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Asmare Z, Erkihun M, Abebe W, Tamrat E. Antimicrobial resistance and ESBL production in uropathogenic Escherichia coli: a systematic review and meta-analysis in Ethiopia. JAC Antimicrob Resist 2024; 6:dlae068. [PMID: 38716402 PMCID: PMC11073753 DOI: 10.1093/jacamr/dlae068] [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] [Received: 02/17/2024] [Accepted: 04/10/2024] [Indexed: 06/29/2024] Open
Abstract
Background Antimicrobial resistance (AMR) is a serious threat to global health systems. Escherichia coli is a major cause of urinary tract infections (UTIs). Understanding the AMR patterns of uropathogenic E. coli (UPEC) is crucial for effective public health interventions worldwide. Objectives This systematic review and meta-analysis aimed to consolidate existing research and provide a comprehensive information on AMR UPEC in Ethiopia. Methods We systematically searched databases such as PubMed, Web of Science, and Science Direct, along with including articles from Google Scholar. Data were extracted into Microsoft Excel and analysed using STATA 17.0. Cohen's kappa was computed to assess reviewer agreement, while the I2 statistic evaluated heterogeneity. Egger's tests were conducted to detect publication bias, and random-effects models were utilized to estimate the pooled resistance, with AMR rates for each antibiotic pooled separately. Results UPEC showed resistance rates, ranging from 3.64% (95% CI: -4.38% to 11.67%) for amikacin to 85.32% (95% CI: 78.6%-92.04%) for ampicillin. Highest resistance was to ampicillin (85.32%), followed by amoxicillin at 82.52% (95% CI: 74.3%-90.74%), tetracycline at 60.67% (95% CI: 51.53%-69.81%) and trimethoprim/sulfamethoxazole at 57.17% (95% CI: 49.93%-64.42%). Conversely, resistance rates were lower for amikacin at 3.64% and meropenem at 5.26% (95% CI: 2.64%-7.88%). UPEC demonstrated a pooled MDR rate of 79.17% (95% CI: 70.32%-88.01%) and a pooled ESBL production rate of 29.16% (95% CI: 22.36%-38.55%). Conclusions High levels of AMR were observed in UPEC strains, highlighting a critical public health issue requiring urgent action through robust antimicrobial stewardship and surveillance to preserve effective UTI treatment options.
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Amhara Region, PO Box: 400, Woldia, Ethiopia
| | - Mulat Erkihun
- Department of Medical Laboratory Science, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wagaw Abebe
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Amhara Region, PO Box: 400, Woldia, Ethiopia
| | - Ephrem Tamrat
- Department of Medical Laboratory Science, College of Health Science, Woldia University, Amhara Region, PO Box: 400, Woldia, Ethiopia
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Krihariyani D, Woelansari ED, Haryanto E, Sasongkowati R, Handayati A, Astuti SSE. In Silico Study of the Potential of Brazilein Sappan Wood as a Beta-Lactamase Inhibitor against Extended-Spectrum Beta-Lactamase-Encoding Genes. Malays J Med Sci 2024; 31:107-116. [PMID: 38984238 PMCID: PMC11229569 DOI: 10.21315/mjms2024.31.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/19/2023] [Indexed: 07/11/2024] Open
Abstract
Background Infectious illnesses are a serious health concern in Indonesia. Widespread use of self-medication by the community increases the risk of developing multi-drug resistant (MDR) bacteria. This study assessed the potential of sappan wood as an inhibitor of extended-spectrum beta-lactamase (ESBL) encoded by blaSHV, blaTEM and blaCTX-M genes. Method In silico testing was conducted to develop an effective and economical starting strategy. Thereby, this study significantly advances the development of novel treatments to combat antibiotic resistance. Using clavulanic acid as the benchmark medicine, the potency of the beta-lactamase inhibitor brazilein was predicted. Using the Molegro Virtual Docker computer tool, docking was performed to estimate the chemical and physical properties of the compounds, as well as the biological activity of brazilein toward the required receptor. The receptors used were SHV-1 beta-lactamase, PDB code: 2H0T; TEM-1 beta-lactamase, PDB code: 4OQG and CTX-M-14 beta-lactamase, PDB code: 6VHS. Data analysis was performed by comparing the binding energies of the docking results between the ligands and the target receptor. The more stable the bond that formed between the ligand and the target receptor, the lower the bond energy. Results The in silico test results on the blaSHV gene were as follows: binding energy of ligand MA4_400[A] = -100.699, brazilein = -82.206, clavulanic acid = -79.3704; in the blaTEM gene: ligand bond energy 2UL_301[B] = -107.681, brazilein = -82.0296, clavulanic acid = -103.3; in the blaCTX-M gene: X57_301[A] ligand bond energy = -86.6197, and brazilein = -88.1586, clavulanic acid = -101.933. Conclusion The findings of this study demonstrate the significant potential of brazilein sappan wood to block the beta-lactamase activity of blaCTX-M.
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Affiliation(s)
- Dwi Krihariyani
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
| | - Evy Diah Woelansari
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
| | - Edy Haryanto
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
| | - Retno Sasongkowati
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
| | - Anik Handayati
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
| | - Sri Sulami Endah Astuti
- Department of Medical Laboratory Technology, Politeknik Kesehatan Kementerian Kesehatan Surabaya, East Java, Indonesia
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Alkan S, Balkan II, Surme S, Bayramlar OF, Kaya SY, Karaali R, Mete B, Aygun G, Tabak F, Saltoglu N. Urinary tract infections in older adults: associated factors for extended-spectrum beta-lactamase production. Front Microbiol 2024; 15:1384392. [PMID: 38784804 PMCID: PMC11112107 DOI: 10.3389/fmicb.2024.1384392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Objective Urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae are among the leading causes of morbidity and mortality in older adults. Identifying associated factors for ESBL production may contribute to more appropriate empirical treatment. Materials and methods This was a prospective observational study. Hospitalized patients of age > 65 with community-onset or hospital-acquired upper UTI due to E. coli or Klebsiella pneumoniae were included. A multivariate analysis was performed. Results A total of 97 patients were included. ESBL prevalence among UTIs with E. coli or Klebsiella pneumoniae was 69.1% (n = 67). CRP values at the time of UTI diagnosis were found to be significantly higher in the ESBL-producing group (p = 0.004). The multivariate analysis revealed that male gender (OR: 2.72, CI: 1.02-7.25), prior recurrent UTI (OR: 3.14, CI: 1.21-8.14), and the development of secondary bacteremia (OR: 4.95, CI: 1.03-23.89) were major associated factors for UTI in older adults due to ESBL-producing E. coli and Klebsiella pneumoniae. Conclusion Severe UTI in older men with a history of recurrent UTI may be a warning to the clinician for ESBL production in the setting of high ESBL prevalence. Carbapenems may be prioritized in the empirical treatment of patients with known risk factors for ESBL.
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Affiliation(s)
- Sena Alkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Serkan Surme
- Department of Medical Microbiology, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Osman Faruk Bayramlar
- Department of Public Health, Bakirkoy District Health Directorate, Istanbul, Türkiye
| | - Sibel Yildiz Kaya
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Ridvan Karaali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Gokhan Aygun
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
| | - Nese Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Türkiye
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Asmare Z, Awoke T, Genet C, Admas A, Melese A, Mulu W. Incidence of catheter-associated urinary tract infections by Gram-negative bacilli and their ESBL and carbapenemase production in specialized hospitals of Bahir Dar, northwest Ethiopia. Antimicrob Resist Infect Control 2024; 13:10. [PMID: 38273339 PMCID: PMC10809431 DOI: 10.1186/s13756-024-01368-7] [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] [Received: 08/01/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) due to multidrug-resistant Gram-negative bacilli (GNB) is a common concern globally. Investigating the incidence of CAUTI and associated antibiotic resistance has paramount importance from the health care associated infections perspective. This study therefore assessed the incidence of CAUTIs due to GNB and the production of extended-spectrum beta-lactamase (ESBL) and carbapenemase among inpatients in specialized hospitals of Northwest, Ethiopia. METHODS A total of 363 patients with indwelling urinary catheters who were admitted in the hospital for > 48 h were consecutively enrolled and followed from 3 to 18 days. Data were collected through interviewing and review of medical records. Patients who developed at least one of the following: fever (> 38 OC), suprapubic tenderness, or costovertebral angle pain, coupled with a GNB positive urine culture of ≥ 103 CFU/mL with no more than two bacterial species were defined as CAUTI. The ESBL and carbapenemase production were detected and identified by chromogenic medium. Logistic regression analysis was done to identify associated factors. RESULTS From 363 patients followed, the incidence rate of CAUTI was 27.8 per 1000 catheter days. Catheterization for ≥ 8 days (AOR = 10.6, 95%CI:1.8-62.1) and hospitalization for > 10 days (AOR = 8.1, 95%CI: 2.4-27.2) were the factors significantly associated with CAUTIs. E. coli (n = 18, 34.6%), Proteus species (n = 7, 13.5%), and P. aeruginosa (n = 6, 11.5%) were the most frequent GNB. Isolates revealed high rates of resistance to amoxicillin-clavulanic acid (100%), cefazolin (n = 51, 98%), ceftazidime (n = 47, 90%) and cefotaxime (n = 46, 88%). Most of the GNB isolates (86.5%) were multidrug-resistant. Overall, 19.2% and 5.8% of GNB isolates were ESBL and carbapenemase producers, respectively. CONCLUSIONS Incidence of CAUTI with Gram-negative bacilli is high. As most of the GNB isolates are MDR and showed a super high rate of resistance to amoxicillin-clavulanic and third-generation cephalosporins, empirical treatment with these substances is virtually ineffective in patients with suspected GNB infection in Ethiopia. The expression of ESBL and carbapenemase among GNB isolates is also a concern. Therefore, improved infection prevention and control measures, careful use of catheters and third generation of cephalosporins are needed to improve patient outcomes and reduce the burden of CAUTIs and the spreading of antimicrobial resistance.
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tewachew Awoke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemale Admas
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Melese
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Toombs-Ruane LJ, Marshall JC, Benschop J, Drinković D, Midwinter AC, Biggs PJ, Grange Z, Baker MG, Douwes J, Roberts MG, French NP, Burgess SA. Extended-spectrum β-lactamase- and AmpC β-lactamase-producing Enterobacterales associated with urinary tract infections in the New Zealand community: a case-control study. Int J Infect Dis 2023; 128:325-334. [PMID: 36529370 DOI: 10.1016/j.ijid.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/28/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess whether having a pet in the home is a risk factor for community-acquired urinary tract infections associated with extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase (ACBL)- producing Enterobacterales. METHODS An unmatched case-control study was conducted between August 2015 and September 2017. Cases (n = 141) were people with community-acquired urinary tract infection (UTI) caused by ESBL- or ACBL-producing Enterobacterales. Controls (n = 525) were recruited from the community. A telephone questionnaire on pet ownership and other factors was administered, and associations were assessed using logistic regression. RESULTS Pet ownership was not associated with ESBL- or ACBL-producing Enterobacterales-related human UTIs. A positive association was observed for recent antimicrobial treatment, travel to Asia in the previous year, and a doctor's visit in the last 6 months. Among isolates with an ESBL-/ACBL-producing phenotype, 126/134 (94%) were Escherichia coli, with sequence type 131 being the most common (47/126). CONCLUSIONS Companion animals in the home were not found to be associated with ESBL- or ACBL-producing Enterobacterales-related community-acquired UTIs in New Zealand. Risk factors included overseas travel, recent antibiotic use, and doctor visits.
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Affiliation(s)
- Leah J Toombs-Ruane
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Jonathan C Marshall
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand; School of Mathematical and Computational Sciences, Massey University, Palmerston North, New Zealand
| | - Jackie Benschop
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Dragana Drinković
- Microbiology Department, North Shore Hospital, Auckland, New Zealand
| | - Anne C Midwinter
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Patrick J Biggs
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand; School of Natural Sciences, Massey University, Palmerston North, New Zealand; New Zealand Food Safety Science and Research Centre, Massey University, Palmerston North, New Zealand
| | - Zoë Grange
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Mick G Roberts
- New Zealand Institute for Advanced Study, Massey University, Auckland, New Zealand
| | - Nigel P French
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand; New Zealand Food Safety Science and Research Centre, Massey University, Palmerston North, New Zealand; Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Sara A Burgess
- (m)EpiLab, School of Veterinary Science, Massey University, Palmerston North, New Zealand.
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Carriage of Extended Spectrum Beta Lactamase-Producing Escherichia coli: Prevalence and Factors Associated with Fecal Colonization of Dogs from a Pet Clinic in Lower Saxony, Germany. Animals (Basel) 2023; 13:ani13040584. [PMID: 36830371 PMCID: PMC9951715 DOI: 10.3390/ani13040584] [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: 11/28/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Extended spectrum beta-lactamase (ESBL)-producing Escherichia coli are an emerging problem in veterinary and human medicine. Our study concentrated on the estimation of the prevalence and factors associated with the carriage of ESBL-producing E. coli in dogs who visited a veterinary clinic in northern Germany in 2017. For this reason, 1000 patients (healthy and sick dogs) were tested, resulting in 1000 samples originating from rectal swabs. Additional data were collected using a self-reported questionnaire that was completed by the dog owner. Factors associated with ESBL carriage were considered for further modeling if p < 0.05 using a two-sided Fisher test. Using a backward elimination procedure, the variables for the final multivariable logistic regression model were identified. In total, 8.9% of the dogs tested were positive for carriage of ESBL-producing E. coli. Seven factors were associated with the colonization of dogs with ESBL-E. coli within the multivariable model, namely husbandry system (p = 0.0019, OR = 3.00; 95% CI: 1.50-6.00), contact with puppies (p = 0.0044, OR = 2.43; 95% CI: 1.32-4.46), feeding of raw meat (p = 0.011, OR = 2.28; 95% CI: 1.21-4.31), food residues (p = 0.0151, OR = 2.31; 95% CI: 1.18-4.53) and food supplements (p = 0.0487, OR = 0.426; 95% CI: 0.18-0.96), and antibiotic treatments of dogs (p = 0.0005, OR = 3.030; 95% CI: 1.62-5.68) or owners (p = 0.041, OR = 2.74; 95% CI: 1.04-7.19) prior to the study. These factors refer to the animals themselves as well as to the owners and their habits or medical treatments. Although the causality and direction of transmission from owners to their dogs cannot be proven, the factor of antibiotic treatment of the owner is clearly associated with the dog's status.
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Fratoni AJ, Avery LM, Nicolau DP, Asempa TE. In vivo pharmacokinetics and pharmacodynamics of ceftibuten/ledaborbactam, a novel oral β-lactam/β-lactamase inhibitor combination. J Antimicrob Chemother 2022; 78:93-100. [PMID: 36272135 PMCID: PMC10205465 DOI: 10.1093/jac/dkac359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Oral β-lactam treatment options for MDR Enterobacterales are lacking. Ledaborbactam (formerly VNRX-5236) is a novel orally bioavailable β-lactamase inhibitor that restores ceftibuten activity against Ambler Class A-, C- and D-producing Enterobacterales. We assessed the ledaborbactam exposure needed to produce bacteriostasis against ceftibuten-resistant Enterobacterales in the presence of humanized ceftibuten exposures in the neutropenic murine thigh infection model. METHODS Twelve ceftibuten-resistant clinical isolates (six Klebsiella pneumoniae, five Escherichia coli and one Enterobacter cloacae) were utilized. Ceftibuten/ledaborbactam MICs ranged from 0.12 to 2 mg/L (ledaborbactam fixed at 4 mg/L). A ceftibuten murine dosing regimen mimicking ceftibuten 600 mg q12h human exposure was developed and administered alone and in combination with escalating exposures of ledaborbactam. The log10 cfu/thigh change at 24 h relative to 0 h controls was plotted against ledaborbactam fAUC0-24/MIC and the Hill equation was used to determine exposures associated with bacteriostasis. RESULTS The mean ± SD 0 h bacterial burden was 5.96 ± 0.24 log10 cfu/thigh. Robust growth (3.12 ± 0.93 log10 cfu/thigh) was achieved in untreated control mice. Growth of 2.51 ± 1.09 log10 cfu/thigh was observed after administration of humanized ceftibuten monotherapy. Individual isolate exposure-response relationships were strong (mean ± SD R2 = 0.82 ± 0.15). The median ledaborbactam fAUC0-24/MIC associated with stasis was 3.59 among individual isolates and 6.92 in the composite model. CONCLUSIONS Ledaborbactam fAUC0-24/MIC exposures for stasis were quantified with a ceftibuten human-simulated regimen against β-lactamase-producing Enterobacterales. This study supports the continued development of oral ceftibuten/ledaborbactam etzadroxil (formerly ceftibuten/VNRX-7145).
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Affiliation(s)
- Andrew J Fratoni
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
| | | | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
| | - Tomefa E Asempa
- Center for Anti-Infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford 06102, CT, USA
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Matsumoto H, Komiya K, Ichihara S, Nagaoka Y, Yamanaka M, Nishiyama Y, Hiramatsu K, Kadota JI. Factors Associated with Extended-spectrum β-lactamase-producing Enterobacteria Isolated from Respiratory Samples. Intern Med 2022. [PMID: 36476547 PMCID: PMC10400397 DOI: 10.2169/internalmedicine.0690-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Although extended-spectrum β-lactamase (ESBL)-producing bacteria are a global threat, as they may cause respiratory infection, the factors associated with the isolation of these bacteria from sputum remain unclear. We therefore explored the factors related to ESBL-producing Klebsiella pneumoniae and Escherichia coli isolated from sputum samples. Patients and Methods This study included consecutive patients admitted to our department from 2010 to 2021 with K. pneumoniae or E. coli isolated from their sputum. The patients were categorized into ESBL-producing and non-ESBL-producing groups, and the factors associated with ESBL-producing bacteria isolation were assessed using a binomial logistic regression analysis. Results We included 82 patients, and ESBL-producing pathogens were isolated from 23 (28%). The usage rates of cephem [odds ratio (OR) 4.000, 95% confidence interval (CI) 1.402-11.409, p=0.010], quinolone (OR 2.961, 95% CI 1.097-7.996, p=0.032), and macrolide (OR 4.273, 95% CI 1.518-12.028, p=0.006) in the past year were significantly higher in the ESBL-producing group than in the non-ESBL-producing group. The multivariate analysis revealed that the applications of cephem (adjusted OR: 4.130, 95% CI: 1.233-13.830, p=0.021) and macrolide (adjusted OR: 6.365, 95% CI: 1.922-21.077, p=0.002) was independently associated with the isolation of ESBL-producing bacteria. Conclusions A history of cephem and macrolide use can be considered a risk factor for ESBL-producing bacteria isolation from sputum samples. Physicians need to consider these risk factors when determining antibiotics for the treatment of patients with respiratory infections.
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Affiliation(s)
- Hiroyuki Matsumoto
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Shogo Ichihara
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Yuhei Nagaoka
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Marimu Yamanaka
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Yoshiki Nishiyama
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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Muacevic A, Adler JR, Alonazi JA, Alqahtani M, Alseraya A, Rajendram R, Alsheikh M, Bawazir A, Dugashim F, Albdah B. Characteristics of Hospitalized Adults With Recurrent Urinary Tract Infection Due to Extended Spectrum Beta-Lactamase Producing Escherichia coli in a Tertiary Center in Saudi Arabia. Cureus 2022; 14:e33054. [PMID: 36721562 PMCID: PMC9881821 DOI: 10.7759/cureus.33054] [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: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The increase in extended-spectrum β-lactamase (ESBL) producing microbes in recent years represents a major challenge. AIM To study the risk factors for urinary tract infections (UTIs) caused by ESBL-producing Escherichia coli in patients requiring hospitalization for treatment. MATERIALS AND METHOD Electronic health records were used to identify 616 inpatients over the age of 18 who had UTI symptoms and/or signs and an ESBL-producing E. coli strain cultured on urine culture between January 1 and December 31, 2018. The electronic health care records of these patients were searched to identify those patients with previous UTIs due to an ESBL-producing E. coli grown on urine culture. Patients with cancer or those taking prophylactic antibiotics or immunosuppression were excluded. RESULT Risk factors for the acquisition of ESBL-producing E. coli included male sex (P = 0.0032), age over 66 years (P < 0.0001), renal stones (P = 0.0021), urology intervention within six months of presentation (P = 0.0360), pressure sores (P = 0.0002), feeding tubes (P = 0.0076), and urinary catheter (P = 0.0023). Comorbidities (e.g., diabetes mellitus and duration of antibiotic therapy were not associated with an increased risk of recurrence of ESBL-producing E. coli UTI (P = 0.4680, P = 0.3826, respectively). CONCLUSION Antimicrobial stewardship programs may have reduced the development of antimicrobial resistance in E. coli. However, the recognition of risk factors for UTI caused by ESBL-producing E. coli may facilitate the early detection of high-risk cases and guide treatment decisions. This can improve patient outcomes while decreasing the length of the hospital stay.
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Prior Antibiotic Use Increases Risk of Urinary Tract Infections Caused by Resistant Escherichia coli among Elderly in Primary Care: A Case-Control Study. Antibiotics (Basel) 2022; 11:antibiotics11101382. [PMID: 36290040 PMCID: PMC9598065 DOI: 10.3390/antibiotics11101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
We investigated whether prior use of antibiotics affects the risk of mecillinam/trimethoprim/nitrofurantoin/multi-resistant Escherichia coli urinary tract infection (UTI) among elderly patients in general practice. Data on urine culture came from urine samples performed in general practice and sent to hospitals in the Capital Region of Denmark, and prescription data came from a nationwide prescription database. The study population consisted of patients with UTI episodes (n = 41,027) caused by E. coli that received a concurrent antibiotic prescription against UTI from 2012 to 2017. We used a case-control design. Cases were UTI episodes caused by mecillinam, trimethoprim, nitrofurantoin or multi-resistant E. coli and controls were UTI episodes caused by E. coli not displaying the respective resistance pattern. We analyzed whether exposure to antibiotics in a period of 8-90 days prior to the UTI episode affected the risk of antibiotic resistant uropathogenic E coli. The analyses were adjusted for age, sex, hospital admission and nursing home status. The odds of resistance to all of the four antibiotics increased significantly after exposure to antibiotics within 90 days prior to the UTI episode. In general, mecillinam showed the lowest increase in the odds for selection of resistance. The results indicate that mecillinam is a favorable antibiotic choice in terms of selection of resistance.
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11
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Ahn ST, Lee HS, Han DE, Lee DH, Kim JW, Park MG, Park HS, Moon DG, Oh MM. What are the risk factors for recurrent UTI with repeated ESBL-producing Enterobacteriaceae? A retrospective cohort study. J Infect Chemother 2022; 29:72-77. [PMID: 36195248 DOI: 10.1016/j.jiac.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A previous study has shown that two-thirds of patients with urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae experience recurrence with the same bacteria on subsequent UTI episodes. However, little is known about which patients suffer from UTI due to ESBL-producing Enterobacteriaceae repeatedly. This study aimed to investigate the risk factors for recurrent UTI due to repeated ESBL-producing organism infections. METHODS This retrospective, single-center, observational cohort study screened all patients with UTI caused by ESBL-producing strains between January 2012 and April 2019. Among the patients who were followed up, patients who experienced UTI recurrence were enrolled and divided into two groups: ESBL recurrence group and non-ESBL recurrence group. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between patient characteristics and the development of recurrent UTI caused by ESBL-producing Enterobacteriaceae. RESULTS A total of 330 patients were followed up after the diagnosis of UTI caused by ESBL-producing organisms. Among the patients, 115 (34.8%) experienced UTI recurrence, and 71 (61.7%) of them experienced subsequent recurrent UTI due to ESBL-producing organisms. Patient's age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.04; P = 0.046) and recurrent UTI history (HR, 1.69; 95% CI, 1.05-2.72; P = 0.031) were significantly associated with an increased risk of recurrence with ESBL-producing Enterobacteriaceae. CONCLUSION These findings showed that a history of previous frequent UTI recurrence is the risk factor for recurrence of UTI due to repeated ESBL producing Enterobacteriaceae infections.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Hyun Soo Lee
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Da Eun Han
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Dong Hyun Lee
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Min Gu Park
- Department of Urology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Mareunnae-ro 9, Jung-gu, Seoul, South Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Nielsen KL, Olsen MH, Pallejá A, Ebdrup SR, Sørensen N, Lukjancenko O, Marvig RL, Møller K, Frimodt-Møller N, Hertz FB. Microbiome Compositions and Resistome Levels after Antibiotic Treatment of Critically Ill Patients: An Observational Cohort Study. Microorganisms 2021; 9:2542. [PMID: 34946144 PMCID: PMC8703874 DOI: 10.3390/microorganisms9122542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022] Open
Abstract
Hospitalization and treatment with antibiotics increase the risk of acquiring multidrug-resistant bacteria due to antibiotic-mediated changes in patient microbiota. This study aimed to investigate how broad- and narrow-spectrum antibiotics affect the gut microbiome and the resistome in antibiotic naïve patients during neurointensive care. Patients admitted to the neurointensive care unit were treated with broad-spectrum (meropenem or piperacillin/tazobactam) or narrow-spectrum antibiotic treatment (including ciprofloxacin, cefuroxime, vancomycin and dicloxacillin) according to clinical indications. A rectal swab was collected from each patient before and after 5-7 days of antibiotic therapy (N = 34), respectively. Shotgun metagenomic sequencing was performed and the composition of metagenomic species (MGS) was determined. The resistome was characterized with CARD RGI software and the CARD database. As a measure for selection pressure in the patient, we used the sum of the number of days with each antibiotic (antibiotic days). We observed a significant increase in richness and a tendency for an increase in the Shannon index after narrow-spectrum treatment. For broad-spectrum treatment the effect was more diverse, with some patients increasing and some decreasing in richness and Shannon index. This was studied further by comparison of patients who had gained or lost >10 MGS, respectively. Selection pressure was significantly higher in patients with decreased richness and a decreased Shannon index who received the broad treatment. A decrease in MGS richness was significantly correlated to the number of drugs administered and the selection pressure in the patient. Bray-Curtis dissimilarities were significant between the pre- and post-treatment of samples in the narrow group, indicating that the longer the narrow-spectrum treatment, the higher the differences between the pre- and the post-treatment microbial composition. We did not find significant differences between pre- and post-treatment for both antibiotic spectrum treatments; however, we observed that most of the antibiotic class resistance genes were higher in abundance in post-treatment after broad-spectrum treatment.
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Affiliation(s)
- Karen Leth Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (N.F.-M.); (F.B.H.)
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.H.O.); (S.R.E.); (K.M.)
| | - Albert Pallejá
- Clinical Microbiomics, Fruebjergvej 3, 2100 Copenhagen, Denmark; (A.P.); (N.S.); (O.L.)
| | - Søren Røddik Ebdrup
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.H.O.); (S.R.E.); (K.M.)
| | - Nikolaj Sørensen
- Clinical Microbiomics, Fruebjergvej 3, 2100 Copenhagen, Denmark; (A.P.); (N.S.); (O.L.)
| | - Oksana Lukjancenko
- Clinical Microbiomics, Fruebjergvej 3, 2100 Copenhagen, Denmark; (A.P.); (N.S.); (O.L.)
| | - Rasmus L. Marvig
- Department of Genomic Medicine, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark;
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.H.O.); (S.R.E.); (K.M.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (N.F.-M.); (F.B.H.)
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (N.F.-M.); (F.B.H.)
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Analysis of β-lactams and Carbapenem Heteroresistance in Extra-intestinal Pathogenic Escherichia coli from Blood Samples in Iran. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2021. [DOI: 10.52547/jommid.9.3.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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14
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Slobodníková L, Markusková B, Kajsík M, Andrezál M, Straka M, Liptáková A, Drahovská H. Characterization of Anti-Bacterial Effect of the Two New Phages against Uropathogenic Escherichia coli. Viruses 2021; 13:v13071348. [PMID: 34372554 PMCID: PMC8310266 DOI: 10.3390/v13071348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 07/09/2021] [Indexed: 12/02/2022] Open
Abstract
Urinary tract infections (UTIs) are among the events that most frequently need medical intervention. Uropathogenic Escherichia coli are frequently their causative agents and the infections are sometimes complicated by the presence of polyresistant nosocomial strains. Phage therapy is a tool that has good prospects for the treatment of these infections. In the present study, we isolated and characterized two bacteriophages with broad host specificity against a panel of local uropathogenic E. coli strains and combined them into a phage cocktail. According to genome sequencing, these phages were closely related and belonged to the Tequatrovirus genus. The newly isolated phages showed very good activity on a panel of local clinical E. coli strains from urinary tract infections. In the form of a two-phage cocktail, they were active on E. coli strains belonging to phylogroups B2 and D, with relatively lower activity in B1 and no response in phylogroup A. Our study is a preliminary step toward the establishment of a national phage bank containing local, well-characterized phages with therapeutic potential for patients in Slovakia.
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Affiliation(s)
- Lívia Slobodníková
- Medical Faculty, Institute of Microbiolog, Comenius University in Bratislava, 81108 Bratislava, Slovakia; (L.S.); (M.S.)
| | - Barbora Markusková
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 84104 Bratislava, Slovakia; (B.M.); (M.K.); (M.A.); (H.D.)
| | - Michal Kajsík
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 84104 Bratislava, Slovakia; (B.M.); (M.K.); (M.A.); (H.D.)
- Comenius University Science Park, Ilkovičova 8, 84104 Bratislava, Slovakia
| | - Michal Andrezál
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 84104 Bratislava, Slovakia; (B.M.); (M.K.); (M.A.); (H.D.)
| | - Marek Straka
- Medical Faculty, Institute of Microbiolog, Comenius University in Bratislava, 81108 Bratislava, Slovakia; (L.S.); (M.S.)
| | - Adriána Liptáková
- Medical Faculty, Institute of Microbiolog, Comenius University in Bratislava, 81108 Bratislava, Slovakia; (L.S.); (M.S.)
- Correspondence:
| | - Hana Drahovská
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Ilkovičova 6, 84104 Bratislava, Slovakia; (B.M.); (M.K.); (M.A.); (H.D.)
- Comenius University Science Park, Ilkovičova 8, 84104 Bratislava, Slovakia
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15
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Larramendy S, Gaultier A, Fournier JP, Caillon J, Moret L, Beaudeau F. Local characteristics associated with higher prevalence of ESBL-producing Escherichia coli in community-acquired urinary tract infections: an observational, cross-sectional study. J Antimicrob Chemother 2021; 76:789-795. [PMID: 33351903 DOI: 10.1093/jac/dkaa514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/15/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The prevalence of ESBL-producing Escherichia coli (ESBL-E. coli) in community-acquired urinary tract infections (UTI) has been increasing worldwide since 2000, but with large geographical variations. The aim of this study was to determine whether the ESBL-E. coli rate in urine samples from individuals with community-acquired UTI was associated with the local socio-economic, environmental, agricultural and healthcare characteristics. METHODS This was a cross-sectional study in western France using data on antibiotic susceptibility of E. coli isolated from urine samples of individuals with community-acquired UTI analysed in non-hospital laboratories from 2015 to 2017. The ESBL-E. coli rate was calculated for each laboratory. Data on socio-economic characteristics, human antibiotic consumption, hospital bed density, animal farming density and percentage of agricultural land and surface water were retrieved at the municipality level and aggregated by study area. Their association with ESBL-E. coli prevalence was quantified using multivariate linear regression models with a backward selection. RESULTS From 358 291 E. coli isolates from urine samples tested in 92 laboratories, the mean ESBL-E. coli prevalence for the study period was 3.30%. In an adjusted model, the ESBL-E. coli rate was significantly (P < 0.05) and positively associated with the local percentage of people >65 years old, third-generation cephalosporin use (DDD/1000 inhabitants), number of hospital beds/km2, poultry density, pig density and percentage of agricultural land. Lower deprivation was associated with a higher ESBL-E. coli rate. CONCLUSIONS Several anthropogenic factors (primary care, hospitals and animal farming) are associated with the local ESBL-E. coli rate in community-acquired UTI. These results could contribute to improve risk management, including identification of at-risk patient groups.
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Affiliation(s)
- Stéphanie Larramendy
- Department of General Practice, Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, 44000 Nantes, France
| | - Aurélie Gaultier
- Department of General Practice, Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, 44000 Nantes, France.,CHU Nantes, DRCI, Plateforme de Méthodologie et Biostatistiques, 44000 Nantes, France
| | - Jean-Pascal Fournier
- Department of General Practice, Faculty of Medicine, University of Nantes, 1 rue Gaston Veil, 44000 Nantes, France
| | - Jocelyne Caillon
- Laboratory EA3826 Thérapeutique Expérimentale et Clinique des Infections, Faculty of Medicine, University of Nantes, 44400 Nantes, France
| | - Leïla Moret
- CHU Nantes, Public Health Department, Saint-Jacques Hospital, 85 rue Saint Jacques, 44093 Nantes, France.,UMR 1246 INSERM SPHERE 'MethodS in Patients-centered outcomes and HEalth ResEarch', University of Nantes and Tours, Bd Benoni-Goullin, 44200 Nantes, France
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16
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Stewart AG, Harris PNA, Henderson A, Schembri MA, Paterson DL. Oral cephalosporin and β-lactamase inhibitor combinations for ESBL-producing Enterobacteriaceae urinary tract infections. J Antimicrob Chemother 2021; 75:2384-2393. [PMID: 32443141 DOI: 10.1093/jac/dkaa183] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
ESBL-producing Enterobacteriaceae as uropathogens have given rise to a sizeable amount of global morbidity. Community and hospital surveillance studies continue to report increasing proportions of these organisms as causes of urinary tract infection (UTI). Due to limited treatment options and the presence of cross-resistance amongst oral antibiotics of different classes, patients often require IV therapy, thereby increasing healthcare costs and reducing the effectiveness of delivering healthcare. Oral cephalosporin antibiotics are well known for their ability to achieve high urinary concentrations, in addition to achieving clinical success for treatment of uncomplicated UTI with a drug-susceptible pathogen. Novel cephalosporin/β-lactamase inhibitor combinations have been developed and demonstrate good in vitro activity against ESBL-producing isolates. A pooled analysis of in vitro activity of existing oral cephalosporin/clavulanate combinations in ESBL-producing Enterobacteriaceae has shown MIC50s of 0.5-1, 0.125-1 and 0.25 mg/L for cefpodoxime, ceftibuten and cefixime, respectively. A novel cyclic boronic acid β-lactamase inhibitor, QPX7728, was able to produce MIC50 values of 0.5 and ≤0.06 mg/L when paired with cefpodoxime and ceftibuten, respectively. Other novel combinations, cefpodoxime/ETX0282 and ceftibuten/VNRX7145, have also demonstrated excellent activity against ESBL producers. Clinical trials are now awaited.
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Affiliation(s)
- Adam G Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andrew Henderson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia.,Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia.,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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17
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Opatowski M, Brun-Buisson C, Touat M, Salomon J, Guillemot D, Tuppin P, Watier L. Antibiotic prescriptions and risk factors for antimicrobial resistance in patients hospitalized with urinary tract infection: a matched case-control study using the French health insurance database (SNDS). BMC Infect Dis 2021; 21:571. [PMID: 34126937 PMCID: PMC8201676 DOI: 10.1186/s12879-021-06287-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Antibiotic resistance is increasing among urinary pathogens, resulting in worse clinical and economic outcomes. We analysed factors associated with antibiotic-resistant bacteria (ARB) in patients hospitalized for urinary tract infection, using the comprehensive French national claims database. METHODS Hospitalized urinary tract infections were identified from 2015 to 2017. Cases (due to ARB) were matched to controls (without ARB) according to year, age, sex, infection, and bacterium. Healthcare-associated (HCAI) and community-acquired (CAI) infections were analysed separately; logistic regressions were stratified by sex. RESULTS From 9460 cases identified, 6468 CAIs and 2855 HCAIs were matched with controls. Over a 12-months window, the risk increased when exposure occurred within the last 3 months. The following risk factors were identified: antibiotic exposure, with an OR reaching 3.6 [2.8-4.5] for men with CAI, mostly associated with broad-spectrum antibiotics; surgical procedure on urinary tract (OR 2.0 [1.5-2.6] for women with HCAI and 1.3 [1.1-1.6] for men with CAI); stay in intensive care unit > 7 days (OR 1.7 [1.2-2.6] for men with HCAI). Studied co-morbidities had no impact on ARB. CONCLUSIONS This study points out the critical window of 3 months for antibiotic exposure, confirms the impact of broad-spectrum antibiotic consumption on ARB, and supports the importance of prevention during urological procedures, and long intensive care unit stays.
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Affiliation(s)
- Marion Opatowski
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Christian Brun-Buisson
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Mehdi Touat
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
| | - Jérôme Salomon
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Didier Guillemot
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France
- AP-HP, Paris Saclay, Public Health, Medical Information, Clinical Research, Le Kremlin-Bicêtre, France
| | - Philippe Tuppin
- French National Health Insurance (Cnam), 50 Avenue du Pr-André-Lemierre, 75986, Paris Cedex 20, France
| | - Laurence Watier
- Epidemiology and Modeling of bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, 25-28, Rue du Dr. Roux, 75724, Paris Cedex 15, France.
- Center for Research in Epidemiology and Population Health (CESP), INSERM U1018, Paris-Saclay University, UVSQ, Montigny-Le-Bretonneux, France.
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Espinosa-Gongora C, Jessen LR, Kieler IN, Damborg P, Bjørnvad CR, Gudeta DD, Pires Dos Santos T, Sablier-Gallis F, Sayah-Jeanne S, Corbel T, Nevière A, Hugon P, Saint-Lu N, de Gunzburg J, Guardabassi L. Impact of oral amoxicillin and amoxicillin/clavulanic acid treatment on bacterial diversity and β-lactam resistance in the canine faecal microbiota. J Antimicrob Chemother 2021; 75:351-361. [PMID: 31778166 DOI: 10.1093/jac/dkz458] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/03/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aminopenicillins with or without a β-lactamase inhibitor are widely used in both human and veterinary medicine. However, little is known about their differential impact on the gut microbiota and development of antimicrobial resistance. OBJECTIVES To investigate changes in the faecal microbiota of dogs treated with amoxicillin or amoxicillin/clavulanic acid. METHODS Faeces collected from 42 dogs (21 per treatment group) immediately before, during and 1 week after termination of oral treatment with amoxicillin or amoxicillin/clavulanic acid were analysed by culture and 16S rRNA gene sequence analysis. RESULTS In both groups, bacterial counts on ampicillin selective agar revealed an increase in the proportion of ampicillin-resistant Escherichia coli during treatment, and an increased occurrence and proportion of ampicillin-resistant enterococci during and after treatment. 16S rRNA gene analysis showed reductions in microbial richness and diversity during treatment followed by a return to pre-treatment conditions approximately 1 week after cessation of amoxicillin or amoxicillin/clavulanic acid treatment. While no significant differences were observed between the effects of amoxicillin and amoxicillin/clavulanic acid on microbial richness and diversity, treatment with amoxicillin/clavulanic acid reduced the abundance of taxa that are considered part of the beneficial microbiota (such as Roseburia, Dialister and Lachnospiraceae) and enriched Escherichia, although the latter result was not corroborated by phenotypic counts. CONCLUSIONS Our results suggest a limited effect of clavulanic acid on selection of antimicrobial resistance and microbial richness when administered orally in combination with amoxicillin. However, combination with this β-lactamase inhibitor appears to broaden the spectrum of amoxicillin, with potential negative consequences on gut health.
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Affiliation(s)
- Carmen Espinosa-Gongora
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, DK 1870, Frederiksberg C, Denmark
| | - Lisbeth Rem Jessen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, DK 1870, Frederiksberg C, Denmark
| | - Ida Nordang Kieler
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, DK 1870, Frederiksberg C, Denmark
| | - Peter Damborg
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, DK 1870, Frederiksberg C, Denmark
| | - Charlotte Reinhard Bjørnvad
- Department of Veterinary Clinical Sciences, University of Copenhagen, Dyrlægevej 16, DK 1870, Frederiksberg C, Denmark
| | - Dereje Dadi Gudeta
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, DK 1870, Frederiksberg C, Denmark
| | - Teresa Pires Dos Santos
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, DK 1870, Frederiksberg C, Denmark
| | | | | | - Tanguy Corbel
- Da Volterra, 172 rue de Charonne, 75011 Paris, France
| | | | - Perrine Hugon
- Da Volterra, 172 rue de Charonne, 75011 Paris, France
| | | | | | - Luca Guardabassi
- Department of Veterinary and Animal Sciences, University of Copenhagen, Stigbøjlen 4, DK 1870, Frederiksberg C, Denmark.,Department of Pathobiology & Population Sciences, Royal Veterinary College, Hawkhead Lane, North Mymms, Hatfield, Herts AL9 7TA, UK
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Evins CW, Sutton CM, Withers ST, Grier JT, Schammel CMG, Fiester SE. Community-Acquired, Extended-Spectrum β-Lactamase-Producing and Extensively Drug-Resistant Escherichia coli in a 28-Year-Old Pyelonephritis Patient Lacking Risk Factors. Antibiotics (Basel) 2021; 10:antibiotics10050533. [PMID: 34062970 PMCID: PMC8147929 DOI: 10.3390/antibiotics10050533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 11/21/2022] Open
Abstract
While Escherichia coli is a common cause of urinary tract infections and pyelonephritis, there are few documented cases of extended-spectrum β-lactamase (ESBL)-producing and extensively drug-resistant (XDR) isolates from the community resulting in infection requiring hospitalization, especially in individuals lacking risk factors. In the United States, exposure to ESBL-producing E. coli is typically nosocomial, whereas patients from developing countries often encounter ESBL-producing E. coli in the community through the consumption of contaminated food or water. Considering the rarity at which XDR E. coli isolates are encountered, there is also a scarcity of literature describing the successful treatment of ESBL-producing XDR E. coli. Here we present a case of an otherwise healthy 28-year-old female delicatessen worker infected with ESBL-producing and XDR E. coli without recent travel, antibiotic use, or healthcare contact, who required admission to the intensive care unit (ICU) with pyelonephritis and septic shock. Treatment with intravenous meropenem through a peripherally inserted central catheter (PICC) line at home was curative and follow up thereafter unremarkable. Given the patient’s lack of obvious exposure to and risk factors for an ESBL-producing XDR E. coli infection and the specific lack of risk factors for severe pyelonephritis requiring hospitalization, this case represents a unique addition to the literature and is of value to clinicians by describing successful treatment.
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Affiliation(s)
- Connor W. Evins
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (C.W.E.); (S.T.W.); (J.T.G.)
| | | | - Sarah T. Withers
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (C.W.E.); (S.T.W.); (J.T.G.)
- Department of Pharmacy, Prisma Health, Greenville, SC 29605, USA;
| | - Jennifer T. Grier
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (C.W.E.); (S.T.W.); (J.T.G.)
| | | | - Steven E. Fiester
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville, SC 29605, USA; (C.W.E.); (S.T.W.); (J.T.G.)
- Pathology Associates and Consultants, Greenville, SC 29605, USA;
- Correspondence:
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20
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Iskandar K, Rizk R, Matta R, Husni-Samaha R, Sacre H, Bouraad E, Dirani N, Salameh P, Molinier L, Roques C, Dimassi A, Hallit S, Abdo R, Hanna PA, Yared Y, Matta M, Mostafa I. Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study. Value Health Reg Issues 2021; 25:90-98. [PMID: 33852980 DOI: 10.1016/j.vhri.2021.03.001] [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: 01/22/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer's perspective. METHODS A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality. RESULTS Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality. CONCLUSION In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR, Toulouse, France; INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon.
| | - Rana Rizk
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Health Services Research, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Rola Husni-Samaha
- School of Medicine, Lebanese American University, Byblos, Lebanon; Infection Control Department, Lebanese American University Medical Center, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Etwal Bouraad
- School of Pharmacy, Pharmacy Practice Department, Lebanese International University, Beirut, Lebanon
| | - Natalia Dirani
- Department of Infectious Diseases, Dar El Amal University Hospital, Baalbeck, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon; Lebanese University, Beirut, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Christine Roques
- Department of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR, Toulouse, France; Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, Toulouse, France
| | | | | | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Rachel Abdo
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Yasmina Yared
- Clinical Pharmacy Department, Geitaoui Hospital, Beirut, Lebanon
| | - Matta Matta
- Saint Joseph University, Beirut, Lebanon; Department of Infectious Diseases, Bellevue Medical Center, Mount Lebanon, Lebanon; Department of Infectious Diseases, Mounla Hospital, Tripoli, Lebanon
| | - Inas Mostafa
- Quality and Safety Department, Nabatieh Governmental Hospital, Nabatieh, Lebanon
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21
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Iskandar K, Rizk R, Matta R, Husni-Samaha R, Sacre H, Bouraad E, Dirani N, Salameh P, Molinier L, Roques C, Dimassi A, Hallit S, Abdo R, Hanna PA, Yared Y, Matta M, Mostafa I. Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study. Value Health Reg Issues 2021; 24:38-46. [PMID: 33494034 DOI: 10.1016/j.vhri.2020.01.006] [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: 09/27/2019] [Revised: 01/06/2020] [Accepted: 01/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer's perspective. METHODS A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality. RESULTS Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality. CONCLUSION In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR, Toulouse, France; INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon.
| | - Rana Rizk
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Health Services Research, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | | | - Rola Husni-Samaha
- School of Medicine, Lebanese American University, Byblos, Lebanon; Infection Control Department, Lebanese American University Medical Center, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon
| | - Etwal Bouraad
- School of Pharmacy, Pharmacy Practice Department, Lebanese International University, Beirut, Lebanon
| | - Natalia Dirani
- Department of Infectious Diseases, Dar El Amal University Hospital, Baalbeck, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Lebanese University, Beirut, Lebanon; Lebanese University, Beirut, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | - Christine Roques
- Department of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR, Toulouse, France; Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, Toulouse, France
| | | | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Rachel Abdo
- INSPECT-LB: Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban, Beirut, Lebanon; Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR, Université Paul Sabatier Toulouse III, Toulouse, France
| | | | - Yasmina Yared
- Clinical Pharmacy Department, Geitaoui Hospital, Beirut, Lebanon
| | - Matta Matta
- Saint Joseph University, Beirut, Lebanon; Department of Infectious Diseases, Bellevue Medical Center, Mount Lebanon, Lebanon; Department of Infectious Diseases, Mounla Hospital, Tripoli, Lebanon
| | - Inas Mostafa
- Quality and Safety Department, Nabatieh Governmental Hospital, Nabatieh, Lebanon
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22
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Larramendy S, Deglaire V, Dusollier P, Fournier JP, Caillon J, Beaudeau F, Moret L. Risk Factors of Extended-Spectrum Beta-Lactamases-Producing Escherichia coli Community Acquired Urinary Tract Infections: A Systematic Review. Infect Drug Resist 2020; 13:3945-3955. [PMID: 33177845 PMCID: PMC7650195 DOI: 10.2147/idr.s269033] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) has been increasing worldwide since the early 2000s. E. coli is found in 70–90% of community-acquired urinary tract infections (CA-UTIs). We performed a systematic literature review to determine the risk factors for CA-UTI caused by ESBL-EC. Methods We searched the MEDLINE, Cochrane Library, Embase and Web of Science databases without language or date restriction up to March 2019. Two independent reviewers selected studies with quantified risk factors for CA-UTI due to ESBL-EC, and assessed their quality using the Newcastle-Ottawa Scale. Results Among the 5,597 studies identified, 16 observational studies (n=12,138 patients) met the eligibility criteria. The included studies were performed in various countries, and 14/16 were published after 2012. The most relevant risk factors for CA-UTI due to ESBL-EC identified were prior use of antibiotics (odds ratio (OR) from 2.2 to 21.4), previous hospitalization (OR: 1.7 to 3.9), and UTI history (OR: 1.3 to 3.8). Two risk factors were related to environmental contamination: travelling abroad, and swimming in freshwater. Conclusion Our findings could allow adapting empiric antibiotic treatments according to the patient profile. Further studies are needed to quantify the relationships between CA-UTI due to ESBL-EC and the environment.
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Affiliation(s)
- Stéphanie Larramendy
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Valentine Deglaire
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Paul Dusollier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Jean-Pascal Fournier
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes 44000, France
| | - Jocelyne Caillon
- IRS 2 Laboratoire de Thérapeutique Expérimentale et Clinique des Infections, EA3826, University of Nantes, Nantes 44400, France
| | | | - Leïla Moret
- Public Health Department, CHU Nantes, Saint-Jacques Hospital, Nantes 44093, France.,UMR 1246 INSERM SPHERE "MethodS in Patients-Centered Outcomes and HEalth ResEarch", University of Nantes and Tours, Nantes 44200, France
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23
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Effects of Antibiotics on the Intestinal Microbiota of Mice. Antibiotics (Basel) 2020; 9:antibiotics9040191. [PMID: 32316518 PMCID: PMC7235770 DOI: 10.3390/antibiotics9040191] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022] Open
Abstract
Studies on human and mouse gastrointestinal microbiota have correlated the composition of the microbiota to a variety of diseases, as well as proved it vital to prevent colonization with resistant bacteria, a phenomenon known as colonization resistance. Antibiotics dramatically modify the gut community and there are examples of how antibiotic usage lead to colonization with resistant bacteria [e.g., dicloxacillin usage selecting for ESBL-producing E. coli carriage], as shown by Hertz et al. Here, we investigated the impact of five antibiotics [cefotaxime, cefuroxime, dicloxacillin, clindamycin, and ciprofloxacin] on the intestinal microbiota in mice. Five different antibiotics were each given to groups of five mice. The intestinal microbiotas were profiled by use of the IS-pro analysis; a 16S–23S rDNA interspace [IS]-region-based profiling method. For the mice receiving dicloxacillin and clindamycin, we observed dramatic shifts in dominating phyla from day 1 to day 5. Of note, diversity increased, but overall bacterial load decreased. For ciprofloxacin, cefotaxime, and cefuroxime there were few overall changes. We speculate that antibiotics with efficacy against the abundant anaerobes in the gut, particularly Bacteroidetes, can in fact be selected for resistant bacteria, disregarding the spectrum of activity.
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24
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Raja NS. Emerging clinical role of pivmecillinam in the treatment of urinary tract infections caused by Extended Spectrum βeta-lactamase (ESBL) producing Enterobacteriaceae. Int J Clin Pract 2019; 73:1-5. [PMID: 31243859 DOI: 10.1111/ijcp.13387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/07/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Extended Spectrum βeta-lactamase (ESBL)-producing Enterobacteriaceae causing urinary tract infections (UTIs) appear resistant to many common oral agents. There is a growing need to discover new antibiotics to combat with emerging antibiotic resistance problem. Until the discovery of new antimicrobials, we can bring back forgotten antibiotics to our clinical formulary. Pivmecillinam (prodrug of mecillinam), an oral antimicrobial agent is effective against ESBL producing organisms. We analysed the sensitivity rates of ESBL-producing Enterobacteriaceae from urine samples to mecillinam and to document if pivmecillinam is a suitable alternative option in the treatment of UTI. MATERIALS/METHODS This retrospective study was conducted from September 2015 to September 2017. Data were collected from the pathology information system. Antimicrobial sensitivity testing on ESBL-producing Enterobacteriaceae isolates was carried out by disc diffusion method in accordance with The European Committee on Antimicrobial Susceptibility Testing. RESULTS A total of 986 ESBL-producing Enterobacteriaceae were tested for mecillinam during the study period. Of 986 organisms, Escherichia coli was the most common organism (889); followed by Klebsiella species (71) and others Enterobacteriaceae (26). Mecillinam sensitivity was found in 96% Escherichia coli (855/889 isolates), 83% Klebsiella species (59/71 isolates) and 88% other Enterobacteriaceae (23/26 isolates). Overall 95% (935/986 isolates) of ESBL-producing urinary isolates were sensitive to mecillinam. CONCLUSIONS Pivmecillinam appears to be suitable option to treat ESBL-producing Enterobacteriaceae causing uncomplicated UTI. Our results showed low resistance rate to mecillinam. We recommend the use of pivmecillinam in uncomplicated UTIs because of ESBL-producing Enterobacteriaceae. More studies on in vitro activity of mecillinam against ESBL producing organism and its use and clinical outcome should be tried in future.
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Affiliation(s)
- Nadeem S Raja
- Department of Clinical Microbiology, The Conquest Hospital, East Sussex Healthcare Trust, Hastings, UK
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25
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Xiao T, Yang K, Zhou Y, Zhang S, Ji J, Ying C, Shen P, Xiao Y. Risk factors and outcomes in non-transplant patients with extended-spectrum beta-lactamase-producing Escherichia coli bacteremia: a retrospective study from 2013 to 2016. Antimicrob Resist Infect Control 2019; 8:144. [PMID: 31467670 PMCID: PMC6712786 DOI: 10.1186/s13756-019-0599-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
Background Escherichia coli is one of the most common strains of extended-spectrum β-lactam (ESBL)-producing bacteria, and the prevention and treatment of ESBL-producing E. coli infections is an ongoing challenge. The clinical characteristics and outcomes of ESBL-producing E. coli bacteremia in non-transplant patients remain to be elucidated. Methods This retrospective study included 491 non-transplant patients with E. coli bloodstream infections (BSIs) from January 2013 to December 2016 and was conducted to investigate the risk factors, clinical features, and outcomes of these infections. Results Of the 491 E. coli BSI patients, 57.6% suffered from infections with ESBL-producing strains. A multivariate analysis showed that urinary tract infection, prior use of cephalosporin, and treatment with β-lactam-β-lactamase inhibitor (BLBLI) combination antibiotics were independent risk factors for the development of ESBL-producing E. coli BSIs. The overall mortality rate in E. coli BSI patients was 14.46%, and there was no significant difference in the 28 day mortality rate between ESBL-producing E. coli and non-ESBL-producing E. coli BSI patients (14.8% vs. 14.0%, respectively; P = 0.953). Similarly, there was no difference between the community-acquired infection group and the nosocomial infection group. Hepatobiliary disease, carbapenem exposure, high APACHE II score, and hypoproteinemia were independent risk factors for death in E. coli BSI patients. Multivariate analysis showed that hypoproteinemia and severe disease were independent risk factors for death from ESBL-producing E. coli BSIs. Furthermore, there was no significant difference in the 28 day mortality between patients with ESBL-producing E. coli BSIs treated with carbapenem monotherapy versus those treated with BLBLI combination antibiotics (12.8% vs. 17.9%, respectively; P = 0.384). Conclusions Prior use of cephalosporin or BLBLI combination antibiotics increased the risk ratio for ESBL-producing E. coli infection. Hypoproteinemia and severe disease are independent risk factors for death in patients with E. coli BSIs. There was no significant difference in the 28 day prognosis of patients with ESBL-producing E. coli and those with non-ESBL-producing E. coli BSIs. These data do not support the conclusion that carbapenems might be more effective than BLBLI antibiotics for treatment of patients with BSIs caused by ESBL-producing E. coli. Electronic supplementary material The online version of this article (10.1186/s13756-019-0599-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tingting Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Kai Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanzi Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shuntian Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jinru Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chaoqun Ying
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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26
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Risk Factors Associated with Community-Acquired Urinary Tract Infections Caused by Extended-Spectrum β-Lactamase-Producing Escherichia coli: a Systematic Review. CURR EPIDEMIOL REP 2019. [DOI: 10.1007/s40471-019-00206-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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27
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Hertz FB, Jansåker F, Okon KO, Abdulmumin IS, Onah JO, Ladan J, Knudsen JD. ESBL-production in Escherichia coli and Klebsiella pneumoniae isolates from Nigeria. Microbiologyopen 2019; 8:e00816. [PMID: 30801967 PMCID: PMC6741120 DOI: 10.1002/mbo3.816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/20/2019] [Accepted: 01/22/2019] [Indexed: 11/12/2022] Open
Abstract
The worldwide increase in infections caused by extended‐spectrum beta‐lactamase‐ (ESBL) and AmpC‐producing Enterobacteriaceae (ESBL‐E) is a concern. Surveillance is extensive in Europe, North America, and Asia. Yet, there is no summarizing surveillance in Africa. This study aimed to perform a preliminary investigation on the prevalence of ESBL‐E in the northeastern part of Nigeria. However, of the 60 samples collected, we were able to culture 15 Escherichia coli and 7 Klebsiella spp. only. In the collection of clinical hospital samples, we found eight of 15 E. coli isolates to be ESBL (53%) and two out of seven Klebsiella spp. to be ESBL/AmpC (29%). Due to the limitations of this study, our findings cannot take a broad view on the prevalence of ESBL‐E, in Nigeria and other parts of Africa. Yet, to know which genes encode ESBL in Nigeria, and to know exact prevalence of every ESBL gene would be of importance.
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Affiliation(s)
- Frederik B Hertz
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Fillip Jansåker
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Kenneth O Okon
- Department of Medical Microbiology, Federal Medical Centre, Makurdi, Nigeria
| | - Ibrahim S Abdulmumin
- Department of Medical Microbiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
| | | | - Joshua Ladan
- Department of Disease and Immunization, National Primary Health Care Development Agency, Abuja, Nigeria
| | - Jenny D Knudsen
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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28
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Association of systemic antimicrobials with the expression of beta-lactamases in bacteria cultured from urological patients. Diagn Microbiol Infect Dis 2019; 94:391-394. [PMID: 30890298 DOI: 10.1016/j.diagmicrobio.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patients with abnormalities of the genitourinary tract are at high risk for infections with antimicrobial-resistant pathogens. METHODS All urine cultures ordered by members of the Division of Urology from four quarterly one-week periods were included. All gram-negative bacilli isolated were analyzed using the Check-Points Check-MDR CT103XL assay to identify the presence of genes associated with resistance to beta-lactam antibiotics. Association between the days of antibiotics and the presence of an ESBL-producing organism was determined. RESULTS One hundred eleven positive cultures were included in this analysis, of which 5 (4.5%) contained ESBL-producing species. Days of systemic antibiotics within 30 days of urine culture was associated with an increased risk of isolating an ESBL-producing pathogen. CONCLUSION The overall prevalence of ESBL-producing organisms is low in this cohort. The number of days of systemic antibiotics within 30 days of a urine culture was significantly associated with increased risk of isolating an ESBL-producing organism.
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Bollestad M, Grude N, Solhaug S, Raffelsberger N, Handal N, Nilsen HJS, Romstad MR, Emmert A, Tveten Y, Søraas A, Jenum PA, Jenum S, Møller-Stray J, Weme ET, Lindbaek M, Simonsen GS. Clinical and bacteriological efficacy of pivmecillinam treatment for uncomplicated urinary tract infections caused by ESBL-producing Escherichia coli: a prospective, multicentre, observational cohort study. J Antimicrob Chemother 2018; 73:2503-2509. [DOI: 10.1093/jac/dky230] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marianne Bollestad
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Nils Grude
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sigrid Solhaug
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Niclas Raffelsberger
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Nina Handal
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | | | - Monica Regine Romstad
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | - Andreas Emmert
- Department of Medical Microbiology, Unilabs Telelab AS, Skien, Norway
| | - Yngvar Tveten
- Department of Medical Biochemistry, Telemark Hospital, Skien, Norway
| | - Arne Søraas
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Bærum, Norway
| | - Pål A Jenum
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Bærum, Norway
| | - Synne Jenum
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Bærum, Norway
| | - Janne Møller-Stray
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Morten Lindbaek
- The Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, and Research Group for Host-Microbe Interaction, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
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Muanda FT, Sheehy O, Bérard A. Use of trimethoprim-sulfamethoxazole during pregnancy and risk of spontaneous abortion: a nested case control study. Br J Clin Pharmacol 2018; 84:1198-1205. [PMID: 29424001 PMCID: PMC5980587 DOI: 10.1111/bcp.13542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 01/21/2018] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS Data available on the fetal safety of trimethoprim-sulfamethoxazole (TMP-SMX) exposure during pregnancy remains scarce and inconclusive. A previous study assessing the link between TMP-SMX exposure during pregnancy and the risk of spontaneous abortion (SA) did not control for protopathic bias and indication bias. METHODS We conducted a nested control study (n = 77 429 pregnancies including 7039 cases of SA and 70 390 controls) within the Quebec Pregnancy Cohort. For each case of SA, we selected 10 controls at the index date that were matched on gestational age and year of pregnancy. TMP-SMX exposure was defined as either having filled at least one prescription between the first day of gestation (1DG) and the index date, or as having filled a prescription before pregnancy but with a duration overlapping the 1DG (102 pregnancies exposed to TMP-SMX, including 25 cases of SA and 77 controls). RESULTS Adjusting for potential confounders, TMP-SMX exposure was associated with an increased risk of SA (AOR 2.94, 95% C 1.89-4.57, 25 exposed cases). Similar results were found after controlling for indication bias and protopathic bias. CONCLUSION Given that this drug is widely use in HIV patients to prevent opportunistic infections and malaria, there is an urgent need to identify potential data sources in Africa for analysis of early pregnancy exposure to TMP-SMX.
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Affiliation(s)
- Flory T. Muanda
- Faculty of PharmacyUniversity of Montreal2900 Edouard MontpetitMontréalQuébecCanadaH3T 1J4
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
| | - Odile Sheehy
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
| | - Anick Bérard
- Faculty of PharmacyUniversity of Montreal2900 Edouard MontpetitMontréalQuébecCanadaH3T 1J4
- Research CenterCHU Sainte‐Justine3175, Côte‐Sainte‐CatherineMontréalQuébecCanadaH3T 1C5
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Tenney J, Hudson N, Alnifaidy H, Li JTC, Fung KH. Risk factors for aquiring multidrug-resistant organisms in urinary tract infections: A systematic literature review. Saudi Pharm J 2018; 26:678-684. [PMID: 29991911 PMCID: PMC6035314 DOI: 10.1016/j.jsps.2018.02.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/08/2018] [Indexed: 11/28/2022] Open
Abstract
Background This is the first review to analyze literature identifying risk factors for a multidrug-resistant urinary tract infection (MDR UTI). Risk factors for other infections involving multidrug-resistant organisms have been evaluated in other reviews, but they do not assess urinary tract infections. The purpose of this study is to collect currently published data to determine the most commonly and consistently identified risk factors for UTIs. Material and methods For this study, 3 independent researchers searched PubMed, Embase, and Cochrane database from 1966 to February 2016 for articles identifying risk factors for MDR UTI. Results A total of 25 studies including 31,284 patients with positive cultures provide evidence for 12 possible risk factors for MDR UTI . The most commonly identified risk factor was previous antibiotic usage as evidenced in 16 of the 20 studies that evaluated this possible risk factor. The time range utilized to define previous antibiotic usage ranged from 2 days to 365 days. Other risk factors with the strongest supporting data were urinary catheterization, previous hospitalization, and nursing home residence. Conclusion We identified 12 different possible risk factors for a MDR UTI, however several risk factors have minimal or conflicting evidence. The definitions of the risk factors varied widely among the studies, and should be standardized for future studies.
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Affiliation(s)
- Justin Tenney
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nicholas Hudson
- Elkhart General Hospital, Department of Pharmacy, Elkhart, IN, USA
| | - Hazar Alnifaidy
- Sidra Medical and Research Center, Department of Pharmacy, Doha, Qatar
| | - Justin Ting Cheung Li
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kathy Harriet Fung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Bérard A, Muanda FT, Sheehy O. The authors respond to "Underlying maternal infection likely cause of study findings". CMAJ 2017; 189:E919. [PMID: 28694314 DOI: 10.1503/cmaj.733254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Anick Bérard
- Professor, Research Center, Centre hospitalier universitaire (CHU) Sainte-Justine; Researcher, Faculty of Pharmacy, Université de Montréal, Montréal, Que
| | - Flory T Muanda
- PhD student, Research Center, Centre hospitalier universitaire (CHU) Sainte-Justine; PhD student, Faculty of Pharmacy, Université de Montréal, Montréal, Que
| | - Odile Sheehy
- Research Coordinator, Research Center, Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que
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33
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Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017; 189:E625-E633. [PMID: 28461374 DOI: 10.1503/cmaj.161020] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although antibiotics are widely used during pregnancy, evidence regarding their fetal safety remains limited. Our aim was to quantify the association between antibiotic exposure during pregnancy and risk of spontaneous abortion. METHODS We conducted a nested case-control study within the Quebec Pregnancy Cohort (1998-2009). We excluded planned abortions and pregnancies exposed to fetotoxic drugs. Spontaneous abortion was defined as having a diagnosis or procedure related to spontaneous abortion before the 20th week of pregnancy. The index date was defined as the calendar date of the spontaneous abortion. Ten controls per case were randomly selected and matched by gestational age and year of pregnancy. Use of antibiotics was defined by filled prescriptions between the first day of gestation and the index date and was compared with (a) non-exposure and (b) exposure to penicillins or cephalosporins. We studied type of antibiotics separately using the same comparator groups. RESULTS After adjustment for potential confounders, use of azithromycin (adjusted odds ratio [OR] 1.65, 95% confidence interval [CI] 1.34-2.02; 110 exposed cases), clarithromycin (adjusted OR 2.35, 95% CI 1.90-2.91; 111 exposed cases), metronidazole (adjusted OR 1.70, 95% CI 1.27-2.26; 53 exposed cases), sulfonamides (adjusted OR 2.01, 95% CI 1.36-2.97; 30 exposed cases), tetracyclines (adjusted OR 2.59, 95% CI 1.97-3.41; 67 exposed cases) and quinolones (adjusted OR 2.72, 95% CI 2.27-3.27; 160 exposed cases) was associated with an increased risk of spontaneous abortion. Similar results were found when we used penicillins or cephalosporins as the comparator group. INTERPRETATION After adjustment for potential confounders, use of macro-lides (excluding erythromycin), quinolones, tetracyclines, sulfonamides and metronidazole during early pregnancy was associated with an increased risk of spontaneous abortion. Our findings may be of use to policy-makers to update guidelines for the treatment of infections during pregnancy.
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Affiliation(s)
- Flory T Muanda
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que
| | - Odile Sheehy
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que
| | - Anick Bérard
- Faculty of Pharmacy (Muanda, Bérard), Université de Montréal; Research Center (Muanda, Sheehy, Bérard), Centre hospitalier universitaire (CHU) Sainte-Justine, Montréal, Que.
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Yang Q, Zhang H, Wang Y, Xu Z, Zhang G, Chen X, Xu Y, Cao B, Kong H, Ni Y, Yu Y, Sun Z, Hu B, Huang W, Wang Y, Wu A, Feng X, Liao K, Luo Y, Hu Z, Chu Y, Lu J, Su J, Gui B, Duan Q, Zhang S, Shao H, Badal RE. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014. BMC Infect Dis 2017; 17:192. [PMID: 28264656 PMCID: PMC5340045 DOI: 10.1186/s12879-017-2296-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/28/2017] [Indexed: 01/30/2023] Open
Abstract
Background The objective of this study was to investigate the distribution and susceptibility of aerobic and facultative Gram-negative bacilli isolated from Chinese patients with UTIs collected within 48 h (community acquired, CA) or after 48 h (hospital acquired, HA) of hospital admission. Methods From 2010 to 2014, the minimum inhibitory concentrations (MICs) of 12 antibiotics for 4,332 aerobic and facultative Gram-negative bacilli, sampled in 21 hospitals in 16 cities, were determined by the broth microdilution method. Results Enterobacteriaceae composed 88.5% of the total isolates, with Escherichia coli (E. coli) (63.2%) the most commonly isolated species, followed by Klebsiella pneumoniae (K. pneumoniae) (12.2%). Non-Enterobacteriaceae accounted for only 11.5% of all isolates and included mainly Pseudomonas aeruginosa (P. aeruginosa) (6.9%) and Acinetobacter baumannii (A. baumannii) (3.3%). Among the antimicrobial agents tested, the susceptibility rates of E.coli to the two carbapenems, ertapenem and imipenem as well as amikacin and piperacillin-tazobactam ranged from 92.5 to 98.7%. Against K. pneumonia, the most potent antibiotics were imipenem (92.6% susceptibility), amikacin (89.2% susceptibility) and ertapenem (87.9% susceptibility). Although non-Enterobacteriaceae did not show high susceptibilities to the 12 common antibiotics, amikacin exhibited the highest in vitro activity against P. aeruginosa over the 5-year study period, followed by piperacillin-tazobactam, imipenem, ceftazidime, cefepime, ciprofloxacin, and levofloxacin. The Extended Spectrum Beta-Lactamase (ESBL) rates decreased slowly during the 5 years in E. coli from 68.6% in 2010 to 59.1% in 2014, in K. pneumoniae from 59.7 to 49.2%, and in Proteus mirabilis (P. mirabilis) from 40.0 to 26.1%. However, the ESBL rates were different in 5 regions of China (Northeast, North, East, South and Middle-China). Conclusion E. coli and K. pneumonia were the major pathogens causing UTIs and carbapenems and amikacin retained the highest susceptibility rates over the 5-year study period, indicating that they are good drug choices for empirical therapies, particularly of CA UTIs in China.
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Affiliation(s)
- Qiwen Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hui Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yao Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhipeng Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinxin Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab., China-Japan Friendship Hospital, Beijing, 100029, China
| | - Haishen Kong
- Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Yuxing Ni
- Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Yunsong Yu
- Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Bijie Hu
- Division of Microbiology, Zhongshan Hospital of Fudan University, Shanghai, 200032, China
| | - Wenxiang Huang
- Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Anhua Wu
- Infection control center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xianju Feng
- Division of Microbiology, The First Affiliated Hospital of Zhengzhou University, Zhenzhou, 450052, China
| | - Kang Liao
- Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yanping Luo
- Department of Microbiology, The Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhidong Hu
- Division of Microbiology, Tianjin Medical University General Hospital, Tianjing, 300052, China
| | - Yunzhuo Chu
- Division of Microbiology, The First Affiliated Hospital of Chinese Medical University, Shenyang, 110001, China
| | - Juan Lu
- Department of Clinical Laboratory, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jianrong Su
- Department of Clinical Laboratory, Beijing Friendship Hospital of Capital Medical University, Beijing, 100020, China
| | - Bingdong Gui
- Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Qiong Duan
- Microbiology Lab, Jilin Province People's Hospital, Changchun, 130021, China
| | - Shufang Zhang
- Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China
| | - Haifeng Shao
- Division of Microbiology, General Hospital of Nanjing Military Command, Nanjing, 210002, China
| | - Robert E Badal
- Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA
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