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Miftode IL, Vâță A, Miftode RȘ, Parângă T, Luca MC, Manciuc C, Țimpău AS, Radu V, Roșu MF, Stămăteanu LO, Leca D, Anton-Păduraru DT, Miftode EG. The Impact of Urinary Catheterization on the Antibiotic Susceptibility of ESBL-Producing Enterobacterales: A Challenging Duo. Antibiotics (Basel) 2024; 13:462. [PMID: 38786190 PMCID: PMC11117663 DOI: 10.3390/antibiotics13050462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. RESULTS We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). MATERIALS AND METHODS We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. CONCLUSIONS The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Andrei Vâță
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Radu-Ștefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Tudorița Parângă
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Mihaela Cătălina Luca
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Carmen Manciuc
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Amalia Stefana Țimpău
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Viorel Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania
| | - Manuel Florin Roșu
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
- Department of Intensive Care Unit, Infectious Diseases Clinical Hospital, 700115 Iasi, Romania
| | - Lidia Oana Stămăteanu
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Daniela Leca
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
| | - Dana Teodora Anton-Păduraru
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania;
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy “Gr. T. Popa”, 700115 Iasi, Romania; (I.-L.M.); (A.V.); (T.P.); (M.C.L.); (C.M.); (L.O.S.); (D.L.); (E.G.M.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania;
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Wang L, Yu X, Qiu Z, Liu P, Tian W, He W, Pan Y, Xu F, Cen Z, Ou Y, Li D. Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones. Front Med (Lausanne) 2024; 11:1393734. [PMID: 38765255 PMCID: PMC11099900 DOI: 10.3389/fmed.2024.1393734] [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: 02/29/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024] Open
Abstract
Objective This retrospective study aims to identify risk factors for urogenic sepsis in patients with upper urinary tract stones following ureteral flexible lithotripsy (FURL). Additionally, we analyze the clinical characteristics of bacterial infections post-surgery. Methods A total of 759 patients who underwent FURL at the Urology Department of Zunyi Medical University were included. Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors for urogenic sepsis post-FURL. The distribution of bacteria based on preoperative urine cultures was also analyzed. Statistical analysis was performed using R4.2.2 software. Results Of the 759 patients, positive preoperative urine culture, urine nitrite positivity, urine white blood cell count (WBC) ≥ 200 cells/μL, residual stones, and neutrophil-to-lymphocyte ratio (NLR) were found to be independent risk factors for urogenic sepsis after FURL. Among the 164 patients with positive preoperative urine cultures, 32 developed urogenic sepsis post-surgery, with 68.75% having positive preoperative cultures. The leading pathogens causing postoperative urogenic sepsis were Escherichia coli (E. coli), Enterococcus faecium, Proteus mirabilis, and Klebsiella pneumoniae. The probabilities of progression to urogenic sepsis were as follows: E. coli 19% (n = 12), Enterococcus faecium 43% (n = 3), Proteus mirabilis 33.3% (n = 1), and Klebsiella pneumoniae 33.3% (n = 1). The ages of affected patients were 47.17 ± 13.2, 53.7, 41, and 79 years, respectively. Rates of comorbid diabetes were 36.4, 66.7, 50, 100%, with nitrite positivity rates at 72.7, 33.3, 50, 0%. Ten female patients were infected with E. coli, while patients infected with Klebsiella pneumoniae had an NLR of 7.62. Conclusion Positive preoperative urine culture, urine nitrite positivity, urine WBC ≥ 200 cells/μL, residual stones, and NLR are independent risk factors for urogenic sepsis after FURL. Escherichia coli is the predominant pathogen post-FURL, with notable female prevalence and nitrite-positive urine in infections. Enterococcus faecium infections are associated with diabetes.
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Affiliation(s)
- Leibo Wang
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xianzhe Yu
- Department of Gastrointestinal Surgery, Chengdu Second People’s Hospital, Chengdu, China
| | - Zuze Qiu
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Puyu Liu
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wu Tian
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Wei He
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Yulin Pan
- Hangzhou Litchi Medical Beauty Clinic, Hangzhou, China
| | - Feng Xu
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Zhuangding Cen
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Yang Ou
- Department of Surgery, Beijing Jishuitan Hospital Guizhou Hospital, Guiyang, China
| | - Daobing Li
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Park KS, Kim DR, Baek JY, Shin A, Kim KR, Park H, Son S, Cho H, Kim YJ. Susceptibility to Fosfomycin and Nitrofurantoin of ESBL-Positive Escherichia coli and Klebsiella pneumoniae Isolated From Urine of Pediatric Patients. J Korean Med Sci 2023; 38:e361. [PMID: 38084025 PMCID: PMC10713444 DOI: 10.3346/jkms.2023.38.e361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Pediatric urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-positive gram-negative bacilli (GNB) has limited options for oral antibiotic treatment. The purpose of this study was to investigate the susceptibility of ESBL-positive Escherichia coli and Klebsiella pneumoniae isolates from pediatric urine samples to two oral antibiotics (fosfomycin and nitrofurantoin). METHODS From November 2020 to April 2022, ESBL-positive E. coli and K. pneumoniae isolates from urine samples were collected at Samsung Medical Center, Seoul, Korea. Patients over 18 years of age or with malignancy were excluded. For repeated isolates from the same patient, only the first isolate was tested. Minimum inhibitory concentrations (MICs) were measured using agar (fosfomycin) or broth (nitrofurantoin) dilution methods. MIC50 and MIC90 were measured for fosfomycin and nitrofurantoin in both E. coli and K. pneumoniae. RESULTS There were 117 isolates from 117 patients, with a median age of 7 months (range, 0.0-18.5 years). Among 117 isolates, 92.3% (108/117) were E. coli and 7.7% (9/117) were K. pneumoniae. Isolates from the pediatric intensive care unit (PICU) and general ward (GW) was 11.1% (13/117) and 88.9% (104/117), respectively. Among 108 E. coli isolates, MIC50 and MIC90 for fosfomycin were 0.5 μg/mL and 2 μg/mL, respectively. Fosfomycin susceptibility rate was 97.2% (105/108) with a breakpoint of 128 μg/mL. Fosfomycin susceptibility rate was significantly lower in PICU isolates than in GW isolates (81.8% vs. 99.0%, P = 0.027). For nitrofurantoin, both the MIC50 and MIC90 were 16 μg/mL. Nitrofurantoin susceptibility rate was 96.3% (104/108) with a breakpoint of 64 μg/mL based on Clinical and Laboratory Standards Institute guidelines. Among the nine K. pneumoniae isolates, the MIC50 and MIC90 for fosfomycin was 2 μg/mL and 32 μg/mL, respectively. MIC50 and MIC90 for nitrofurantoin were 64 μg/mL and 128 μg/mL, respectively. CONCLUSION For uncomplicated UTI caused by ESBL-positive GNB in Korean children, treatment with fosfomycin and nitrofurantoin for E. coli infections can be considered as an effective oral therapy option.
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Affiliation(s)
- Ki-Sup Park
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
- Planning Team, SML Genetree, Seoul, Korea
| | - Doo Ri Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Yang Baek
- Asia Pacific Foundation for Infectious Diseases (APFID), Seoul, Korea
| | - Areum Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ran Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hwanhee Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sohee Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
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Fang Y, Tao S, Chen H, Xu Y, Chen L, Liang W. ESBL-Producing and Non-ESBL-Producing Escherichia coli Isolates from Urinary Tract Differ in Clonal Distribution, Virulence Gene Content and Phylogenetic Group. Infect Drug Resist 2023; 16:5563-5571. [PMID: 37641799 PMCID: PMC10460598 DOI: 10.2147/idr.s423860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose The objectives of this study are to determine the differences in clonality, virulence gene (VG) content and phylogenetic group between non extended-spectrum beta-lactamase-producing E. coli (non-ESBL-EC) and ESBL-EC isolates from urine. Patients and Methods This study characterized a total of 100 clinical E. coli isolates consecutively obtained from the inpatients hospitalized in The First Affiliated Hospital of Ningbo University in China by polymerase-chain reaction (PCR). Results Phylogenetic group B2 was found to be the most prevalent in both ESBL-EC and non-ESBL-EC group. Among 100 clinical isolates, the count of acquired virulence genes in group B2 was found to be significantly higher than that in group A, B1, and D (p <0.001). Additionally, the presence of content within virulence genes (the total number of virulence genes detected per isolate) in B2 of non-ESBL-EC and ESBL-EC showed a significant difference (p<0.001). ST131 was detected exclusively in ESBL-EC, while ST95 and ST73 were the main sequence types in non-ESBL-EC. Conclusion Our study demonstrated the different distribution of MLST, phylogenetic group in ESBL-EC and non-ESBL-EC group. The inverse association between beta-lactamase resistance and VG content performed in this study should get a lot more attention. At the same time, we should also be wary of the appearance of non-ESBL-EC isolates of group B2 harboring more virulence genes which will lead to high pathogenicity.
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Affiliation(s)
- Yewei Fang
- Department of Clinical Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Shuan Tao
- School of Medicine, Jiangsu University, Zhejiang, People’s Republic of China
| | - Huimin Chen
- School of Medicine, Jiangsu University, Zhejiang, People’s Republic of China
| | - Yao Xu
- School of Medicine, Ningbo University, Ningbo, People’s Republic of China
| | - Luyan Chen
- Department of Blood Transfusion, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Wei Liang
- Department of Clinical Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Kasanga M, Kwenda G, Wu J, Kasanga M, Mwikisa MJ, Chanda R, Mupila Z, Yankonde B, Sikazwe M, Mwila E, Shempela DM, Solochi BB, Phiri C, Mudenda S, Chanda D. Antimicrobial Resistance Patterns and Risk Factors Associated with ESBL-Producing and MDR Escherichia coli in Hospital and Environmental Settings in Lusaka, Zambia: Implications for One Health, Antimicrobial Stewardship and Surveillance Systems. Microorganisms 2023; 11:1951. [PMID: 37630511 PMCID: PMC10459584 DOI: 10.3390/microorganisms11081951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a public health problem threatening human, animal, and environmental safety. This study assessed the AMR profiles and risk factors associated with Escherichia coli in hospital and environmental settings in Lusaka, Zambia. This cross-sectional study was conducted from April 2022 to August 2022 using 980 samples collected from clinical and environmental settings. Antimicrobial susceptibility testing was conducted using BD PhoenixTM 100. The data were analysed using SPSS version 26.0. Of the 980 samples, 51% were from environmental sources. Overall, 64.5% of the samples tested positive for E. coli, of which 52.5% were from clinical sources. Additionally, 31.8% were ESBL, of which 70.1% were clinical isolates. Of the 632 isolates, 48.3% were MDR. Most clinical isolates were resistant to ampicillin (83.4%), sulfamethoxazole/trimethoprim (73.8%), and ciprofloxacin (65.7%) while all environmental isolates were resistant to sulfamethoxazole/trimethoprim (100%) and some were resistant to levofloxacin (30.6%). The drivers of MDR in the tested isolates included pus (AOR = 4.6, CI: 1.9-11.3), male sex (AOR = 2.1, CI: 1.2-3.9), and water (AOR = 2.6, CI: 1.2-5.8). This study found that E. coli isolates were resistant to common antibiotics used in humans. The presence of MDR isolates is a public health concern and calls for vigorous infection prevention measures and surveillance to reduce AMR and its burdens.
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Affiliation(s)
- Maisa Kasanga
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China (J.W.)
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia;
| | - Jian Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Zhengzhou University, Zhengzhou 450001, China (J.W.)
| | - Maika Kasanga
- Department of Pharmacy, University Teaching Hospital, Lusaka 50110, Zambia;
| | - Mark J. Mwikisa
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Raphael Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka 50110, Zambia
| | - Zachariah Mupila
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Baron Yankonde
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Mutemwa Sikazwe
- Department of Pathology, Lusaka Trust Hospital, Lusaka 35852, Zambia
| | - Enock Mwila
- Department of Pathology, Lusaka Trust Hospital, Lusaka 35852, Zambia
| | - Doreen M. Shempela
- Churches Health Association of Zambia, Lusaka 34511, Zambia
- Department of Laboratory and Research, Central University of Nicaragua, Managua 12104, Nicaragua
| | - Benjamin B. Solochi
- Department of Pathology and Microbiology, University Teaching Hospital, Lusaka 50110, Zambia (B.B.S.)
| | - Christabel Phiri
- Department of Microbiology, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka 10101, Zambia
- Research and Surveillance Technical Working Group, Zambia National Public Health Institute, Lusaka 10101, Zambia
| | - Duncan Chanda
- Adult Centre of Excellence, University Teaching Hospital, Lusaka 50110, Zambia
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Afsharikhah S, Ghanbarpour R, Mohseni P, Adib N, Bagheri M, Jajarmi M. High prevalence of β-lactam and fluoroquinolone resistance in various phylotypes of Escherichia coli isolates from urinary tract infections in Jiroft city, Iran. BMC Microbiol 2023; 23:114. [PMID: 37087426 PMCID: PMC10122366 DOI: 10.1186/s12866-023-02860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/11/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most prevalent infectious diseases with worldwide health threatening. Antimicrobial resistant strains of Escherichia coli (E. coli) are a common cause of UTI which were identified as a treatment challenge. This study aimed to assay the prevalence of common β-lactam resistance genes including blaTEM, blaSHV, blaCTX-M and blaCMY and phenotypic resistance to commonly used β-lactam and fluoroquinolone antibiotics in UTIs. These factors were evaluated in various phylogenetic groups (phylotypes) of E. coli isolates. Real-time PCR was applied to detect β-lactam resistance genes and conventional PCR was used to determine the phylotypes. Phenotypic resistance against β-lactams (ceftazidime, cefotaxime, aztreonam and ceftriaxone) and fluoroquinolones (ciprofloxacin) were identified by the disc diffusion technique. The ability of extended spectrum β-lactamases (ESBLs) production in E. coli isolates was detected using the combined disc diffusion method. RESULTS The prevalence of resistance genes were 89.6% for blaTEM, 44.3% for blaCTX-M, 6.6% for blaSHV and 0.9% for blaCMY. The two high prevalent phylotypes were B2 (29.2%) and D (17.9%) followed by E (14.1%), F (9.4%), C (6.6%) and 10.3% of isolates were unknown in phylotyping. Disc diffusion results showed high prevalence of antibiotic resistance to cefotaxime (88.6%), aztreonam (83%), ceftireaxon (77.3%), ceftazidime (76.4%) and ciprofloxacin (55.6%). Totally, 52.8% of isolates were found as phenotypical ESBL-producers. CONCLUSIONS This study's results confirmed an explosion of antibiotic resistance amongst E. coli isolates from UTI against β-lactams and fluoroquinolones. Findings explain the necessity of deep changes in quantity and quality of drug resistance diagnosis and antibiotic therapy strategies. More studies are suggested to better and confident evaluations.
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Affiliation(s)
- Saleh Afsharikhah
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Reza Ghanbarpour
- Molecular Microbiology Research Group, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Parvin Mohseni
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Nasrin Adib
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mahboube Bagheri
- Department of Food Science and Technology, Bardsir Faculty of Agriculture, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Maziar Jajarmi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran.
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Telles JP, Morales R, Yamada CH, Marins TA, D'Amaro Juodinis V, Sztajnbok J, Silva M, Bassetti BR, Albiero J, Tuon FF. Optimization of Antimicrobial Stewardship Programs Using Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics Protocols: A Cost-Benefit Review. Ther Drug Monit 2023; 45:200-208. [PMID: 36622029 DOI: 10.1097/ftd.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. Pharmacokinetics-pharmacodynamics (PK-PD) empirically based prescriptions and therapeutic drug monitoring (TDM) programs are essential for antimicrobial stewardship, but there is a need to fit protocols according to cost benefits. The cost benefits can be demonstrated by reducing toxicity and hospital stay, decreasing the amount of drug used per day, and preventing relapses in infection. Our aim was to review the data available on whether PK-PD empirically based prescriptions and TDM could improve the cost benefits of an antimicrobial stewardship program to decrease global hospital expenditures. METHODS A narrative review based on PubMed search with the relevant studies of vancomycin, aminoglycosides, beta-lactams, and voriconazole. RESULTS TDM protocols demonstrated important cost benefit for patients treated with vancomycin, aminoglycosides, and voriconazole mainly due to reduce toxicities and decreasing the hospital length of stay. In addition, PK-PD strategies that used infusion modifications to meropenem, piperacillin-tazobactam, ceftazidime, and cefepime, such as extended or continuous infusion, demonstrated important cost benefits, mainly due to reducing daily drug needs and lengths of hospital stays. CONCLUSIONS TDM protocols and PK-PD empirically based prescriptions improve the cost-benefits and decrease the global hospital expenditures.
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Affiliation(s)
- João Paulo Telles
- - AC Camargo Cancer Center, Infectious Diseases Department, São Paulo
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
| | - Ronaldo Morales
- - Clinical Pharmacokinetics Center, School of Pharmaceutical Sciences, University of São Paulo
- - Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sírio-Libanês. São Paulo
| | - Carolina Hikari Yamada
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
- - Hospital Universitário Evangélico Mackenzie, Department of Infectious Diseases, Curitiba
| | - Tatiana A Marins
- - Hospital Israelita Albert Einstein, Department of Clinical Pharmacy, São Paulo
| | | | - Jaques Sztajnbok
- - Instituto de Infectologia Emílio Ribas, São Paulo
- - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP)
| | - Moacyr Silva
- - Hospital Israelita Albert Einstein, Department of Infection Prevention and Control, São Paulo
| | - Bil Randerson Bassetti
- - Hospital Santa Rita de Cássia, Department of Infectious Disease and Infection Control, Vitória ; and
| | - James Albiero
- - Universidade Estadual de Maringá, Pharmacy Department, Programa de Pós-Graduação em Assistência Farmacêutica, Maringá, Brazil
| | - Felipe Francisco Tuon
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
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Moir H. Antimicrobial Resistance in Urinary Tract Infections: Is There an Issue and Does It Matter? EMJ MICROBIOLOGY & INFECTIOUS DISEASES 2023. [DOI: 10.33590/emjmicrobiolinfectdis/10127137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Antimicrobial resistance (AMR) has increased substantially among community-acquired uropathogens that cause urinary tract infections (UTI), limiting the availability of effective oral antibiotic treatments.
This review includes coverage of an expert-led Learning Lounge, symposium session, and several poster presentations, that took place between 20th–22nd October 2022 as part of IDWeek2022 in Washington, D.C., USA.
An immersive Learning Lounge, sponsored by GSK, opened with Keith Kaye, Department of Medicine, Rutgers–Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA, who illuminated the concerns of AMR in community-acquired UTIs, delivering contemporary surveillance data, and outlined how in vitro data may translate into practical advice. This led fittingly to Erin McCreary, Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA, who enquired whether enough is being done in clinical practice regarding community-acquired infections, highlighting the importance of antimicrobial stewardship (AMS), and galvanising the audience to adapt healthcare settings to the changing landscape.
The scientific programme also included three data-rich posters that showcased Kaye’s surveillance data on Escherichia coli and Klebsiella pneumoniae co-resistance, along with the geographical distribution of K. pneumoniae. An insightful poster by Claire Trennery, Value Evidence Outcomes, GSK, Brentford, UK, considered the patient perspective of UTI symptoms in defining antibiotic treatment success, and two posters presented by Rodrigo Mendes, JMI Laboratories, North Liberty, Iowa, USA, examined in vitro global surveillance data of emerging antimicrobial treatments.
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Wang S, Xie H, Chen Y, Liu L, Fang M, Sun D, Xu L, Bi Z, Sun G, Li Y, Yu X, Zhang H, Kou Z, Zheng B. Intestinal colonization with ESBL-producing Klebsiella pneumoniae in healthy rural villager: A genomic surveillance study in China, 2015-2017. Front Public Health 2022; 10:1017050. [PMID: 36589964 PMCID: PMC9798286 DOI: 10.3389/fpubh.2022.1017050] [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: 08/11/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background The worldwide emergence and diffusion of extended-spectrum β-lactamase-K. pneumoniae (ESBL-KP) is of particular concern. Although ESBL-KP can inhabit the human gut asymptomatically, colonization with ESBL-KP is associated with an increased risk of ESBL-KP infection and mortality. In this study, we investigated the prevalence and characteristics of ESBL-KP in fecal samples from healthy persons in 12 villages in Shandong Province, China. Methods Screening for ESBL-KP in fecal samples was performed by selective cultivation. The bacterial species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rDNA sequence analysis. Minimum inhibitory concentrations (MICs) of 16 antibiotics were determined by the agar dilution method. Plasmid replicons, antimicrobial resistance genes and Sequence types (STs) of the isolates were determined by whole-genome sequencing (WGS). Genetic relatedness of ESBL-KP isolates was determined by the single nucleotide polymorphisms (SNP). The S1 nuclease-pulsed-field gel electrophoresis (S1-PFGE) was used to characterize the plasmids carried by ESBL-KP isolates. Conjugation assays was used to verify the transferability of bla CTX - M. Results ESBL-KP prevalence rates increased from 12.0% in 2015 to 27.5% in 2017. The experimental results showed that 97% of isolates had multi-drug resistance. Multiple ESBL resistance genotypes were commonly detected in the isolates. STs among the ESBL-KP isolates were diverse. All 69 bla CTX-M-3-positive isolates were located on plasmids, and these genes could be transferred with plasmids between different strains. Phylogenetic analysis showed the possibility of transmission among some isolates. Conclusion This study obtained the drug resistance patterns, the drug resistance phenotype and molecular characteristics of fecal-derived ESBL-KP in rural communities in Shandong Province, China. We report a rapid increase in occurrence of ESBL-KP among fecal samples collected from healthy rural residents of Shandong Province from 2015 to 2017. The carriage rate of multidrug-resistant bacteria in healthy residents is increasing. Thus, a need for further monitoring and possible interventions of ESBL-KP in this region is warranted.
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Affiliation(s)
- Shuang Wang
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Hengjie Xie
- Department of Supervise Sampling, Shandong Institute for Food and Drug Control, Jinan, Shandong, China
| | - Yuzhen Chen
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Lu Liu
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Ming Fang
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Dapeng Sun
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Liuchen Xu
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Zhenqiang Bi
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Gaoxiang Sun
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Yan Li
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Xiaolin Yu
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China
| | - Huaning Zhang
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China,*Correspondence: Huaning Zhang ✉
| | - Zengqiang Kou
- Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, Shandong, China,Zengqiang Kou ✉
| | - Beiwen Zheng
- 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, Zhejiang, China,Jinan Microecological Biomedicine Shandong Laboratory, Department of Structure and Morphology, Jinan, Shandong, China,Research Units of Infectious Diseases and Microecology, Chinese Academy of Medical Sciences, Beijing, China,Beiwen Zheng ✉
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Li J, Jiang F, Xie A, Jiang Y. Analysis of the Distribution and Drug Resistance of Pathogens in Patients with Urinary Tract Infection in the Eastern Chongming Area of Shanghai from 2018 to 2020. Infect Drug Resist 2022; 15:6413-6422. [PMID: 36345539 PMCID: PMC9636864 DOI: 10.2147/idr.s384515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The aim of this study was to clarify the distribution and drug resistance of pathogens causing urinary tract infection (UTI) and to provide a scientific reference for the rational application of antibiotics. Patients and Methods The results of bacterial identification and drug sensitivity analysis of midstream urine samples in our hospital from January 2018 to December 2020 were retrospectively analyzed. The data were analyzed using WHONET 5.6 and SPSS 26.0 (IBM) software. Results In all, 1786 pathogens were isolated from 13,141 midstream urine culture samples. Of these, 1093 (61.2%) were gram-negative bacteria, mainly Escherichia coli [29.1%] and Klebsiella pneumoniae [14.3%]; 543 (30.4%) were gram-positive bacteria, mainly Enterococcus faecium [16.7%] and Enterococcus faecalis [8.4%]; and 150 (8.4%) were fungal isolates, with the most common being Candida albicans (3.7%). The resistance rates of E. coli to piperacillin/tazobactam (3.4% vs 10.0%, p<0.05), ampicillin/sulbactam (43.0% vs 53.8%, p<0.05), and ciprofloxacin (58.0% vs 72.9%, p<0.05) increased significantly. K. pneumoniae was highly sensitive to ertapenem (100%). Two Enterococcus spp were highly sensitive to tigecycline (100%), and a small number of norvancomycin-resistant strains were found. The drug resistance rate of E. faecium to quinupristin was 6.7%. The drug resistance rates of E. faecalis to furantoin and ampicillin were 4.0% and 4.7%, respectively. Conclusion The pathogens that cause UTIs in patients are diverse, with the most common being E. coli. The isolated pathogens exhibited different resistance patterns. Antibiotics should be rationally selected based on the resistance patterns of the pathogens.
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Affiliation(s)
- Jing Li
- Department of Urology, Chongming Branch of Shanghai Tenth People’s Hospital, Shanghai, Tongji University School of Medicine, Shanghai, 202157, People’s Republic of China
| | - Feifei Jiang
- Department of Clinical Laboratory, Chongming Branch of Shanghai Tenth People’s Hospital, Shanghai, Tongji University School of Medicine, Shanghai, 202157, People’s Republic of China
| | - An Xie
- Department of Nosocomial Infection Control, Chongming Branch of Shanghai Tenth People’s Hospital, Shanghai, Tongji University School of Medicine, Shanghai, 202157, People’s Republic of China
| | - Yufeng Jiang
- Department of Urology, Chongming Branch of Shanghai Tenth People’s Hospital, Shanghai, Tongji University School of Medicine, Shanghai, 202157, People’s Republic of China,Correspondence: Yufeng Jiang, Department of Urology, Chongming Branch of Shanghai Tenth People’s Hospital, Shanghai, Tongji University School of Medicine, Shanghai, 202157, People’s Republic of China, Tel +86 18101879807, Email
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11
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Cole MS, Hegde PV, Aldrich CC. β-Lactamase-Mediated Fragmentation: Historical Perspectives and Recent Advances in Diagnostics, Imaging, and Antibacterial Design. ACS Infect Dis 2022; 8:1992-2018. [PMID: 36048623 DOI: 10.1021/acsinfecdis.2c00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The discovery of β-lactam (BL) antibiotics in the early 20th century represented a remarkable advancement in human medicine, allowing for the widespread treatment of infectious diseases that had plagued humanity throughout history. Yet, this triumph was followed closely by the emergence of β-lactamase (BLase), a bacterial weapon to destroy BLs. BLase production is a primary mechanism of resistance to BL antibiotics, and the spread of new homologues with expanded hydrolytic activity represents a pressing threat to global health. Nonetheless, researchers have developed strategies that take advantage of this defense mechanism, exploiting BLase activity in the creation of probes, diagnostic tools, and even novel antibiotics selective for resistant organisms. Early discoveries in the 1960s and 1970s demonstrating that certain BLs expel a leaving group upon BLase cleavage have spawned an entire field dedicated to employing this selective release mechanism, termed BLase-mediated fragmentation. Chemical probes have been developed for imaging and studying BLase-expressing organisms in the laboratory and diagnosing BL-resistant infections in the clinic. Perhaps most promising, new antibiotics have been developed that use BLase-mediated fragmentation to selectively release cytotoxic chemical "warheads" at the site of infection, reducing off-target effects and allowing for the repurposing of putative antibiotics against resistant organisms. This Review will provide some historical background to the emergence of this field and highlight some exciting recent reports that demonstrate the promise of this unique release mechanism.
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Affiliation(s)
- Malcolm S Cole
- Department of Medicinal Chemistry, University of Minnesota, 308 Harvard St SE, Minneapolis, Minnesota 55455, United States
| | - Pooja V Hegde
- Department of Medicinal Chemistry, University of Minnesota, 308 Harvard St SE, Minneapolis, Minnesota 55455, United States
| | - Courtney C Aldrich
- Department of Medicinal Chemistry, University of Minnesota, 308 Harvard St SE, Minneapolis, Minnesota 55455, United States
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Abalkhail A, AlYami AS, Alrashedi SF, Almushayqih KM, Alslamah T, Alsalamah YA, Elbehiry A. The Prevalence of Multidrug-Resistant Escherichia coli Producing ESBL among Male and Female Patients with Urinary Tract Infections in Riyadh Region, Saudi Arabia. Healthcare (Basel) 2022; 10:1778. [PMID: 36141390 PMCID: PMC9498880 DOI: 10.3390/healthcare10091778] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
The Escherichia coli that produces extended-spectrum lactamases (ESBL-E. coli) can develop resistance to many antibiotics. The control of ESBL-E. coli disorders is challenging due to their restricted therapeutic approaches, so this study aims to determine the prevalence and pattern of the antibiotic resistance of ESBL-E. coli among male and female patients with urinary tract infections in Riyadh, Saudi Arabia. During the period of 2019 to 2020 at King Fahd Medical City, Riyadh, 2250 urine samples from patients with urinary tract infections (UTIs) were collected, and microbial species were cultured and identified using standard biochemical techniques. A double-disc synergy test was used to identify ESBL-producing strains of E. coli, and an in vitro method and the clinical laboratory standard institute (CLSI) criteria were employed to determine the resistance of these strains to antimicrobial drugs. ESBL-E. coli was detected in 510 (33.49%) of the 1523 E. coli isolates, 67.27% of which were recovered from women and 33.7% of which were recovered from men. A total of 284 (55.69%) ESBL-E. coli isolates were found in patients under 50 years of age, and 226 (44.31%) were found in patients over 50 years of age. Nearly all the isolates of ESBL-E. coli were resistant to cephalosporins (ceftriaxone, cefotaxime, cefepime, cefuroxime, and cephalothin) and penicillin (ampicillin), whereas the majority of the isolates were sensitive to several carbapenems (imipenem, meropenem, and ertapenem), aminoglycosides (amikacin), and nitrofurantoins. The development of antibiotic resistance by ESBL-E. coli, the most frequent pathogen linked to urinary tract infections, plays a crucial role in determining which antibiotic therapy is appropriate.
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Affiliation(s)
- Adil Abalkhail
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Ahmad S. AlYami
- King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Saudi Arabia
| | | | | | - Thamer Alslamah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
| | - Yasir Ahmed Alsalamah
- General Surgery Department, Unaizah College of Medicine, Qassim University, Unayzah 56453, Saudi Arabia
| | - Ayman Elbehiry
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah 52741, Saudi Arabia
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Siriphap A, Kitti T, Khuekankaew A, Boonlao C, Thephinlap C, Thepmalee C, Suwannasom N, Khoothiam K. High prevalence of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates: A 5-year retrospective study at a Tertiary Hospital in Northern Thailand. Front Cell Infect Microbiol 2022; 12:955774. [PMID: 36004324 PMCID: PMC9393477 DOI: 10.3389/fcimb.2022.955774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The global emergence and spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, especially Escherichia coli and Klebsiella pneumoniae, have been recognized as a public health concern as severe infections caused by these microorganisms increase morbidity and mortality. This study aimed to assess the prevalence of ESBL-positive E. coli and K. pneumoniae strains isolated from hospitalized patients in Chiangrai Prachanukroh hospital, Chiangrai province, Thailand. Methods This retrospective analysis was conducted from January 2016 to December 2020. A total of 384,001 clinical specimens were collected aseptically and further cultivated on an appropriate medium. All clinical isolates (one isolate per patient) were identified based on standard laboratory methods. Antibiotic susceptibility testing was performed by the Kirby Bauer disc diffusion technique following CLSI guidelines. ESBL production was screened with ceftazidime and cefotaxime discs based on the CLSI recommendations. Phenotypic confirmation of ESBL production was carried out using a double-disc synergy technique following the CLSI standard. Results Of a total of 384,001 clinical samples analyzed for bacterial species identification, 11,065 (2.9%) tested positive for E. coli and 5,617 (1.5%) for K. pneumoniae. Approximately 42.5% (4,706/11,065) of E. coli and 30.2% (1,697/5,617) of K. pneumoniae isolates were classified as ESBL producers. A higher proportion of ESBL producers was found in patients older than 60 years and male groups. The highest infection rates of ESBL-positive pathogens were observed among patients in a medical unit. ESBL-producing E. coli and K. pneumoniae isolates were predominantly found in urine and sputum, respectively. ESBL producers exhibited a high resistance rate to ampicillin (99.8–100%), cefazolin (100%), cefotaxime (100%), fluoroquinolones, and trimethoprim/sulfamethoxazole. Conclusions This study demonstrated the high prevalence and emerging antibiotic resistance of ESBL-positive E. coli and K. pneumoniae isolates from patients admitted to a provincial hospital in northern Thailand. Most ESBL-producing strains were highly resistant to several antimicrobial agents apart from carbapenems and aminoglycosides. These findings indicated that carbapenems and aminoglycosides should be advised as the first-line drugs of choice for serious infections with ESBL-producing Enterobacterales.
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Affiliation(s)
- Achiraya Siriphap
- Division of Microbiology, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Thawatchai Kitti
- Faculty of Oriental Medicine, Chiang Rai College, Chiang Rai, Thailand
| | | | - Chalermchai Boonlao
- Department of Clinical Microbiology, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Chonthida Thephinlap
- Division of Biochemistry, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Chutamas Thepmalee
- Division of Biochemistry, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Nittiya Suwannasom
- Division of Biochemistry, School of Medical Sciences, University of Phayao, Phayao, Thailand
| | - Krissana Khoothiam
- Division of Microbiology, School of Medical Sciences, University of Phayao, Phayao, Thailand
- *Correspondence: Krissana Khoothiam,
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14
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Islam K, Sime FB, Wallis SC, Bauer MJ, Forde BM, Harris P, Shirin T, Habib ZH, Flora MS, Roberts JA. Pharmacodynamic evaluation of piperacillin/tazobactam versus meropenem against extended-spectrum β-lactamase-producing and non-producing Escherichia coli clinical isolates in a hollow-fibre infection model. J Antimicrob Chemother 2022; 77:2448-2455. [PMID: 35724128 PMCID: PMC9410668 DOI: 10.1093/jac/dkac186] [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: 01/01/2022] [Accepted: 05/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urosepsis caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is increasing worldwide. Carbapenems are commonly recommended for the treatment of ESBL infections; however, to minimize the emergence of carbapenem resistance, interest in alternative treatments has heightened. OBJECTIVES This study compared pharmacodynamics of piperacillin/tazobactam versus meropenem against ESBL-producing and non-producing E. coli clinical isolates. METHODS E. coli isolates, obtained from national reference laboratory in Bangladesh, were characterized by phenotypic tests, WGS, susceptibility tests and mutant frequency analysis. Three ESBL-producing and two non-producing E. coli were exposed to piperacillin/tazobactam (4.5 g, every 6 h and every 8 h, 30 min infusion) and meropenem (1 g, every 8 h, 30 min infusion) in a hollow-fibre infection model over 7 days. RESULTS Piperacillin/tazobactam regimens attained ∼4-5 log10 cfu/mL bacterial killing within 24 h and prevented resistance emergence over the experiment against ESBL-producing and non-producing E. coli. However, compared with 8 hourly meropenem, the 6 hourly piperacillin/tazobactam attained ∼1 log10 lower bacterial kill against one of three ESBL-producing E. coli (CTAP#173) but comparable killing for the other two ESBL-producing (CTAP#168 and CTAP#169) and two non-producing E. coli (CTAP#179 and CTAP#180). The 6 hourly piperacillin/tazobactam regimen attained ∼1 log10 greater bacterial kill compared with the 8 hourly regimen against CTAP#168 and CTAP#179 at 24 h. CONCLUSIONS Our study suggests piperacillin/tazobactam may be a potential alternative to carbapenems to treat urosepsis caused by ESBL-producing E. coli, although clinical trials with robust design are needed to confirm non-inferiority of outcome.
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Affiliation(s)
- Kamrul Islam
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Fekade B Sime
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Steven C Wallis
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Michelle J Bauer
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brian M Forde
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Patrick Harris
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Zakir H Habib
- Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh
| | - Meerjady S Flora
- Directorate General of Health Services, Mohakhali, Dhaka, Bangladesh
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Australia.,Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
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Thuy TTD, Lu HF, Kuo PY, Lin WH, Lin TP, Lee YT, Duong TTT, Wang MC, Lee YH, Wen LL, Chen YC, Kao CY. Whole-genome-sequence-based characterization of an NDM-5-producing uropathogenic Escherichia coli EC1390. BMC Microbiol 2022; 22:150. [PMID: 35668362 PMCID: PMC9172118 DOI: 10.1186/s12866-022-02562-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Urinary tract infection (UTI) is one of the most common outpatient bacterial infections. In this study, we isolated and characterized an extensively-drug resistant (XDR) NDM-5-producing Escherichia coli EC1390 from a UTI patient by using whole-genome sequencing (WGS) in combination with phenotypic assays. Methods Antimicrobial susceptibility to 23 drugs was determined by disk diffusion method. The genome sequence of EC1390 was determined by Nanopore MinION MK1C platform. Conjugation assays were performed to test the transferability of EC1390 plasmids to E. coli recipient C600. Phenotypic assays, including growth curve, biofilm formation, iron acquisition ability, and cell adhesion, were performed to characterize the function of EC1390 plasmids. Results Our results showed that EC1390 was only susceptible to tigecycline and colistin, and thus was classified as XDR E. coli. A de novo genome assembly was generated using Nanopore 73,050 reads with an N50 value of 20,936 bp and an N90 value of 7,624 bp. WGS analysis showed that EC1390 belonged to the O101-H10 serotype and phylogenetic group A E. coli. Moreover, EC1390 contained 2 conjugative plasmids with a replicon IncFIA (pEC1390-1 with 156,286 bp) and IncFII (pEC1390-2 with 71,840 bp), respectively. No significant difference was observed in the bacterial growth rate in LB broth and iron acquisition ability between C600, C600 containing pEC1390-1, C600 containing pEC1390-2, and C600 containing pEC1390-1 and pEC1390-2. However, the bacterial growth rate in nutrition-limited M9 broth was increased in C600 containing pEC1390-2, and the cell adhesion ability was increased in C600 containing both pEC1390-1 and pEC1390-2. Moreover, these plasmids modulated the biofilm formation under different conditions. Conclusions In summary, we characterized the genome of XDR-E. coli EC1390 and identified two plasmids contributing to the antimicrobial resistance, growth of bacteria in a nutrition-limited medium, biofilm formation, and cell adhesion. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02562-6.
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Affiliation(s)
- Tran Thi Dieu Thuy
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Hsu-Feng Lu
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung City, Taiwan
| | - Pei-Yun Kuo
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tran Thi Thuy Duong
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Ming-Cheng Wang
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hong Lee
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Li-Li Wen
- Department of Clinical Laboratory, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yu-Chen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
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16
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de Carvalho FRT, Telles JP, Tuon FFB, Rabello Filho R, Caruso P, Correa TD. Antimicrobial Stewardship Programs: A Review of Strategies to Avoid Polymyxins and Carbapenems Misuse in Low Middle-Income Countries. Antibiotics (Basel) 2022; 11:antibiotics11030378. [PMID: 35326841 PMCID: PMC8944697 DOI: 10.3390/antibiotics11030378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of Acinetobacter baumannii, carbapenem-resistant Enterobacterales, and Pseudomonas aeruginosas infections. Additionally, we highlight how to implement cumulative antibiograms and biomarkers to a sooner de-escalation of antibiotics.
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Affiliation(s)
- Fabrício Rodrigues Torres de Carvalho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | - João Paulo Telles
- Department of Infectious Diseases, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil
- School of Medicine, Pontifical Catholic University, Curitiba 80215-901, PR, Brazil;
- Department of Infectious Diseases, Hospital Universitario Evangelico Mackenzie, Curitiba 80730-420, PR, Brazil
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | | | - Roberto Rabello Filho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
| | - Pedro Caruso
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
| | - Thiago Domingos Correa
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
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A Descriptive Analysis of Urinary ESBL-Producing-Escherichia coli in Cerdanya Hospital. Microorganisms 2022; 10:microorganisms10030488. [PMID: 35336064 PMCID: PMC8953596 DOI: 10.3390/microorganisms10030488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
Urinary tract infections caused by extended-spectrum β-lactamase Escherichia coli (ESBL-EC) are increasing worldwide and are a current concern because treatment options are often limited. This study investigated antimicrobial susceptibility, antimicrobial resistance genes (ARGs), and the biological diversity of urinary ESBL-EC isolates at Cerdanya Hospital, a European cross-border hospital that combines French and Spanish healthcare models. Bacterial identification and susceptibility were determined using the Microscan WalkAway® system and ESBL production was examined by the double-disk synergy method. Isolates were sequenced using the Ion S5™ next-generation sequencing system, with the whole-genome sequences then assembled using SPADEs software and analyzed using PubMLST, ResFinder, FimTyper, PlasmidFinder, and VirulenceFinder. A phylogenetic analysis was performed by constructing an assembly-based core-SNV alignment, followed by a phylogenetic tree constructed using Parsnp from the Harvest suite. All isolates studied were multidrug-resistant and could be classified into 19 different sequence types characterized by a high genetic diversity. The most prevalent ESBL-enzymes were CTX-M-14 and CTX-M-15. High-risk international clones (ST131, ST10, and ST405) were also identified. The results demonstrated the absence of a single predominant clone of ESBL-MDR-EC at Cerdanya Hospital.
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Mohapatra S, Panigrahy R, Tak V, J. V. S, K. C. S, Chaudhuri S, Pundir S, Kocher D, Gautam H, Sood S, Das BK, Kapil A, Hari P, Kumar A, Kumari R, Kalaivani M, R. A, Salve HR, Malhotra S, Kant S. Prevalence and resistance pattern of uropathogens from community settings of different regions: an experience from India. Access Microbiol 2022; 4:000321. [PMID: 35355869 PMCID: PMC8941965 DOI: 10.1099/acmi.0.000321] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Urinary tract infection (UTI) is one of the most common infections in clinical practice worldwide in both healthcare and community settings causing significant morbidity and mortality. It is one of the major conditions at the community level treated empirically and regarded as a potential cause of emergence of antimicrobial resistance (AMR). Limited information is available regarding community-acquired UTI (CA-UTI) from India. Methodology This is a first of its kind, multicentric-cross-sectional study at the community level targeting patients attending the out-patient department (OPD) of the community health centre (CHC) from four geographical regions (North, South, West and East) of India. The study had been designed to determine the epidemiology, antibiogram profile and identification of extended-spectrum beta-lactamase (ESBL) producer and carbapenem resistant (CR) uropathogens. Samples were collected prospectively from UTI suspected patients coming at CHC and processed at the tertiary healthcare centres using a common standard operating procedure. Clinical history of all the patients exhibiting significant bacteriuria was collected and data was analysed. Result Overall, 250 out of a total of 2459 (10.1 %) urine samples were positive for bacteria with significant bacteriuria (adult: paediatrics, 6.7 : 1). Females were predominantly affected (male: female, 1 : 2.9). History of recent episode of UTI was observed as the commonest risk factor followed by diabetes mellitus. Altogether, 86 % of total cases were caused by Escherichia coli (68 %) and Klebsiella pneumoniae (17.6 %) together. Among the commonly used oral antibiotics for the Gram-negative bacilli (GNB), the highest resistance was observed against beta-lactams, first- and second-generation cephalosporins, fluoroquinolones and co-trimoxazole. Overall, the prevalence of ESBL producer and CR isolates were 44.8, and 4.3 %, respectively. However, the ESBL production, CR and nitrofurantoin resistance among the uropathogenic E. coli (UPEC) isolates was 52.8, 5.1 and 14 %, respectively. No resistance was found against fosfomycin among the UPEC isolates. Conclusion The current study highlights the increasing incidence of AMR among uropathogens at the community-settings of India. A significant percentage of ESBL producers among the isolated UPEC and K. pneumoniae were observed. The currently available evidence supports the clinical recommendation of fosfomycin and nitrofurantoin for empiric therapy in CA-UTI in India.
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Affiliation(s)
- Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India
| | - Shwetha J. V.
- Department of Microbiology, Bangalore Medical College and Research Institute, Karnataka, India
| | - Sneha K. C.
- Department of Microbiology, Bangalore Medical College and Research Institute, Karnataka, India
| | - Susmita Chaudhuri
- Translational Health Science and Technology Institute, Faridabad, India
| | - Swati Pundir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Kocher
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Hari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumari
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ambica R.
- Department of Microbiology, Bangalore Medical College and Research Institute, Karnataka, India
| | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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19
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Yamashita K, Ishiyama Y, Yoshino M, Tachibana H, Toki D, Konda R, Kondo T. Urinary Tract Infection in Hemodialysis-Dependent End-Stage Renal Disease Patients. Res Rep Urol 2022; 14:7-15. [PMID: 35079597 PMCID: PMC8778613 DOI: 10.2147/rru.s346020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/08/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction The aim of this study was to analyze urinalysis findings and urinary bacterial culture in hemodialysis-dependent end-stage renal disease patients. The research goal was to understand the proportion, risk factors, and the causative organisms of urinary tract infection in hemodialysis-dependent end-stage renal disease patients. Materials and Methods Between May 2020 and June 2021, this study included 100 hemodialysis-dependent end-stage renal disease patients (50 male patients and 50 female patients). The urine underwent microscopic examination, pyuria was defined as ≥5 white blood cells per high-power field, and urinary bacterial cultures were conducted for patients with pyuria. Bacteriuria was defined as ≥104 colony-forming units/mL in men and ≥105 colony-forming units/mL in women. Daily urine output was investigated by oral listening. Postvoiding residual urine volume was measured. Results Fifty-six percent of male patients and 30% of female patients had normosthenuria, 24% of male patients and 38% of female patients had pyuria, and 20% of male patients and 32% of female patients had a urinary tract infection. A comparison of normosthenuria and urinary tract infection revealed no statistically significant difference in age, time on dialysis, daily urine output, and postvoiding residual urine volume. The proportion of female patients among those with normosthenuria was 34.8%, whereas the proportion of female patients among those with UTI was 61.5%. Urinary bacterial cultures showed that the major causative organisms were Escherichia coli (45%; 18/40 cultures) and extended spectrum beta-lactamase-producing Escherichia coli (17.5%; 7/40 cultures). Conclusion The incidence of urinary tract infection was higher in female patients than in male patients. The proportion of resistant bacteria as the causative organisms was high in hemodialysis-dependent end-stage renal disease patients. Urinary bacterial culture should be checked while patients are able to void urine.
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Affiliation(s)
- Kaori Yamashita
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
- Tomioka Clinic, Tokiwa Foundation, Fukushima, Japan
- Correspondence: Kaori Yamashita, Department of Urology, Tokyo Women’s Medical University Medical Center East, 2-1-10, Nishi-ogu, Arakawa-ku, Tokyo, 116-8567, Japan, Tel +81 338101111, Fax +81 338940282, Email
| | - Yudai Ishiyama
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Maki Yoshino
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Hidekazu Tachibana
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | - Daisuke Toki
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
| | | | - Tunenori Kondo
- Department of Urology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
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