10.5472/marumj.1244732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Despite the increase in the frequency of multi-drug resistant organism (MDRO) colonisation and infection in dialysis
patients, it is not well known whether the risk of multi-drug resistant (MDR) pneumonia increases in mild-to-severe chronic kidney
disease patients not undergoing dialysis. Therefore, we aimed to evaluate the relationship between renal functions and the risk of MDR
ventilator-associated pneumonia (VAP) and the specific microbial pattern.
Patients and Methods: A total of 133 patients who developed VAP were divided according to their renal function into two groups, an
estimated glomerular filtration rate of (eGFR) ≥ 60 mL/ min/1.73 m2 (high eGFR, n=65) and eGFR < 60 mL/min/1.73 m2 (low eGFR,
n=68).
Results: The low eGFR group presented a significantly high MDRO ratio (p
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Marino A, Stracquadanio S, Campanella E, Munafò A, Gussio M, Ceccarelli M, Bernardini R, Nunnari G, Cacopardo B. Intravenous Fosfomycin: A Potential Good Partner for Cefiderocol. Clinical Experience and Considerations. Antibiotics (Basel) 2022; 12:antibiotics12010049. [PMID: 36671250 PMCID: PMC9854867 DOI: 10.3390/antibiotics12010049] [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: 12/07/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022] Open
Abstract
Multidrug resistant Gram-negative bacteremia represents a therapeutic challenge clinicians have to deal with. This concern becomes more difficult when causing germs are represented by carbapenem resistant Acinetobacter baumannii or difficult-to-treat Pseudomonas aeruginosa. Few antibiotics are available against these cumbersome bacteria, although literature data are not conclusive, especially for Acinetobacter. Cefiderocol could represent a valid antibiotic choice, being a molecule with an innovative mechanism of action capable of overcoming common resistance pathways, whereas intravenous fosfomycin may be an appropriate partner either enhancing cefiderocol activity or avoiding resistance development. Here we report two patients with MDR Gram negative bacteremia who were successfully treated with a cefiderocol/fosfomycin combination.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Stefano Stracquadanio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Correspondence:
| | - Edoardo Campanella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Antonio Munafò
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
| | - Renato Bernardini
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS, Garibaldi Hospital, University of Catania, 95123 Catania, Italy
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Palusiak A. Proteus mirabilis and Klebsiella pneumoniae as pathogens capable of causing co-infections and exhibiting similarities in their virulence factors. Front Cell Infect Microbiol 2022; 12:991657. [PMID: 36339335 PMCID: PMC9630907 DOI: 10.3389/fcimb.2022.991657] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/03/2022] [Indexed: 09/23/2023] Open
Abstract
The genera Klebsiella and Proteus were independently described in 1885. These Gram-negative rods colonize the human intestinal tract regarded as the main reservoir of these opportunistic pathogens. In favorable conditions they cause infections, often hospital-acquired ones. The activity of K. pneumoniae and P. mirabilis, the leading pathogens within each genus, results in infections of the urinary (UTIs) and respiratory tracts, wounds, bacteremia, affecting mainly immunocompromised patients. P. mirabilis and K. pneumoniae cause polymicrobial UTIs, which are often persistent due to the catheter biofilm formation or increasing resistance of the bacteria to antibiotics. In this situation a need arises to find the antigens with features common to both species. Among many virulence factors produced by both pathogens urease shows some structural similarities but the biggest similarities have been observed in lipids A and the core regions of lipopolysaccharides (LPSs). Both species produce capsular polysaccharides (CPSs) but only in K. pneumoniae these antigens play a crucial role in the serological classification scheme, which in Proteus spp. is based on the structural and serological diversity of LPS O-polysaccharides (OPSs). Structural and serological similarities observed for Klebsiella spp. and Proteus spp. polysaccharides are important in the search for the cross-reacting vaccine antigens.
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Affiliation(s)
- Agata Palusiak
- Laboratory of General Microbiology, Department of Biology of Bacteria, Institute of Microbiology, Biotechnology and Immunology, University of Łódź, Łódź, Poland
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Adil FZ, Benaissa E, Benlahlou Y, Bakkali H, Doghmi N, Balkhi H, Maleb A, Elouennass M. Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study. Eur J Microbiol Immunol (Bp) 2022; 12:46-52. [PMID: 35998067 PMCID: PMC9630931 DOI: 10.1556/1886.2022.00010] [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: 06/02/2022] [Accepted: 07/17/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. Methods It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Conclusion Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.
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Affiliation(s)
- Fatima Zahra Adil
- 1 Department of Bacteriology, Mohammed V Military Teaching Hospital, Rabat, Morocco
- 2 Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Elmostafa Benaissa
- 1 Department of Bacteriology, Mohammed V Military Teaching Hospital, Rabat, Morocco
- 3 Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Yassine Benlahlou
- 1 Department of Bacteriology, Mohammed V Military Teaching Hospital, Rabat, Morocco
- 3 Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Hicham Bakkali
- 4 Department of Anesthesiology and Critical Care, Military Teaching Hospital Mohammed V, Rabat, Morocco
| | - Nawfal Doghmi
- 4 Department of Anesthesiology and Critical Care, Military Teaching Hospital Mohammed V, Rabat, Morocco
| | - Hicham Balkhi
- 4 Department of Anesthesiology and Critical Care, Military Teaching Hospital Mohammed V, Rabat, Morocco
| | - Adil Maleb
- 3 Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
- 5 Laboratory of Microbiology, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Oujda, Morocco
| | - Mostafa Elouennass
- 1 Department of Bacteriology, Mohammed V Military Teaching Hospital, Rabat, Morocco
- 3 Research Team of Epidemiology and Bacterial Resistance, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Beshah D, Desta A, Belay G, Abebe T, Gebreselasie S, Sisay Tessema T. Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa. Infect Drug Resist 2022; 15:5043-5059. [PMID: 36068835 PMCID: PMC9441145 DOI: 10.2147/idr.s371654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria. Objective To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia. Methods A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software. Results The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI. Conclusion Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.
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Affiliation(s)
- Daniel Beshah
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Diagnostic Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Daniel Beshah, Microbial Cellular Molecular Biology infection Biology stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251 911151317, Email ;
| | - Adey Desta
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gurja Belay
- Microbial Cellular Molecular Biology Infection Biology Stream, College of Natural and Computational Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Gebreselasie
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Rodrigues Pires de Campos L, Farrel Côrtes M, Deo B, Rizek C, Santos S, Perdigão L, Costa SF. Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference trauma hospital. Am J Infect Control 2022; 50:673-679. [PMID: 34756966 DOI: 10.1016/j.ajic.2021.10.020] [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: 08/05/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Bloodstream infections (BSI) by multidrug-resistant (MDR) organisms are responsible for significant mortality in critically ill trauma patients. Our objective is to identify the risk factors for BSI by MDR agents and their resistance mechanisms in a trauma reference hospital. METHODS During 18 months, all patients admitted in our Intensive Care Unit (ICU) were enrolled in this prospective cohort. We included the first episode of BSI by carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus. Demographic and clinical data were compared among patients with and without BSI and variables with P < .05 were tested in a multivariate analysis. We performed PCR for identification of carbapenemase and SCC mec genes and Pulsed-field gel electrophoresis for clonality. RESULTS Out of 1,528 patients, 302 (19.8%) were trauma and 66 (4.3%) had a MDR-BSI (19.5% were trauma). The multivariate analysis showed that mechanical ventilation (OR3.16; 95% CI 1-8; P = .02), hemodialysis (OR3.16; 95% CI 1-5; P = .0003) and surgery (OR1.76; 95% CI 1-3; P = .04) were independent risk factors for MDR-BSI. The most frequent MDR were Klebsiella pneumoniae (n = 26) and MRSA (n = 27). Regarding K pneumoniae strains (n = 24), 20 (83.8%) harbored bla KPC gene and 1 bla NDM. The majority of KPC isolates belonged to a predominant clone; while the MRSA were polyclonal and SCC mec type II. CONCLUSIONS Mechanical ventilation, surgery and hemodialysis were independent risk factors for MDR-BSI in our cohort, but trauma was not. KPC was the main mechanism of resistance among carbapenem-resistant K pneumoniae that belonged to a predominant clone which could indicate cross-transmission.
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Seman A, Mihret A, Sebre S, Awoke T, Yeshitela B, Yitayew B, Aseffa A, Asrat D, Abebe T. Prevalence and Molecular Characterization of Extended Spectrum β-Lactamase and Carbapenemase-Producing Enterobacteriaceae Isolates from Bloodstream Infection Suspected Patients in Addis Ababa, Ethiopia. Infect Drug Resist 2022; 15:1367-1382. [PMID: 35378892 PMCID: PMC8976516 DOI: 10.2147/idr.s349566] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/11/2022] [Indexed: 12/30/2022] Open
Abstract
Background Production of Extended spectrum beta-lactamase (ESBL) and Carbapenemase is the most common strategy for drug resistance in clinical isolates of Enterobacteriaceae. This study was conducted to determine the magnitude of ESBL and Carbapenemase production (CPE) among clinical isolates of Enterobacteriaceae causing bloodstream infections (BSI) in Ethiopia. Methods A cross-sectional study was performed from September 2018 to January 2019 in Ethiopia. A total of 2397 BSI suspected patients were enrolled and blood culture was performed using a BacT/Alert instrument in combination with conventional methods for identification. After antimicrobial susceptibility test, phenotypic confirmation of ESBLs was done by combined disc-diffusion. Meanwhile carbapenemase production was done by modified carbapenem inactivation method. Multiplex PCR was conducted to detect the presence of blaCTX-M,blaSHV,blaTEM, blaKPC and blaNDM genes. Results A total of 104 (4.3%) Enterobacteriaceae were isolated from 2397 BSI suspected patients. Klebsiella pneumoniae (55/104, 52%) was the predominant isolate followed by E. coli, (19.2%, 20/104) and K.oxytoca (17.3%, 18/104). ESBL and carbapenemase production were observed from 70 (67.3%, 57.4 −76.2% at 95% CI) and 8 (7.7%, 3.4–14.6% at 95% CI) isolates respectively. The highest frequency of ESBL and carbapenemase production was observed in K. pneumoniae 78.2% (43/55) and 9.1% (5/55), respectively. All the 70 isolates confirmed as ESBL producers harbored at least one of the ESBL genes and the majority of them carried multiple beta-lactamase genes (84.3%), where blaCTX-M, type was the most predominant (67.3%). Similarly, the entire eight isolates positive for carbapenemase carried blaNDM but none of them carried blaKPC. Conclusion In our study, the rate of ESBL production among BSI-causing Enterobacteriaceae was alarming and most of the isolates carried multiple types of ESBL genes. A significant magnitude of CPE isolates causing BSI was recorded.
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Affiliation(s)
- Aminu Seman
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Correspondence: Aminu Seman, Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box: 9086, Addis Ababa, Ethiopia, Tel +251 920 747 176, Email ;
| | - Adane Mihret
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Shemse Sebre
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Tewachew Awoke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Yitayew
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abraham Aseffa
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Daniel Asrat
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology, and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Anversa L, Romani CD, Caria ES, Saeki EK, Nascentes GAN, Garbelotti M, Stancari RCA, Dantas STA, Rall VLM, Ruiz LS, Camargo CH, Richini-Pereira VB. Quality of dialysis water and dialysate in hemodialysis centers: highlight for occurrence of non-fermenting gram-negative bacilli. J Appl Microbiol 2022; 132:3416-3429. [PMID: 35108426 DOI: 10.1111/jam.15470] [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: 08/18/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from hemodialysis centers. METHODS AND RESULTS Samples were fortnightly collected from three hemodialysis centers in Bauru City, Brazil, between July/2017 and June/2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulfate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity, and genetic similarity among some isolated NFGNB. Of the analyzed samples, only 4/72 (5.6%) had conductivity values ≥ 10 mS/cm, 4/216 (1.9%) presented total coliforms, and 1/216 (0.5%) had heterotrophic bacteria count > 100 CFU/mL. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified microorganisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating persistence of bacterial clones in the systems over time. CONCLUSIONS NFGNB were observed in several dialysis water and dialysate samples from all investigated centers, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY Regular inclusion of actions for NFGNB control and monitoring in hemodialysis fluids are suggested for greater safety of the dialytic process.
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Affiliation(s)
- L Anversa
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C D Romani
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E S Caria
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E K Saeki
- Adolfo Lutz Institute, Regional Laboratories Center Presidente Prudente, Presidente Prudente, Brazil
| | - G A N Nascentes
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Uberaba, Brazil
| | - M Garbelotti
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - R C A Stancari
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - S T A Dantas
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - V L M Rall
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - L S Ruiz
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C H Camargo
- Adolfo Lutz Institute, Central Laboratory, São Paulo, Brazil
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21
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Volpicelli L, Venditti M, Ceccarelli G, Oliva A. Place in Therapy of the Newly Available Armamentarium for Multi-Drug-Resistant Gram-Negative Pathogens: Proposal of a Prescription Algorithm. Antibiotics (Basel) 2021; 10:antibiotics10121475. [PMID: 34943687 PMCID: PMC8698671 DOI: 10.3390/antibiotics10121475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022] Open
Abstract
The worldwide propagation of antimicrobial resistance represents one of the biggest threats to global health and development. Multi-drug-resistant organisms (MDROs), including carbapenem-resistant non-fermenting Gram-negatives and Enterobacterales, present a heterogeneous and mutating spread. Infections by MDRO are often associated with an unfavorable outcome, especially among critically ill populations. The polymyxins represented the backbone of antibiotic regimens for Gram-negative MDROs in recent decades, but their use presents multiple pitfalls. Luckily, new agents with potent activity against MDROs have become available in recent times and more are yet to come. Now, we have the duty to make the best use of these new therapeutic tools in order not to prematurely compromise their effectiveness and at the same time improve patients’ outcomes. We reviewed the current literature on ceftazidime/avibactam, meropenem/vaborbactam and cefiderocol, focusing on antimicrobial spectrum, on the prevalence and mechanisms of resistance development and on the main in vitro and clinical experiences available so far. Subsequently, we performed a step-by-step construction of a speculative algorithm for a reasoned prescription of these new antibiotics, contemplating both empirical and targeted use. Attention was specifically posed on patients with life-risk conditions and in settings with elevated prevalence of MDRO.
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22
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Bassetti M, Garau J. Current and future perspectives in the treatment of multidrug-resistant Gram-negative infections. J Antimicrob Chemother 2021; 76:iv23-iv37. [PMID: 34849997 PMCID: PMC8632738 DOI: 10.1093/jac/dkab352] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Microbial resistance is a serious threat to human health worldwide. Among the World Health Organisation's list of priority resistant bacteria, three are listed as critical-the highest level of concern-and all three are Gram-negative. Gram-negative resistance has spread worldwide via a variety of mechanisms, the most problematic being via AmpC enzymes, extended-spectrum β-lactamases, and carbapenemases. A combination of older drugs, many with high levels of toxicity, and newer agents are being used to combat multidrug resistance, with varying degrees of success. This review discusses the current treatments for multidrug-resistant Gram-negative bacteria, including new agents, older compounds, and new combinations of both, and some new treatment targets that are currently under investigation.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino—IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Javier Garau
- Hospital Universitari Mutua de Terrassa, Barcelona, Spain
- Clínica Rotger Quironsalud, Palma de Mallorca, Spain
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23
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Di Carlo P, Serra N, Lo Sauro S, Carelli VM, Giarratana M, Signorello JC, Lucchesi A, Manta G, Napolitano MS, Rea T, Cascio A, Sergi CM, Giammanco A, Fasciana T. Epidemiology and Pattern of Resistance of Gram-Negative Bacteria Isolated from Blood Samples in Hospitalized Patients: A Single Center Retrospective Analysis from Southern Italy. Antibiotics (Basel) 2021; 10:1402. [PMID: 34827340 PMCID: PMC8614669 DOI: 10.3390/antibiotics10111402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Blood culturing remains the mainstream tool to inform an appropriate treatment in hospital-acquired bloodstream infections and to diagnose any bacteremia. METHODS A retrospective investigation on the prevalence of Gram-negative bacteria (GNB) and their resistance in hospitalized patients by age, sex, and units from blood cultures (BCs) was conducted from January 2018 to April 2020 at Sant'Elia hospital, Caltanissetta, southern Italy. We divided the patient age range into four equal intervals. RESULTS Multivariate demographic and microbiological variables did not show an association between bacteria distributions and gender and age. The distribution by units showed a higher prevalence of Klebsiella pneumoniae and Acinetobacter baumannii in the intensive care unit (ICU) and Escherichia coli in the non-intensive care units (non-ICUs). The analysis of antibiotic resistance showed that E. coli was susceptible to a large class of antibiotics such as carbapenem and trimethoprim-sulfamethoxazole. K. pneumoniae showed a significant susceptibility to colistin, tigecycline, and trimethoprim-sulfamethoxazole. From the survival analysis, patients with E. coli had a higher survival rate. CONCLUSIONS The authors stress the importance of the implementation of large community-level programs to prevent E. coli bacteremia. K. pneumoniae and E. coli susceptibility patterns to antibiotics, including in the prescription patterns of general practitioners, suggest that the local surveillance and implementation of educational programs remain essential measures to slow down the spread of resistance and, consequently, increase the antibiotic lifespan.
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Affiliation(s)
- Paola Di Carlo
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, 90127 Palermo, Italy; (P.D.C.); (M.S.N.); (A.C.); (A.G.)
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80131 Napoli, Italy; (N.S.); (T.R.)
| | | | | | - Maurizio Giarratana
- Microbiology Unit, Sant’Elia Hospital, 93100 Caltanissetta, Italy; (V.M.C.); (M.G.)
| | - Juan Camilo Signorello
- Hypatia School of Medicine (UNIPA-Caltanissetta), University of Palermo, 90127 Palermo, Italy;
| | - Alessandro Lucchesi
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy;
| | - Giuseppe Manta
- Intensive Cure Unit (ICU), Sant’Elia Hospital, 93100 Caltanissetta, Italy;
| | - Maria Santa Napolitano
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, 90127 Palermo, Italy; (P.D.C.); (M.S.N.); (A.C.); (A.G.)
| | - Teresa Rea
- Department of Public Health, University Federico II of Naples, 80131 Napoli, Italy; (N.S.); (T.R.)
| | - Antonio Cascio
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, 90127 Palermo, Italy; (P.D.C.); (M.S.N.); (A.C.); (A.G.)
| | - Consolato Maria Sergi
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Anna Giammanco
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, 90127 Palermo, Italy; (P.D.C.); (M.S.N.); (A.C.); (A.G.)
| | - Teresa Fasciana
- Department of Health Promotion, Maternal-Childhood, Internal Medicine of Excellence G. D’Alessandro, University of Palermo, 90127 Palermo, Italy; (P.D.C.); (M.S.N.); (A.C.); (A.G.)
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Monteiro ADSS, Oliveira EGD, Santos DBD, Cordeiro SM, Couto RD, Couto FD. Sickle cell disease children's gut colonization by extended-spectrum β-lactamase (ESBL)-producing Enterobacterales: an antibiotic prophylaxis effect? J Med Microbiol 2021; 70. [PMID: 34477545 DOI: 10.1099/jmm.0.001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Sickle cell disease (SCD) children have a high susceptibility to pneumococcal infection. For this reason, they are routinely immunized with pneumococcal vaccines and use antibiotic prophylaxis (AP).Hypothesis/Gap Statement. Yet, little is known about SCD children's gut microbiota. If antibiotic-resistant Enterobacterales may colonize people on AP, we hypothesized that SCD children on AP are colonized by resistant enterobacteria species.Objective. To evaluate the effect of continuous AP on Enterobacterales gut colonization from children with SCD.Methodology. We analysed 30 faecal swabs from SCD children on AP and 21 swabs from children without the same condition. Enterobacterales was isolated on MacConkey agar plates and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (bioMérieux, Marcy l'Etoile, France). We performed the antibiogram by Vitek 2 system (bioMérieux, Marcy l'Etoile, France), and the resistance genes were identified by multiplex PCR.Results. We found four different species with resistance to one or more different antibiotic types in the AP-SCD children's group: Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, and Citrobacter farmeri. Colonization by resistant E. coli was associated with AP (prevalence ratio 2.69, 95 % confidence interval [CI], 1.98-3.67, P<0.001). Strains producing extended-spectrum β-lactamases (ESBL) were identified only in SCD children, E. coli, 4/30 (13 %), and K. pneumoniae, 2/30 (7 %). The ESBL-producing Enterobacterales were associated with penicillin G benzathine use (95 % CI, 22.91-86.71, P<0.001). CTX-M-1 was the most prevalent among ESBL-producers (3/6, 50 %), followed by CTX-M-9 (2/6, 33 %), and CTX-M-2 (1/6, 17 %).Conclusion. Resistant enterobacteria colonize SCD children on AP, and this therapy raises the chance of ESBL-producing Enterobacterales colonization. Future studies should focus on prophylactic vaccines as exclusive therapy against pneumococcal infections.
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Affiliation(s)
- Adriano de Souza Santos Monteiro
- Graduate Program in Pharmacy, Faculty of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil.,Present address: Postgraduate Course in Biotechnology in Health and Investigative Medicine, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | | | | | | | | | - Fábio David Couto
- Center of Agricultural, Environmental, and Biological Sciences, Federal University of Reconcavo of Bahia, Cruz das Almas, Bahia, Brazil
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Dai Y, Chang W, Zhou X, Yu W, Huang C, Chen Y, Ma X, Lu H, Ji R, Ying C, Wang P, Liu Z, Yuan Q, Xiao Y. Evaluation of Ceftazidime/Avibactam Administration in Enterobacteriaceae and Pseudomonas aeruginosa Bloodstream Infections by Monte Carlo Simulation. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2899-2905. [PMID: 34262257 PMCID: PMC8275101 DOI: 10.2147/dddt.s309825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022]
Abstract
Purpose To evaluate the administration regimen of ceftazidime/avibactam (CZA) for bloodstream infections caused by Enterobacteriaceae and Pseudomonas aeruginosa. Methods The minimal inhibitory concentrations (MICs) of CZA against Enterobacteriaceae and P. aeruginosa isolated from blood cultures at member hospitals in BRICS (Blood Bacterial Resistant Investigation Collaborative System) in 2019 were determined by broth micro-dilution methodology. A 10,000-patient Monte Carlo simulation (MCS) was used to calculate the probability of target attainment (PTA) and cumulative fraction of response (CFR) for different CZA dosage regimens to evaluate their efficacies and optimize the best initial dosage regimen. Results Altogether, 6487 Enterobacteriaceae and P. aeruginosa strains were isolated from the blood cultures. The overall CZA resistance rate was 2.31%, of which the Enterobacteriaceae and P. aeruginosa rates were 1.57% and 14.29%, respectively. The MCS showed that the greater the MIC value, the worse the therapeutic effect. When the CZA MIC was ≤8 mg/L, the standard dose (2.5g iv q8h) achieved 90% PTA in the subset of patients with creatinine clearance (CrCl) values from 51 to 120 mL/min. Although the high-dose regimen (3.75g iv q8h) achieved 90% PTA in patients with CrCl values from 121 to 190 mL/min, implementing the low-dose regimen (1.25g iv q8h) was also effective for patients in the 51–89 mL/min CrCl range. Generally, the high-dose regimen (3.75g iv q8h) reached 90% CFR against all of the strains. Conversely, in patients with CrCl values of 121–190 mL/min, the standard dose (2.5g iv q8h) failed to reach 90% CFR against some Enterobacteriaceae members and P. aeruginosa. When the dose was reduced to the low-dose regimen (1.25g iv q8h), no patients reached 90% CFR against some Enterobacteriaceae members and P. aeruginosa. Conclusion CZA has good antibacterial activity against Enterobacteriaceae and P. aeruginosa in bloodstream infections. Clinicians could make individualized treatment regimens in accordance with the sensitivity of the strains and the level of renal function in their patients to best predict the drug-related clinical responses.
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Affiliation(s)
- Yuanyuan Dai
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Wenjiao Chang
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Xin Zhou
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Chen Huang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiaoling Ma
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Huaiwei Lu
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Rujin Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Chaoqun Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Peipei Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Zhiying Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
| | - Qingfeng Yuan
- Department of Laboratory, First Affiliated Hospital of University of Science and Technology of China, Hefei, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China
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Amanati A, Sajedianfard S, Khajeh S, Ghasempour S, Mehrangiz S, Nematolahi S, Shahhosein Z. Bloodstream infections in adult patients with malignancy, epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance. BMC Infect Dis 2021; 21:636. [PMID: 34215207 PMCID: PMC8254331 DOI: 10.1186/s12879-021-06243-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. Methods We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. Results 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015–2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. Conclusions The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06243-z.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Somayeh Khajeh
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran
| | | | - Salma Mehrangiz
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran
| | | | - Zahra Shahhosein
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran.
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Alemayehu T. Prevalence of multidrug-resistant bacteria in Ethiopia: a systematic review and meta-analysis. J Glob Antimicrob Resist 2021; 26:133-139. [PMID: 34129993 DOI: 10.1016/j.jgar.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Multidrug-resistant (MDR) bacteria are a significant public-health threat worldwide, especially in low- and middle-income countries. Comprehensive data are important to understand the magnitude of multidrug resistance (MDR), however these are not available in Ethiopia. METHODS Five electronic databases and grey literature of Addis Ababa University Repository were searched for data regarding the prevalence of MDR bacteria in Ethiopia. OpenMetaAnalyst R1.3 was used for analysis using a random-effects model to determine the effect size. Heterogeneity among articles was checked using the inconsistency index (I2). Funnel plot was used to check for publication bias. The quality of each article was checked using the Newcastle-Ottawa checklist adapted for cross-sectional studies. RESULTS Through database searching, 2094 articles were identified, of which 37 fulfilled the study inclusion criteria. This review comprises 6856 bacteria, of which 4949 isolates were MDR. The overall pooled prevalence of MDR was 70.5% (95% CI 64.9-76.1%), with considerable heterogeneity (I2 = 97.48%, P < 0.001). Funnel plot revealed no publication bias. Sidama (81.7%) had the highest MDR and Tigray (51.1%) the lowest. The greatest source of MDR was from multiple sites of infection (MSI) (76.8%); the least was from bloodstream infections (62.9%). MDR was higher in studies conducted on hospital-acquired infections (72.1%) compared with both hospital- and community-acquired infections (69.8%). CONCLUSION Our study indicates a high prevalence of MDR in Ethiopia. Sidama region, MSI and hospital-acquired infections showed the highest MDR in subgroup analysis. Regional hospitals should implement infection prevention and proper use of antibiotics in the community.
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Affiliation(s)
- Tsegaye Alemayehu
- Hawassa University College of Medicine and Health Science, School of Medical Laboratory, P.O. Box. 1560, Hawassa, Ethiopia.
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Bavaro DF, Belati A, Diella L, Stufano M, Romanelli F, Scalone L, Stolfa S, Ronga L, Maurmo L, Dell’Aera M, Mosca A, Dalfino L, Grasso S, Saracino A. Cefiderocol-Based Combination Therapy for "Difficult-to-Treat" Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives. Antibiotics (Basel) 2021; 10:antibiotics10060652. [PMID: 34072342 PMCID: PMC8227820 DOI: 10.3390/antibiotics10060652] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
- Correspondence:
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Lucia Diella
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Monica Stufano
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Federica Romanelli
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luca Scalone
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Stefania Stolfa
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luigi Ronga
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Leonarda Maurmo
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Maria Dell’Aera
- Direttore Farmacia Ospedaliera AOU Policlinico di Bari, University of Bari, 70124 Bari, Italy;
| | - Adriana Mosca
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Salvatore Grasso
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
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Komatsu T, Yoshida E, Shigenaga A, Yasuie N, Uchiyama S, Takamura Y, Sugie K, Kimura K, Haritani M, Shibahara T. Fatal suppurative meningoencephalitis caused by Klebsiella pneumoniae in two calves. J Vet Med Sci 2021; 83:1113-1119. [PMID: 34024871 PMCID: PMC8349807 DOI: 10.1292/jvms.21-0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
One calf died (No. 1) and another was euthanized following astasia (No. 2). Histopathological examination revealed suppurative meningoencephalitis in these
calves. Klebsiella pneumoniae antigens were detected in lesions. Thymocytes were decreased in the thymus cortex in both cases. 16S rRNA gene
sequencing of the No. 1 isolate and bacterial extracts from formalin fixed paraffin embedded sections of No. 2 revealed that both samples were K.
pneumoniae. The No. 1 isolate showed multidrug resistance against penicillin antibiotics, fosfomycin, streptomycin, macrolide antibiotics,
tetracycline antibiotics, and clindamycin. Immunosuppression is a significant septicemic K. pneumoniae infection risk factor. Our study
provides new aspects regarding K. pneumoniae infections in cattle, bacterial meningoencephalitis differentiation, and K.
pneumoniae and bacterial meningoencephalitis treatments.
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Affiliation(s)
- Tetsuya Komatsu
- Aichi Prefectural Chuo Livestock Hygiene Service Center, 1-306 Jizono, Miaicho, Okazaki, Aichi 444-0805, Japan
| | - Erina Yoshida
- Miyazaki Prefectural Livestock Hygiene Service Center, 3151-1 Shimonaka, Sadowaracho, Miyazaki, Miyazaki 880-0212, Japan
| | - Ayumi Shigenaga
- Miyazaki Prefectural Livestock Hygiene Service Center, 3151-1 Shimonaka, Sadowaracho, Miyazaki, Miyazaki 880-0212, Japan
| | - Nozomi Yasuie
- Hinode Animal Clinic, 4-1 Owaki, Heijimacho, Yatomi, Aichi 498-0031, Japan
| | - Shintaro Uchiyama
- Aichi Prefectural Tobu Livestock Hygiene Service Center, 51-1 Konami, Nishimiyukicho, Toyohashi, Aichi 441-8113, Japan
| | - Yuji Takamura
- Aichi Prefectural Chuo Livestock Hygiene Service Center, 1-306 Jizono, Miaicho, Okazaki, Aichi 444-0805, Japan
| | - Kennosuke Sugie
- Aichi Prefectural Chuo Livestock Hygiene Service Center, 1-306 Jizono, Miaicho, Okazaki, Aichi 444-0805, Japan
| | - Kumiko Kimura
- Division of Pathology and Pathophysiology, National Institute of Animal Health, National Agriculture and Food Research Organization (NARO), 3-1-5 Kannondai, Tsukuba, Ibaraki 305-0856, Japan
| | - Makoto Haritani
- Department of Veterinary Medical Science, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.,School of Veterinary Nursing and Technology, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonancho, Musashino, Tokyo 180-8602, Japan
| | - Tomoyuki Shibahara
- Division of Pathology and Pathophysiology, National Institute of Animal Health, National Agriculture and Food Research Organization (NARO), 3-1-5 Kannondai, Tsukuba, Ibaraki 305-0856, Japan.,Department of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, 1-58 Rinku-Oraikita, Izumisano, Osaka 598-8531, Japan
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Giovannenze F, Murri R, Palazzolo C, Taccari F, Camici M, Spanu T, Posteraro B, Sanguinetti M, Cauda R, Onder G, Fantoni M. Predictors of mortality among adult, old and the oldest old patients with bloodstream infections: An age comparison. Eur J Intern Med 2021; 86:66-72. [PMID: 33414015 DOI: 10.1016/j.ejim.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bloodstream infections (BSIs) are a major cause of mortality in elderly. Objective of the study is to identify factors predictive of mortality in old and oldest old patients. METHODS This is a single centre retrospective observational study, including all patients admitted to Fondazione Policlinico A. Gemelli university hospital and diagnosed with BSI. Patients were stratified into three groups according to age: adult (A), younger than 65; old (O), aged between 65 and 80; oldest old (OO), older than 80. Primary outcome was 30-day in-hospital mortality. Secondary outcomes were duration of antimicrobial therapy (DOT) and length of hospital stay (LOS). RESULTS Of the 1034 patients included in the study, 346 were in group A, 447 in group O and 241 in group OO. The rate of 30-day mortality raised from 6.9% (24/346) in group A to 10.8% (84/447) in group O and 33.2% (80/241) in group OO (p<0.01), while DOT and LOS significantly decreased moving from adults to oldest old (p<0.01). Methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp were both independently correlated to an increased 30-day mortality risk selectively in patients older than 80 (MRSA: HR 2.37, p=0.03; Enterococcus spp: HR 2.44, p=0.01). CONCLUSIONS BSIs have a high impact on survival in old and oldest old patients. BSIs by gram-positive pathogens, in particular MRSA and Enterococcus spp, should be a wake-up call for physicians, who should focus efforts on adequate and prompt antibiotic and support treatment.
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Affiliation(s)
- Francesca Giovannenze
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy.
| | - Rita Murri
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Claudia Palazzolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Istituto Nazionale Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Francesco Taccari
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Marta Camici
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Istituto Nazionale Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Cauda
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Sezione Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Yincharoen K, Adekoya AE, Chokpaisarn J, Kunworarath N, Jaisamut P, Limsuwan S, Chusri S. Anti-infective effects of traditional household remedies described in the national list of essential medicines, Thailand, on important human pathogens. J Herb Med 2021. [DOI: 10.1016/j.hermed.2020.100401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Silveira MC, Rocha-de-Souza CM, de Oliveira Santos IC, Pontes LDS, Oliveira TRTE, Tavares-Teixeira CB, Cossatis NDA, Pereira NF, da Conceição-Neto OC, da Costa BS, Rodrigues DCS, Albano RM, da Silva FAB, Marques EA, Leão RS, Carvalho-Assef APD. Genetic Basis of Antimicrobial Resistant Gram-Negative Bacteria Isolated From Bloodstream in Brazil. Front Med (Lausanne) 2021; 8:635206. [PMID: 33791325 PMCID: PMC8005515 DOI: 10.3389/fmed.2021.635206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant microorganisms are a well-known global problem, and gram-negative bacilli are top-ranking. When these pathogens are associated with bloodstream infections (BSI), outcomes become even worse. Here we applied whole-genome sequencing to access information about clonal distribution, resistance mechanism diversity and other molecular aspects of gram-negative bacilli (GNB) isolated from bloodstream infections in Brazil. It was possible to highlight international high-risk clones circulating in the Brazilian territory, such as CC258 for Klebsiella pneumoniae, ST79 for Acinetobacter baumannii and ST233 for Pseudomonas aeruginosa. Important associations can be made such as a negative correlation between CRISPR-Cas and K. pneumoniae CC258, while the genes blaTEM, blaKPC and blaCTX−M are highly associated with this clone. Specific relationships between A. baumannii clones and blaOXA−51 variants were also observed. All P. aeruginosa ST233 isolates showed the genes blaVIM and blaOXA486. In addition, some trends could be identified, where a new P. aeruginosa MDR clone (ST3079), a novel A. baumannii clonal profile circulating in Brazil (ST848), and important resistance associations in the form of blaVIM−2 and blaIMP−56 being found together in one ST233 strain, stand out. Such findings may help to develop approaches to deal with BSI and even other nosocomial infections caused by these important GNB.
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Affiliation(s)
- Melise Chaves Silveira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Leilane da Silva Pontes
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | - Nataly de Almeida Cossatis
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | - Natacha Ferreira Pereira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Bianca Santos da Costa
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Rodolpho Mattos Albano
- Departamento de Bioquímica, Instituto de Biologia Roberto de Alcântara Gome, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | | | - Elizabeth Andrade Marques
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Robson Souza Leão
- Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
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Habyarimana T, Murenzi D, Musoni E, Yadufashije C, N Niyonzima F. Bacteriological Profile and Antimicrobial Susceptibility Patterns of Bloodstream Infection at Kigali University Teaching Hospital. Infect Drug Resist 2021; 14:699-707. [PMID: 33654414 PMCID: PMC7914060 DOI: 10.2147/idr.s299520] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Worldwide, bacterial bloodstream infections (BSIs) constitute an important cause of morbidity and mortality in clinical settings. Due to the limited laboratory facilities in sub-Saharan Africa, poor diagnosis of BSIs results in poor clinical outcomes and leads to a risk of antimicrobial resistance. The present work was carried out to describe the microbiological features of BSIs using the data collected from Centre Hospitalier Universitaire de Kigali (CHUK). METHODS A retrospective study was carried out at CHUK. The blood culture results of 2,910 cases - from adults, children and infants - were reviewed in the Microbiology service from October 2017 to October 2018. The following variables were considered: age, gender, admitting department, blood culture results, and antimicrobials sensitivity test results. Data were entered and analyzed using Microsoft Excel 2013. RESULTS Twelve percent (341/2,910) of blood culture results reviewed were positive with 108 (31.7%) Gram positive bacteria and 233 (68.3%) Gram negative bacteria. The most prevalent pathogens were Klebsiella pneumoniae 108 (31.7%) and Staphylococcus aureus 100 (29.3%). This study revealed a high resistance to commonly prescribed antibiotics such as penicillin, trimethoprim sulfamethoxazole, and Ampicillin with 91.8, 83.3, and 81.8% of resistance, respectively. However, bacteria were sensitive to imipenem and vancomycin with 98.1 and 94.3% of sensitivity, respectively. The pediatrics and neonatology departments showed a high number of positive culture with 97/341 (28.4%), and 93/341 (27%) respectively. The overall prevalence of multidrug resistance was 77.1%. CONCLUSION The prevalence of bacterial pathogens in BSIs was found to be high. The antibiotic resistance to the commonly used antibiotics was high. Appropriate treatment of BSIs should be based on the current knowledge of bacterial resistance pattern. This study will help in formulating management of diagnostic guidelines and antibiotic policy.
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Affiliation(s)
| | - Didier Murenzi
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Emile Musoni
- Pathology Department, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
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Direct DNA Sequencing-Based Analysis of Microbiota Associated with Hematological Malignancies in the Eastern Province of Saudi Arabia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4202019. [PMID: 33623780 PMCID: PMC7875615 DOI: 10.1155/2021/4202019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/25/2021] [Indexed: 12/02/2022]
Abstract
Introduction Bloodstream infections (BSI) among patients with hematological malignancies (HM) could predispose them to higher morbidity and mortality for various underlying conditions. Several microorganisms, either pathogenic or opportunistic normal human flora, could cause severe bacteremia and septicemia. While conventional methods have their own limitations, molecular methods such as next-generation sequencing (NGS) can detect these blood infections with more reliability, specificity, and sensitivity, in addition to information on microbial population landscape. Methodology. Blood samples from HM patients (n = 50) and volunteer blood donor control individuals with no HM (n = 50) were subjected to 16S rRNA gene amplification using standard PCR protocols. A metagenomic library was prepared, and NGS was run on a MiSeq (Illumina) sequencer. Sequence reads were analyzed using MiSeq Reporter, and microbial taxa were aligned using the Green Genes library. Results 82% of the patients showed BSI with Gram-negative bacteria as the most predominant group. E. coli comprised a major chunk of the bacterial population (19.51%), followed by K. pneumoniae (17.07%). The CoNS and Viridans Streptococci groups are 17.07% and 14.63%, respectively. Other major species were S. aureus (9.75%), P. aeruginosa (7.31%), A. baumannii (4.87%), E. cloacae (4.87%), and P. mirabilis (4.87%). 34.14% of the cases among patients showed a Gram-positive infection, while 14.63% showed polymicrobial infections. Conclusion Most of the BSI in patients were characterized by polymicrobial infections, unlike the control samples. Molecular methods like NGS showed robust, fast, and specific identification of infectious agents in BSI in HM, indicating the possibility of its application in routine follow-up of such patients for infections.
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Hospital Acquired Bloodstream Infection by Multi Drug Resistant Organisms-Alarming and Challenging Issue in the Intensive Care Units at Present Era. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.4.35] [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
Hospital-acquired bloodstream infections (BSIs) cause high mortality in the intensive care units (ICUs) compared to wards. Furthermore, the isolation of multidrug resistant (MDR) organisms in ICUs add to the gravity of the condition making the treatment a bigger challenge. The present study was aimed to evaluate the prevalence, spread, and the possible MDR organisms contributing to ICU-acquired BSI & the source of the secondary BSI in the ICUs. A prospective study was conducted in four ICU of tertiary teaching hospital over a period of six months. Patient that developed features of BSI within 48 hours after hospital admission were included in the present study Blood culture was performed by an automated BacT/ALERT®3D system. The source of secondary BSI was identified by analysing culture results for the samples other than blood. These samples were taken within 48 hours of the patient’s blood culture test being positive. A total of 50 patients (25%) had an ICU acquired bloodstream infection. Out of 50 patients, 74% of them had bacterial etiology. Thirty one patients (62%) among them developed multidrug resistant bacteraemia. Fifty six percent of Gram negative bacilli were multi drug resistant. The resistance to carbapenem was 42%. The most common MDR Gram negative isolate was identified as Klebsiella pneumoniae (n=12; 38.7%,) and the most common source was pulmonary infection (26.7% (n=12). 42% of isolates in our study were carbapenem resistant suggesting the need for a proper antibiotic policy in the ICUs. Prolonged stay in the ICU with mechanical ventilation was the critical risk factor and ICU mortality was high (38%).
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Andrianaki AM, Koutserimpas C, Kafetzakis A, Tavlas E, Maraki S, Papadakis JA, Ioannou P, Samonis G, Kofteridis DP. Diabetic foot infection and osteomyelitis. Are deep-tissue cultures necessary? Germs 2020; 10:346-355. [PMID: 33489950 DOI: 10.18683/germs.2020.1227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/17/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
Introduction Diabetic foot infections (DFIs) are common and difficult to treat. The objective of this study was to compare swab and tissue cultures as indicators of appropriate treatment of DFIs. Methods This is a prospective study conducted during a 4-year period. All patients with DFIs and/or diabetic foot osteomyelitis (DFO) admitted to the University Hospital of Heraklion, Greece, were included. Clinical data were collected, while cultures taken with swabs and/or tissue biopsies were used as indicators of the microbiological cause and the appropriate treatment. Results In total, 83 individuals (62.7% males) with mean age of 72 years, were enrolled. Coexisting osteomyelitis was present in 18.1%. From tissue and pus cultures, 131 and 176 pathogens, respectively, were isolated. Gram-positive aerobes were the most common microorganisms, followed by Gram-negatives. Infection was polymicrobial in 40 (70.2%) out of 57 patients with tissue culture and in 54 (75.0%) out of 72 with pus culture. Microbiological results from tissue cultures were compatible with those from pus at a rate of 80%, while in cases of osteomyelitis concordance reached 100%. Multidrug-resistant organisms (MDROs) were isolated from 32 (24.4%) tissue and 44 (25%) pus cultures (p=0.910). Initial empirical antimicrobial treatment was considered inappropriate in 44.6% of cases. Conclusions A high concordance between easily taken swab cultures and those taken by biopsy was noted, especially in DFO. This was helpful for early change to appropriate treatment in cases where MDROs were isolated and empirical treatment was inappropriate. Further research is needed to confirm this observation in clinical practice.
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Affiliation(s)
- Angeliki M Andrianaki
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Christos Koutserimpas
- MD, Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, PC 11525, Greece
| | - Alexandros Kafetzakis
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Emmanouil Tavlas
- MD, Department of Vascular Surgery, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Sofia Maraki
- MD, PhD, Department of Microbiology, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - John A Papadakis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Petros Ioannou
- MD, MSc, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - George Samonis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
| | - Diamantis P Kofteridis
- MD, PhD, Department of Internal Medicine, University Hospital of Heraklion, Crete, PC 71110, Greece
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Rapid detection of antimicrobial resistance markers with Allplex™ Entero-DR assay directly from positive blood culture bottles. Eur J Clin Microbiol Infect Dis 2020; 40:801-806. [PMID: 33099709 DOI: 10.1007/s10096-020-04082-5] [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: 06/23/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
A method for rapid detection of one extended-spectrum β-lactamase (ESBL) and five carbapenemase-encoding genes as well as vancomycin resistance markers directly from blood cultures using the Allplex™ Entero-DR assay (Seegene, Seoul, South Korea) is presented. Altogether 28 previously well-characterized resistant Gram-negative bacilli and Enterococcus spp., and 142 clinical blood cultures containing Gram-negative bacilli or Gram-positive cocci were analyzed. The method had 100% sensitivity and specificity for detecting blaOXA-48-like, blaKPC, blaVIM, blaIMP, blaNDM, blaCTX-M, vanA, and vanB. The lowest detectable amount of viable cells in blood culture samples were 5.39·104 CFU/mL, 6.66·104 CFU/mL, 5.13·103 CFU/mL, 6.09·104 CFU/mL, 6.66·104 CFU/mL, 6.66·104 CFU/mL, 3.12·104 CFU/mL, and 5.34·104 CFU/mL for the blaKPC, blaOXA-48-like, blaVIM, blaIMP, blaNDM, blaCTX-M, vanA, and vanB, respectively. The results were available within 90 min from signal positive blood cultures, as no separate DNA extraction steps were needed, and the assay showed no interference from blood or culture media used allowing reliable and simplified detection of the resistance markers.
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Taşdelen Öğülmen D, Ateş S. Use of alcohol containing caps for preventing bloodstream infections: A randomized controlled trial. J Vasc Access 2020; 22:920-925. [PMID: 32854563 DOI: 10.1177/1129729820952961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A majority of bloodstream infections seen in intensive care units stem from intravascular catheters used on patients. Catheter hubs are the entrance for pathogenic microorganisms into the inner surfaces of the catheters. The pathogenic microorganisms colonization in the mentioned areas can cause central line-associated bloodstream infection (CLABSI). METHODS This study was conducted as a randomized controlled trial to investigate the effect of alcohol-containing caps on the prevention of CLABSI. Total of 95 patients participated in the study. Isopropyl alcohol-containing caps were used for protecting the needle-free connectors closing the hubs of the central venous catheters in the intervention group. However, the control group patient received standard catheter caps. RESULT There was a statistically significant difference between groups in terms of infection distribution (X2 = 13.058; p < 0.001). The risk of infection in the control group was 13.7 times higher than the risk of infection in the intervention group. DISCUSSION Our results suggest that alcohol-containing caps are effective or in preventing CLABSI. CONCLUSION These findings suggest that alcohol-containing caps on ports are effective in preventing CLABSI.
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Affiliation(s)
- Deniz Taşdelen Öğülmen
- Infection Control Nurse, Kartal Koşuyolu High Speciality Educational And Research Hospital, İstanbul, Turkey
| | - Sebahat Ateş
- School of Nursing, Maltepe Üniversity, İstanbul, Turkey
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Falconer K, Hammond R, Gillespie SH. Improving the recovery and detection of bloodstream pathogens from blood culture. J Med Microbiol 2020; 69:806-811. [PMID: 32490793 PMCID: PMC7451035 DOI: 10.1099/jmm.0.001209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Bloodstream infections (BSI) are growing in incidence and present a serious health threat. Most patients wait up to 48 h before microbiological cultures can confirm a diagnosis. Low numbers of circulating bacteria in patients with BSI mean we need to develop new methods and optimize current methods to facilitate efficient recovery of bacteria from the bloodstream. This will allow detection of positive blood cultures in a more clinically useful timeframe. Many bacterial blood recovery methods are available and usually include a combination of techniques such as centrifugation, filtration, serum separation or lysis treatment. Here, we evaluate nine different bacteria recovery methods performed directly from blood culture. Aim. We sought to identify a bacterial recovery method that would allow for a cost-effective and efficient recovery of common BSI pathogens directly from blood culture. Methods. Simulated E. coli ATCC 25922 blood culture was used as a model system to evaluate nine different bacteria recovery methods. Each method was assessed on recovery yield, cost, hands-on time, risk of contamination and ease of use. The highest scoring recovery method was further evaluated using simulated blood cultures spiked with seven of the most frequently occurring bloodstream pathogens. The recovery yield was calculated based on c.f.u. count before and after each recovery method. Independent t-tests were performed to determine if the recovery methods evaluated were significantly different based on c.f.u. ml−1 log recovery. Results. All nine methods evaluated successfully recovered E. coli ATCC 25922 from simulated blood cultures although the bacterial yield differed significantly. The MALDI-TOF intact cell method offered the poorest recovery with a mean loss of 2.94±0.37 log c.f.u. ml−1. In contrast, a method developed by Bio-Rad achieved the greatest bacterial yield with a mean bacteria loss of 0.27±0.013 log c.f.u. ml−1. Overall, a low-speed serum-separation method was demonstrated to be the most efficient method in terms of time, cost and recovery efficiency and successfully recovered seven of the most frequent BSI pathogens with a mean bacteria loss of 0.717±0.18 log c.f.u. ml−1. Conclusion. The efficiency of bacterial recovery can vary significantly between different methods and thereby can have a critical impact on downstream analysis. The low-speed serum-separation method offered a simple and effective means of recovering common BSI pathogens from blood culture and will be further investigated for use in the rapid detection of bacteraemia and susceptibility testing in clinical practice.
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Affiliation(s)
- Kerry Falconer
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Robert Hammond
- School of Medicine, University of St Andrews, St Andrews, UK
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Wang D, Li H, Khan WU, Ma X, Tang H, Tang Y, Huang D, Liu Z. SmpB and tmRNA Orchestrate Purine Pathway for the Trimethoprim Resistance in Aeromonas veronii. Front Cell Infect Microbiol 2020; 10:239. [PMID: 32547961 PMCID: PMC7270562 DOI: 10.3389/fcimb.2020.00239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
Small protein B(SmpB) cooperates with transfer-messenger RNA (tmRNA) for trans-translation to ensure the quality control of protein synthesis in prokaryotes. Furthermore, they regulate cell metabolism separately. According to research, SmpB functions as a transcription factor, and tmRNA acts as a small RNA. Purine pathway has been reported to be related to trimethoprim resistance, including hypoxanthine synthesis, adenosine metabolism and guanosine metabolism. Another reason of drug tolerance is the efflux pump of the bacterium. In transcriptomic data, it was shown that the expression of some related enzymes in adenosine metabolism were raised significantly in smpB deletion strain than that of wild type, which led to the differential trimethoprim resistance of Aeromonas veronii (A. veronii). Furthermore, the metabolic products of adenosine AMP, cAMP, and deoxyadenosine were accumulated significantly. However, the expressions of the enzymes related to hypoxanthine synthesis and guanosine metabolism were elevated significantly in ssrA (small stable RNA, tmRNA) deletion strain, which eventually caused an augmented metabolic product xanthine. In addition, the deletion of ssrA also affected the significant downregulations of efflux pump acrA/acrB. The minimal inhibitory concentrations (MIC) were overall decreased after the trimethoprim treatment to the wild type, ΔsmpB and ΔssrA. And the difference in sensitivity between ΔsmpB and ΔssrA was evident. The MIC of ΔsmpB was descended significantly than those of wild type and ΔssrA in M9 medium supplemented with 1 mM adenosine, illustrating that the adenosine metabolism pathway was principally influenced by SmpB. Likewise, the strain ΔssrA conferred more sensitivity than wild type and ΔsmpB in M9 medium supplemented with 1mM guanosine. By overexpressing acrA/acrB, the tolerance to trimethoprim was partially recovered in ΔssrA. These results revealed that SmpB and tmRNA acted on different branches in purine metabolism, conferring the diverse trimethoprim resistance to A. veronii. This study suggests that the trans-translation system might be an effective target in clinical treatment of A. veronii and other multi-antibiotic resistance bacteria with trimethoprim.
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Affiliation(s)
- Dan Wang
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China.,Key Laboratory for Sustainable Utilization of Tropical Bioresource, College of Tropical Crops Hainan University, Haikou, China
| | - Hong Li
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China
| | - Wasi Ullah Khan
- Key Laboratory for Sustainable Utilization of Tropical Bioresource, College of Tropical Crops Hainan University, Haikou, China
| | - Xiang Ma
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China
| | - Hongqian Tang
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China
| | - Yanqiong Tang
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China
| | - Dongyi Huang
- Key Laboratory for Sustainable Utilization of Tropical Bioresource, College of Tropical Crops Hainan University, Haikou, China
| | - Zhu Liu
- Key Laboratory of Tropical Biological Resources of Ministry of Education, School of Life and Pharmaceutical Science, Hainan University, Haikou, China
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Genovese C, La Fauci V, D'Amato S, Squeri A, Anzalone C, Costa GB, Fedele F, Squeri R. Molecular epidemiology of antimicrobial resistant microorganisms in the 21th century: a review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:256-273. [PMID: 32420962 PMCID: PMC7569612 DOI: 10.23750/abm.v91i2.9176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/26/2022]
Abstract
Healthcare-associated infections (HAIs) are the most frequent and severe complication acquired in healthcare settings with high impact in terms of morbidity, mortality and costs. Many bacteria could be implicated in these infections, but, expecially multidrug resistance bacteria could play an important role. Many microbial typing technologies have been developed until to the the bacterial whole-genome sequencing and the choice of a molecular typing method therefore will depend on the skill level and resources of the laboratory and the aim and scale of the investigation. In several studies the molecular investigation of pathogens involved in HAIs was performed with many microorganisms identified as causative agents such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Clostridium difficile, Acinetobacter spp., Enterobacter spp., Enterococcus spp., Staphylococcus aureus and several more minor species. Here, we will describe the most and least frequently reported clonal complex, sequence types and ribotypes with their worldwide geographic distribution for the most important species involved in HAIs.
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Affiliation(s)
- Cristina Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Vincenza La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Smeralda D'Amato
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Italy.
| | - Andrea Squeri
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Carmelina Anzalone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Gaetano Bruno Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Francesco Fedele
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
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Morris S, Cerceo E. Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting. Antibiotics (Basel) 2020; 9:E196. [PMID: 32326058 PMCID: PMC7235729 DOI: 10.3390/antibiotics9040196] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
The increasing prevalence of antibiotic resistance is a threat to human health, particularly within vulnerable populations in the hospital and acute care settings. This leads to increasing healthcare costs, morbidity, and mortality. Bacteria rapidly evolve novel mechanisms of resistance and methods of antimicrobial evasion. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii have all been identified as pathogens with particularly high rates of resistance to antibiotics, resulting in a reducing pool of available treatments for these organisms. Effectively combating this issue requires both preventative and reactive measures. Reducing the spread of resistant pathogens, as well as reducing the rate of evolution of resistance is complex. Such a task requires a more judicious use of antibiotics through a better understanding of infection epidemiology, resistance patterns, and guidelines for treatment. These goals can best be achieved through the implementation of antimicrobial stewardship programs and the development and introduction of new drugs capable of eradicating multi-drug resistant Gram-negative pathogens (MDR GNB). The purpose of this article is to review current trends in MDR Gram-negative bacterial infections in the hospitalized setting, as well as current guidelines for management. Finally, new and emerging antimicrobials, as well as future considerations for combating antibiotic resistance on a global scale are discussed.
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Affiliation(s)
- Sabrina Morris
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA;
| | - Elizabeth Cerceo
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA;
- Department of Hospitalist Medicine, Cooper University Hospital, Camden, NJ 08103, USA
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Garza-González E, Franco-Cendejas R, Morfín-Otero R, Echaniz-Aviles G, Rojas-Larios F, Bocanegra-Ibarias P, Flores-Treviño S, Ponce-de-León A, Rodríguez-Noriega E, Alavez-Ramírez N, Mena-Ramirez JP, Rincón-Zuno J, Fong-Camargo MG, Morales-De-la-Peña CT, Huerta-Baltazar CR, López-Jacome LE, Carnalla-Barajas MN, Soto-Noguerón A, Sanchez-Francia D, Moncada-Barrón D, Ortíz-Brizuela E, García-Mendoza L, Newton-Sánchez OA, Choy-Chang EV, Aviles-Benitez LK, Martínez-Miranda R, Feliciano-Guzmán JM, Peña-Lopez CD, Couoh-May CA, López-Gutiérrez E, Gil-Veloz M, Armenta-Rodríguez LC, Manriquez-Reyes M, Gutierrez-Brito M, López-Ovilla I, Adame-Álvarez C, Barajas-Magallón JM, Aguirre-Burciaga E, Coronado-Ramírez AM, Rosales-García AA, Sida-Rodríguez S, Urbina-Rodríguez RE, López-Moreno LI, Juárez-Velázquez GE, Martínez-Villarreal RT, Canizales-Oviedo JL, Cetina-Umaña CM, Perez-Juárez MM, González-Moreno A, Romero-Romero D, Bello-Pazos FD, Aguilar-Orozco G, Barlandas-Rendón NRE, Maldonado-Anicacio JY, Valadez-Quiroz A, Camacho-Ortiz A. The Evolution of Antimicrobial Resistance in Mexico During the Last Decade: Results from the INVIFAR Group. Microb Drug Resist 2020; 26:1372-1382. [PMID: 32027229 DOI: 10.1089/mdr.2019.0354] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Surveillance of antimicrobial resistance (AMR) requires an international approach with national and local strategies. Our aim was to summarize a retrospective 10-year report of antibiotic resistance of gram-positive and gram-negative bacteria in Mexico. Methods: A total of 46 centers from 22 states of Mexico participated. Databases of AMR from January 2009 to December 2018 were included for most species. The 10-year period was divided into five 2-year periods. Results: For Staphylococcus aureus, a decrease in resistance in all specimens was observed for erythromycin and oxacillin (p < 0.0001 for each). For Enterobacter spp., resistance to meropenem increased for urine specimens (p = 0.0042). For Klebsiella spp., increased drug resistance in specimens collected from blood was observed for trimethoprim/sulfamethoxazole, gentamicin, tobramycin (p < 0.0001 for each), meropenem (p = 0.0014), and aztreonam (p = 0.0030). For Acinetobacter baumannii complex, high drug resistance was detected for almost all antibiotics, including carbapenems, except for tobramycin, which showed decreased resistance for urine, respiratory, and blood isolates (p < 0.0001 for each), and for amikacin, which showed a decrease in resistance in urine specimens (p = 0.0002). An increase in resistance to cefepime was found for urine, respiratory, and blood specimens (p < 0.0001 for each). For Pseudomonas aeruginosa, aztreonam resistance increased for isolates recovered from blood (p = 0.0001). Conclusion: This laboratory-based surveillance of antibiotic resistance shows that resistance is increasing for some antibiotics in different bacterial species in Mexico and highlights the need for continuous monitoring of antibiotic resistance.
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Affiliation(s)
- Elvira Garza-González
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rafael Franco-Cendejas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara e Instituto de Patología Infecciosa, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | - Paola Bocanegra-Ibarias
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Samantha Flores-Treviño
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Alfredo Ponce-de-León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Eduardo Rodríguez-Noriega
- Hospital Civil de Guadalajara e Instituto de Patología Infecciosa, Universidad de Guadalajara, Guadalajara, Mexico
| | - Norma Alavez-Ramírez
- Hospital Regional Tipo B, de Alta Especialidad Bicentenario de La Independencia, Tultitlán de Mariano Escobedo, Mexico
| | - Juan Pablo Mena-Ramirez
- Hospital General de Zona No. 21 IMSS, Centro Universitario de los Altos (CUALTOS), Universidad de Guadalajara, Tepatitlán de Morelos, Mexico
| | - Joaquín Rincón-Zuno
- Hospital Para el Niño de Toluca, Instituto Materno Infantil del Estado De México, Toluca, Mexico
| | | | | | | | - Luis Esau López-Jacome
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | | | | | | | | | - Edgar Ortíz-Brizuela
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Luis Canizales-Oviedo
- Centro Universitario De Salud, Universidad Autónoma de Nuevo León, Laboratorio Pueblo Nuevo, Monterrey, Mexico
| | | | | | | | | | | | | | | | | | | | - Adrián Camacho-Ortiz
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Cherkaoui A, Renzi G, Azam N, Schorderet D, Vuilleumier N, Schrenzel J. Rapid identification by MALDI-TOF/MS and antimicrobial disk diffusion susceptibility testing for positive blood cultures after a short incubation on the WASPLab. Eur J Clin Microbiol Infect Dis 2020; 39:1063-1070. [PMID: 31965365 DOI: 10.1007/s10096-020-03817-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/12/2020] [Indexed: 12/19/2022]
Abstract
The objectives of this study were to define the shortest incubation times on the WASPLab for reliable MALDI-TOF/MS-based species identification and for the preparation of a 0.5 McFarland suspension for antimicrobial disk diffusion susceptibility testing using short subcultures growing on solid culture media inoculated by positive blood cultures spiked with a wide range of pathogens associated with bloodstream infections. The 520 clinical strains (20 × 26 different species) included in this study were obtained from a collection of non-consecutive and non-duplicate pathogens identified at Geneva University Hospitals. After 4 h of incubation on the WASPLab, microorganisms' growth allowed accurate identification of 73% (380/520) (95% CI, 69.1-76.7%) of the strains included in this study. The identification rate increased to 85% (440/520) (95% CI, 81.3-87.5%) after 6-h incubation. When excluding Corynebacterium and Candida spp., the microbial growth was sufficient to permit accurate identification of all tested species (100%, 460/460) (95% CI, 99.2-100%) after 8-h incubation. With the exception of Burkholderia cepacia and Haemophilus influenzae, AST by disk diffusion could be performed for Enterobacterales and non-fermenting Gram-negative bacilli after only 4 h of growth in the WASPLab. The preparation of a 0.5 McFarland suspension for Gram-positive bacteria required incubation times ranging between 3 and 8 h according to the bacterial species. Only Corynebacterium spp. required incubation times as long as 16 h. The WASPLab enables rapid pathogen identification as well as swift comprehensive AST from positive blood cultures that can be implemented without additional costs nor hands-on time by defining optimal time points for image acquisition.
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Affiliation(s)
- Abdessalam Cherkaoui
- Department of Diagnostics, Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.
| | - Gesuele Renzi
- Department of Diagnostics, Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Nouria Azam
- Department of Diagnostics, Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Didier Schorderet
- Department of Diagnostics, Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland
| | - Nicolas Vuilleumier
- Department of Diagnostics, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland.,Department of Medical Specialities, Division of Laboratory Medicine, Faculty of Medicine, Geneva, Switzerland
| | - Jacques Schrenzel
- Department of Diagnostics, Bacteriology Laboratory, Division of Laboratory Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.,Department of Medicine, Genomic Research Laboratory, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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