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Jochim-Vukosavic A, Schwab F, Knegendorf L, Schlüter D, Bange FC, Ebadi E, Baier C. Epidemiology and infection control of vancomycin-resistant enterococci at a German university hospital: A three-year retrospective cohort study. PLoS One 2024; 19:e0297866. [PMID: 38408053 PMCID: PMC10896503 DOI: 10.1371/journal.pone.0297866] [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: 05/18/2023] [Accepted: 01/05/2024] [Indexed: 02/28/2024] Open
Abstract
Vancomycin-resistant enterococci (VRE) occur in hospitalized patients, causing both infection and colonization. In recent years, there has been an increase in VRE in German and other hospitals, raising the question of how to control this epidemic best. To better understand the specific epidemiology and to guide infection control, we conducted a retrospective cohort study analyzing all patients with VRE at Hannover Medical School, a tertiary university clinic in Germany that specializes in solid organ transplantation. Epidemiologic and clinical characteristics of patients with VRE from 2015-2017 were collected. Basic epidemiologic parameters, including VRE incidence and incidence density, were calculated. Independent risk factors for nosocomial VRE infection compared to colonization were assessed using a logistic regression model. There were 1,492 VRE cases corresponding to 822 individual patients. The incidence was 0.8 VRE cases per 100 cases. A total of 536 (35.9%) of the 1,492 VRE cases were acquired nosocomially. Of the 1,492 cases, 912 cases had VRE-positive samples (894 Enterococcus (E.) faecium and 18 E. faecalis) in our hospital laboratory and the remaining cases were known VRE carriers. The vanB-phenotype was observed in 369 of the 894 (41.3%) E. faecium isolates and in 6 of the 18 (33.3%) E. faecalis isolates. There was an increase over time in the vanB-phenotype proportion in E. faecium (2015: 63 of 171, 36.8%, 2016: 115 of 322, 35.7% and 2017: 191 of 401, 47.6%). A total of 107 cases had a VRE infection (7.2% of all VRE cases) according to the criteria of the German National Reference Center for Surveillance of Nosocomial Infections. The remaining cases were only colonized. Among other factors, leukocytopenia (<1,000/μL), the use of a central venous catheter and the visceral surgery medical specialty were independently associated with nosocomial VRE infection. VRE imposed a relevant and increasing infection control burden at our hospital. Nosocomial VRE infection was predominantly found in certain medical specialties, such as hematology and oncology and visceral surgery. Infection control efforts should focus on these highly affected patient groups/specialties.
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Affiliation(s)
- Adrian Jochim-Vukosavic
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité—University Medicine, Berlin, Germany
| | - Leonard Knegendorf
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Dirk Schlüter
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Franz-Christoph Bange
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Ella Ebadi
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
| | - Claas Baier
- Hannover Medical School, Institute for Medical Microbiology and Hospital Epidemiology, Hannover, Germany
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Smelikova E, Drevinek P, Nyc O, Brajerova M, Tkadlec J, Krutova M. To screen or not to screen medical students for carriage of multidrug-resistant pathogens? J Hosp Infect 2023; 140:15-23. [PMID: 37478913 DOI: 10.1016/j.jhin.2023.06.028] [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: 02/09/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND The carriage of multidrug-resistant (MDR) pathogens in medical students has not been studied extensively, despite the fact that they are in contact with patients and exposed to a hospital environment. AIM To investigate the intestinal and nasal carriage of MDR pathogens among medical students and its association with their lifestyle and demographic data. METHODS In 2021, first- and final-year medical students were invited to the study. Two rectal swabs were used for detection of extended-spectrum β-lactamase (ESBL)-producing, colistin-, tigecycline- or carbapenem-resistant Gram-negative bacteria and vancomycin-resistant enterococci. Nasal swab was used for Staphylococcus aureus culture. S. aureus isolates were characterized by spa typing; Gram-negative resistant isolates and meticillin-resistant S. aureus (MRSA) were subjected to whole-genome short and/or long sequencing. FINDINGS From 178 students, 80 (44.9%) showed nasal carriage of S. aureus; two isolates were MRSA. In rectal swabs, seven ESBL-producing strains were detected. Sixteen students were colonized by colistin-resistant bacteria, three isolates carried the mcr-1 gene (1.7%). The mcr-9 (10.7%, 19/178) and mcr-10 (2.2%, 4/178) genes were detected by quantitative polymerase chain reaction, but only two colistin-susceptible mcr-10-positive isolates were cultured. The S. aureus nasal carriage was negatively associated with antibiotic and probiotic consumption. S. aureus and colistin-resistant bacteria were detected more frequently among students in contact with livestock. CONCLUSION Medical students can be colonized by (multi)drug-resistant bacteria with no difference between first- and final-year students. The participation of students in self-screening increases their awareness of possible colonization by resistant strains and their potential transmission due to poor hand hygiene.
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Affiliation(s)
- E Smelikova
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic; Department of Genetics and Microbiology, Faculty of Science, Charles University, Prague, Czech Republic
| | - P Drevinek
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - O Nyc
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - M Brajerova
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - J Tkadlec
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - M Krutova
- Department of Medical Microbiology, 2(nd) Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
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Ioannou P, Maraki S, Koumaki D, Manios GA, Koumaki V, Kassotakis D, Zacharopoulos GV, Kofteridis DP, Manios A, de Bree E. A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward. Antibiotics (Basel) 2023; 12:antibiotics12030490. [PMID: 36978357 PMCID: PMC10044204 DOI: 10.3390/antibiotics12030490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
- Correspondence:
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios A. Manios
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 38221 Lamia, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dimitrios Kassotakis
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Andreas Manios
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Eelco de Bree
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
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Vancomycin-Resistant Enterococcus faecium and the emergence of new Sequence Types associated with Hospital Infection. Res Microbiol 2023; 174:104046. [PMID: 36858192 DOI: 10.1016/j.resmic.2023.104046] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
Enterococcus faecium is a major cause of vancomycin-resistant enterococcal (VRE) infection. New variants of the pathogen have emerged and become dominant in healthcare settings. Two such examples, vanB ST796 and vanA ST1421 sequence types, originally arose in Australia and proceeded to cause VRE outbreaks in other countries. Of concern is the detection of a vancomycin variable enterococcal (VVE) variant of ST1421 in Europe that exhibits a vancomycin-susceptible phenotype but which can revert to resistant in the presence of vancomycin. The recent application of genome sequencing for increasing our understanding of the evolution and spread of VRE is also explored here.
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Polemis M, Mandilara G, Pappa O, Argyropoulou A, Perivolioti E, Koudoumnakis N, Pournaras S, Vasilakopoulou A, Vourli S, Katsifa H, Karampatakis T, Papavasiliou A, Petinaki E, Xitsas S, Skoura L, Protonotariou E, Mantzana P, Gartzonika K, Priavali E, Kallinteri A, Giannopoulou P, Charalampaki N, Memezas M, Calina Oana Z, Papadogianni M, Panopoulou M, Koutsidou A, Vatopoulos A, Tryfinopoulou K. COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance-WHONET-Greece (January 2018-March 2021). Life (Basel) 2021; 11:996. [PMID: 34685368 PMCID: PMC8538738 DOI: 10.3390/life11100996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
Changes in hospitals' daily practice due to COVID-19 pandemic may have an impact on antimicrobial resistance (AMR). We aimed to assess this possible impact as captured by the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece). Routine susceptibility data of 17,837 Gram-negative and Gram-positive bacterial isolates from blood and respiratory specimens of hospitalized patients in nine COVID-19 tertiary hospitals were used in order to identify potential differences in AMR trends in the last three years, divided into two periods, January 2018-March 2020 and April 2020-March 2021. Interrupted time-series analysis was used to evaluate differences in the trends of non-susceptibility before and after the changes due to COVID-19. We found significant differences in the slope of non-susceptibility trends of Acinetobacter baumannii blood and respiratory isolates to amikacin, tigecycline and colistin; of Klebsiella pneumoniae blood and respiratory isolates to meropenem and tigecycline; and of Pseudomonas aeruginosa respiratory isolates to imipenem, meropenem and levofloxacin. Additionally, we found significant differences in the slope of non-susceptibility trends of Staphylococcus aureus isolates to oxacillin and of Enterococcus faecium isolates to glycopeptides. Assessing in this early stage, through surveillance of routine laboratory data, the way a new global threat like COVID-19 could affect an already ongoing pandemic like AMR provides useful information for prompt action.
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Affiliation(s)
- Michalis Polemis
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Georgia Mandilara
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Olga Pappa
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Athina Argyropoulou
- “Evaggelismos” General Hospital, 10676 Athens, Greece; (A.A.); (E.P.); (N.K.)
| | | | | | - Spyros Pournaras
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | | | - Sophia Vourli
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | - Helen Katsifa
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Theodoros Karampatakis
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Anastasia Papavasiliou
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Efthymia Petinaki
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Stylianos Xitsas
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Lemonia Skoura
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Paraskevi Mantzana
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Efthalia Priavali
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | - Amalia Kallinteri
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | | | | | - Meletis Memezas
- “Thriasio” General Hospital of Elefsina, 19600 Athens, Greece; (P.G.); (N.C.); (M.M.)
| | - Zervaki Calina Oana
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Marina Papadogianni
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Maria Panopoulou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Athanasia Koutsidou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Alkiviadis Vatopoulos
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
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Perry MR, Lepper HC, McNally L, Wee BA, Munk P, Warr A, Moore B, Kalima P, Philip C, de Roda Husman AM, Aarestrup FM, Woolhouse MEJ, van Bunnik BAD. Secrets of the Hospital Underbelly: Patterns of Abundance of Antimicrobial Resistance Genes in Hospital Wastewater Vary by Specific Antimicrobial and Bacterial Family. Front Microbiol 2021; 12:703560. [PMID: 34566912 PMCID: PMC8461093 DOI: 10.3389/fmicb.2021.703560] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/10/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Hospital wastewater is a major source of antimicrobial resistance (AMR) outflow into the environment. This study uses metagenomics to study how hospital clinical activity impacts antimicrobial resistance genes (ARGs) abundances in hospital wastewater. Methods: Sewage was collected over a 24-h period from multiple wastewater collection points (CPs) representing different specialties within a tertiary hospital site and simultaneously from community sewage works. High throughput shotgun sequencing was performed using Illumina HiSeq4000. ARG abundances were correlated to hospital antimicrobial usage (AMU), data on clinical activity and resistance prevalence in clinical isolates. Results: Microbiota and ARG composition varied between CPs and overall ARG abundance was higher in hospital wastewater than in community influent. ARG and microbiota compositions were correlated (Procrustes analysis, p=0.014). Total antimicrobial usage was not associated with higher ARG abundance in wastewater. However, there was a small positive association between resistance genes and antimicrobial usage matched to ARG phenotype (IRR 1.11, CI 1.06-1.16, p<0.001). Furthermore, analyzing carbapenem and vancomycin resistance separately indicated that counts of ARGs to these antimicrobials were positively associated with their increased usage [carbapenem rate ratio (RR) 1.91, 95% CI 1.01-3.72, p=0.07, and vancomycin RR 10.25, CI 2.32-49.10, p<0.01]. Overall, ARG abundance within hospital wastewater did not reflect resistance patterns in clinical isolates from concurrent hospital inpatients. However, for clinical isolates of the family Enterococcaceae and Staphylococcaceae, there was a positive relationship with wastewater ARG abundance [odds ratio (OR) 1.62, CI 1.33-2.00, p<0.001, and OR 1.65, CI 1.21-2.30, p=0.006 respectively]. Conclusion: We found that the relationship between hospital wastewater ARGs and antimicrobial usage or clinical isolate resistance varies by specific antimicrobial and bacterial family studied. One explanation, we consider is that relationships observed from multiple departments within a single hospital site will be detectable only for ARGs against parenteral antimicrobials uniquely used in the hospital setting. Our work highlights that using metagenomics to identify the full range of ARGs in hospital wastewater is a useful surveillance tool to monitor hospital ARG carriage and outflow and guide environmental policy on AMR.
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Affiliation(s)
- Meghan R. Perry
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- NHS Lothian Infection Service, Edinburgh Clinical Infection Research Group, Edinburgh, United Kingdom
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Hannah C. Lepper
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Luke McNally
- Centre for Synthetic and Systems Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - Bryan A. Wee
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Patrick Munk
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Amanda Warr
- Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Barbara Moore
- NHS Lothian Infection Service, Edinburgh Clinical Infection Research Group, Edinburgh, United Kingdom
| | - Pota Kalima
- NHS Lothian Infection Service, Edinburgh Clinical Infection Research Group, Edinburgh, United Kingdom
| | - Carol Philip
- NHS Lothian Infection Service, Edinburgh Clinical Infection Research Group, Edinburgh, United Kingdom
| | | | - Frank M. Aarestrup
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
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Multi-Drug Resistant Organisms Infection Impact on Patients Length of Stay in Respiratory Care Ward. Antibiotics (Basel) 2021; 10:antibiotics10050608. [PMID: 34065381 PMCID: PMC8160736 DOI: 10.3390/antibiotics10050608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the effects of multi-drug-resistant organism (MDRO) infection and other factors on the length of hospital stay (LOS) of patients in the respiratory care ward (RCW) of a regional hospital in Taiwan. In this retrospective study, we collected cases from MDRO-infected patients in the RCW from January 2016 to March 2020. The RCW comprises 13 beds in total. There were 106 infected patients, of which 42 were in the case group (infected with MDROs) and 64 were in the control group (not infected with MDROs). Clinical specimens were inoculated in a selective medium to isolate the pathogenic bacteria by standard procedures. The results showed the main factors affecting the LOS were: patients with MDRO infection, patients discharged from the RCW, and patients who underwent catheterization. The LOS of patients infected with MDROs was significantly longer than that of patients without MDRO infection (β = 0.55, 95% CI = 0.02–1.09), with the case group and the control group being 479.8 ± 546.5 and 307.3 ± 436.2 days, respectively. Infection with carbapenem-resistant Pseudomonas aeruginosa (CRPA) was associated with a longer LOS than other MDRO strains. These findings have important implications for infection control in RCW and in better tracking the health of patients.
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Vasilakopoulou A, Karakosta P, Vourli S, Kalogeropoulou E, Pournaras S. Detection of KPC, NDM and VIM-Producing Organisms Directly from Rectal Swabs by a Multiplex Lateral Flow Immunoassay. Microorganisms 2021; 9:microorganisms9050942. [PMID: 33925719 PMCID: PMC8146855 DOI: 10.3390/microorganisms9050942] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
We report a preliminary evaluation of the NG-Test CARBA 5 immunochromatographic assay for detecting carbapenemases directly from rectal swabs on the same day of sampling. Thirty fecal swabs were examined for carbapenemase-producing organisms (CPOs) by conventional culture, PCR, and NG-Test CARBA 5. Each sample was tested by the immunochromatographic assay five times, including direct testing and incubation in trypticase soy broth for 1, 2, 3, and 4 h. Twenty patients yielded CPOs by culture. Immunochromatographic and PCR results were concordant and detected the same 25 carbapenemases (11 KPC, 8 VIM, and 6 NDM). In five cases, we detected co-carriage of KPC and VIM. Compared with PCR, the sensitivity of NG-Test CARBA 5 for the detection of KPC, VIM, and NDM was 80% without incubation, 88% with one hour, 92% with two, and 100% with three hours incubation, while specificity was 100% for all time points. All samples containing adequate fecal content were detected by NG-Test CARBA 5 concordantly with PCR, without incubation. NG-Test CARBA 5 is a reliable test that rapidly detects the presence of carbapenemases at the same day of sampling, directly from rectal swabs. It thus provides early information to guide antimicrobial treatment and infection control interventions.
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Konar D, Perween N, Kumar SK, Aggarwal P, Uppal B. Molecular Characterization of New Delhi Metallo-ß-Lactamases-Producing Bacteria in the Gastrointestinal Tract of Intensive Care Unit Patients. Cureus 2020; 12:e12257. [PMID: 33520479 PMCID: PMC7834560 DOI: 10.7759/cureus.12257] [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] [Indexed: 12/04/2022] Open
Abstract
Background: The emergence of carbapenem-resistance in the gut flora of patients in the intensive care unit (ICU) poses a significant risk for infection with these types of pathogens. Materials and methods: New Delhi metallo-ß-lactamase 1 (NDM-1) in the gut flora of ICU patients was detected in cultures of a single rectal swab from each patient admitted to the ICU for a minimum period of 48 hrs. Samples were processed in the microbiology laboratory using blood agar and MacConkey agar. Identification of pathogens, carbapenem resistance, and metallo-ß-lactamase production was made using standard laboratory procedures. Bacterial isolates were also used for the determination of the NDM-1 gene by molecular methods. Results: One hundred twenty-two patients with different clinical presentations were recruited in the study. Two hundred nine bacteria were isolated, with Escherichia coli being the most common isolate. A total of 54/122 (44.3%) patients harbored carbapenem-resistant organisms (CRO), 36/122 (29.5%) carried metallo-β-lactamase-producing organisms (MBLO), and 30/122 (24.6%) carried bacteria with the NDM-1 gene. Patients who harbored CRO and MBLO had longer mean duration of stay in the ICU and hospital than those not harboring CRO and MBLO. All the metallo-β-lactamases were simultaneously resistant to other groups of antibiotics also. Use of invasive devices, three or more classes of antibiotics, hospitalization during the previous six months, comorbidities, and hospital stay for ≥48 hours before ICU admission had a significant association with colonization with CRO. Conclusion: Patients admitted in ICU or with serious diseases should be screened for gastrointestinal carriage of carbapenem-resistant organisms. Irrational use of antibiotics must be stopped to prevent the emergence and spread of such organisms.
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Affiliation(s)
- Dipasri Konar
- Microbiology, Jan Swasthya Sahyog, Chhatishgarh, IND
| | - Naz Perween
- Microbiology, Superspeciality Paediatric Hospital & Postgraduate Teaching Institute, Noida, IND
| | | | | | - Beena Uppal
- Microbiology, Maulana Azad Medical College, New Delhi, IND
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Bibbò S, Settanni CR, Porcari S, Bocchino E, Ianiro G, Cammarota G, Gasbarrini A. Fecal Microbiota Transplantation: Screening and Selection to Choose the Optimal Donor. J Clin Med 2020; 9:jcm9061757. [PMID: 32517023 PMCID: PMC7356099 DOI: 10.3390/jcm9061757] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
In the past decade, fecal microbiota transplantation (FMT) has rapidly spread worldwide in clinical practice as a highly effective treatment option against recurrent Clostridioides difficile infection. Moreover, new evidence also supports a role for FMT in other conditions, such as inflammatory bowel disease, functional gastrointestinal disorders, or metabolic disorders. Recently, some studies have identified specific microbial characteristics associated with clinical improvement after FMT, in different disorders, paving the way for a microbiota-based precision medicine approach. Moreover, donor screening has become increasingly more complex over years, along with standardization of FMT and the increasing number of stool banks. In this narrative review, we discuss most recent evidence on the screening and selection of the stool donor, with reference to recent studies that have identified specific microbiological features for clinical conditions such as Clostridioides difficile infection, irritable bowel syndrome, inflammatory bowel disease, and metabolic disorders.
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Affiliation(s)
- Stefano Bibbò
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Carlo Romano Settanni
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Serena Porcari
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Enrico Bocchino
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Gianluca Ianiro
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Giovanni Cammarota
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Antonio Gasbarrini
- UOC Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Roma, Italy; (S.B.); (C.R.S.); (S.P.); (G.I.); (G.C.)
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, 00168 Roma, Italy;
- Correspondence:
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