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Papadopoulou M, Deliolanis I, Polemis M, Vatopoulos A, Psichogiou M, Giakkoupi P. Characteristics of the Genetic Spread of Carbapenem-Resistant Acinetobacter baumannii in a Tertiary Greek Hospital. Genes (Basel) 2024; 15:458. [PMID: 38674392 PMCID: PMC11050095 DOI: 10.3390/genes15040458] [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: 03/11/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Acinetobacter baumannii (Ab) has increasingly been identified as a cause of hospital-acquired infections and epidemics. The rise of carbapenem-resistant Acinetobacter baumannii (CRAB) poses significant challenges in treatment. Nosocomial outbreaks linked to CRAΒ A. baumannii strains have been reported worldwide, including in Greece. This study aimed to analyze the molecular epidemiology trends of multidrug-resistant A. baumannii isolates in a tertiary hospital in Athens, Greece. A total of 43 clinical isolates of extensively drug-resistant (XDRAB), pan-drug-resistant (PDRAB), and CRAB were collected from patients suffering from blood infection, hospitalized between 2016 and 2020 at the internal medicine clinics and the ICU. A.baumannii isolates underwent testing for Ambler class B and D carbapenemases and the detection of ISAba1, and were typed, initially, using pulsed-field gel electrophoresis, and, subsequently, using sequence-based typing and multiplex PCR to determine European Clone lineages. The blaOXA-23 gene accompanied by ISAba1 was prevalent in nearly all A. baumannii isolates, except for one carrying blaOXA-58. The intrinsic blaOXA-51-like gene was found in all isolates. No Ambler class B carbapenemases (VIM, NDM) were detected. Isolates were grouped into four PF-clusters and no one-cluster spread was documented, consistent with the absence of outbreak. The study indicated that XDR/PDR-CRAB isolates predominantly produce OXA-23 carbapenemase and belong to European Clone II. Further research is needed to understand the distribution of resistant bacteria and develop effective prevention and control strategies.
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Affiliation(s)
- Martha Papadopoulou
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
| | - Ioannis Deliolanis
- Department of Microbiology, Laiko General Hospital, 11527 Athens, Greece;
| | - Michalis Polemis
- Hellenic National Public Health Organization, 15123 Athens, Greece;
| | - Alkiviadis Vatopoulos
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
| | - Mina Psichogiou
- 1st Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Panagiota Giakkoupi
- Laboratory for the Surveillance of Infectious Diseases-LSID, Department of Public Health Policy, University of West Attica, 11521 Athens, Greece; (A.V.); (P.G.)
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Alghamdi SAA, Mir SS, Alghamdi FS, Al Banghali MAMMA, Almalki SSR. Evaluation of Extended-Spectrum Beta-Lactamase Resistance in Uropathogenic Escherichia coli Isolates from Urinary Tract Infection Patients in Al-Baha, Saudi Arabia. Microorganisms 2023; 11:2820. [PMID: 38137964 PMCID: PMC10745543 DOI: 10.3390/microorganisms11122820] [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: 10/11/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023] Open
Abstract
Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms are prevalent in both outpatient and inpatient settings, representing the most often encountered forms of infection. This research aimed to estimate the prevalence of ESBL-UTIs along with other uropathogens in the adult population and to assess the antibiotic activity against Escherichia coli extended-spectrum beta-lactamase (E. coli ESBL) isolates from patient samples in Al-Baha. A retrospective cross-sectional study included patients who presented to King Fahad Hospital in Al-Baha with clinical suspicion of UTI between 1 January 2019 and 30 September 2022. A total of 4406 urine samples with significant microbial growth were included in the scope of this investigation. A collective count of 1644 incidents of Escherichia coli (E. coli) was observed, wherein E. coli constituted 85% of the cases, while the remaining 15% comprised E. coli ESBL producers. The prevalence of E. coli ESBL was observed to be 64.7% in females and 35.3% in males, with a majority (67%) of the affected individuals being over the age of 50. The incidence of E. coli infections in the outpatient setting was found to be greater than that observed in the inpatient setting. E. coli ESBL were sensitive to colistin, tigecycline, amikacin, meropenem, imipenem, and nitrofurantoin by 100% and 93.3-100%, 95-99.6%, 95-99.06%, and 81-91%, respectively. On the other hand, the most resistant agents for E. coli ESBL were the group of cephalosporins, aztreonam, and ampicillin with 100% resistance, ciprofloxacin with 56-74% resistance, and cotrimoxazole with a 45-53% resistance level. ESBL-resistant E. coli strains are moderately prevalent in community- and hospital-acquired UTIs, especially in females and elderly patients (>50 years).
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Affiliation(s)
| | - Shazia Shaheen Mir
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65779, Saudi Arabia;
| | - Fayez Saad Alghamdi
- Medical Training and Education Department, King Fahad Hospital, Al-Baha 65732, Saudi Arabia;
| | | | - Shaia Saleh Rajab Almalki
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha 65779, Saudi Arabia;
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3
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Guo HB, Huang HL, Li YY. Detection and homology analysis of carbapenem resistant Acinetobacter baumannii resistance gene. Front Cell Infect Microbiol 2023; 12:987260. [PMID: 36683680 PMCID: PMC9853024 DOI: 10.3389/fcimb.2022.987260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/08/2022] [Indexed: 01/07/2023] Open
Abstract
Objective To explore the carrying status and homology of carbapenem resistant Acinetobacter baumannii (CRAB) in our hospital. Methods From January 2015 to December 2017, 52 strains of acinetobacter baumannii isolated from the bacteria room of the clinical laboratory of Baogang hospital in Inner Mongolia were selected as the research object. K-B disk diffusion method and Vitek-2 were used to determine the drug sensitivity of Acinetobacter baumannii. The drug resistance gene was detected by polymerase chain reaction (PCR) and its homology was analyzed by pulsed field gel electrophoresis (PFGE). Results Except for Cefoperazone/sulbactam, other antibiotics were resistant to ab. The detection rate of drug resistance gene class C β-lactamases (ADC) was 100%, and the higher detection rates of other drug resistance genes were class D β-lactamases (OXA)-51 (36 strains, 90.0%),disinfectant gene qacE△1-sull (32 strains, 80.0%), and klebsiella pneumoniae carbapenemase (KPC) gene was not detected. 2-8 drug resistance genes were detected in each CRAB strain, and the strains with 6 drug resistance genes were the most (15 strains, 37.5%); Among the detected drug-resistant gene combinations, ADC+OXA-23 + OXA-51 gene was detected at the same time (29 strains, 72.5%), followed by ADC+ intl1 + qacE △ 1-sull gene (26 strains, 65.0%), ADC + qacE △ 1-sull + ant (3 '') -i gene (19 strains, 47.5%), and 11 strains (27.5%). There were 19 different types in PFGE homology test, each type was 1-9 strains, including 9 strains of A5 type and 8 strains of A18 type, mainly from intensive care unit. Conclusion CRAB in the hospital is highly resistant to common clinical antibiotics. OXA-23 and OXA-51 genes are most likely to be the main factors causing drug resistance of Acinetobacter baumannii in the hospital. Homology analysis showed that there was CRAB nosocomial infection transmission in different wards of the hospital.
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Affiliation(s)
- Hong-Bo Guo
- Department of Laboratory, Inner Mongolia Baogang Hospital, Baotou, China
| | - Hua-Liang Huang
- Department of Laboratory, Inner Mongolia Baogang Hospital, Baotou, China
| | - Yue-Yu Li
- Department of Laboratory, Inner Mongolia Baogang Hospital, Baotou, China
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Sharma S, Das A, Garg R, Pramanik S, Marndi P, Singh R, Banerjee T, Yadav G, Kumar A. Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Hospital Environment and Colonization Pressure: A Surveillance-Based Study in Indian Intensive Care Unit. Microb Drug Resist 2022; 28:1079-1086. [DOI: 10.1089/mdr.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rahul Garg
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sangita Pramanik
- Applied Microbiology, Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Pooja Marndi
- Applied Microbiology, Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Ravindra Singh
- Institute of Medical Sciences, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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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: 12] [Impact Index Per Article: 6.0] [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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The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon. Antibiotics (Basel) 2022; 11:antibiotics11070911. [PMID: 35884165 PMCID: PMC9311570 DOI: 10.3390/antibiotics11070911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.
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Mete B, Kurt AF, Urkmez S, Demirkiran O, Can G, Dumanli GY, Bozbay S, Arsu HY, Otlu B, Karaali R, Balkan II, Saltoglu N, Dikmen Y, Tabak F, Aygun G. The Bad Bug is Back: Acinetobacter Baumannii Bacteremia Outbreak during the COVID-19 Pandemic in an Intensive Care Unit. Niger J Clin Pract 2022; 25:702-709. [PMID: 35593616 DOI: 10.4103/njcp.njcp_2001_21] [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: 01/08/2023]
Abstract
Background Epidemiology of nosocomial infections may show variability because of under-estimation of infection control measures (ICMs) in coronavirus disease 19 (COVID-19) outbreak. Aim To investigate the Acinetobacter bacteremia outbreak developed in an intensive care unit (ICU) between March 20 to May 15, 2020, examine the risk factors, and re-evaluate ICM retrospectively. Material and Methods A retrospective cohort analysis was conducted to determine the risk factors, pulsed field gel electrophoresis (PFGE) was performed for analysis of the outbreak, ICM practices were observed by a team, and infection control interventions were undertaken. Results Acinetobacter bacteremia developed in 17 patients (21.5%) within 79 COVID-19 patients included in the study. The mean age of the bacteremic patients was 67.3 (SD = 14.82) years, and 82.4% of them were male; of these, 15 died, leading to 88.2% mortality. The bacteremia rate was higher compared with a 14-month period preceding the COVID-19 pandemic (17/79 versus 12/580 patients, respectively). PFGE revealed that the outbreak was polyclonal. On multi-variate analysis, the bacteremia development rate was 13.7 and 5.06 times higher with central venous catheter (CVC) use and in patients with chronic obstructive pulmonary disease (COPD), respectively. The mortality rate was higher in bacteremic patients (p = 0.0016). It was observed that ICMs were not followed completely, especially change of gloves and hand hygiene. Contamination of A. baumannii was observed in 38% of the gloves. Conclusion COPD and CVC use were determined as risk factors for Acinetobacter bacteremia development, and failures in ICM may have led to cross-contamination of endemic A. baumannii. The outbreak could be controlled within 3 weeks of interventions.
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Affiliation(s)
- B Mete
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - A F Kurt
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - S Urkmez
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - O Demirkiran
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Can
- Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Y Dumanli
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - S Bozbay
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - H Y Arsu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - B Otlu
- Department of Medical Microbiology, Inonu University Medical Faculty, Elazig yolu 15. Kilometre, 44280-Battalgazi, Malatya, Turkey
| | - R Karaali
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - I I Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - N Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - Y Dikmen
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasacaddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - F Tabak
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
| | - G Aygun
- Department of Medical Microbiology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Kocamustafapasa caddesi No: 53, Cerrahpasa, 34098-Fatih, Istanbul, Turkey
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Containment of a carbapenem-resistant Acinetobacter baumannii complex outbreak in a COVID-19 intensive care unit. Am J Infect Control 2022; 50:477-481. [PMID: 35227793 PMCID: PMC8881223 DOI: 10.1016/j.ajic.2022.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/10/2023]
Abstract
Background A carbapenem-resistant Acinetobacter baumannii outbreak in the COVID intensive care unit of a community hospital was contained using multidrug resistant organism guidelines. The purpose of this study is to report on an outbreak investigation and containment strategy that was used, and to discuss prevention strategy. Methods A multidisciplinary approach contained the spread of infection. Strategies implemented included consultation with experts, screening, and reversal of personal protective equipment conservation. Ensuring infection control best practices are maintained remain important efforts to reduce the spread of multidrug resistant organisms. Results Five patients with carbapenem-resistant Acinetobacter baumannii were identified from routine clinical cultures within one week and one patient was identified from active surveillance cultures. Discussion Personal protective equipment conservation, strategies to prevent health care personnel exposure, and patient surge staffing protocols may have increased the likelihood of multidrug resistant organism transmission. Environmental and behavioral infection control regulations with effective administrative guidance, active surveillance cultures, and antimicrobial stewardship are critical to prevent future outbreaks. Conclusions After outbreak containment strategies were implemented, no additional patients were identified with carbapenem-resistant Acinetobacter baumannii. Conventional infection prevention and control strategies were re-instituted. A multidisciplinary approach with continued focus on hand hygiene, environmental cleaning, and correct use of personal protective equipment needs to be put in place to successfully contain and prevent the spread of carbapenem resistant infections.
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Javkar K, Rand H, Hoffmann M, Luo Y, Sarria S, Thirunavukkarasu N, Pillai CA, McGann P, Johnson JK, Strain E, Pop M. Whole-Genome Assessment of Clinical Acinetobacter baumannii Isolates Uncovers Potentially Novel Factors Influencing Carbapenem Resistance. Front Microbiol 2021; 12:714284. [PMID: 34659144 PMCID: PMC8518998 DOI: 10.3389/fmicb.2021.714284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/01/2021] [Indexed: 12/30/2022] Open
Abstract
Carbapenems-one of the important last-line antibiotics for the treatment of gram-negative infections-are becoming ineffective for treating Acinetobacter baumannii infections. Studies have identified multiple genes (and mechanisms) responsible for carbapenem resistance. In some A. baumannii strains, the presence/absence of putative resistance genes is not consistent with their resistance phenotype-indicating the genomic factors underlying carbapenem resistance in A. baumannii are not fully understood. Here, we describe a large-scale whole-genome genotype-phenotype association study with 349 A. baumannii isolates that extends beyond the presence/absence of individual antimicrobial resistance genes and includes the genomic positions and pairwise interactions of genes. Ten known resistance genes exhibited statistically significant associations with resistance to imipenem, a type of carbapenem: blaOXA-23, qacEdelta1, sul1, mphE, msrE, ant(3")-II, aacC1, yafP, aphA6, and xerD. A review of the strains without any of these 10 genes uncovered a clade of isolates with diverse imipenem resistance phenotypes. Finer resolution evaluation of this clade revealed the presence of a 38.6 kbp conserved chromosomal region found exclusively in imipenem-susceptible isolates. This region appears to host several HTH-type DNA binding transcriptional regulators and transporter genes. Imipenem-susceptible isolates from this clade also carried two mutually exclusive plasmids that contain genes previously known to be specific to imipenem-susceptible isolates. Our analysis demonstrates the utility of using whole genomes for genotype-phenotype correlations in the context of antibiotic resistance and provides several new hypotheses for future research.
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Affiliation(s)
- Kiran Javkar
- Department of Computer Science, University of Maryland, College Park, MD, United States.,Joint Institute for Food Safety and Applied Nutrition, University of Maryland, College Park, MD, United States
| | - Hugh Rand
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, Department of Health and Human Services, College Park, MD, United States
| | - Maria Hoffmann
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, Department of Health and Human Services, College Park, MD, United States
| | - Yan Luo
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, Department of Health and Human Services, College Park, MD, United States
| | - Saul Sarria
- Center for Veterinary Medicine, United States Food and Drug Administration, Department of Health and Human Services, Laurel, MD, United States
| | - Nagarajan Thirunavukkarasu
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, Department of Health and Human Services, College Park, MD, United States
| | - Christine A Pillai
- Center for Food Safety and Applied Nutrition, United States Food and Drug Administration, Department of Health and Human Services, College Park, MD, United States
| | - Patrick McGann
- Multidrug Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Errol Strain
- Center for Veterinary Medicine, United States Food and Drug Administration, Department of Health and Human Services, Laurel, MD, United States
| | - Mihai Pop
- Department of Computer Science, University of Maryland, College Park, MD, United States
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10
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Rangel K, Chagas TPG, De-Simone SG. Acinetobacter baumannii Infections in Times of COVID-19 Pandemic. Pathogens 2021; 10:pathogens10081006. [PMID: 34451470 PMCID: PMC8399974 DOI: 10.3390/pathogens10081006] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has generated an overuse of antimicrobials in critically ill patients. Acinetobacter baumannii frequently causes nosocomial infections, particularly in intensive care units (ICUs), where the incidence has increased over time. Since the WHO declared the COVID-19 pandemic on 12 March 2020, the disease has spread rapidly, and many of the patients infected with SARS-CoV-2 needed to be admitted to the ICU. Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. However, we cannot neglect the increased incidence of antimicrobial resistance, which may be attributed to the excess use of antimicrobial agents during the COVID-19 pandemic. Patients with COVID-19 could be vulnerable to other infections owing to multiple comorbidities with severe COVID-19, prolonged hospitalization, and SARS-CoV-2-associated immune dysfunction. These patients have acquired secondary bacterial infections or superinfections, mainly bacteremia and urinary tract infections. This review will summarize the prevalence of A. baumannii coinfection and secondary infection in patients with COVID-19.
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Affiliation(s)
- Karyne Rangel
- FIOCRUZ, Center for Technological Development in Health (CDTS), National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Rio de Janeiro 21040-900, Brazil
- Correspondence: (K.R.); (S.G.D.-S.); Tel.: +55-213865-8240 (K.R. & S.G.D.-S.)
| | | | - Salvatore Giovanni De-Simone
- FIOCRUZ, Center for Technological Development in Health (CDTS), National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Rio de Janeiro 21040-900, Brazil
- Department of Molecular and Cellular Biology, Biology Institute, Federal Fluminense University, Niterói 24220-008, Brazil
- Correspondence: (K.R.); (S.G.D.-S.); Tel.: +55-213865-8240 (K.R. & S.G.D.-S.)
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Jayathilaka EHTT, Rajapaksha DC, Nikapitiya C, De Zoysa M, Whang I. Antimicrobial and Anti-Biofilm Peptide Octominin for Controlling Multidrug-Resistant Acinetobacter baumannii. Int J Mol Sci 2021; 22:ijms22105353. [PMID: 34069596 PMCID: PMC8161146 DOI: 10.3390/ijms22105353] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Acinetobacter baumannii is a serious nosocomial pathogen with multiple drug resistance (MDR), the control of which has become challenging due to the currently used antibiotics. Our main objective in this study is to determine the antibacterial and antibiofilm activities of the antimicrobial peptide, Octominin, against MDR A. baumannii and derive its possible modes of actions. Octominin showed significant bactericidal effects at a low minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of 5 and 10 µg/mL, respectively. Time-kill kinetic analysis and bacterial viability tests revealed that Octominin showed a concentration-dependent antibacterial activity. Field-emission scanning electron microscopy (FE-SEM) analysis revealed that Octominin treatment altered the morphology and membrane structure of A. baumannii. Propidium iodide (PI) and reactive oxygen species (ROS) generation assays showed that Octominin increased the membrane permeability and ROS generation in A. baumannii, thereby causing bacterial cell death. Further, a lipopolysaccharides (LPS) binding assay showed an Octominin concentration-dependent LPS neutralization ability. Biofilm formation inhibition and eradication assays further revealed that Octominin inhibited biofilm formation and showed a high biofilm eradication activity against A. baumannii. Furthermore, up to a concentration of 100 µg/mL, Octominin caused no hemolysis and cell viability changes in mammalian cells. An in vivo study in zebrafish showed that the Octominin-treated group had a significantly higher relative percentage survival (54.1%) than the untreated group (16.6%). Additionally, a reduced bacterial load and fewer alterations in histological analysis confirmed the successful control of A. baumannii by Octominin in vivo. Collectively, these data suggest that Octominin exhibits significant antibacterial and antibiofilm activities against the multidrug-resistant A. baumannii, and this AMP can be developed further as a potent AMP for the control of antibiotic resistance.
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Affiliation(s)
- E. H. T. Thulshan Jayathilaka
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon 34134, Korea; (E.H.T.T.J.); (D.C.R.); (C.N.)
| | - Dinusha C. Rajapaksha
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon 34134, Korea; (E.H.T.T.J.); (D.C.R.); (C.N.)
| | - Chamilani Nikapitiya
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon 34134, Korea; (E.H.T.T.J.); (D.C.R.); (C.N.)
| | - Mahanama De Zoysa
- College of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon 34134, Korea; (E.H.T.T.J.); (D.C.R.); (C.N.)
- Correspondence: (M.D.Z.); (I.W.)
| | - Ilson Whang
- National Marine Biodiversity Institute of Korea (MABIK), 75, Jangsan-ro 101 beon-gil, Janghang-eup, Seochun-gun, Chungchungnam-do 33662, Korea
- Correspondence: (M.D.Z.); (I.W.)
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Sharma S, Das A, Banerjee T, Barman H, Yadav G, Kumar A. Adaptations of carbapenem resistant Acinetobacter baumannii (CRAB) in the hospital environment causing sustained outbreak. J Med Microbiol 2021; 70. [PMID: 33739918 DOI: 10.1099/jmm.0.001345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction. Carbapenem resistance in Acinetobacter baumannii (A. baumannii) is an emerging global threat.Gap statement. The adaptation strategies of A. baumannii for this emergence as a nosocomial pathogen has been less studied.Aim. This prospective study analysed a sustained outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) in the intensive care unit (ICU) with reference to antimicrobial resistance and virulence in the colonizing and pathogenic isolates under carbapenem stress.Results. The CRAB isolates from initial and sustained outbreak were found harbouring multiple carbapenemase genes. These genes included bla OXA-23 ,bla IMP, bla VIM and bla NDM. From NICU environment three phenotypically carbapenem susceptible isolates were found carrying bla OXA-23, bla IMP, bla VIM genes. Prior imipenem therapy was one of the risk factors (P=0.0016). The outbreak was polyclonal. Under imipenem stress, outbreak isolates showed no loss of carbapenemase genes against stress free conditions (23.7±1.33 days). Biofilm formation increased with imipenem concentration, with outbreak isolates producing highest biomass. While the pathogens showed a slow growth rate on imipenem exposure, the colonisers grew rapidly (P <0.0001).Methods. Sustained outbreak of CRAB was identified in the ICU (July 2015 to December 2017). Risk factors for acquisition of CRAB was studied. A. baumannii isolates were also collected from the environments of ICU and neonatal ICU (NICU) and blood cultures of septic neonates. Isolates were characterized based on antimicrobial susceptibility, genetic profile, integrons carriage and clonality. Biofilm formation and growth kinetics were studied under varying carbapenem stress.Conclusion. Intense carbapenem exposure in the ICU facilitates persistence of CRAB by several adaptations causing sustained outbreaks.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Hiranmay Barman
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Perez S, Innes GK, Walters MS, Mehr J, Arias J, Greeley R, Chew D. Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions - New Jersey, February-July 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1827-1831. [PMID: 33270611 PMCID: PMC7714028 DOI: 10.15585/mmwr.mm6948e1] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Liu L, Liu B, Li W. Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection Acinetobacter baumannii Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital. Infect Drug Resist 2020; 13:2557-2570. [PMID: 32801793 PMCID: PMC7396956 DOI: 10.2147/idr.s260525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/05/2020] [Indexed: 01/22/2023] Open
Abstract
Objective We estimated the efficacy of antimicrobial stewardship (AMS), infection control programs (ICP), and environmental cleaning (ENC) for controlling the resistance of Acinetobacter baumannii (AB) and controlling the incidence of multidrug-resistant AB (MDRAB), extensively drug-resistant AB (XDRAB), and nosocomial infection AB in the ICU (NIAB-ICU) at a university hospital. Methods The intervention included 4-year AMS+ICP and 3-year AMS+ICP+ENC between January 2012 and December 2019. Results A total of 2636 AB isolates were collected totally, and 64.98% of AB isolates were MDR and 29.97% were XDR. Preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP measures ranged from 84.96% to 71.98%, 41.96% to 33.13%, and 45.6% to 38%, respectively. However, all of them were not statistically changed (P=0.085, 0.072, 0.061, separately). The preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP+ENC measures ranged from 71.98% to 36.55%, 33.13% to 19.88%, and 38% to 22.5%, respectively. Statistically significant declines were observed (P=0.016, 0.041, 0.032, separately). The defined daily doses (DDD) per 1000 patient-days (PD) decreased from 45±3.3 to 30.81±1.5 per 1000 PD across from 2012 to 2019, and a statistical decline was seen (P=0.01). Concurrently, the alcohol-based hand gel (ABHG) consumption per 1000 PD increased from 0.6±0.05 L to 12.5±2.3 L per 1000 PD, and a statistical increase was observed (P=0.0001). A statistically positive correlation was revealed between the DDD and incidence of MDRAB, XDRAB, and NIAB-ICU (r=0.905 and p=0.002; r=0.939 and p=0.001; r=0.956 and p=0.0002; respectively). Simultaneously, a statistically negative correlation was showed between the ABHG and incidence of MDRAB, XDRAB, and NIAB-ICU (r=-0.858 and p=0.006; r=-0.888 and p=0.003; r=-0.882 and p=0.004, separately). Conclusion The AMS, ICP, and ENC may be one of the most effective and best measures to address the increasing incidence of MDRAB, XDRAB, and NIAB-ICU currently.
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Affiliation(s)
- Lei Liu
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China.,Department of Respiratory Medicine, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Bin Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Wei Li
- Heilongjiang Key Laboratory for Zoonosis, College of Veterinary Medicine, Northeast Agricultural University, Harbin, People's Republic of China
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Moghnieh R, Tamim H, Jadayel M, Abdallah D, Al-Kassem R, Kadiri H, Hafez H, Al-Hassan S, Ajjour L, Lakkis R, Jisr T, Samaha NL, Haddad N. The effect of temporary closure and enhanced terminal disinfection using aerosolized hydrogen peroxide of an open-bay intensive care unit on the acquisition of extensively drug-resistant Acinetobacter baumannii. Antimicrob Resist Infect Control 2020; 9:108. [PMID: 32665037 PMCID: PMC7362486 DOI: 10.1186/s13756-020-00772-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background At Makassed Hospital’s open-bay intensive care unit (ICU), enhanced terminal disinfection (ETD) using hydrogen peroxide (H2O2) was performed without a predefined schedule in extensively-drug-resistant Acinetobacter baumannii (XDR-AB) outbreaks. In this study, we aimed to check for the value of the temporary closure of the ICU and the use of ETD with aerosolized H2O2 and Ag+ on minimizing the rate of XDR-AB acquisition in patients admitted to the ICU of our facility, which might consequently help us determine the optimal schedule for such procedure in this unit. Methods This is a retrospective medical file review of patients admitted to the ICU between January 2016 and May 2018. We divided this period into numerical weeks (NW) after each closure and ETD episode. Risk factors of acquisition (RFA) were determined by comparing the characteristics of patients who acquired XDR-AB to those who didn’t. The proportion of patients residing in each NW was included in the RFA analysis. Results Out of 335 patients, 13% acquired XDR-AB. The overall incidence of XDR-AB acquisition was 14.6 cases/1000 patient days. RFA were XDR-AB contact pressure ≥ 3 days [Odds Ratio (OR) = 9.86, 95% Confidence Interval (CI) (3.65–26.64), P < 0.0001)], mechanical ventilation [OR = 4.99, 95%CI (1.76–14.15), P = 0.002)], and having a wound [OR = 3.72, 95%CI (0.99–13.96), P = 0.05)]. Patients who stayed during NW 7,11 and 14 were at risk of acquisition where the odds significantly increased by 6.5, 9.7 and 14.4 folds respectively (P = 0.03,0.01, and 0.01, respectively). We considered NW 7 as the most suitable time for temporary closure of the ICU and ETD with aerosolized H2O2. Conclusion Contact pressure, mechanical ventilation, and presence of a wound were RFA of XDR-AB. Temporary closure of the ICU with ETD using aerosolized H2O2 decreased the rate of XDR-AB acquisition, yet this effect fades away with time. The ETD was shown to be most efficiently done when repeated every 7 calendar weeks in our open-bay ICU as part of a prevention bundle.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Hôtel Dieu de France, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Rasha Al-Kassem
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Hind Kadiri
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Hani Hafez
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Salam Al-Hassan
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Lina Ajjour
- Nursing Department, Makassed General Hospital, Beirut, Lebanon
| | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Nadia-Lara Samaha
- College of Human Ecology, Cornell University, Ithaca, NY, 14853, USA
| | - Nicholas Haddad
- Associate Professor of Infectious Disease and Residency Program Director, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
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Rivera-Izquierdo M, Benavente-Fernández A, López-Gómez J, Láinez-Ramos-Bossini AJ, Rodríguez-Camacho M, Valero-Ubierna MDC, Martín-delosReyes LM, Jiménez-Mejías E, Moreno-Roldán E, Lardelli-Claret P, Martínez-Ruiz V. Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study. Antibiotics (Basel) 2020; 9:E324. [PMID: 32545738 PMCID: PMC7345506 DOI: 10.3390/antibiotics9060324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem.
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Affiliation(s)
- Mario Rivera-Izquierdo
- Service of Preventive Medicine and Public Health, Hospital Universitario San Cecilio, 18016 Granada, Spain;
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Programme in Clinical Medicine and Public Health, University of Granada, 18016 Granada, Spain;
| | - Alberto Benavente-Fernández
- Service of Internal Medicine, Hospital Universitario San Cecilio, 18016 Granada, Spain; (A.B.-F.); (J.L.-G.)
| | - Jairo López-Gómez
- Service of Internal Medicine, Hospital Universitario San Cecilio, 18016 Granada, Spain; (A.B.-F.); (J.L.-G.)
| | | | | | | | - Luis Miguel Martín-delosReyes
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Eladio Jiménez-Mejías
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Elena Moreno-Roldán
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Pablo Lardelli-Claret
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
| | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (L.M.M.-d.); (E.J.-M.); (E.M.-R.); (P.L.-C.); (V.M.-R.)
- Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, 18012 Granada, Spain
- Consorcio de Investigación Biomédica en Red (CIBER) de Epidemiología y Salud Pública de España, CIBERESP, 28029 Madrid, Spain
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Bozkurt-Guzel C, Inci G, Oyardi O, Savage PB. Synergistic Activity of Ceragenins Against Carbapenem-Resistant Acinetobacter baumannii Strains in Both Checkerboard and Dynamic Time-Kill Assays. Curr Microbiol 2020; 77:1419-1428. [PMID: 32189050 PMCID: PMC7223130 DOI: 10.1007/s00284-020-01949-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Abstract
Acinetobacter baumannii is an emerging opportunistic pathogen that primarily infects critically ill patients in nosocomial settings and there is a need for identifying new alternative therapeutic agents against these organisms. Ceragenins are non-peptide, membrane-active agents that mimic the antimicrobial properties of antimicrobial peptides (AMPs) and affect the membrane permeability of microorganisms. The in vitro activities of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 either alone or in combination with colistin (sulphate) were determined against 25 carbapenem-resistant A. baumannii strains. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of selected ceragenins and colistin against these isolates were measured by in vitro microbroth dilution techniques. Checkerboard techniques and time-kill assays were performed to determine the activities of combinations. The MIC50 values (mg/L) of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 and colistin were 32, 4, 8, 2, 4 and 0.5, respectively. The MIC90 (mg/L) of CSA-8, CSA-13, CSA-44, CSA-131, CSA-138 and colistin were 128, 8, 16, 8, 16 and 16, respectively. At 6 h, 1×MIC and 2×MIC of CSA-13 were bactericidal. CSA-13 + colistin combination displayed synergistic interaction. Antagonism between antimicrobials was not observed. According to the results, CSA-13 and CSA-131 can be good alternatives for infections caused by carbapenem-resistant A. baumannii.
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Affiliation(s)
- Cagla Bozkurt-Guzel
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Gozde Inci
- Department of Biochemistry, College of Medicine, Hallym University, Gangwon-do, Chuncheon, 200-702, South Korea
| | - Ozlem Oyardi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey.
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, 84602, USA
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Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli. Microorganisms 2020; 8:microorganisms8030397. [PMID: 32178340 PMCID: PMC7142802 DOI: 10.3390/microorganisms8030397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 01/13/2023] Open
Abstract
The increasing emergence of multidrug-resistant (MDR) bacteria has been recognized as a public health threat worldwide. Hospitalized patients and outpatients are commonly infected by non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) and Pseudomonas aeruginosa. Antimicrobial agents are critical for treating the nosocomial infections caused by NFGNB. The aim of this study was to assess antimicrobial resistance and the use of antimicrobial agents. The bacterial isolates of 638,152 specimens from both inpatients and outpatients, retrieved from 2001 to 2008 at a medical center in central Taiwan, were examined for their susceptibility to various antimicrobial agents, including cefepime, imipenem, ciprofloxacin, gentamicin, amikacin, meropenem, and levofloxacin. Administrated prescriptions of the monitored antibiotics were analyzed using the Taiwan National Health Insurance Research Database (NHIRD). Our results show that the defined daily doses (DDDs) for cefepime, imipenem, and ciprofloxacin increased with time, and a trend toward reduced antimicrobial sensitivities of both ACB and P. aeruginosa was noticeable. In conclusion, the antimicrobial sensitivities of ACB and P. aeruginosa were reduced with the increased use of antibiotics. Continuous surveillance of antibiotic prescriptions and the prevalence of emerging resistance in nosocomial infections is warranted.
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Giraldi G, Montesano M, Napoli C, Frati P, La Russa R, Santurro A, Scopetti M, Orsi GB. Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs. Curr Pharm Biotechnol 2020; 20:643-652. [PMID: 30961489 DOI: 10.2174/1389201020666190408095811] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 12/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The increasing antimicrobial resistance poses a challenge to surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. OBJECTIVE The study aimed to estimate extra hospital stay and economic burden of infections due to alert organisms - mostly multidrug-resistant - in a teaching hospital. METHODS The present retrospective matched cohort study was conducted based on the analysis of hospital admissions at Sant'Andrea Teaching Hospital in Rome from April to December 2015. Extra hospital stay was the difference in the length of stay between each case and control. All the patients developing an infection due to an alert organism were considered cases, all others were eligible as controls. The costs of LOS were evaluated by multiplying the extra stay with the hospital daily cost. RESULTS Overall, 122 patients developed an infection due to alert organisms and were all matched with controls. The attributable extra stay was of 2,291 days (mean 18.8; median 19.0) with a significantly increased hospitalization in intensive care units (21.2 days), bloodstream infections (52.5 days), and infections due to Gram-negative bacteria (mean 29.2 days; median 32.6 days). Applying the single day hospital cost, the overall additional expenditure was 11,549 euro per patient. The average additional cost of antibiotic drugs for the treatment of infections was about 1,200 euro per patient. CONCLUSION The present study presents an accurate mapping of the clinical and economic impact of infections attributable to alert organisms demonstrating that infections due to multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Article Highlights Box: The increasing antimicrobial resistance poses a challenge for surveillance systems and raises concerns about the impact of multidrug-resistant organisms on patient safety. • Healthcare-associated infections (HAIs) have historically been recognized as a significant public health problem requiring close surveillance. • Despite several and reliable findings have been achieved on clinical issues, our knowledge on the economic impact of healthcare-associated infections due to multidrug-resistant organisms needs to be widened. • Estimating the cost of infections due to multidrug-resistant organisms in terms of extra hospital stay and economic burden is complex, and the financial impact varies across different health systems. • Evaluations of social and economic implications of hospital infections play an increasingly important role in the implementation of surveillance systems. • The costs of infection prevention and control programs and dedicated personnel are relatively low and self-sustainable when efficient.
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Affiliation(s)
- Guglielmo Giraldi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
| | | | - Christian Napoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Alessandro Santurro
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Giovanni B Orsi
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy
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Rossi I, Royer S, Ferreira ML, Campos PA, Fuga B, Melo GN, Machado LG, Resende DS, Batistão D, Urzedo JE, Gontijo-Filho PP, Ribas RM. Incidence of infections caused by carbapenem-resistant Acinetobacter baumannii. Am J Infect Control 2019; 47:1431-1435. [PMID: 31399285 DOI: 10.1016/j.ajic.2019.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter baumannii (CR-Ab) has become a worrying health care problem, mainly in developing countries, such as Brazil. The objective was to investigate the prevalence and prognostic factors for CR-Ab infections at a Brazilian university hospital and examine the impact of inappropriate antimicrobial therapy on patient outcome. METHODS A retrospective study on hospitalized patients with CR-Ab infections was carried out from January 2013 to December 2017. An epidemiologic analysis was carried out to determine the frequency of infections, the epidemiologic indicators by year, the risk factors for 30-day mortality, and the impact of inappropriate therapy. RESULTS A total of 489 patients were included in the study. A rate of 0.7 per 1,000 patient-day CR-Ab infections was observed, mostly in the lungs (54.7%), and predominantly in the adult intensive care unit. The occurrence of infections by CR-Ab per 1,000 patient-days in November 2014 exceeded the established control limit, confirming an outbreak. CONCLUSIONS The prevalence of CR-Ab increased in the investigated hospital, passing to an endemic pathogen with a direct impact on mortality and the control of these strains.
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Affiliation(s)
- Iara Rossi
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
| | - Sabrina Royer
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Melina Lorraine Ferreira
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Paola Amaral Campos
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Bruna Fuga
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Gabriel Nogueira Melo
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Luiz Gustavo Machado
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Daiane Silva Resende
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Deivid Batistão
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Jane Eire Urzedo
- Hospital Infection Control Committee, Hospital das Clínicas, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Paulo P Gontijo-Filho
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Rosineide Marques Ribas
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Hospital Infection Control Committee, Hospital das Clínicas, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Khilnani GC, Dubey D, Hadda V, Sahu SR, Sood S, Madan K, Tiwari P, Mittal S, Mohan A, Pandey RM, Guleria R. Predictors and microbiology of ventilator-associated pneumonia among patients with exacerbation of chronic obstructive pulmonary disease. Lung India 2019; 36:506-511. [PMID: 31670298 PMCID: PMC6852209 DOI: 10.4103/lungindia.lungindia_13_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Understanding the risk factors and microbiology of ventilator-associated pneumonia (VAP) among patients with chronic obstructive pulmonary disease (COPD) is important for the application of preventive and therapeutic interventions. Therefore, this study was planned to assess the clinical predictors and microbiological features of VAP among COPD patients. MATERIALS AND METHODS This prospective study involved patients with exacerbation of COPD who required mechanical ventilation and admitted in respiratory intensive care unit at a tertiary care teaching hospital. Various baseline demographic and clinical features were compared between patients with VAP and without VAP. Univariate and multivariable analyses were done to assess the impact of demographic and clinical features on the development of VAP. RESULTS The study included 100 intubated patients with age (mean ± standard deviation [SD]) of 62.45 ± 8.32 years, duration (median) of COPD of 6 years, and Acute Physiology, Age, and Chronic Health Evaluation score (mean ± SD) of 18.60 ± 4.30. In this cohort, 17 patients developed VAP. Multivariable analysis showed that Sequential Organ Failure Assessment (SOFA) score at admission, re-intubation, and history of previous hospitalization were independent predictors of VAP with odds ratio (95% confidence interval) of 2.70 (1.24, 5.63; P = 0.012), 66.96 (4.86, 922.72; P = 0.002), and 35.92 (2.84, 454.63; P = 0.006), respectively. Acinetobacter baumannii was the most frequent organism (n = 8; 47%), followed by Klebsiella pneumoniae (n = 5; 29%), Pseudomonas aeruginosa (n = 1; 6%), and Enterobacter spp. (n = 1; 6%). All organisms were multidrug resistant (MDR). CONCLUSIONS SOFA score at admission, re-intubation, and history of previous hospitalization were independent predictors of VAP. Antimicrobial therapy for VAP should cover MDR Gram-negative organisms.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dilip Dubey
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Satya Ranjan Sahu
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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Yeong EK, Huang WL. Risk Factors for Multidrug-Resistant Acinetobacter baumannii Infections in a Mass Burn Casualty Incident. J Burn Care Res 2019; 40:823-827. [PMID: 31197367 DOI: 10.1093/jbcr/irz092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
They investigated the risk factors of multidrug-resistant Acinetobacter baumannii infections in 33 burn patients in a mass burn casualty. The independent variables included sex, burn size, vancomycin, ampicillin/sulbactam, cefazolin, meropenem, third-/fourth-generation cephalosporin, the number of classes of antibiotic used, and the number of days of antibiotic use. Multidrug-resistant A. baumannii infection was the outcome variable. Logistic regressions and structural equation model were used for statistical analysis. The average age was 21.7 years (range, 17-32 years; M = 11 [33%], F = 22 [67%]; mean burn area, 42% of the total body surface area; study period, June 28, 2015 to July 31, 2015). The incidence of infection was 39% (n = 13/33). For every percent increase in burn size, the odds of developing A. baumannii infections increased by 1.1 (P < .05). Similarly, the odds increased by 2.5 in every number increase in the classes of antibiotic used, by 1.2 in everyday increase in the days of antibiotic used, and by 12 in patients treated with vancomycin (P < .05). The correlations of these risk factors were demonstrated in a hypothetical structural equation model (P-value of chi-squared test > .05 and root mean square error of approximation < 0.05) in which burn size was the fundamental risk factor of multidrug-resistant A. baumannii infections. The model did not predict the emergence of multidrug-resistant A. baumannii infections. Conclusively, the risks of multidrug-resistant A. baumannii infections in burns are correlated with burn size, the number of classes of antibiotic used, the number of days of antibiotic use, and the prior use of vancomycin.
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Affiliation(s)
- Eng-Kean Yeong
- Department of Surgery, National Taiwan University Hospital, National Taiwan.,Department of Surgery, National Taiwan University Hospital Yunlin Branch, Douliou City of Yunlin County, Douliu City, Yunlin County, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yun-Lin Branch, Douliu City, Yunlin County, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
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Fragkou PC, Poulakou G, Blizou A, Blizou M, Rapti V, Karageorgopoulos DE, Koulenti D, Papadopoulos A, Matthaiou DK, Tsiodras S. The Role of Minocycline in the Treatment of Nosocomial Infections Caused by Multidrug, Extensively Drug and Pandrug Resistant Acinetobacter baumannii: A Systematic Review of Clinical Evidence. Microorganisms 2019; 7:microorganisms7060159. [PMID: 31159398 PMCID: PMC6617316 DOI: 10.3390/microorganisms7060159] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022] Open
Abstract
Treatment options for multidrug resistant Acinetobacter baumannii strains (MDR-AB) are limited. Minocycline has been used alone or in combination in the treatment of infections associated with AB. A systematic review of the clinical use of minocycline in nosocomial infections associated with MDR-AB was performed according to the PRISMA-P guidelines. PubMed-Medline, Scopus and Web of Science TM databases were searched from their inception until March 2019. Additional Google Scholar free searches were performed. Out of 2990 articles, 10 clinical studies (9 retrospective case series and 1 prospective single center trial) met the eligibility criteria. In total, 223 out of 268 (83.2%) evaluated patients received a minocycline-based regimen; and 200 out of 218 (91.7%) patients with available data received minocycline as part of a combination antimicrobial regimen (most frequently colistin or carbapenems). Pneumonia was the most common infection type in the 268 cases (80.6% with 50.4% ventilator-associated pneumonia). The clinical and microbiological success rates following minocycline treatment were 72.6% and 60.2%, respectively. Mortality was 20.9% among 167 patients with relevant data. In this systematic review, minocycline demonstrated promising activity against MDR-AB isolates. This review sets the ground for further studies exploring the role of minocycline in the treatment of MDR-AB associated infections.
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Affiliation(s)
- Paraskevi C Fragkou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Garyfallia Poulakou
- rd Department of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Athens, 11527, Greece.
| | - Andromachi Blizou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Myrto Blizou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Vasiliki Rapti
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Drosos E Karageorgopoulos
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Despoina Koulenti
- Adult Critical Care Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
- TCCRC, UQCCR, Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Antonios Papadopoulos
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Dimitrios K Matthaiou
- Adult Critical Care Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Sotirios Tsiodras
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
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Campos A, Lopes MS, Carvalheira A, Barbosa J, Teixeira P. Survival of clinical and food Acinetobacter spp. isolates exposed to different stress conditions. Food Microbiol 2019; 77:202-207. [PMID: 30297051 DOI: 10.1016/j.fm.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022]
Abstract
Acinetobacter baumanni is recognized as one of the most important agents of nosocomial infections. Other species such as Acinetobacter lwoffii have also been associated with such infections. These species can be found in food products, such as vegetables, fruits and meats which can be a source of transmission of these organisms to community and hospital settings. Evidence that hospitals' kitchens are a route of entry of pathogenic and antimicrobial-resistant bacteria was recently demonstrated. This study aimed to determine whether different Acinetobacter spp. isolated from human and food samples (lettuce, turkey meat, apple and pear) were resistant to stress conditions often applied in food processes, such as exposure to 60 °C, AMUKINA® and vinegar. Also the influence of food matrices on the behavior of isolates to these stress conditions was evaluated. Treatment with AMUKINA® and vinegar were effective against all clinical and food isolates. Exposure to 60 °C resulted in the reduction of the majority of isolates to values below the detection limit of the enumeration technique, however, it is important to note that most of the reductions only occurred after 30 min of exposure. One food isolate identified as A. baumanni was resistant to this thermal treatment and one clinical isolate only decreased 4 log cycles after 1 h. In general, food isolates were demonstrated to be more resistant than clinical isolates and no significant differences (p > 0.05) were found between A. baumanni and A. lwoffii species. With the exception of one food isolate that was more resistant to thermal stress in the presence of turkey meat, the food matrices investigated did not confer protection to the applied stresses. Due to the limited knowledge on this topic, we believe that this study is an important contribution to understanding the behavior of Acinetobacter spp. when exposed to treatments commonly applied to foods.
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Affiliation(s)
- Ana Campos
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374, Porto, Portugal
| | - Maria Sequeira Lopes
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374, Porto, Portugal
| | - Ana Carvalheira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374, Porto, Portugal
| | - Joana Barbosa
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374, Porto, Portugal
| | - Paula Teixeira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Rua Arquiteto Lobão Vital, 172, 4200-374, Porto, Portugal.
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Chen CH, Kuo HY, Hsu PJ, Chang CM, Chen JY, Lu HHS, Chen HY, Liou ML. Clonal spread of carbapenem-resistant Acinetobacter baumannii across a community hospital and its affiliated long-term care facilities: A cross sectional study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:377-384. [PMID: 28826855 DOI: 10.1016/j.jmii.2017.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 07/17/2017] [Accepted: 08/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The global spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is now a public health problem. In Taiwan, the relationship of the CRAB circulation between long-term care facilities (LTCFs) and acute care hospitals remains unclear. Here, we use molecular epidemiologic methods to describe the transmission of CRAB isolates between a community hospital and its affiliated LTCFs. METHODS Subjects localized in eight LTCFs who were not admitted acute care hospitals in recent a year were enrolled in this study. CRAB isolates were collected during June 1, 2015 and December 31, 2015. DNA fingerprinting was performed by repetitive extragenic palindromic sequence-based polymerase chain reaction (Rep-PCR) and multilocus sequence typing (MLST). Multiplex-PCR amplification for the detection of blaOXA genes and beta-lactamase genes was performed. RESULTS Twenty one subjects were enrolled. The major hospital admission diagnoses among the 21 subjects were pneumonia (71.4%). Genotyping of CRAB isolates by Rep-PCR revealed that a major clone, designated as type III, comprised fifteen of 21 (71.4%) isolates taken from 5 LTCFs and one study hospital. The isolates with type III were subtyped by PubMLST into 4 ST types. The most prevalent blaOXA genes in these isolates were blaOXA-23-like (85.70%, 18/21). Twenty isolates carried blaSHV. CONCLUSION: Clonal spread of blaOxA-23-carrying CRABs was found around LTCFs and the affiliated hospital. In Taiwan, it is important for the government to focus attention on the importance of identifying and tracing CRAB infections in LTCFs.
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Affiliation(s)
- Chang-Hua Chen
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua City, Taiwan; Center of Infection Prevention and Control, Changhua Christian Hospital, Changhua City, Taiwan; Department of Nursing, College of Medicine & Nursing, Hung Kuang University, Taichung County, Taiwan
| | - Han-Yueh Kuo
- Department of Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan; School of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Po-Jui Hsu
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsin-Chu City, Taiwan
| | - Chien-Min Chang
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsin-Chu City, Taiwan
| | - Jiann-Yuan Chen
- Department of Laboratory Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | | | - Hsin-Yao Chen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Li Liou
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsin-Chu City, Taiwan.
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Liou ML, Chen KH, Yeh HL, Lai CY, Chen CH. Persistent nasal carriers of Acinetobacter baumannii in long-term-care facilities. Am J Infect Control 2017; 45:723-727. [PMID: 28284750 DOI: 10.1016/j.ajic.2017.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acinetobacter baumannii and Staphylococcus aureus have persisted as 2 major pathogens worldwide. AIM We designed a prevalence study to investigate the prevalence of nasal carriage of S aureus and A baumannii in long-term-care facilities (LCTFs) and their collaborative community hospitals. In addition, we aimed to clarify persistent or nonpersistent carriage of the 2 organisms among residents of LTCFs. METHODS We performed a prevalence study concerning nasal carriers of A baumannii and S aureus in 3 LTCFs and 1 collaborative community hospital. RESULTS Seventy subjects were enrolled and clustered into 3 groups: the elderly sick group (n = 24), the elderly healthy group (n = 33), and the healthy health care worker group (n = 13). Nasal samples were collected, and the nuc and mecA genes of S aureus and the blaOXA gene of A baumannii were analyzed by polymerase chain reaction. Among the 3 groups, the rate of nasal carriage of S aureus was approximately 0%-15%. However, the rate for A baumannii was approximately 54%-92%. Notably, the persistent carrier rate of A baumannii in the elderly sick group was 83.3% (20 out of 24) despite a 12.5% (3 out of 24) rate of carbapenem-resistant A baumannii. CONCLUSIONS We emphasized that the persistent nasal carriage of A baumannii in LTCFs could be another portal of exit to cause A baumannii infection in Taiwan.
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Chiang SR, Jung F, Tang HJ, Chen CH, Chen CC, Chou HY, Chuang YC. Desiccation and ethanol resistances of multidrug resistant Acinetobacter baumannii embedded in biofilm: The favorable antiseptic efficacy of combination chlorhexidine gluconate and ethanol. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:770-777. [PMID: 28732564 DOI: 10.1016/j.jmii.2017.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/04/2017] [Accepted: 02/21/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND/PURPOSE Globally, multidrug-resistant Acinetobacter baumannii (MDRAB) has emerged as an important pathogen in nosocomial outbreaks. This study aimed to investigate the correlation between the biofilm formation and survival of MDRABs, and to investigate the antiseptic efficacy of hand sanitizers for the MDRABs, embedded with biofilm (MDRAB-Bs). METHODS The MDRABs were selected randomly after pulsed-field gel electrophoresis (PFGE), and their biofilm formation was analyzed. Desiccation and ethanol tolerances were assayed to test the bacterial survival. The antiseptic efficacy of combined chlorhexidine gluconate (CHG) and 70% ethanol agents against MDRAB-Bs were compared with the 70% ethanol cleanser. RESULTS Eleven MDRABs, which varied in biofilm formation (MRDAB-B) and planktonic type (MDRAB-P), were tested. In desiccation survival, the mean survival time for the MDRAB-Bs was 49.0 days which was significantly higher than that of their planktonic type (17.3 days) (P < 0.005). The MDRAB-Ps could be eliminated after a 10 min contact with a 30% ethanol agent, however, it took 10 min of 70% ethanol to eliminate the MDRAB-Bs. On the other hand, a 2% CHG in 70% ethanol solution completely eliminated all MDRAB-Bs after 1 min contacted time. The 2% CHG in 70% ethanol agent provided a significantly superior efficacy than the 70% ethanol solution at eliminating the MDRAB-Bs (P < 0.005). CONCLUSION MDRAB with biofilm-formation presented significantly higher desiccation and ethanol resistances than their planktonic type. Moreover, the 2% CHG in 70% ethanol agent provided a superior antiseptic efficacy for MDRAB-Bs than that of the 70% ethanol agent.
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Affiliation(s)
- Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Chia Nan University of Pharmacy & Science, Tainan City, Taiwan.
| | - Fang Jung
- Department of Respiratory Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Chia Nan University of Pharmacy & Science, Tainan City, Taiwan.
| | - Chung-Hua Chen
- Department of Medicine, En Chu Kong Hospital, Taipei County, Taiwan.
| | - Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan; Institute of Biotechnology, National Cheng Kung University, Tainan City, Taiwan.
| | - Hsiu-Yin Chou
- Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan.
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Chi Mei Medical Center-Liou Ying, Tainan City, Taiwan.
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Hu YF, Hou CJY, Kuo CF, Wang NY, Wu AYJ, Leung CH, Liu CP, Yeh HI. Emergence of carbapenem-resistant Acinetobacter baumannii ST787 in clinical isolates from blood in a tertiary teaching hospital in Northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:640-645. [PMID: 28711441 DOI: 10.1016/j.jmii.2016.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study is to investigate the predominant clones of carbapenem-resistant Acinetobacter baumannii (CRAB) in our hospital in Taiwan by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) technique. METHODS We collected 108 non-duplicate A. baumannii clinical blood isolates from January 2012 to December 2013 in MacKay Memorial Hospital. PFGE and MLST were used for typing the A. baumannii isolates and for investigation of the predominant clones. Bacteria isolates were screened by polymerase chain reaction for the presence of the carbapenemase-encoding genes. RESULTS All 108 isolates were classified as 33 pulsotypes by PFGE. The predominant clones were pulsotype 10 (12.04%) in 2012 and pulsotype 8 (16.67%) in 2013, respectively. The 31 predominant pulsotype isolates were typed by MLST, and ST787 (54.84%) and ST455 (45.16%) were identified. All isolates carried blaOXA-51-like genes, and blaOXA-23-like genes was founded in 101 isolates (93.52%). Other identified resistance genes included blaOXA-24-like and blaOXA-IMP. CONCLUSION To the best of our knowledge, this study is the first to describe the microbiological characteristics of CRAB ST787, which carried high genetic resistance to carbapenem, but remained susceptible to colistin. CRAB ST787 was the predominant clone in our hospital in the study period.
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Affiliation(s)
- Yi-Fan Hu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Division of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chien-Feng Kuo
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nai-Yu Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Alice Ying-Jung Wu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ching-Hsiang Leung
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Hung-I Yeh
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan.
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Zhang W, Aurosree B, Gopalakrishnan B, Balada-Llasat JM, Pancholi V, Pancholi P. The role of LpxA/C/D and pmrA/B g ene systems in colistin-resistant clinical strains of Acinetobacter baumannii. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.flm.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gholami M, Haghshenas M, Moshiri M, Razavi S, Pournajaf A, Irajian G, Heidary M. Frequency of 16S rRNA Methylase and Aminoglycoside-Modifying Enzyme Genes among Clinical Isolates of Acinetobacter baumannii in Iran. IRANIAN JOURNAL OF PATHOLOGY 2017; 12:329-338. [PMID: 29563928 PMCID: PMC5844677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/26/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND & OBJECTIVE Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important nosocomial pathogen which is associated with significant morbidity and mortality, particularly in high-risk populations. Aminoglycoside-modifying enzymes (AMEs) and 16S ribosomal RNA (16S rRNA) methylation are two important mechanisms of resistance to aminoglycosides. The aim of this study was to determine the prevalence of 16S rRNA methylase (armA, rmtA, rmtB, rmtC, and rmtD), and the AME genes [aac(6')-Ib, aac(3)-I, ant(3'')-I, aph(3')-I and aac(6')-Id], among clinical isolates of A. baumannii in Tehran, Iran. METHODS Between November 2015 to July 2016, a total of 110 clinical strains of A. baumannii were isolated from patients in two teaching hospitals in Tehran, Iran. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines. The presence of genes encoding the AMEs and 16S rRNA methylases responsible for resistance was investigated by multiplex polymerase chain reaction. RESULTS The results showed that colistin was an effective antibiotic and could be used as a last-resort treatment of infections caused by MDR-AB. The resistance rate to aminoglycosides were 100%, 96.36% and 90.9% for tobramycin, gentamicin and amikacin, respectively. In this study, AME genes of aac(6')-Ib, aac(3)-I and ant(3'')-I were most prevalent among the isolated strains. CONCLUSION Markedly high resistance to tobramycin, gentamicin and amikacin was noted in current study. Our results suggested that modifying enzyme genes in conjunction with methylation of 16S rRNA might contribute to aminoglycoside resistance induced in vivo in A. baumannii. Further studies are required to determine the prevalence of the aminoglycoside resistance genes in other hospitals of Iran.
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Affiliation(s)
- Mehrdad Gholami
- Dept. of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran,Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Haghshenas
- Dept. of Microbiology, Molecular and Cell-Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mona Moshiri
- Dept. of Pathobiology, Division of Microbiology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Razavi
- Dept. of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran,Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abazar Pournajaf
- Dept. of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Irajian
- Dept. of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran,Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran,Corresponding information: Gholamreza Irajian, Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran, E-mail: ,
| | - Mohsen Heidary
- Dept. of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yakupogullari Y, Otlu B, Ersoy Y, Kuzucu C, Bayindir Y, Kayabas U, Togal T, Kizilkaya C. Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital. Am J Infect Control 2016; 44:1595-1599. [PMID: 27561435 DOI: 10.1016/j.ajic.2016.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding the dynamics of aerial spread of Acinetobacter may provide useful information for production of effective control measurements. We investigated genetic relationships between air and clinical isolates of Acinetobacter baumannii in an intensive care unit (ICU) setting. METHODS We conducted a prospective surveillance study in a tertiary care hospital for 8 months. A total of 186 air samples were taken from 2 ICUs. Clonal characteristics of air isolates were compared with the prospective clinical strains and the previously isolated strains of ICU patients over a 23-month period. RESULTS Twenty-six (11.4%) air samples yielded A baumannii, of which 24 (92.3%) isolates were carbapenem-resistant. The Acinetobacter concentration was the highest in bedside sampling areas of infected patients (0.39 CFU/m3). Air isolates were clustered in 13 genotypes, and 7 genotypes (including 18 air strains) were clonally related to the clinical strains of 9 ICU patients. One clone continued to be cultured over 27 days in ICU air, and air isolates could be clonally related to 7-week retrospective and approximately 15-week prospective clinical strains. CONCLUSIONS The results of this study suggest that infected patients could spread significant amounts of Acinetobacter to ICU air. These strains could survive in air for some weeks and could likely still infect new patients after some months. Special control measurements may be required against the airborne spread of Acinetobacter in ICUs.
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Affiliation(s)
- Yusuf Yakupogullari
- Medical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey
| | - Baris Otlu
- Medical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey.
| | - Yasemin Ersoy
- Infectious Diseases and Clinical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey
| | - Cigdem Kuzucu
- Medical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey
| | - Yasar Bayindir
- Infectious Diseases and Clinical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey
| | - Uner Kayabas
- Infectious Diseases and Clinical Microbiology Department, Inonu University Medical Faculty, Malatya, Turkey
| | - Turkan Togal
- Inonu University Medical Faculty, Anesthesiology and Reanimation Department, Malatya, Turkey
| | - Canan Kizilkaya
- Recep Tayyip Erdogan University, Medical Microbiology Department, Rize, Turkey
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Fang C, Chen X, Zhou M. Epidemiology and Cytokine Levels among Children with Nosocomial Multidrug-Resistant Acinetobacter baumannii Complex in a Tertiary Hospital of Eastern China. PLoS One 2016; 11:e0161690. [PMID: 27579592 PMCID: PMC5007015 DOI: 10.1371/journal.pone.0161690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/10/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND AIM The present study was aimed at assessing the characteristics of children with nosocomial multidrug-resistant Acinetobacter baumannii complex (MDR ABC) in a tertiary hospital of eastern China. MDR ABC poses a serious threat to public health. However, information on nosocomial MDR ABC in children is lacking. METHOD This study retrospectively reviewed the cases in a tertiary hospital of eastern China between January 1, 2011, and December 31, 2014 (excluding outpatients). RESULTS A total of 377 non-duplicated nosocomial ABC isolates were collected from various samples including 200 (53.1%) MDR ABC isolates. Moreover, 158 of the 200 MDR ABC isolates were collected from intensive care units (ICUs; MDR constituent ratios, 62.5%), while 98 of the 200 MDR ABC isolates were collected from children older than 1 year (MDR constituent ratios, 62.8%). Multivariate logistic analysis revealed that being in the surgical intensive care unit (SICU), prolonged hospital stay, surgical intervention, and mechanical ventilation were independent risk factors for MDR acquisition among children with nosocomial ABC. The interleukin (IL)-6 level of children with nosocomial MDR ABC was significantly lower than that of the children with nosocomial non-MDR ABC. CONCLUSION Nosocomial MDR ABC infection is a serious concern in pediatric patients. Being in the SICU, prolonged hospital stay, surgical intervention, and mechanical ventilation increased the risk of nosocomial MDR ABC. IL-6 might be involved in developing nosocomial MDR ABC among children.
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Affiliation(s)
- Chao Fang
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- * E-mail:
| | - Xuejun Chen
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Mingming Zhou
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Greene C, Wu J, Rickard AH, Xi C. Evaluation of the ability of Acinetobacter baumannii to form biofilms on six different biomedical relevant surfaces. Lett Appl Microbiol 2016; 63:233-9. [PMID: 27479925 DOI: 10.1111/lam.12627] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED The human opportunistic pathogen, Acinetobacter baumannii, has the propensity to form biofilms and frequently cause medical device-related infections in hospitals. However, the physio-chemical properties of medical surfaces, in addition to bacterial surface properties, will affect colonization and biofilm development. The objective of this study was to compare the ability of A. baumannii to form biofilms on six different materials common to the hospital environment: glass, porcelain, stainless steel, rubber, polycarbonate plastic and polypropylene plastic. Biofilms were developed on material coupons in a CDC biofilm reactor. Biofilms were visualized and quantified using fluorescent staining and imaged using confocal laser scanning microscopy (CLSM) and by direct viable cell counts. Image analysis of CLSM stacks indicated that the mean biomass values for biofilms grown on glass, rubber, porcelain, polypropylene, stainless steel and polycarbonate were 0·04, 0·26, 0·62, 1·00, 2·08 and 2·70 μm(3) /μm(2) respectively. Polycarbonate developed statistically more biofilm mass than glass, rubber, porcelain and polypropylene. Viable cell counts data were in agreement with the CLSM-derived data. In conclusion, polycarbonate was the most accommodating surface for A. baumannii ATCC 17978 to form biofilms while glass was least favourable. Alternatives to polycarbonate for use in medical and dental devices may need to be considered. SIGNIFICANCE AND IMPACT OF THE STUDY In the hospital environment, Acinetobacter baumannii is one of the most persistent and difficult to control opportunistic pathogens. The persistence of A. baumannii is due, in part, to its ability to colonize surfaces and form biofilms. This study demonstrates that A. baumannii can form biofilms on a variety of different surfaces and develops substantial biofilms on polycarbonate - a thermoplastic material that is often used in the construction of medical devices. The findings highlight the need to further study the in vitro compatibility of medical materials that could be colonized by A. baumannii and allow it to persist in hospital settings.
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Affiliation(s)
- C Greene
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA
| | - J Wu
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA
| | - A H Rickard
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - C Xi
- Department of Environmental Health and Science, University of Michigan, Ann Arbor, MI, USA.
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Smani Y, Pachón-Ibáñez ME, Pachón J. New molecules and adjuvants in the treatment of infections by Acinetobacter baumannii. Expert Opin Pharmacother 2016; 17:1207-14. [PMID: 27067283 DOI: 10.1080/14656566.2016.1176144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The current problems of the treatment of infections by Acinetobacter baumannii are linked with the increase of multidrug- and extensive-drug resistance and the lack of development of new antimicrobial drugs for Gram-negative bacilli. For these reasons, new alternatives for the treatment and control of severe infections by A. baumannii are necessary. Several studies have reported the effect of adjuvants to restore the efficacy of existing antimicrobial agents. AREAS COVERED In the present review, the authors describe the main results in the development of adjuvant drugs as well as new data on antimicrobial peptides, in monotherapy or in combination therapy with existing antimicrobial agents, which have shown promising preclinical results in vitro and in vivo. EXPERT OPINION The preclinical evaluation of adjuvants and antimicrobial peptides, in monotherapy or in combination therapy, for A. baumannii infections has shown promising results. However, caution is needed and further extensive in vivo studies and clinical trials have to be performed to confirm the potential use of these adjuvants as true therapeutic alternatives.
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Affiliation(s)
- Younes Smani
- a Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
| | - María Eugenia Pachón-Ibáñez
- a Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
| | - Jerónimo Pachón
- a Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
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Pachón-Ibáñez ME, Smani Y, Pachón J. Use of adjuvants in the treatment of Acinetobacter baumannii. Expert Rev Anti Infect Ther 2015; 14:153-5. [PMID: 26620637 DOI: 10.1586/14787210.2016.1126508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The current antibiotic crisis to treat infections by Acinetobacter baumannii is linked with the increase of antimicrobial resistance and the lack of development of new antimicrobial drugs. For this reason, new alternatives for the treatment and control of infections by A. baumannii are necessary. Several studies have reported the effect of adjuvants to restore the efficacy of existing antimicrobial agents. Herein, we analyzed the main results on the development of adjuvant drugs, as monotherapy or in combination therapy with existing antimicrobial agents, which have shown promising results in vitro and in vivo. However, caution is needed and further extensive in vivo studies have to be performed to confirm the potential use of these adjuvants as true therapeutic alternatives.
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Affiliation(s)
- María Eugenia Pachón-Ibáñez
- a Clinical Unit of Infectious Diseases, microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
| | - Younes Smani
- a Clinical Unit of Infectious Diseases, microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
| | - Jerónimo Pachón
- a Clinical Unit of Infectious Diseases, microbiology, and Preventive Medicine , Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
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