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Gomaa Elsayed A, M Fahmy E, Abdellatif Alsayed M, Ahmed ME, El Sayed Zaki M, Mofreh Mohamed M. Study of plasmid mediated quinolone resistance genes among Escherichia coli and Klebsiella pneumoniae isolated from pediatric patients with sepsis. Sci Rep 2024; 14:11849. [PMID: 38783019 PMCID: PMC11116374 DOI: 10.1038/s41598-024-61357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
The resistance to antibiotics in Gram-negative bacilli causing sepsis is a warning sign of failure of therapy. Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) represent major Gram-negative bacilli associated with sepsis. Quinolone resistance is an emerging resistance among E. coli and K. pneumoniae. Therefore, the present study aimed to study the presence of plasmid-mediated quinolone resistance (PMQR) genes qnrA, qnrB, and qnrS by polymerase chain reaction (PCR) in E. coli and K. pneumoniae isolated from pediatric patients with sepsis. This was a retrospective cross-sectional study that included pediatric patients with healthcare-associated sepsis. The E. coli and K. pneumoniae isolates were identified by microbiological methods. PMQR genes namely qnrA, qnrB, and qnrS were detected in E. coli and K. pneumoniae isolates by PCR. The results were analyzed by SPPS24, and the qualitative data was analyzed as numbers and percentages and comparison was performed by Chi-square test, P was significant if < 0.05. The most prevalent gene detected by PCR was qnrA (75%), followed by qnrB (28.1%), and qnrS (25%). The most frequently detected qnr gene in E coli and K. pneumoniae was qnrA (28.8%, and 16.3% respectively). The present study highlights the high prevalence of ciprofloxacin resistance among E. coli and K. pneumoniae isolated from pediatric patients with healthcare-associated sepsis. There was a high frequency of PMQR genes in E. coli and K. pneumoniae isolated from pediatric patients. Therefore, it is important to monitor the spread of PMQR genes in clinical isolates to ensure efficient antibiotic use in those children. The finding denotes the importance of an antibiotics surveillance program.
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Affiliation(s)
- Ahmed Gomaa Elsayed
- Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ehab M Fahmy
- Medical Microbiology and Immunology, Helwan Faculty of Medicine, Helwan, Egypt
| | | | - Mai Essam Ahmed
- Clinical Pathology, Beni suef Faculty of Medicine, Beni Suef, Egypt
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Hambrick HR, Cervantes F, Dong M, Tang P, Arbough T, Vinks AA, Mizuno T, Goldstein SL, Kaplan J, Girdwood, ST. Ceftriaxone Pharmacokinetics and Pharmacodynamic Target Attainment for Three Pediatric Patients Receiving Continuous Kidney Replacement Therapy. J Pediatr Pharmacol Ther 2024; 29:180-187. [PMID: 38596427 PMCID: PMC11001209 DOI: 10.5863/1551-6776-29.2.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/16/2023] [Indexed: 04/11/2024]
Abstract
Ceftriaxone is used commonly for sepsis, including in children requiring continuous kidney replacement therapy (CKRT). No reports exist of pharmacokinetic (PK) parameters for children receiving ceftriaxone on CKRT. We enrolled children admitted to our pediatric intensive care unit (PICU) who received CKRT for >24 hours and received >1 dose of ceftriaxone while on and off CKRT. We measured free ceftriaxone -concentrations from residual blood samples then used Bayesian estimation with PK modeling software to generate concentration-time profiles and determine PK parameters and the percentage of time free ceftriaxone concentrations were above 1× or 4× MIC (% fT >MIC). Three patients aged 2 to 17 years were included; all were anuric at CKRT initiation and received 50 mg/kg (max 2000 mg) ceftriaxone every 12 to 24 hours. Total ceftriaxone clearance (CL) was 0.50 to 3.67 L/hr while receiving CKRT and 0.29 to 2.71 L/hr while off, indicating CKRT provided 25% to 42% of total ceftriaxone CL. All achieved 100% fT >1× and 4× MIC using an estimated MIC (1 mg/L) for patients 1 to 2 (no culture data) and a measured MIC (0.016 mg/L) for patient 3. Therefore, CKRT contributed significantly to total ceftriaxone clearance in 3 children though the dosing strategies used in each patient attained PD targets.
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Affiliation(s)
- H. Rhodes Hambrick
- Division of Nephrology and Hypertension (HRH, SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Francisco Cervantes
- Department of Medical Education (FC), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Min Dong
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Peter Tang
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Pathology and Laboratory Medicine (PT), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Trent Arbough
- Department of Anesthesiology (TA), University of Kentucky College of Medicine, Lexington, KY
| | - Alexander A. Vinks
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tomoyuki Mizuno
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension (HRH, SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Clinical Pharmacology (HRH, MD, AAV, TM, STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Center for Acute Care Nephrology (SLG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jennifer Kaplan
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine (JK), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Sonya Tang Girdwood,
- Department of Pediatrics (MD, PT, AAV, TM, SLG, JK, STG), University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Hospital Medicine (STG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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