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Wei Y, Palacios Araya D, Palmer KL. Enterococcus faecium: evolution, adaptation, pathogenesis and emerging therapeutics. Nat Rev Microbiol 2024:10.1038/s41579-024-01058-6. [PMID: 38890478 DOI: 10.1038/s41579-024-01058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/20/2024]
Abstract
The opportunistic pathogen Enterococcus faecium colonizes humans and a wide range of animals, endures numerous stresses, resists antibiotic treatment and stubbornly persists in clinical environments. The widespread application of antibiotics in hospitals and agriculture has contributed to the emergence of vancomycin-resistant E. faecium, which causes many hospital-acquired infections. In this Review, we explore recent discoveries about the evolutionary history, the environmental adaptation and the colonization and dissemination mechanisms of E. faecium and vancomycin-resistant E. faecium. These studies provide critical insights necessary for developing novel preventive and therapeutic approaches against vancomycin-resistant E. faecium and also reveal the intricate interrelationships between the environment, the microorganism and the host, providing knowledge that is broadly relevant to how antibiotic-resistant pathogens emerge and endure.
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Affiliation(s)
- Yahan Wei
- School of Podiatric Medicine, The University of Texas Rio Grande Valley, Harlingen, TX, USA
| | - Dennise Palacios Araya
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Kelli L Palmer
- Department of Biological Sciences, The University of Texas at Dallas, Richardson, TX, USA.
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Al Bshabshe A, Algarni A, Shabi Y, Alwahhabi A, Asiri M, Alasmari A, Alshehry A, Mousa WF, Noreldin N. Characterization and Antimicrobial Susceptibility Patterns of Enterococcus Species Isolated from Nosocomial Infections in a Saudi Tertiary Care Hospital over a Ten-Year Period (2012-2021). Diagnostics (Basel) 2024; 14:1190. [PMID: 38893716 PMCID: PMC11171566 DOI: 10.3390/diagnostics14111190] [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: 05/06/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. METHOD This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. RESULT A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). CONCLUSION Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Abdullah Algarni
- Department of Family Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia;
| | - Yahya Shabi
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Abdulrahman Alwahhabi
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Mohammed Asiri
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Ahmed Alasmari
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Adil Alshehry
- Department of Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Wesam F. Mousa
- Department of Anesthesia and ICU, College of Medicine, Tanta University, Tanta 31512, Egypt
| | - Nashwa Noreldin
- Department of Internal Medicine, College of Medicine, Tanta University, Tanta 31512, Egypt;
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Giersch K, Tanida K, Both A, Nörz D, Heim D, Rohde H, Aepfelbacher M, Lütgehetmann M. Adaptation and validation of a quantitative vanA/vanB DNA screening assay on a high-throughput PCR system. Sci Rep 2024; 14:3523. [PMID: 38347048 PMCID: PMC10861526 DOI: 10.1038/s41598-024-54037-5] [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: 10/11/2023] [Accepted: 02/07/2024] [Indexed: 02/15/2024] Open
Abstract
Vancomycin resistant enterococci (VRE) are a leading cause of ICU-acquired bloodstream infections in Europe. The bacterial load in enteral colonization may be associated with a higher probability of transmission. Here, we aimed to establish a quantitative vanA/vanB DNA real-time PCR assay on a high-throughput system. Limits of detection (LOD), linear range and precision were determined using serial bacterial dilutions. LOD was 46.9 digital copies (dcp)/ml for vanA and 60.8 dcp/ml for vanB. The assay showed excellent linearity between 4.7 × 101 and 3.5 × 105 dcp/ml (vanA) and 6.7 × 102 and 6.7 × 105 dcp/ml (vanB). Sensitivity was 100% for vanA and vanB, with high positive predictive value (PPV) for vanA (100%), but lower PPV for vanB (34.6%) likely due to the presence of vanB DNA positive anerobic bacteria in rectal swabs. Using the assay on enriched VRE broth vanB PPV increased to 87.2%. Quantification revealed median 2.0 × 104 dcp/ml in PCR positive but VRE culture negative samples and median 9.1 × 104 dcp/ml in VRE culture positive patients (maximum: 107 dcp/ml). The automated vanA/B_UTC assay can be used for vanA/vanB detection and quantification in different diagnostic settings and may support future clinical studies assessing the impact of bacterial load on risk of infection and transmission.
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Affiliation(s)
- Katja Giersch
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Konstantin Tanida
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Anna Both
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Denise Heim
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.
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Kimishima A, Tsuruoka I, Tsutsumi H, Honsho M, Honma S, Matsui H, Sugamata M, Wasuwanich P, Inahashi Y, Hanaki H, Asami Y. A new tetronomycin analog, broad-spectrum and potent antibiotic against drug-resistant Gram-positive bacteria. Chem Biodivers 2024; 21:e202301834. [PMID: 38179845 DOI: 10.1002/cbdv.202301834] [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: 11/17/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/06/2024]
Abstract
We discovered a new tetronomycin analog, C-32-OH tetronomycin (2) from the Streptomyces sp. K20-0247 strain, which produces tetronomycin (1). After NMR analysis of 2, we determined the planar structure. Futhermore, the absolute stereochemistry of 2 was deduced based on the biosynthetic pathway of 1 in the K20-0247 strain and a comparison of experimental electronic circular dichroism (ECD) results of 1 with 2. While 2 exihibits potent antibacterial activity aganist Gram-positive baceria including vancomycin-intermediate Staphylococcus aureus (VISA) strains and vancomycin-resistant Enterococci (VRE), the antibacterial activity of 2 shows 16-32-folds weaker than that of 1 suggesting that the C-34 methyl group in 1 is one of the very important functinal group. Moreover, we evaluated the ionophore activity of 1 and 2 and neither compound shows ionophore activity at reasonable concetrations. Our research suggests that 1 and 2 would have different target(s) from an ionophore mechanism in the antibacterial activity and tetronomycins are promising natural products for broad-spectrum antibiotics.
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Affiliation(s)
- Aoi Kimishima
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Iori Tsuruoka
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Hayama Tsutsumi
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Masako Honsho
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Sota Honma
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Hidehito Matsui
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Miho Sugamata
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Paul Wasuwanich
- University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Yuki Inahashi
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Hideaki Hanaki
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
| | - Yukihiro Asami
- Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
- Ōmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane Minato-ku, 108-8641, Tokyo, Japan
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Rothe K, Bachfischer T, Karapetyan S, Hapfelmeier A, Wurst M, Gleich S, Dichtl K, Schmid RM, Triebelhorn J, Wagner L, Erber J, Voit F, Burgkart R, Obermeier A, Seibold U, Busch DH, Rämer PC, Spinner CD, Schneider J. Are enterococcal bloodstream infections an independent risk factor for a poorer 5-year survival or just a marker for severity of illness?-The Munich multicentric enterococci cohort. Microbiol Spectr 2023; 11:e0258523. [PMID: 37791770 PMCID: PMC10715215 DOI: 10.1128/spectrum.02585-23] [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: 06/20/2023] [Accepted: 08/17/2023] [Indexed: 10/05/2023] Open
Abstract
IMPORTANCE The present study provides a substantial contribution to literature, showing that patients with enterococcal bloodstream infections (BSI) have a lower survival rate than those with Escherichia coli (E. coli) bloodstream infections after adjusting for 17 limiting prognostic factors and excluding patients with a limited life expectancy [metastatic tumor disease, Charlson Comorbidity Index (CCI) (greater than or equal to) 5]. This difference in the 5-year long-term survival was mainly driven by Enterococcus faecium (ECFM) bloodstream infections, with vancomycin resistance not being a significant contributing factor. Our findings imply that E. faecium bloodstream infections seem to be an independent risk factor for poor long-term outcomes. As such, future research should confirm this relationship and prioritize investigating its causality through prospective studies.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Tobias Bachfischer
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Siranush Karapetyan
- Institute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
- Institute of AI and Informatics in Medicine, University Hospital rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Milena Wurst
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sabine Gleich
- Public Health Service, City of Munich, Munich, Germany
| | - Karl Dichtl
- Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Medizinische Fakultät, Ludwig-Maximilians-Universität München, Munich, Germany
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Roland M. Schmid
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Julian Triebelhorn
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Laura Wagner
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Florian Voit
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Rainer Burgkart
- Clinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Andreas Obermeier
- Clinic of Orthopaedics and Sports Orthopaedics, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Ulrich Seibold
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
- Division of Infectious Diseases, Department of Medicine IV, Hospital of the LMU Munich, Munich, Germany
| | - Dirk H. Busch
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Patrick C. Rämer
- Department of Hospital Hygiene and Infection Control, Munich Municipal Hospital Group, Munich, Germany
| | - Christoph D. Spinner
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
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Meschiari M, Kaleci S, Monte MD, Dessilani A, Santoro A, Scialpi F, Franceschini E, Orlando G, Cervo A, Monica M, Forghieri F, Venturelli C, Ricchizzi E, Chester J, Sarti M, Guaraldi G, Luppi M, Mussini C. Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study. Antimicrob Resist Infect Control 2023; 12:126. [PMID: 37957773 PMCID: PMC10644555 DOI: 10.1186/s13756-023-01332-x] [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: 07/23/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Vancomycin-resistant enterococcus (VRE) was the fastest growing pathogen in Europe in 2022 (+ 21%) but its clinical relevance is still unclear. We aim to identify risk factors for acquired VRE rectal colonization in hematological patients and evaluate the clinical impact of VRE colonization on subsequent infection, and 30- and 90-day overall mortality rates, compared to a matched control group. METHODS A retrospective, single center, case-control matched study (ratio 1:1) was conducted in a hematological department from January 2017 to December 2020. Case patients with nosocomial isolation of VRE from rectal swab screening (≥ 48 h) were matched to controls by age, sex, ethnicity, and hematologic disease. Univariate and multivariate logistic regression compared risk factors for colonization. RESULTS A total of 83 cases were matched with 83 controls. Risk factors for VRE colonization were febrile neutropenia, bone marrow transplant, central venous catheter, bedsores, reduced mobility, altered bowel habits, cachexia, previous hospitalization and antibiotic treatments before and during hospitalization. VRE bacteraemia and Clostridioides difficile infection (CDI) occurred more frequently among cases without any impact on 30 and 90-days overall mortality. Vancomycin administration and altered bowel habits were the only independent risk factors for VRE colonization at multivariate analysis (OR: 3.53 and 3.1; respectively). CONCLUSIONS Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for VRE nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between CDI and VRE, which deserves further investigation to target new therapeutic approaches.
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Affiliation(s)
- Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy.
| | - Shaniko Kaleci
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Martina Del Monte
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Andrea Dessilani
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Francesco Scialpi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Gabriella Orlando
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Adriana Cervo
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Morselli Monica
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Forghieri
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Venturelli
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Enrico Ricchizzi
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Viale Aldo Moro 21, Bologna, 40127, Italy
| | - Johanna Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, 41121, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
| | - Mario Luppi
- Section of Hematology, Department of Surgical and Medical Sciences, AOU Policlinico, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41122, Italy
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Healthcare-associated infections and antimicrobial resistance in Canadian acute care hospitals, 2017-2021. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:235-252. [PMID: 38425696 PMCID: PMC10903608 DOI: 10.14745/ccdr.v49i05a09] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2017 to 2021 (Candida auris 2012-2021) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial laboratories to the National Microbiology Laboratory (NML). Methods Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for Clostridioides difficile infections (CDI), carbapenemase-producing Enterobacterales (CPE), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2012 by the NML. Case counts, rates, outcomes, molecular characterization and antimicrobial resistance profiles are presented. Results From 2017 to 2021, increased rates per 10,000 patient days were observed for MRSA BSIs (35%; 0.84-1.13), VRE BSIs (43%; 0.23-0.33) and CPE infections (166%, 0.03-0.08). CDI rates decreased 11% (5.68-5.05). Thirty-one C. auris isolates were identified in Canada from 2012 to 2021, with the majority from Western Canada (68%). Conclusion From 2017 to 2021, the incidence of MRSA and VRE BSIs, and CPE infections increased in Canadian acute care hospitals participating in a national sentinel network (CNISP) while CDI decreased. Few C. auris isolates were identified from 2012 to 2021. Reporting standardized surveillance data and the consistent application of infection prevention and control practises in acute care hospitals are critical to help decrease the burden of HAIs and AMR in Canada.
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GÜMÜŞ H. Vankomisine Dirençli Enterococcus faecium: Kısa Bir Derleme. ARŞIV KAYNAK TARAMA DERGISI 2023. [DOI: 10.17827/aktd.1246260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Antimikrobiyal direnç (AMD) ile ilişkili morbidite ve mortalite küresel bir halk sağlığı sorunudur. Sağlık hizmeti ilişkili enfeksiyonlarda sık olarak görülen vankomisine dirençli Enterococcus faecium (VRE), Dünya Sağlık Örgütü’nün AMD’i olan öncelikli patojenler listesinde yüksek öncelik verdiği bir Gram pozitif koktur. Son zamanlarda Türkiye’de invaziv enfeksiyonlarda VRE izolasyon oranı %15.8 bildirilmiştir. Vankomisine direncin ana mekanizması, hedef bölgedeki D-Alanil-D-Alanin terminal molekülünün değişmesi ve ilacın affinitesinin azalmasıdır. Vankomisin direncinden sorumlu olan van geni kromozomal olarak kodlanmakta veya plazmid, transpozon gibi mobil genetik elemanlar ile kazanılmaktadır. Yayılımındaki ana mekanizma, mobil genetik elemanların Enterokoklar veya Staphylococcus aereus gibi farklı tür bakteriler arasında transfer edilebilmeleridir. Bu derlemede PubMed ve Web of Science veritabanlarında “Vankomisin-dirençli Enterococcus faecium”, “Vankomisin direnç mekanizmaları”, “Gram pozitif koklarda vankomisin direnci” terimleri ile arama yapılarak elde edilen literatür verileri özetlenmiş ve önerilerle birlikte kısaca tartışılmıştır.
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Bandy SM, Jackson CB, Black CA, Godinez W, Gawrys GW, Lee GC. Molecular Rapid Diagnostics Improve Time to Effective Therapy and Survival in Patients with Vancomycin-Resistant Enterococcus Bloodstream Infections. Antibiotics (Basel) 2023; 12:210. [PMID: 36830121 PMCID: PMC9952532 DOI: 10.3390/antibiotics12020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Delays in appropriate antibiotic therapy are a key determinant for deleterious outcomes among patients with vancomycin-resistant Enterococcus (VRE) bloodstream infections (BSIs). This was a multi-center pre/post-implementation study, assessing the impact of a molecular rapid diagnostic test (Verigene® GP-BC, Luminex Corporation, Northbrook, IL, USA) on outcomes of adult patients with VRE BSIs. The primary outcome was time to optimal therapy (TOT). Multivariable logistic and Cox proportional hazard regression models were used to determine the independent associations of post-implementation, TOT, early vs. delayed therapy, and mortality. A total of 104 patients with VRE BSIs were included: 50 and 54 in the pre- and post-implementation periods, respectively. The post- vs. pre-implementation group was associated with a 1.8-fold faster rate to optimized therapy (adjusted risk ratio, 1.841 [95% CI 1.234-2.746]), 6-fold higher likelihood to receive early effective therapy (<24 h, adjusted odds ratio, 6.031 [2.526-14.401]), and a 67% lower hazards for 30-day in-hospital mortality (adjusted hazard ratio, 0.322 [0.124-1.831]), after adjusting for age, sex, and severity scores. Inversely, delayed therapy was associated with a 10-fold higher risk of in-hospital mortality (aOR 10.488, [2.497-44.050]). Reduced TOT and in-hospital mortality were also observed in subgroups of immunosuppressed patients in post-implementation. These findings demonstrate that the addition of molecular rapid diagnostic tests (mRDT) to clinical microbiology and antimicrobial stewardship practices are associated with a clinically significant reduction in TOT, which is associated with lower mortality for patients with VRE BSIs, underscoring the importance of mRDTs in the management of VRE infections.
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Affiliation(s)
- Sarah M. Bandy
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Christopher B. Jackson
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Cody A. Black
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - William Godinez
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- University Health System, 4502 Medical Drive, San Antonio, TX 78229, USA
| | - Gerard W. Gawrys
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
- University Health System, 4502 Medical Drive, San Antonio, TX 78229, USA
- Methodist Hospital and Methodist Children’s Hospital, 7700 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Grace C. Lee
- College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- Pharmacotherapy Education and Research Center, School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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10
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Piezzi V, Wassilew N, Atkinson A, D'Incau S, Kaspar T, Seth-Smith HMB, Casanova C, Bittel P, Jent P, Sommerstein R, Buetti N, Marschall J. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020. Euro Surveill 2022; 27:2200285. [PMID: 36695463 PMCID: PMC9716646 DOI: 10.2807/1560-7917.es.2022.27.48.2200285] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.
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Affiliation(s)
- Vanja Piezzi
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Nasstasja Wassilew
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Stéphanie D'Incau
- Department of Infectious Diseases, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Tanja Kaspar
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Helena MB Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland and Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland,Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Carlo Casanova
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Pascal Bittel
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland,Department Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Lucerne, Switzerland
| | - Niccolò Buetti
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland,INSERM, IAME, Université Paris-Cité, Paris, France
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Bern, Switzerland,Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
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11
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Clinical Impact of Vancomycin Treatment in Ampicillin-Susceptible Enterococci Bloodstream Infections. Antibiotics (Basel) 2022; 11:antibiotics11121698. [PMID: 36551355 PMCID: PMC9774542 DOI: 10.3390/antibiotics11121698] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Enterococci are major causes of bacteremia. Although the mortality rate of ampicillin- susceptible enterococci (ASE) bloodstream infections (BSI) is lower, compared with that of ampicillin-resistant enterococci BSI, the role of treatment regimens in ASE BSI remains to be determined. This retrospective study aimed to evaluate the treatment outcomes and factors associated with mortality among patients with ASE BSI. The charts of 145 enrolled patients with ASE BSI between January 2013 and April 2022 at Phramongkutklao Hospital were reviewed. The 30-day and in-hospital mortality rates were 28.8 and 41.9%, respectively. The 30-day mortality rate was higher in the vancomycin treatment group than in the beta-lactam treatment group (61.5 vs. 26%; p = 0.02). Pitt bacteremia score (OR 1.44, 95% CI 1.20-1.71); age-adjusted Charlson Comorbidity Index (OR 1.34, 95% CI 1.14-1.58); and vancomycin treatment (OR 4.07, 95% CI 1.02-16.22) were independent factors associated with 30-day mortality. The severity of illness, comorbidity and definitive therapy with vancomycin increased the mortality rate of patients with ASE BSI. Anti-enterococcal beta-lactams remain the first line antibiotics for ASE bacteremia.
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12
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Kunugiza Y, Tanaka T, Hirota R, Kakunaga S, Okamoto Y, Tsuji S. Polymicrobial periprosthetic joint infection and osteomyelitis of the tibia with circumferential abscess and skin ulcer 11 years after total knee arthroplasty. Radiol Case Rep 2022; 17:3987-3991. [PMID: 36032206 PMCID: PMC9411183 DOI: 10.1016/j.radcr.2022.07.070] [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: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022] Open
Abstract
We report the case of a 71-year-old woman with a skin ulcer derived from an abscess around the tibia. The abscess resulted in periprosthetic joint infection and osteomyelitis 11 years after total knee arthroplasty. The first symptom was a skin ulcer of the lower leg. Magnetic resonance imaging revealed a circumferential mass around the proximal tibia. A skin biopsy taken around the ulcer showed thrombosis and degenerated collagen. Contrast-enhanced computed tomography showed a circumferential mass around the proximal tibia with ring enhancement. Biopsies of the skin ulcer and circumferential mass showed an abscess caused by Enterococcus faecium and methicillin-resistant Staphylococcus epidermis. We conducted debridement of the abscess, a gastrocnemius flap and split-thickness skin grafting and a 2-stage revision of the total knee component with a hinged prosthesis. Two years later, the infection did not reoccur and the patient can walk without a cane. This case is unique as abscess around proximal tibia caused necrotic skin ulcer and appearance of abscess was fibrous and different from typical bacterial abscesses containing pus or fluid. Contrast-enhanced computed tomography was effective for differentiation of the pathological condition.
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