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Nkontcho Djamkeba F, Sainte-Rose V, Lontsi Ngoulla GR, Roujansky A, Abboud P, Walter G, Houcke S, Demar M, Kallel H, Pujo JM, Djossou F. Trends in the Prevalence of Antimicrobial Resistance in Escherichia coli Isolated from Outpatient Urine Cultures in French Amazonia. Am J Trop Med Hyg 2024; 111:287-296. [PMID: 38917783 PMCID: PMC11310616 DOI: 10.4269/ajtmh.23-0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 06/27/2024] Open
Abstract
Antimicrobial resistance (AMR) in the community is increasing worldwide. We aimed to assess AMR trends in Escherichia coli from the community urine isolates in French Amazonia. We conducted a retrospective study from January 2016 to December 2022 in the Cayenne General Hospital microbiology laboratory (French Guiana). It included all urine samples positive for E. coli collected from adult outpatients. During the study period, 3,443 urinalyses positive for E. coli were studied. In 46% of cases, patients were women. In 64.4% of cases, E. coli were β-lactamase producers. The most frequently diagnosed resistance mechanisms were penicillinase production and sparing third-generation cephalosporins. Isolated E. coli were extended-spectrum β-lactamase (ESBL) producers in 6.1% of cases. Overall, E. coli was susceptible to amoxicillin in 35.9% [95% CI: 34.3-37.5], to amoxicillin/clavulanic acid in 62.2% [95% CI: 60.6-63.9], to cefotaxime in 94% [95% CI: 93.1-94.7], to gentamicin in 92.1% [95% CI: 89.1-92.6], to ofloxacin in 76.8% [95% CI: 75.3-78.2], to trimethoprim/sulfamethoxazole (SXT) in 58.8% [95% CI: 57.1-60.5], to fosfomycin in 99.1% [95% CI: 98.6-99.4], and to nitrofurantoin in 99% of cases [95% CI: 98.6-99.3]. We have observed a gradual decline in the susceptibility profile of E. coli for amoxicillin/clavulanic acid (P <0.001), piperacillin/tazobactam (P = 0.003), and temocillin (P = 0.006). However, susceptibility to ciprofloxacin was increasing (P = 0.001). In contrast, the susceptibility trends for amoxicillin, third-generation cephalosporins, gentamicin, SXT, nitrofurantoin, and fosfomycin remained stable over the 28 quarters of the study. In conclusion, isolated E. coli from outpatient urinalyses showed increased resistance profiles involving penicillinase and ESBL production. Close monitoring and strategies to decrease antibiotic consumption in the community are needed.
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Affiliation(s)
| | | | | | | | - Philippe Abboud
- Tropical and Infectious Diseases Department, Cayenne General Hospital, French Guiana
| | - Gaelle Walter
- Tropical and Infectious Diseases Department, Cayenne General Hospital, French Guiana
| | | | - Magalie Demar
- Laboratory of Microbiology, Cayenne General Hospital, French Guiana
- Tropical Biome and immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, French Guiana
- Tropical Biome and immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
| | - Jean Marc Pujo
- Emergency Department, Cayenne General Hospital, French Guiana
| | - Felix Djossou
- Tropical and Infectious Diseases Department, Cayenne General Hospital, French Guiana
- Tropical Biome and immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
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Goltz J, Uhland C, Pearce S, Murphy C, Carson C, Parmley J. Thematic description of factors linked with extended-spectrum beta-lactamase-producing Enterobacteriaceae in humans. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2024; 50:211-222. [PMID: 39021380 PMCID: PMC11251730 DOI: 10.14745/ccdr.v50i06a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Background Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are associated with serious antimicrobial-resistant infections in Canadians. Humans are exposed to ESBL-producing Enterobacteriaceae through many interconnected pathways. To better protect Canadians, it is important to generate an understanding of which sources and activities contribute most to ESBL exposure and infection pathways in Canada. Objective The aims of this scoping review were to thematically describe factors potentially associated with ESBL-producing Enterobacteriaceae colonization, carriage and/or infection in humans from countries with a very high human development index and describe the study characteristics. Methods Four databases (PubMed, CAB Direct, Web of Science, EBSCOhost) were searched to retrieve potentially relevant studies. Articles were screened for inclusion, and factors were identified, grouped thematically and described. Results The review identified 381 relevant articles. Factors were grouped into 13 themes: antimicrobial use, animals, comorbidities and symptoms, community, demographics, diet and substance use, health care, household, occupation, prior ESBL colonization/carriage/infection, residential care, travel, and other. The most common themes reported were demographics, health care, antibiotic use and comorbidities and symptoms. Most articles reported factors in hospital settings (86%) and evaluated factors for ESBL-producing Enterobacteriaceae infections (52%). Conclusion This scoping review provided valuable information about which factor themes have been well described (e.g., health care) and which have been explored less frequently (e.g., diet or animal contact). Themes identified spanned human, animal and environmental contexts and settings, supporting the need for a diversity of perspectives and a multisectoral approach to mitigating exposure to antimicrobial resistance.
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Affiliation(s)
- Jamie Goltz
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON
- Centre for Food-borne, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Guelph, ON
| | - Carl Uhland
- Centre for Food-borne, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Guelph, ON
| | - Sydney Pearce
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON
| | - Colleen Murphy
- Centre for Food-borne, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Guelph, ON
| | - Carolee Carson
- Centre for Food-borne, Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Guelph, ON
| | - Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON
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Doua J, Rodríguez-Baño J, Froget R, Puranam P, Go O, Geurtsen J, van Rooij S, Vilken T, Minoru I, Yasumori I, Spiessens B, Tacconelli E, Biehl LM, Thaden JT, Sarnecki M, Goossens H, Poolman J, Bonten M, Ekkelenkamp M. Clinical presentation and antimicrobial resistance of invasive Escherichia coli disease in hospitalized older adults: a prospective multinational observational study. Infection 2024; 52:1073-1085. [PMID: 38267801 PMCID: PMC11142950 DOI: 10.1007/s15010-023-02163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Clinical data characterizing invasive Escherichia coli disease (IED) are limited. We assessed the clinical presentation of IED and antimicrobial resistance (AMR) patterns of causative E. coli isolates in older adults. METHODS EXPECT-2 (NCT04117113) was a prospective, observational, multinational, hospital-based study conducted in patients with IED aged ≥ 60 years. IED was determined by the microbiological confirmation of E. coli from blood; or by the microbiological confirmation of E. coli from urine or an otherwise sterile body site in the presence of requisite criteria of systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), or quick SOFA (qSOFA). The primary outcomes were the clinical presentation of IED and AMR rates of E. coli isolates to clinically relevant antibiotics. Complications and in-hospital mortality were assessed through 28 days following IED diagnosis. RESULTS Of 240 enrolled patients, 80.4% had bacteremic and 19.6% had non-bacteremic IED. One-half of infections (50.4%) were community-acquired. The most common source of infection was the urinary tract (62.9%). Of 240 patients, 65.8% fulfilled ≥ 2 SIRS criteria, and 60.4% had a total SOFA score of ≥ 2. Investigator-diagnosed sepsis and septic shock were reported in 72.1% and 10.0% of patients, respectively. The most common complication was kidney dysfunction (12.9%). The overall in-hospital mortality was 4.6%. Of 299 E. coli isolates tested, the resistance rates were: 30.4% for trimethoprim-sulfamethoxazole, 24.1% for ciprofloxacin, 22.1% for levofloxacin, 16.4% for ceftriaxone, 5.7% for cefepime, and 4.3% for ceftazidime. CONCLUSIONS The clinical profile of identified IED cases was characterized by high rates of sepsis. IED was associated with high rates of AMR to clinically relevant antibiotics. The identification of IED can be optimized by using a combination of clinical criteria (SIRS, SOFA, or qSOFA) and culture results.
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Affiliation(s)
- Joachim Doua
- Janssen Research and Development, Infectious Diseases and Vaccines, Janssen Pharmaceutica, Beerse, Belgium
- European and Developing Countries Clinical Trials Partnership (EDCTP), Brussels, Belgium
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Department of Medicine, University of Sevilla and Biomedicine Institute of Sevilla/CSIC, Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Rachel Froget
- Inserm Clinical Investigation Center 1435, Dupuytren University Hospital, Limoges, France
| | - Padma Puranam
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Oscar Go
- Janssen Research and Development, Raritan, NJ, USA
| | - Jeroen Geurtsen
- Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Sanne van Rooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tuba Vilken
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Inage Minoru
- Department of Respiratory Medicine, Okitama Public General Hospital, 2000, Nishi-Otsuka, Kawanishi, Yamagata, Japan
| | - Izumi Yasumori
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Bart Spiessens
- Janssen Research and Development, Infectious Diseases and Vaccines, Janssen Pharmaceutica, Beerse, Belgium
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50924, Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Joshua T Thaden
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Michal Sarnecki
- Janssen Vaccines, Branch of Cilag GmbH International, Bern, Switzerland.
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Jan Poolman
- Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miquel Ekkelenkamp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Matsumoto T, Yuasa A, Matsuda H, Ainiwaer D, Yonemoto N. Burden of Antimicrobial Resistance in Japan: A Systematic Literature Review and Meta-Analysis. Infect Dis Ther 2024; 13:1105-1125. [PMID: 38662332 PMCID: PMC11098996 DOI: 10.1007/s40121-024-00960-z] [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: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is one of the most serious public health challenges worldwide, including in Japan. However, there is limited evidence assessing the AMR burden in Japan. Thus, this systematic literature review (SLR) and meta-analysis (MA) were conducted to assess the clinical and economic burden of AMR in Japan. METHODS Comprehensive literature searches were performed on EMBASE, MEDLINE, the Cochrane Library, and ICHUSHI between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. MA estimated a pooled effect between the two comparative arms (AMR vs. non-AMR). The results were reported in measures of odds ratios (ORs) for in-hospital mortality and in standardized mean differences (SMDs) for length of stay (LOS) and direct medical costs. RESULTS Literature searches identified 1256 de-duplicated records, of which 56 observational studies (English, n = 35; Japanese, n = 21) were included. Of note, twenty-two studies (39.3%) compared the AMR group with non-AMR group. In the SLR, in-hospital mortality, LOS, and direct medical costs were higher in the AMR group compared to the non-AMR group. Eight studies were selected for the MA. In the AMR group, the pooled estimate showed a statistically higher in-hospital mortality [random effect (RE)-OR 2.25, 95% CI 1.34-3.79; I2 = 89%; τ2 = 0.2257, p < 0.01], LOS (RE-SMD 0.37, 95% CI - 0.09-0.84; I2 = 99%; τ2 = 0.3600, p < 0.01), and direct medical cost (RE-SMD 0.53, 95% CI 0.43-0.62; I2 = 0.0%; τ2 = 0.0, p = 0.88) versus the non-AMR group. CONCLUSION Our study presents an overview of the clinical and economic burden of AMR in Japan. Patients with AMR infections experience significantly higher in-hospital mortality, LOS, and direct medical costs compared with patients without AMR infections.
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Affiliation(s)
- Tetsuya Matsumoto
- Department of Infectious Diseases, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Akira Yuasa
- Japan Access & Value, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan.
| | - Hiroyuki Matsuda
- Real World Evidence Solutions & HEOR, IQVIA Solutions Japan G.K., Tokyo, Japan
| | - Dilinuer Ainiwaer
- Real World Evidence Solutions & HEOR, IQVIA Solutions Japan G.K., Tokyo, Japan
| | - Naohiro Yonemoto
- Japan Access & Value, Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
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Kasanga M, Shempela DM, Daka V, Mwikisa MJ, Sikalima J, Chanda D, Mudenda S. Antimicrobial resistance profiles of Escherichia coli isolated from clinical and environmental samples: findings and implications. JAC Antimicrob Resist 2024; 6:dlae061. [PMID: 38680604 PMCID: PMC11055401 DOI: 10.1093/jacamr/dlae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background The overuse and misuse of antimicrobials has worsened the problem of antimicrobial resistance (AMR) globally. This study investigated the AMR profiles of Escherichia coli isolated from clinical and environmental samples in Lusaka, Zambia. Methods This was a cross-sectional study conducted from February 2023 to June 2023 using 450 samples. VITEK® 2 Compact was used to identify E. coli and perform antimicrobial susceptibility testing. Data analysis was done using WHONET 2022 and SPSS version 25.0. Results Of the 450 samples, 66.7% (n = 300) were clinical samples, whereas 33.3% (n = 150) were environmental samples. Overall, 47.8% (n = 215) (37.8% clinical and 10% environmental) tested positive for E. coli. Of the 215 E. coli isolates, 66.5% were MDR and 42.8% were ESBL-producers. Most isolates were resistant to ampicillin (81.4%), sulfamethoxazole/trimethoprim (70.7%), ciprofloxacin (67.9%), levofloxacin (64.6%), ceftriaxone (62.3%) and cefuroxime (62%). Intriguingly, E. coli isolates were highly susceptible to amikacin (100%), imipenem (99.5%), nitrofurantoin (89.3%), ceftolozane/tazobactam (82%) and gentamicin (72.1%). Conclusions This study found a high resistance of E. coli to some antibiotics that are commonly used in humans. The isolation of MDR and ESBL-producing E. coli is a public health concern and requires urgent action. Therefore, there is a need to instigate and strengthen interventional strategies including antimicrobial stewardship programmes to combat AMR in Zambia.
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Affiliation(s)
- Maisa Kasanga
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Doreen Mainza Shempela
- Laboratory Department, Churches Health Association of Zambia, CHAZ COMPLEX Meanwood Drive (off Great East Road), Plot No. 2882/B/5/10, P.O. Box 34511, JC9H+VFF, Lusaka, Zambia
| | - Victor Daka
- Public Health Department, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Mark J Mwikisa
- Department of Pathology and Microbiology, Lusaka Trust Hospital, Plot 2191, H8CC+52F, Nsumbu Rd, Woodlands, Lusaka, Zambia
| | - Jay Sikalima
- Laboratory Department, Churches Health Association of Zambia, CHAZ COMPLEX Meanwood Drive (off Great East Road), Plot No. 2882/B/5/10, P.O. Box 34511, JC9H+VFF, Lusaka, Zambia
| | - Duncan Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
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Takaya R, Mori N, Saito E, Ohde S. Cost-effectiveness analysis of CTZ/TAZ for the treatment of ventilated hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia in Japan. BMC Health Serv Res 2024; 24:389. [PMID: 38549158 PMCID: PMC10976789 DOI: 10.1186/s12913-024-10883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/20/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Resistant bacterial infections, particularly those caused by gram-negative pathogens, are associated with high mortality and economic burdens. Ceftolozane/tazobactam demonstrated efficacy comparable to meropenem in patients with ventilated hospital-acquired bacterial pneumonia in the ASPECT-NP study. One cost-effectiveness analysis in the United States revealed that ceftolozane/tazobactam was cost effective, but no Japanese studies have been conducted. Therefore, the objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam compared to meropenem for patients with ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia from a health care payer perspective. METHODS A hybrid decision-tree Markov decision-analytic model with a 5-year time horizon were developed to estimate costs and quality-adjusted life-years and to calculate the incremental cost-effectiveness ratio associated with ceftolozane/tazobactam and meropenem in the treatment of patients with ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia. Clinical outcomes were based on the ASPECT-NP study, costs were based on the national fee schedule of 2022, and utilities were based on published data. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to assess the robustness of our modeled estimates. RESULTS According to our base-case analysis, compared with meropenem, ceftolozane/tazobactam increased the total costs by 424,731.22 yen (£2,626.96) and increased the quality-adjusted life-years by 0.17, resulting in an incremental cost-effectiveness ratio of 2,548,738 yen (£15,763.94) per quality-adjusted life-year gained for ceftolozane/tazobactam compared with meropenem. One-way sensitivity analysis showed that although the incremental cost-effectiveness ratio remained below 5,000,000 yen (£30,925) for most of the parameters, the incremental net monetary benefit may have been less than 0 depending on the treatment efficacy outcome, especially the cure rate and mortality rate for MEPM and mortality rate for CTZ/TAZ. 53.4% of the PSA simulations demonstrated that CTZ/TAZ was more cost-effective than MEPM was. CONCLUSION Although incremental cost-effectiveness ratio was below ¥5,000,000 in base-case analysis, whether ceftolozane/tazobactam is a cost-effective alternative to meropenem for ventilated hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia in Japan remains uncertain. Future research should examine the unobserved heterogeneity across patient subgroups and decision-making settings, to characterise decision uncertainty and its consequences so as to assess whether additional research is required.
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Affiliation(s)
- Risako Takaya
- Graduate School of Public Health, St. Luke's International University, 10-1 Akashi-Cho, Chuo-City, Tokyo, 104-0044, Japan.
| | | | - Eiko Saito
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St. Luke's International University, 10-1 Akashi-Cho, Chuo-City, Tokyo, 104-0044, Japan
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Handal N, Whitworth J, Lyngbakken MN, Berdal JE, Dalgard O, Bakken Jørgensen S. Mortality and length of hospital stay after bloodstream infections caused by ESBL-producing compared to non-ESBL-producing E. coli. Infect Dis (Lond) 2024; 56:19-31. [PMID: 37795955 DOI: 10.1080/23744235.2023.2261538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To compare mortality and length of hospital stay between patients with ESBL-producing E. coli bloodstream infections (BSIs) and patients with non-ESBL E. coli BSIs. We also aimed at describing risk factors for ESBL-producing E. coli BSIs and time to effective antibiotic treatment for the two groups. METHODS A retrospective case-control study among adults admitted between 2014 and 2021 to a Norwegian University Hospital. RESULTS A total of 468 E. coli BSI episodes from 441 patients were included (234 BSIs each in the ESBL- and non-ESBL group). Among the ESBL-producing E. coli BSIs, 10.9% (25/230) deaths occurred within 30 days compared to 9.0% (21/234) in the non-ESBL group. The adjusted 30-day mortality OR was 1.6 (95% CI 0.7-3.7, p = 0.248). Effective antibiotic treatment was administered within 24 hours to 55.2% (129/234) in the ESBL-group compared to 86.8% (203/234) in the non-ESBL group. Among BSIs of urinary tract origin (n = 317), the median length of hospital stay increased by two days in the ESBL group (six versus four days, p < 0.001). No significant difference in the length of hospital stay was found for other sources of infection (n = 151), with a median of seven versus six days (p = 0.550) in the ESBL- and non-ESBL groups, respectively. CONCLUSION There was no statistically significant difference in 30-day mortality in ESBL-producing E. coli compared to non-ESBL E. coli BSI, despite a delay in the administration of an effective antibiotic in the former group. ESBL-production was associated with an increased length of stay in BSIs of urinary tract origin.
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Affiliation(s)
- Nina Handal
- Department of Microbiology and Infection Control, Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Jimmy Whitworth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Magnus Nakrem Lyngbakken
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Jan Erik Berdal
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Silje Bakken Jørgensen
- Department of Microbiology and Infection Control, Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
- Department for Emergency Medicine, Division for Internal Medicine, Akershus University Hospital, Lørenskog, Norway
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Uhland FC, Li XZ, Mulvey MR, Reid-Smith R, Sherk LM, Ziraldo H, Jin G, Young KM, Reist M, Carson CA. Extended Spectrum β-Lactamase-Producing Enterobacterales of Shrimp and Salmon Available for Purchase by Consumers in Canada-A Risk Profile Using the Codex Framework. Antibiotics (Basel) 2023; 12:1412. [PMID: 37760708 PMCID: PMC10525137 DOI: 10.3390/antibiotics12091412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
The extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) encompass several important human pathogens and are found on the World Health Organization (WHO) priority pathogens list of antibiotic-resistant bacteria. They are a group of organisms which demonstrate resistance to third-generation cephalosporins (3GC) and their presence has been documented worldwide, including in aquaculture and the aquatic environment. This risk profile was developed following the Codex Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance with the objectives of describing the current state of knowledge of ESBL-EB in relation to retail shrimp and salmon available to consumers in Canada, the primary aquacultured species consumed in Canada. The risk profile found that Enterobacterales and ESBL-EB have been found in multiple aquatic environments, as well as multiple host species and production levels. Although the information available did not permit the conclusion as to whether there is a human health risk related to ESBLs in Enterobacterales in salmon and shrimp available for consumption by Canadians, ESBL-EB in imported seafood available at the retail level in Canada have been found. Surveillance activities to detect ESBL-EB in seafood are needed; salmon and shrimp could be used in initial surveillance activities, representing domestic and imported products.
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Affiliation(s)
- F. Carl Uhland
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Xian-Zhi Li
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Richard Reid-Smith
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Lauren M. Sherk
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Hilary Ziraldo
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Grace Jin
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Kaitlin M. Young
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Mark Reist
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
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Hernandez-Pastor L, Geurtsen J, Baugh B, El Khoury AC, Kalu N, Gauthier-Loiselle M, Bungay R, Cloutier M, Sarnecki M, Saade E. Clinical burden of invasive Escherichia coli disease among older adult patients treated in hospitals in the United States. BMC Infect Dis 2023; 23:550. [PMID: 37608247 PMCID: PMC10464165 DOI: 10.1186/s12879-023-08479-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/22/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Invasive extraintestinal pathogenic Escherichia coli disease (IED) can lead to severe outcomes, particularly among older adults. However, the clinical burden of IED in the U.S. has not been well characterized. METHODS IED encounters among patients ≥ 60 years old were identified using the PINC AI™ Healthcare Database (10/01/2015-03/31/2020) by either a positive E. coli culture in blood or another normally sterile body site and ≥ 1 sign of systemic inflammatory response syndrome or signs of sepsis, or a positive E. coli culture in urine with urinary tract infection and signs of sepsis. Medical resource utilization, clinical outcomes, and E. coli isolate characteristics were descriptively reported during the first IED encounter and during the following year (observation period). RESULTS Overall, 19,773 patients with IED were included (mean age: 76.8 years; 67.4% female; 78.5% with signs of sepsis). Most encounters involved community-onset IED (94.3%) and required hospitalization (96.5%; mean duration: 6.9 days), with 32.4% of patients being admitted to the intensive care unit (mean duration: 3.7 days). Most E. coli isolates were resistant to ≥ 1 antibiotic category (61.7%) and 34.4% were resistant to ≥ 3 antibiotic categories. Following their first IED encounter, 34.8% of patients were transferred to a skilled nursing/intermediate care facility, whereas 6.8% had died. During the observation period, 36.8% of patients were rehospitalized, 2.4% had IED recurrence, and in-hospital death increased to 10.9%. CONCLUSIONS IED is associated with substantial clinical burden at first encounter with considerable long-term consequences. Findings demonstrate the need for increased IED awareness and highlight potential benefits of prevention.
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Affiliation(s)
- Luis Hernandez-Pastor
- Global Market Access, Vaccines Janssen Pharmaceutica NV, Turnhoutseweg 30, Beerse, B-2340, Belgium.
| | - Jeroen Geurtsen
- Molecular Bacteriology & Bacterial Epidemiology, Janssen Vaccines & Prevention BV, Archimedesweg 4, Leiden, 2333 CN, The Netherlands
| | - Bryan Baugh
- Global Medical Affairs, Janssen Research & Development, LLC, 1000 U.S. Route 202 South, Raritan, NJ, 08869, USA
| | - Antoine C El Khoury
- Global Market Access, Janssen Global Services, LLC, 1000 U.S. Route 202 South, Vaccines, Raritan, NJ, 08869, USA
| | - Nnanya Kalu
- US Vaccines Medical Affairs, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, 08560, Titusville, NJ, USA
| | - Marjolaine Gauthier-Loiselle
- Health Economics and Outcomes Research, Analysis Group, Inc, 1190 avenue des Canadiens- de-Montréal, Tour Deloitte, Suite 1500, H3B 0G7, Montreal, QC, Canada
| | - Rebecca Bungay
- Health Economics and Outcomes Research, Analysis Group, Inc, 1190 avenue des Canadiens- de-Montréal, Tour Deloitte, Suite 1500, H3B 0G7, Montreal, QC, Canada
| | - Martin Cloutier
- Health Economics and Outcomes Research, Analysis Group, Inc, 1190 avenue des Canadiens- de-Montréal, Tour Deloitte, Suite 1500, H3B 0G7, Montreal, QC, Canada
| | - Michal Sarnecki
- Clinical Development, Janssen Vaccines, Rehhagstrasse 79, 3018, Bern, Switzerland
| | - Elie Saade
- Department of Medicine, Case Western Reserve University, Health Education Campus, 9501 Euclid Ave, 44106, Cleveland, OH, USA
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Patil S, Chen H, Chen Y, Dong S, Mai H, Lopes BS, Liu S, Wen F. Trends in Antibiotic Resistance Patterns and Burden of Escherichia Coli Infections in Young Children: A Retrospective Cross-Sectional Study in Shenzhen, China from 2014-2018. Infect Drug Resist 2023; 16:5501-5510. [PMID: 37638069 PMCID: PMC10455885 DOI: 10.2147/idr.s425728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose The emergence of multi-drug resistant ESBL-producing E. coli poses a global health problem. In this study, we aimed to investigate the prevalence of E. coli infections and their antibiotic susceptibility profiles in paediatric clinical cases in Shenzhen, China from Jan 1, 2014, to Jan 30, 2019, while also determining temporal trends, identifying ESBL-producing strains, and recommending potential empirical antibiotic therapy options. Methods We isolated a total of 4148 E. coli from different specimens from a single paediatric healthcare centre. Additionally, we obtained relevant demographic data from the hospital's electronic health records. Subsequently, we performed antimicrobial susceptibility testing for 8 classes of antibiotics and assessed ESBL production. Results Out of the 4148 isolates, 2645 were from males. The highest burden of E. coli was observed in the age group of 0-1 years, which gradually declined over the five-year study period. Antimicrobial susceptibility results indicated that 82% of E. coli isolates were highly resistant to ampicillin, followed by 52.36% resistant to cefazolin and 47.46% resistant to trimethoprim/sulfamethoxazole. Notably, a high prevalence of ESBL production (49.54%) was observed among the E. coli isolates, with 60% of them displaying a multi-drug resistance phenotype. However, it is worth mentioning that a majority of the isolates remained susceptible to ertapenem and imipenem. Our findings also highlighted a decrease in E. coli infections in Shenzhen, primarily among hospitalized patients in the 0-1 year age group. However, this decline was accompanied by a considerably high rate of ESBL production and increasing resistance to multiple antibiotics. Conclusion Our study underscores the urgent need for effective strategies to combat multi-drug resistant ESBL-producing E. coli Infections.
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Affiliation(s)
- Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Paediatric Research Institute, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Hongyu Chen
- Department of Laboratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yunsheng Chen
- Department of Laboratory Medicine, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Shaowei Dong
- Paediatric Research Institute, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Huirong Mai
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Bruno Silvester Lopes
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- National Horizons Centre, Teesside University, Darlington, UK
| | - Sixi Liu
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Feiqiu Wen
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
- Paediatric Research Institute, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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Tayeb BA, Mohamed-Sharif YH, Choli FR, Haji SS, Ibrahim MM, Haji SK, Rasheed MJ, Mustafa NA. Antimicrobial Susceptibility Profile of Listeria monocytogenes Isolated from Meat Products: A Systematic Review and Meta-Analysis. Foodborne Pathog Dis 2023; 20:315-333. [PMID: 37389828 DOI: 10.1089/fpd.2023.0004] [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: 07/01/2023] Open
Abstract
The objective of this study was to conduct a systematic review to comprehensively understand antimicrobial resistance (AMR) in Listeria monocytogenes (LM) isolated from meat and meat products. The study was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Published articles from 2000 to 2022 were collected from six widely used online databases, including AGRICOLA, PubMed, Web of Science (WoS), Scopus, Cochrane Library, and CINAHL-EBSCO. Prevalence rates and AMR of pathogen isolates were analyzed using MedCalc software, including the I2 statistic and Cochrane Q test for heterogeneity. Sensitivity analysis, subgroup analysis, and meta-regression were conducted to analyze potential sources of heterogeneity at a 95% significance level. The distribution and prevalence of multidrug resistance (MDR) were examined using a random-effect model. The pooled frequency of bacterial MDR was 22.97% (95% confidence interval [CI] = 14.95-32.13). The studies exhibited high heterogeneity (I2 = 94.82%, 95% CI = 93.74-95.71, p < 0.0001). Furthermore, the most prevalent antibiotics resistance found in the majority of included studies were tetracycline, clindamycin, penicillin, ampicillin, and oxacillin (I2 = 86.66%, 95% CI = 73.20-93.36, p < 0.0001). This meta-analysis provides a comprehensive understanding of AMR in LM isolates, and the results indicate that none of the variable factors, including sampling location, sampling size, or methodology, significantly influenced the outcome of LM isolates resistant to multidrug.
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Affiliation(s)
- Bizhar Ahmed Tayeb
- Institute of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
- Department of Laboratory, Directorate of Veterinary in Duhok, Duhok, Iraq
| | - Yousif Hamed Mohamed-Sharif
- Department of Food Microbiology, Ibrahim Khlail-Habur International Border, New-Standard Company, Zakho, Iraq
| | - Farhad Ramadhan Choli
- Food Safety and Animal Health Department, Veterinary Directorate in Duhok, Duhok, Iraq
| | - Shamal Subhi Haji
- Department of Food Microbiology, Ibrahim Khlail-Habur International Border, New-Standard Company, Zakho, Iraq
| | - Mohammed Mahmood Ibrahim
- Food Industry Department, Standardization and Quality Control Authority, Directorate of Quality Control, Zakho, Iraq
| | - Shana Khalid Haji
- Department of Food Microbiology, Ibrahim Khlail-Habur International Border, New-Standard Company, Zakho, Iraq
| | - Mohammed Jomaa Rasheed
- Food Industry Department, Standardization and Quality Control Authority, Directorate of Quality Control, Zakho, Iraq
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Barbu IC, Gheorghe-Barbu I, Grigore GA, Vrancianu CO, Chifiriuc MC. Antimicrobial Resistance in Romania: Updates on Gram-Negative ESCAPE Pathogens in the Clinical, Veterinary, and Aquatic Sectors. Int J Mol Sci 2023; 24:7892. [PMID: 37175597 PMCID: PMC10178704 DOI: 10.3390/ijms24097892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Multidrug-resistant Gram-negative bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and members of the Enterobacterales order are a challenging multi-sectorial and global threat, being listed by the WHO in the priority list of pathogens requiring the urgent discovery and development of therapeutic strategies. We present here an overview of the antibiotic resistance profiles and epidemiology of Gram-negative pathogens listed in the ESCAPE group circulating in Romania. The review starts with a discussion of the mechanisms and clinical significance of Gram-negative bacteria, the most frequent genetic determinants of resistance, and then summarizes and discusses the epidemiological studies reported for A. baumannii, P. aeruginosa, and Enterobacterales-resistant strains circulating in Romania, both in hospital and veterinary settings and mirrored in the aquatic environment. The Romanian landscape of Gram-negative pathogens included in the ESCAPE list reveals that all significant, clinically relevant, globally spread antibiotic resistance genes and carrying platforms are well established in different geographical areas of Romania and have already been disseminated beyond clinical settings.
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Affiliation(s)
- Ilda Czobor Barbu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Irina Gheorghe-Barbu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Georgiana Alexandra Grigore
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
- National Institute of Research and Development for Biological Sciences, 060031 Bucharest, Romania
| | - Corneliu Ovidiu Vrancianu
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- The Research Institute of the University of Bucharest, 050095 Bucharest, Romania
- Academy of Romanian Scientists, 050044 Bucharest, Romania
- Romanian Academy, 010071 Bucharest, Romania
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Doua J, Geurtsen J, Rodriguez-Baño J, Cornely OA, Go O, Gomila-Grange A, Kirby A, Hermans P, Gori A, Zuccaro V, Gravenstein S, Bonten M, Poolman J, Sarnecki M. Epidemiology, Clinical Features, and Antimicrobial Resistance of Invasive Escherichia Coli Disease in Patients Admitted in Tertiary Care Hospitals. Open Forum Infect Dis 2023; 10:ofad026. [PMID: 36817744 PMCID: PMC9933942 DOI: 10.1093/ofid/ofad026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
Background Invasive Escherichia coli disease (IED), including bloodstream infection, sepsis, and septic shock, can lead to high hospitalization and mortality rates. This multinational study describes the clinical profile of patients with IED in tertiary care hospitals. Methods We applied clinical criteria of systemic inflammatory response syndrome (SIRS), sepsis, or septic shock to patients hospitalized with culture-confirmed E coli from urine or a presumed sterile site. We assessed a proposed clinical case definition against physician diagnoses. Results Most patients with IED (N = 902) were adults aged ≥60 years (76.5%); 51.9%, 25.1%, and 23.0% of cases were community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA), respectively. The urinary tract was the most common source of infection (52.3%). Systemic inflammatory response syndrome, sepsis, and septic shock were identified in 77.4%, 65.3%, and 14.1% of patients, respectively. Patients >60 years were more likely to exhibit organ dysfunction than those ≤60 years; this trend was not observed for SIRS. The case-fatality rate (CFR) was 20.0% (60-75 years, 21.5%; ≥75 years, 22.2%), with an increase across IED acquisition settings (HA, 28.3%; HCA, 21.7%; CA, 15.2%). Noticeably, 77.8% of patients initiated antibiotic use on the day of culture sample collection. A total of 65.6% and 40.8% of E coli isolates were resistant to ≥1 agent in ≥1 or ≥2 drug class(es). A 96.1% agreement was seen between the proposed clinical case definition and physician's diagnoses of IED. Conclusions This study contributes valuable, real-world data about IED severity. An accepted case definition could promote timely and accurate diagnosis of IED and inform the development of novel preventative strategies.
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Affiliation(s)
- Joachim Doua
- Correspondence: Joachim Doua, MD, MPH, Janssen Research & Development, Infectious Diseases & Vaccines Therapeutic Area, Janssen Pharmaceutica: Antwerpseweg 15-17, Beerse, Antwerp, 2340, Belgium (). Michal Sarnecki, Clinical Development, Janssen Vaccines, Morgenstrasse 129, Bern, 3018, Switzerland ()
| | - Jeroen Geurtsen
- Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Jesus Rodriguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain,Department of Medicine, University of Sevilla, Seville, Spain,Biomedicine Institute of Sevilla/CSIC, Seville, Spain,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Oscar Go
- Janssen Research & Development, Raritan, New Jersey, USA
| | - Aina Gomila-Grange
- Infectious Diseases Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain,Infectious Diseases Department, Hospital Parc Taulí de Sabadell, Parc Tauli, Barcelona, Spain
| | - Andrew Kirby
- Leeds Institute of Medical Research, The University of Leeds, Old Medical School, Leeds General Infirmary, Leeds, West Yorkshire, United Kingdom
| | - Peter Hermans
- Julius Center for Health Sciences and Primary Care University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina Zuccaro
- Infectious Diseases Department, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Lombardy, Italy
| | - Stefan Gravenstein
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Jan Poolman
- Bacterial Vaccines Discovery and Early Development, Janssen Vaccines & Prevention B.V., Leiden, The Netherlands
| | - Michal Sarnecki
- Correspondence: Joachim Doua, MD, MPH, Janssen Research & Development, Infectious Diseases & Vaccines Therapeutic Area, Janssen Pharmaceutica: Antwerpseweg 15-17, Beerse, Antwerp, 2340, Belgium (). Michal Sarnecki, Clinical Development, Janssen Vaccines, Morgenstrasse 129, Bern, 3018, Switzerland ()
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Van An N, Hoang LH, Le HHL, Thai Son N, Hong LT, Viet TT, Le TD, Thang TB, Vu LH, Nguyen VTH, Xuan Nguyen K. Distribution and Antibiotic Resistance Characteristics of Bacteria Isolated from Blood Culture in a Teaching Hospital in Vietnam During 2014-2021. Infect Drug Resist 2023; 16:1677-1692. [PMID: 36992965 PMCID: PMC10041986 DOI: 10.2147/idr.s402278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose Studies on the epidemiology of bloodstream infection (BSI) and antimicrobial resistance (AMR) are limited in Vietnam. Thus, the present study aimed to elucidate the epidemiology of BSI and AMR of BSI-causing bacteria in Vietnam. Methods Data regarding blood cultures from 2014 to 2021 were collected and analyzed using the chi-square test, Cochran-Armitage test, and binomial logistic regression model. Results Overall, 2405 (14.15%) blood cultures were positive during the study period. In total, 55.76% of BSIs occurred in patients aged ≥60 years. The male-to-female ratio of patients with BSI was 1.87:1. Escherichia coli (26.11%), Staphylococcus aureus (15.79%), Klebsiella pneumoniae (10.44%), Acinetobacter baumannii (4.70%), and Pseudomonas aeruginosa (3.45%) were the leading bacterial species causing BSI. The AMR rate of these bacteria isolated in the intensive care unit (ICU) was significantly higher compared with that of those in other wards. E. coli was the least resistant to carbapenems (2.39%-4.14%), amikacin (3.85%), and colistin (11.54%) and most resistant to penicillins (>80.0%). S. aureus was the least resistant to glycopeptides (0%-3.38%), quinupristin-dalfopristin (0.59%), and linezolid (1.02%) and most resistant to clindamycin (71.57%). K. pneumoniae was the least resistant to ertapenem (8.86%), amikacin (9.39%), and colistin (15.38%) and most resistant to aztreonam (83.33%). A. baumannii was the least resistant to amikacin (16.67%) and colistin (16.67%) and highly resistant to other antibiotics (≥50.0%). P. aeruginosa was the least resistant to colistin (16.33%) and piperacillin (28.17%) and highly resistant to other antibiotics (≥50.0%). Notably, the multidrug resistance rate of E. coli (76.41%) was the highest among common pathogens, followed by A. baumannii (71.57%), P. aeruginosa (64.56%), S. aureus (56.99%), and K. pneumoniae (43.72%). Conclusion The AMR rate of BSI-causing bacteria, particularly strains isolated from ICU, was alarmingly high. There is a need for new antibiotics, therapeutic strategies, as well as prevention and control to combat BSI and AMR.
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Affiliation(s)
- Nguyen Van An
- Department of Microbiology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Huy Hoang
- Department of Bacteriology, National of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Hai Ha Long Le
- Department of Microbiology, Mycology and Parasitology, National hospital of Dermatology and Venereology, Hanoi, Vietnam
- Department of Clinical Microbiology and Parasitology, Ha Noi Medical University, Hanoi, Vietnam
| | - Nguyen Thai Son
- Department of Microbiology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Thu Hong
- Department of Microbiology, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tien Tran Viet
- Department of Infectious Diseases, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Tuan Dinh Le
- Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam
| | - Ta Ba Thang
- Respiratory Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Luong Huy Vu
- Department of Laser and Skin Care, National hospital of Dermatology and Venereology, Hanoi, Vietnam
- Department of Dermatology and Venereology, Ha Noi Medical University, Hanoi, Vietnam
| | - Vinh Thi Ha Nguyen
- Department of Dermatology and Venereology, Ha Noi Medical University, Hanoi, Vietnam
- Department of General Planning, National hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Kien Xuan Nguyen
- Department of Military Medical Command and Organization, Vietnam Medical Military University, Hanoi, Vietnam
- Correspondence: Kien Xuan Nguyen, Department of Military Medical Command and Organization, Vietnam Medical Military University, Hanoi, Vietnam, Email
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Clonal Lineages and Virulence Factors of Carbapenem Resistant E. coli in Alameda County, California, 2017-2019. Antibiotics (Basel) 2022; 11:antibiotics11121794. [PMID: 36551451 PMCID: PMC9774732 DOI: 10.3390/antibiotics11121794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
The prevalence of carbapenem-resistant Enterobacterales (CRE) has been increasing since the year 2000 and is considered a serious public health threat according to the Centers for Disease Control and Prevention. Limited studies have genotyped Carbapenem-resistant Escherichia coli using whole genome sequencing to characterize the most common lineages and resistance and virulence genes. The aim of this study was to characterize sequence data from carbapenem-resistant E. coli isolates (n = 82) collected longitudinally by the Alameda County Public Health Laboratory (ACPHL) between 2017 and 2019. E. coli genomes were screened for antibiotic resistance genes (ARGs) and extraintestinal pathogenic E. coli virulence factor genes (VFGs). The carbapenem-resistant E. coli lineages were diverse, with 24 distinct sequence types (STs) represented, including clinically important STs: ST131, ST69, ST95, and ST73. All Ambler classes of Carbapenemases were present, with NDM-5 being most the frequently detected. Nearly all isolates (90%) contained genes encoding resistance to third-generation cephalosporins; blaCTX-M genes were most common. The number of virulence genes present within pandemic STs was significantly higher than the number in non-pandemic lineages (p = 0.035). Virulence genes fimA (92%), trat (71%), kpsM (54%), and iutA (46%) were the most prevalent within the isolates. Considering the public health risk associated with CRE, these data enhance our understanding of the diversity of clinically important E. coli that are circulating in Alameda County, California.
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Angnunavuri PN, Attiogbe F, Mensah B. Microbial contamination and quantitative microbial risk assessment of high-density polyethylene (HDPE) film sachet drinking water in Ghana. JOURNAL OF WATER AND HEALTH 2022; 20:1587-1603. [PMID: 36308501 DOI: 10.2166/wh.2022.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The present research estimated the impact of storage on the microbial quality of high-density polyethylene drinking water. Samples were taken from two popular companies in Greater Accra using a two-sided exact test in SAS JMP to estimate the sample size. The samples were stored across three temperature profiles at 8 °C, 30 °C (average room temperature), and 40 °C (average outdoor temperature) for 28 days. The samples were examined using standard microbiological methods for heterotrophic plate counts (HPCs), faecal coliforms, and Escherichia coli. The data were described and regressed with Microsoft Excel, Argo 4.3.1, and SAS JMP software. The results demonstrated increasing deterioration of the water samples for all microbial indices at all temperatures with increasing storage duration. The highest HPC, faecal coliforms, and E. coli were 1,312; 622; and 252 cfu/100 mL, respectively, all at 40 °C. The daily risk of infection due to E. coli O157:H7 was 5.22 × 10-5 infections per child per day for children under 5 years, and 1.6 × 10-4 attacks per adult per day, compared to the upper limit of 1.0 × 10-6. These results are higher than recommended exposures, and interventions along the sachet drinking water value chain are needed to protect public health.
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Affiliation(s)
- Prosper Naah Angnunavuri
- School of Engineering, Department of Civil and Environmental Engineering, University of Energy and Natural Resources, Sunyani, Ghana E-mail:
| | - Francis Attiogbe
- School of Engineering, Department of Civil and Environmental Engineering, University of Energy and Natural Resources, Sunyani, Ghana E-mail:
| | - Bismark Mensah
- School of Engineering, University of Ghana, Legon, Ghana
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A scoping review of factors potentially linked with antimicrobial-resistant bacteria from turkeys (iAM.AMR Project). Epidemiol Infect 2022; 150:e153. [PMID: 35843720 PMCID: PMC9428905 DOI: 10.1017/s0950268822001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Antimicrobial resistance (AMR) is a complex problem that is a threat to global public health. Consumption of turkey meat may be an important source of foodborne exposure to resistant bacteria; recent outbreaks of multi-drug-resistant Salmonella Reading in Canada and the USA have implicated raw turkey products. To better understand the epidemiology of AMR in farmed turkey production, a scoping review was conducted. The objectives were to identify (1) modifiable factors potentially associated with antimicrobial-resistant Campylobacter, Enterococcus, Escherichia coli and Salmonella enterica along the farm-to-fork pathway in turkeys, and (2) data gaps with respect to factors potentially associated with AMR and Canadian commercial turkey production. A comprehensive search of the peer-reviewed literature was conducted in 2019 and updated in 2021. Thirteen references were included, reporting 36 factors. Antimicrobial use factors and their potential associations with AMR were most frequently reported (n = 15 factors; 42%), followed by biosecurity (n = 11; 31%) and management practices (n = 10; 28%). This review revealed important data gaps; no factors pertaining to S. enterica or to stages other than the farm (e.g. abattoir, retail) were identified, and only one Canadian reference was identified. These findings will inform priorities for future research and surveillance regarding turkeys and AMR.
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Loest D, Uhland FC, Young KM, Li XZ, Mulvey MR, Reid-Smith R, Sherk LM, Carson CA. Carbapenem-resistant Escherichia coli from shrimp and salmon available for purchase by consumers in Canada: a risk profile using the Codex framework. Epidemiol Infect 2022; 150:e148. [PMID: 35968840 PMCID: PMC9386791 DOI: 10.1017/s0950268822001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 11/05/2022] Open
Abstract
Resistance to carbapenems in human pathogens is a growing clinical and public health concern. The carbapenems are in an antimicrobial class considered last-resort, they are used to treat human infections caused by multidrug-resistant Enterobacterales, and they are classified by the World Health Organization as 'High Priority Critically Important Antimicrobials'. The presence of carbapenem-resistant Enterobacterales (CREs) of animal-origin is of concern because targeted studies of Canadian retail seafood revealed the presence of carbapenem resistance in a small number of Enterobacterales isolates. To further investigate this issue, a risk profile was developed examining shrimp and salmon, the two most important seafood commodities consumed by Canadians and Escherichia coli, a member of the Enterobacterales order. Carbapenem-resistant E. coli (CREc) isolates have been identified in shrimp and other seafood products. Although carbapenem use in aquaculture has not been reported, several classes of antimicrobials are utilised globally and co-selection of antimicrobial-resistant microorganisms in an aquaculture setting is also of concern. CREs have been identified in retail seafood purchased in Canada and are currently thought to be uncommon. However, data concerning CRE or CREc occurrence and distribution in seafood are limited, and argue for implementation of ongoing or periodic surveillance.
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Affiliation(s)
- Daleen Loest
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - F. Carl Uhland
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Kaitlin M. Young
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Xian-Zhi Li
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Richard Reid-Smith
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Lauren M. Sherk
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Carolee A. Carson
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
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19
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Tantoso E, Eisenhaber B, Kirsch M, Shitov V, Zhao Z, Eisenhaber F. To kill or to be killed: pangenome analysis of Escherichia coli strains reveals a tailocin specific for pandemic ST131. BMC Biol 2022; 20:146. [PMID: 35710371 PMCID: PMC9205054 DOI: 10.1186/s12915-022-01347-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Escherichia coli (E. coli) has been one of the most studied model organisms in the history of life sciences. Initially thought just to be commensal bacteria, E. coli has shown wide phenotypic diversity including pathogenic isolates with great relevance to public health. Though pangenome analysis has been attempted several times, there is no systematic functional characterization of the E. coli subgroups according to the gene profile. RESULTS Systematically scanning for optimal parametrization, we have built the E. coli pangenome from 1324 complete genomes. The pangenome size is estimated to be ~25,000 gene families (GFs). Whereas the core genome diminishes as more genomes are added, the softcore genome (≥95% of strains) is stable with ~3000 GFs regardless of the total number of genomes. Apparently, the softcore genome (with a 92% or 95% generation threshold) can define the genome of a bacterial species listing the critically relevant, evolutionarily most conserved or important classes of GFs. Unsupervised clustering of common E. coli sequence types using the presence/absence GF matrix reveals distinct characteristics of E. coli phylogroups B1, B2, and E. We highlight the bi-lineage nature of B1, the variation of the secretion and of the iron acquisition systems in ST11 (E), and the incorporation of a highly conserved prophage into the genome of ST131 (B2). The tail structure of the prophage is evolutionarily related to R2-pyocin (a tailocin) from Pseudomonas aeruginosa PAO1. We hypothesize that this molecular machinery is highly likely to play an important role in protecting its own colonies; thus, contributing towards the rapid rise of pandemic E. coli ST131. CONCLUSIONS This study has explored the optimized pangenome development in E. coli. We provide complete GF lists and the pangenome matrix as supplementary data for further studies. We identified biological characteristics of different E. coli subtypes, specifically for phylogroups B1, B2, and E. We found an operon-like genome region coding for a tailocin specific for ST131 strains. The latter is a potential killer weapon providing pandemic E. coli ST131 with an advantage in inter-bacterial competition and, suggestively, explains their dominance as human pathogen among E. coli strains.
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Affiliation(s)
- Erwin Tantoso
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore, 138672, Republic of Singapore.,Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore
| | - Birgit Eisenhaber
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore, 138672, Republic of Singapore.,Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore
| | - Miles Kirsch
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore.,Present address: Northeastern University, Boston, USA
| | - Vladimir Shitov
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore
| | - Zhiya Zhao
- Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore.,Present address: The University of Cambridge, Cambridge, UK
| | - Frank Eisenhaber
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Singapore, 138672, Republic of Singapore. .,Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), 30 Biopolis Street #07-01, Matrix Building, Singapore, 138671, Republic of Singapore. .,School of Biological Sciences (SBS), Nanyang Technological University (NTU), 60 Nanyang Drive, 637551, Singapore, Republic of Singapore.
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20
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Arbab S, Ullah H, Wang W, Zhang J. Antimicrobial drug resistance against Escherichia coli and its harmful effect on animal health. Vet Med Sci 2022; 8:1780-1786. [PMID: 35608149 PMCID: PMC9297802 DOI: 10.1002/vms3.825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Multidrug resistance among pathogenic bacteria is imperilling the worth of antibiotic infection, which has become an emerging problem, which previously transformed the veterinary sciences. Since its discovery, many antibiotics have been effective in treating bacterial infections in animals. Escherichia coli, a bacterium, is one of the reservoirs of antibiotic resistance genes in a community. The current use of antibiotics and demographic factors usually increase multidrug resistance. Genetically, the continuous adoption of environmental changes by E. coli allows it to acquire many multidrug resistance. During the host's life, antimicrobial resistance rarely poses a threat to the E. coli strain and pressure, similar to that of a flexible animal lower intestine. In this review, we describe the E. coli antibiotic drug–resistance mechanism driving transmission, the causes of transmission and the harmful effects on animal health.
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Affiliation(s)
- Safia Arbab
- Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou, China.,Key Laboratory of New Animal Drug Project of Gansu Province, Lanzhou, China.,Lanzhou Institute of Husbandry and Pharmaceutical Sciences, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Hanif Ullah
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Weiwei Wang
- Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou, China.,Key Laboratory of New Animal Drug Project of Gansu Province, Lanzhou, China.,Lanzhou Institute of Husbandry and Pharmaceutical Sciences, Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Jiyu Zhang
- Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture, Lanzhou, China.,Key Laboratory of New Animal Drug Project of Gansu Province, Lanzhou, China.,Lanzhou Institute of Husbandry and Pharmaceutical Sciences, Chinese Academy of Agricultural Sciences, Lanzhou, China
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21
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Nielsen SS, Bicout DJ, Calistri P, Canali E, Drewe JA, Garin‐Bastuji B, Gonzales Rojas JL, Gortázar C, Herskin M, Michel V, Miranda Chueca MÁ, Padalino B, Pasquali P, Roberts HC, Spoolder H, Ståhl K, Velarde A, Viltrop A, Winckler C, Baldinelli F, Broglia A, Kohnle L, Alvarez J. Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): antimicrobial‐resistant Escherichia coli in dogs and cats, horses, swine, poultry, cattle, sheep and goats. EFSA J 2022; 20:e07311. [PMID: 35582363 PMCID: PMC9087955 DOI: 10.2903/j.efsa.2022.7311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Escherichia coli (E. coli) was identified among the most relevant antimicrobial‐resistant (AMR) bacteria in the EU for dogs and cats, horses, swine, poultry, cattle, sheep and goats in previous scientific opinions. Thus, it has been assessed according to the criteria of the Animal Health Law (AHL), in particular criteria of Article 7 on disease profile and impacts, Article 5 on its eligibility to be listed, Annex IV for its categorisation according to disease prevention and control rules as in Article 9 and Article 8 for listing animal species related to the bacterium. The assessment has been performed following a methodology previously published. The outcome is the median of the probability ranges provided by the experts, which indicates whether each criterion is fulfilled (lower bound ≥ 66%) or not (upper bound ≤ 33%), or whether there is uncertainty about fulfilment. Reasoning points are reported for criteria with uncertain outcome. According to the assessment here performed, it is uncertain whether AMR E. coli can be considered eligible to be listed for Union intervention according to Article 5 of the AHL (33–66% probability). According to the criteria in Annex IV, for the purpose of categorisation related to the level of prevention and control as in Article 9 of the AHL, the AHAW Panel concluded that the bacterium does not meet the criteria in Sections 1, 2, 3 and 4 (Categories A, B, C and D; 0–5%, 5–10%, 10–33% and 10–33% probability of meeting the criteria, respectively) and the AHAW Panel was uncertain whether it meets the criteria in Section 5 (Category E, 33–66% probability of meeting the criteria). The animal species to be listed for AMR E. coli according to Article 8 criteria include mammals, birds, reptiles and fish.
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22
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Vogt NA, Hetman BM, Vogt AA, Pearl DL, Reid-Smith RJ, Parmley EJ, Kadykalo S, Ziebell K, Bharat A, Mulvey MR, Janecko N, Ricker N, Allen SE, Bondo KJ, Jardine CM. Using whole-genome sequence data to examine the epidemiology of antimicrobial resistance in Escherichia coli from wild meso-mammals and environmental sources on swine farms, conservation areas, and the Grand River watershed in southern Ontario, Canada. PLoS One 2022; 17:e0266829. [PMID: 35395054 PMCID: PMC8993012 DOI: 10.1371/journal.pone.0266829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022] Open
Abstract
Antimicrobial resistance (AMR) threatens the health of humans and animals and has repeatedly been detected in wild animal species across the world. This cross-sectional study integrates whole-genome sequence data from Escherichia coli isolates with demonstrated phenotypic resistance that originated from a previous longitudinal wildlife study in southern Ontario, as well as phenotypically resistant E. coli water isolates previously collected as part of a public health surveillance program. The objective of this work was to assess for evidence of possible transmission of antimicrobial resistance determinants between wild meso-mammals, swine manure pits, and environmental sources on a broad scale in the Grand River watershed, and at a local scale—for the subset of samples collected on both swine farms and conservation areas in the previous wildlife study. Logistic regression models were used to assess potential associations between sampling source, location type (swine farm vs. conservation area), and the occurrence of select resistance genes and predicted plasmids. In total, 200 isolates from the following sources were included: water (n = 20), wildlife (n = 73), swine manure pit (n = 31), soil (n = 73), and dumpsters (n = 3). Several genes and plasmid incompatibility types were significantly more likely to be identified on swine farms compared to conservation areas. Conversely, internationally distributed sequence types (e.g., ST131), extended-spectrum beta-lactamase- and AmpC-producing E. coli were isolated in lower prevalences (<10%) and were almost exclusively identified in water sources, or in raccoon and soil isolates obtained from conservation areas. Differences in the odds of detecting resistance genes and predicted plasmids among various sources and location types suggest different primary sources for individual AMR determinants, but, broadly, our findings suggest that raccoons, skunks and opossums in this region may be exposed to AMR pollution via water and agricultural sources, as well as anthropogenic sources in conservation areas.
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Affiliation(s)
- Nadine A. Vogt
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
- * E-mail:
| | - Benjamin M. Hetman
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Adam A. Vogt
- Independent Researcher, Mississauga, Ontario, Canada
| | - David L. Pearl
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Richard J. Reid-Smith
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - E. Jane Parmley
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Stefanie Kadykalo
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Kim Ziebell
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Amrita Bharat
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicol Janecko
- Quadram Institute Bioscience, Norwich, United Kingdom
| | - Nicole Ricker
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Samantha E. Allen
- Wyoming Game and Fish Department, Laramie, Wyoming, United States of America
- Department of Veterinary Sciences, University of Wyoming, Laramie, Wyoming, United States of America
| | - Kristin J. Bondo
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Claire M. Jardine
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
- Canadian Wildlife Health Cooperative, Ontario Veterinary College, Guelph, Ontario, Canada
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23
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A Peek into the Bacterial Microbiome of the Eurasian Red Squirrel ( Sciurus vulgaris). Animals (Basel) 2022; 12:ani12050666. [PMID: 35268234 PMCID: PMC8909207 DOI: 10.3390/ani12050666] [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: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Sciurus vulgaris (the Eurasian red squirrel) is native to Europe and Asia, but due to habitat destruction or fragmentation, interspecific competition, and infectious diseases, especially in European island areas the species finds itself at the brink of extinction. The repopulation of such bare habitats requires healthy squirrel specimens, either translocated from other wild habitats or reintroduced to the wilderness following captive breeding. Captivity, nonetheless, has shown an immense capacity to reshape the structure of wild species’ microbiota, adapting it to the less diverse diet and fewer environmental challenges. Therefore, assessing the differences between “wild” and “captive” microbiota in this species could elucidate if special living conditions are needed in order to augment the survival rate of specimens reintroduced into the wild. Furthermore, the microflora profile of the normal flora of healthy red squirrels raised in captivity could support clinicians in addressing infectious diseases episodes and also raise awareness on the zoonotic risk. Hence, this study aimed at documenting the bacterial species carried by S. vulgaris, disclosing overall similarities and variability patterns of the microbiota identified in individuals from two different living environments. We anticipated that the bacterial community would be less diverse in individuals raised in captivity, owing to their restrictive diet and to unchanging conditions in the enclosure. We also hypothesized that there would be a higher prevalence of zoonotic microorganisms in the captive animals, due to the proximity of humans and of other domestic species. To test this, samples (n = 100) were taken from five body regions of 20 red squirrels, both free-ranging and bred in captivity, processed by classical microbiology techniques, and further identified by biochemical assay (VITEK®2 Compact System). A relatively poor bacterial community, comprising 62 bacterial strains belonging to 18 species and 8 different genera, was identified. Most of these microorganisms were reported for the first time in S. vulgaris. With no discrimination between living environments, the highest prevalence (p < 0.001), was registered in Staphylococcus sciuri (60%; 12/20), followed by Escherichia coli (45%; 9/20) and Bacillus cereus (35%; 7/20). The results suggest unremarkable differences in diversity and richness of the resident aerobic microbiota of S. vulgaris, in relation to the living environment.
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24
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Isolation and Chemical Characterization of an Alpha-Helical Peptide, Dendrocin-ZM1, Derived from Zataria multiflora Boiss with Potent Antibacterial Activity. Probiotics Antimicrob Proteins 2022; 14:326-336. [PMID: 35050481 DOI: 10.1007/s12602-022-09907-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
Today, resistance of microorganisms to antibiotics has become a major challenge. To overcome this problem, development of new drugs, besides research on their antibacterial activity, is essential. Among chemical components, antimicrobial peptides (AMPs) exhibit antibacterial activity and can be selected as suitable antimicrobial candidates. In this study, a novel antimicrobial peptide, called dendrocin-ZM1, with a molecular weight of ~3716.48 Da, was isolated from Zataria multiflora Boiss (ZM) and purified via precipitation with ammonium sulfate and reverse-phase HPLC chromatography; it was then sequenced via Edman degradation. The in silico method was used to examine the physicochemical properties of dendrocin-ZM1. In this study, four reference strains (gram-positive and gram-negative) and one clinical vancomycin-resistant Staphylococcus aureus strain were used to survey the antimicrobial activities. Moreover, to examine cytotoxicity and hemolytic activity, a HEK-293 cell line and human red blood cells (RBCs) were used, respectively. Evaluation of the physicochemical properties of dendrocin-ZM1, as an AMP, indicated a net charge of + 7 and a hydrophobicity percentage of 54%. This peptide had an amphipathic alpha-helical conformation. It exhibited broad-spectrum antibacterial activities against the tested strains at minimum inhibitory concentrations (MICs) of 4-16 μg/mL. Besides, this peptide showed negligible hemolysis and cytotoxicity in the MIC range. It also exhibited heat stability at temperatures of 20 to 80 °C and was active in a broad pH range (from 6.0 to 10.0). Overall, the present results suggested dendrocin-ZM1 as a remarkable antimicrobial candidate.
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25
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Alarfaj RE, Alkhulaifi MM, Al-Fahad AJ, Aljihani S, Yassin AEB, Alghoribi MF, Halwani MA. Antibacterial Efficacy of Liposomal Formulations Containing Tobramycin and N-Acetylcysteine against Tobramycin-Resistant Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii. Pharmaceutics 2022; 14:130. [PMID: 35057026 PMCID: PMC8778299 DOI: 10.3390/pharmaceutics14010130] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022] Open
Abstract
The antibacterial activity and biofilm reduction capability of liposome formulations encapsulating tobramycin (TL), and Tobramycin-N-acetylcysteine (TNL) were tested against tobramycin-resistant strains of E. coli, K. pneumoniae and A. baumannii in the presence of several resistant genes. All antibacterial activity were assessed against tobramycin-resistant bacterial clinical isolate strains, which were fully characterized by whole-genome sequencing (WGS). All isolates acquired one or more of AMEs genes, efflux pump genes, OMP genes, and biofilm formation genes. TL formulation inhibited the growth of EC_089 and KP_002 isolates from 64 mg/L and 1024 mg/L to 8 mg/L. TNL formulation reduced the MIC of the same isolates to 16 mg/L. TNL formulation was the only effective formulation against all A. baumannii strains compared with TL and conventional tobramycin (in the plektonic environment). Biofilm reduction was significantly observed when TL and TNL formulations were used against E. coli and K. pneumoniae strains. TNL formulation reduced biofilm formation at a low concentration of 16 mg/L compared with TL and conventional tobramycin. In conclusion, TL and TNL formulations particularly need to be tested on animal models, where they may pave the way to considering drug delivery for the treatment of serious infectious diseases.
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Affiliation(s)
- Reem E. Alarfaj
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (R.E.A.); (M.M.A.)
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh 11481, Saudi Arabia
| | - Manal M. Alkhulaifi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia; (R.E.A.); (M.M.A.)
| | - Ahmed J. Al-Fahad
- National Center for Biotechnology, Life Science & Environment Research Institute, King Abdulaziz City for Science and Technology (KACST), Riyadh 12354, Saudi Arabia;
| | - Shokran Aljihani
- Nanomedicine Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh 11481, Saudi Arabia;
| | - Alaa Eldeen B. Yassin
- Pharmaceutical Sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh 11481, Saudi Arabia;
| | - Majed F. Alghoribi
- Infectious Diseases Research Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh 11481, Saudi Arabia
| | - Majed A. Halwani
- Nanomedicine Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh 11481, Saudi Arabia;
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26
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Ng W, Chow W, Ismail H. Hybridization of 5-nitroisatin and silver nanoparticles for boosting the antimicrobial performance of poly(lactic acid)/nanocellulose nanocomposite films. Food Packag Shelf Life 2021. [DOI: 10.1016/j.fpsl.2021.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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27
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Poletajew S, Pawlik K, Bonder-Nowicka A, Pakuszewski A, Nyk Ł, Kryst P. Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland. Antibiotics (Basel) 2021; 10:antibiotics10101232. [PMID: 34680812 PMCID: PMC8532629 DOI: 10.3390/antibiotics10101232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
- Correspondence: ; Tel.: +48-225690148; Fax: +48-225690150
| | - Katarzyna Pawlik
- Infection Control Team, Bielanski Hospital, 80 Cegłowska St., 00809 Warsaw, Poland;
| | - Anna Bonder-Nowicka
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Artur Pakuszewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
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28
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Feng K, Jia N, Zhu P, Sy S, Liu Y, Dong D, Zhu S, Zhang J, Liu Y, Martins FS, Gong H, Lv Z, Yu M, Sy SKB, Zhu Y. Aztreonam/avibactam effect on pharmacodynamic indices for mutant selection of Escherichia coli and Klebsiella pneumoniae harbouring serine- and New Delhi metallo-β-lactamases. J Antimicrob Chemother 2021; 76:2875-2883. [PMID: 34383928 DOI: 10.1093/jac/dkab292] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/17/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Ceftazidime/avibactam is not active against MBL-producing bacteria. Combining ceftazidime/avibactam or avibactam with aztreonam can counter the resistance of MBL-producing Enterobacterales. The aim of this study was to evaluate whether the addition of avibactam could reduce or close the mutant selection window (MSW) of aztreonam in Escherichia coli and Klebsiella pneumoniae harbouring MBLs; MSW is a pharmacodynamic (PD) parameter for the selection of emergent resistant mutants. METHODS In vitro susceptibility of 19 clinical isolates to ceftazidime/avibactam, aztreonam alone, and in co-administration (aztreonam/ceftazidime/avibactam and aztreonam/avibactam) was determined, as well as the mutant prevention concentration (MPC). The fraction of time within 24 h that the free drug concentration was within the MSW (fTMSW) and the fraction of time that the free drug concentration was above the MPC (fT>MPC) in both plasma and epithelial lining fluid (ELF) were determined from simulations of 10 000 profiles. The joint PTA was used to derive a joint cumulative fraction of response (CFR). RESULTS All isolates were resistant to ceftazidime/avibactam or aztreonam. Combining aztreonam and avibactam or ceftazidime/avibactam resulted in synergistic bactericidal activities against all isolates. Synergism was primarily due to the aztreonam/avibactam combination. For aztreonam/avibactam dosing regimens evaluated in clinical trials, fT>MPC values were >90% and >80%, whereas fTMSW measures were <10% and <20% in plasma and ELF, respectively. The CFR was 100% for aztreonam/avibactam against the collection of clinical isolates. CONCLUSIONS Effective antimicrobial combination optimized the PD parameters measuring selection for emergent mutants by increasing fT>MPC and reducing fTMSW.
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Affiliation(s)
- Kun Feng
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China
| | - Nan Jia
- Department of Laboratory Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Peijuan Zhu
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA, USA
| | - Serubbabel Sy
- Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Yanfei Liu
- Department of Laboratory Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Dandan Dong
- Department of Laboratory Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Shixing Zhu
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China
| | - Jiayuan Zhang
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China
| | - Yuwei Liu
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China
| | | | - Hugh Gong
- Department of Statistics, Valparaiso University, Valparaiso, IN, USA
| | - Zhihua Lv
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China.,Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266003, PR China
| | - Mingming Yu
- School of Medicine and Pharmacy, Ocean University of China, Qingdao 266003, PR China.,Laboratory for Marine Drugs and Bioproducts of Qingdao National Laboratory for Marine Science and Technology, Qingdao 266003, PR China
| | - Sherwin K B Sy
- Department of Statistics, State University of Maringá, Maringá, Paraná, Brazil
| | - Yuanqi Zhu
- Department of Laboratory Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
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29
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Fulgenzio C, Massari M, Traversa G, Da Cas R, Ferrante G, Aschbacher R, Moser V, Pagani E, Vestri AR, Massidda O, Kurotschka PK. Impact of Prior Antibiotic Use in Primary Care on Escherichia coli Resistance to Third Generation Cephalosporins: A Case-Control Study. Antibiotics (Basel) 2021; 10:antibiotics10040451. [PMID: 33923682 PMCID: PMC8073604 DOI: 10.3390/antibiotics10040451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
Research is lacking on the reversibility of antimicrobial resistance (AMR). Thus, we aimed to determine the influence of previous antibiotic use on the development and decay over time of third generation cephalosporin (3GC)-resistance of E. coli. Using the database of hospital laboratories of the Autonomous Province of Bolzano/Bozen (Italy), anonymously linked to the database of outpatient pharmaceutical prescriptions and the hospital discharge record database, this matched case-control study was conducted including as cases all those who have had a positive culture from any site for 3GC resistant E. coli (3GCREC) during a 2016 hospital stay. Data were analyzed by conditional logistic regression. 244 cases were matched to 1553 controls by the date of the first isolate. Male sex (OR 1.49, 95% CI 1.10–2.01), older age (OR 1.11, 95% CI 1.02–1.21), the number of different antibiotics taken in the previous five years (OR 1.20, 95% CI 1.08–1.33), at least one antibiotic prescription in the previous year (OR 1.92, 95% CI 1.36–2.71), and the diagnosis of diabetes (OR 1.57, 95% CI 1.08–2.30) were independent risk factors for 3GCREC colonization/infection. Patients who last received an antibiotic prescription two years or three to five years before hospitalization showed non-significant differences with controls (OR 0.97, 95% CI 0.68–1.38 and OR 0.85, 95% CI 0.59–1.24), compared to an OR of 1.92 (95% CI 1.36–2.71) in those receiving antibiotics in the year preceding hospitalization. The effect of previous antibiotic use on 3GC-resistance of E. coli is highest after greater cumulative exposure to any antibiotic as well as to 3GCs and in the first 12 months after antibiotics are taken and then decreases progressively.
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Affiliation(s)
- Chiara Fulgenzio
- Department of Public Health and Infectious Diseases, Postgraduate School of Medical Statistics and Biometry, University of Rome “La Sapienza”, 00185 Rome, Italy; (C.F.); (A.R.V.)
| | - Marco Massari
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
| | - Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
- Agenzia Italiana del Farmaco, 00187 Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.M.); (G.T.); (R.D.C.)
| | - Gianluigi Ferrante
- Azienda Ospedaliera, Universitaria Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Richard Aschbacher
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Verena Moser
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Elisabetta Pagani
- Health Service of Bolzano/Bozen Province, 39100 Bolzano/Bozen, Italy; (R.A.); (V.M.); (E.P.)
| | - Anna Rita Vestri
- Department of Public Health and Infectious Diseases, Postgraduate School of Medical Statistics and Biometry, University of Rome “La Sapienza”, 00185 Rome, Italy; (C.F.); (A.R.V.)
| | - Orietta Massidda
- Department of Cellular, Computational and Integrative Biology, University of Trento, 38123 Povo, Italy;
| | - Peter Konstantin Kurotschka
- Department of Medical Sciences and Public Health, Faculty of Medicine and Surgery, University of Cagliari, 09124 Cagliari, Italy
- Correspondence:
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