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Jing J, Wei Y, Dong X, Li D, Zhang C, Fang Z, Wang J, Wan X. Characteristics and Clinical Prognosis of Septic Patients With Persistent Lymphopenia. J Intensive Care Med 2024; 39:733-741. [PMID: 38225173 DOI: 10.1177/08850666241226877] [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] [Indexed: 01/17/2024]
Abstract
Background: Septic patients with persistent lymphopenia may be in an immunosuppressed state. Therefore, we evaluated and compared the clinical characteristics and outcomes of septic patients with persistent lymphopenia (≥2d) and those with nonpersistent lymphopenia. Methods: A retrospective cohort study was designed. A total of 1306 patients with sepsis who were attended to the First Affiliated Hospital of Dalian Medical University from March 2016 to August 2022 were included. The primary clinical outcome was 90d mortality. The secondary clinical outcomes were the length of stay, hospital mortality, 28d mortality, the incidence of secondary infection, and differences in clinical characteristics. Results: Among 1306 patients with sepsis, 913 (69.9%) patients developed persistent lymphopenia. Compared with patients with nonpersistent lymphopenia, patients with persistent lymphocytopenia were admitted to intensive care unit (75.7% vs 52.7%, P < .05), treated with mechanical ventilation (67.6% vs 39.2%, P < .05), positive rate of microbial culture pathogens (86.7% vs 71.2%, P < .05), SOFA [8.0 (6.0-10.0) vs 6.0 (4.0-8.0), P < .05], length of stay [17.0d (12.0-27.0) vs 13.0d (10.0-21.0), P < .05], hospital mortality (37.7% vs 24.2%, P < .05), 28d mortality (38.0% vs 22.9%, P < .05), and 90d mortality (51.2% vs 31.3%, P < .05) were higher. As the duration of lymphocytopenia increased, so did the mortality rate in hospital. In addition, the onset time of persistent lymphopenia was not associated with SOFA. But we found that the frequency of persistent lymphopenia during hospitalization was positively associated with SOFA. Conclusion: Septic patients with persistent lymphopenia have higher mortality, worse conditions, increased risk of secondary infection, and poor prognosis regardless of shock.
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Affiliation(s)
- Juanjuan Jing
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yushan Wei
- Department of Scientific Research, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xue Dong
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dandan Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenyang Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhiyao Fang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jia Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianyao Wan
- Department of Critical Care Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Pitiriga VC, Campos E, Bakalis J, Saroglou G, Tsakris A. Differences in the Dwell Time of Peripherally Inserted Central Catheters between Patients with Catheter Colonization and Those Developing Central Line-Associated Bloodstream Infection: A Single Centre Retrospective Cohort Study. Antibiotics (Basel) 2024; 13:632. [PMID: 39061314 PMCID: PMC11273596 DOI: 10.3390/antibiotics13070632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Substantial knowledge gaps exist concerning the varying durations of peripherally inserted central catheter (PICC) placements that lead to either central line-associated bloodstream infection (CLABSI) or catheter colonization. We aimed to compare PICCs dwell time between patients who developed CLABSIs due to multidrug-resistant microorganisms (MDROs) and patients with catheter colonization by MDROs. Data from 86 patients admitted consecutively to a tertiary-care hospital from 2017 to 2020 were retrospectively analyzed. The mean dwell time was 25.73 ± 16.19 days in the PICC-CLABSI group and 16.36 ± 10.28 days in the PICC-colonization group (p = 0.002). The mean dwell time was 17.38 ± 9.5 days in the PICC-MDRO group and 22.48 ± 15.64 days in the PICC-non-MDRO group (p = 0.005). Within the PICC-CLABSI group, the mean dwell time for CLABSIs caused by MDROs was 21.50 ± 12.31 days, compared to 27.73 ± 16.98 days for CLABSIs caused by non-MDROs (p = 0.417). Within the PICC-colonization group, the mean dwell time was 15.55 ± 7.73 days in PICCs colonized by MDROs and 16.92 ± 11.85 days in PICCs colonized by non-MDROs (p = 0.124). The findings of the present study suggest that CLABSIs caused by MDROs in PICCs are associated with a shorter mean catheter dwell time compared to those caused by non-MDROs, underscoring the importance of considering infections by MDROs when evaluating PICC dwell times.
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Affiliation(s)
- Vassiliki C. Pitiriga
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
| | - Elsa Campos
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece
| | - John Bakalis
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece
| | - George Saroglou
- Department of Internal Medicine, Metropolitan Hospital, 9 Ethnarchou Makariou Street, 18547 Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece
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Abdul Hak A, Zedan HH, El-Mahallawy HA, El-Sayyad GS, Zafer MM. In Vivo and in Vitro activity of colistin-conjugated bimetallic silver-copper oxide nanoparticles against Pandrug-resistant Pseudomonas aeruginosa. BMC Microbiol 2024; 24:213. [PMID: 38886632 PMCID: PMC11181629 DOI: 10.1186/s12866-024-03358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Addressing microbial resistance urgently calls for alternative treatment options. This study investigates the impact of a bimetallic formulation containing colistin, silver, and copper oxide on a pandrug-resistant, highly virulent Pseudomonas aeruginosa (P. aeruginosa) isolate from a cancer patient at the National Cancer Institute, Cairo University, Egypt. METHODS Silver nanoparticles (Ag NPs), copper oxide nanoparticles (CuO NPs), and bimetallic silver-copper oxide nanoparticles (Ag-CuO NPs) were synthesized using gamma rays, combined with colistin (Col), and characterized by various analytical methods. The antimicrobial activity of Col-Ag NPs, Col-CuO NPs, and bimetallic Col-Ag-CuO NPs against P. aeruginosa was evaluated using the agar well diffusion method, and their minimum inhibitory concentration (MIC) was determined using broth microdilution. Virulence factors such as pyocyanin production, swarming motility, and biofilm formation were assessed before and after treatment with bimetallic Col-Ag-CuO NPs. The in vivo efficacy was evaluated using the Galleria mellonella model, and antibacterial mechanism were examined through membrane leakage assay. RESULTS The optimal synthesis of Ag NPs occurred at a gamma ray dose of 15.0 kGy, with the highest optical density (OD) of 2.4 at 375 nm. Similarly, CuO NPs had an optimal dose of 15.0 kGy, with an OD of 1.5 at 330 nm. Bimetallic Ag-CuO NPs were most potent at 15.0 kGy, yielding an OD of 1.9 at 425 nm. The MIC of colistin was significantly reduced when combined with nanoparticles: 8 µg/mL for colistin alone, 0.046 µg/mL for Col-Ag NPs, and 0.0117 µg/mL for Col-Ag-CuO NPs. Bimetallic Col-Ag-CuO NPs reduced the MIC four-fold compared to Col-Ag NPs. Increasing the sub-inhibitory concentration of bimetallic nanoparticles from 0.29 × 10-2 to 0.58 × 10-2 µg/mL reduced P. aeruginosa swarming by 32-64% and twitching motility by 34-97%. At these concentrations, pyocyanin production decreased by 39-58%, and biofilm formation was inhibited by 33-48%. The nanoparticles were non-toxic to Galleria mellonella, showing 100% survival by day 3, similar to the saline-treated group. CONCLUSIONS The synthesis of bimetallic Ag-CuO NPs conjugated with colistin presents a promising alternative treatment for combating the challenging P. aeruginosa pathogen in hospital settings. Further research is needed to explore and elucidate the mechanisms underlying the inhibitory effects of colistin-bimetallic Ag-CuO NPs on microbial persistence and dissemination.
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Affiliation(s)
- Asmaa Abdul Hak
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt
| | - Hamdallah H Zedan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Hadir A El-Mahallawy
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Gharieb S El-Sayyad
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt.
- Department of Microbiology and Immunology, Faculty of Pharmacy, Galala University, New Galala City, Suez, Egypt.
- Drug Microbiology Lab, Drug Radiation Research Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt.
| | - Mai M Zafer
- Department of Microbiology and Immunology, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt.
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You T, Shi K. Monitoring of antimicrobial resistance in respiratory tract pathogens during the COVID-19 pandemic: A retrospective study. Medicine (Baltimore) 2024; 103:e38101. [PMID: 38728506 PMCID: PMC11081541 DOI: 10.1097/md.0000000000038101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
To understand the distribution and antimicrobial resistance (AMR) of pathogens in respiratory samples in Changle District People's Hospital in Fujian Province in recent years, and provide empirical guidance for infection control and clinical treatment in the region. A retrospective analysis was conducted on 5137 isolates of pathogens from respiratory samples collected from 2019 to 2022. The AMR patterns were systematically analyzed. For research purposes, the data was accessed on October 12, 2023. A total of 3517 isolates were included in the study, including 811 (23.06%) gram-positive bacteria and 2706 (76.94%) gram-negative bacteria. The top 3 gram-positive bacteria were Staphylococcus aureus with 455 isolates (12.94%), Streptococcus pneumoniae with 99 isolates (2.81%), and Staphylococcus hemolytic with 99 isolates (2.81%). The top 3 gram-negative bacteria were Klebsiella pneumoniae with 815 isolates (23.17%), Pseudomonas aeruginosa with 589 isolates (16.75%), and Acinetobacter baumannii with 328 isolates (9.33%). The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and K pneumoniae fluctuated between 41.9% and 70.5%, and 18.6% and 20.9%, respectively. The resistance rates of E coli, K pneumoniae, P aeruginosa, and A baumannii to carbapenems were 2.36%, 8.9%, 18.5%, and 19.6%, respectively. The prevalence of methicillin-resistant S aureus (MRSA) was 48.55%, but it decreased to 38.4% by 2022. The resistance rate of Staphylococcus haemolyticus to methicillin was 100%, and 1 case of vancomycin-resistant strain was detected. K pneumoniae, P aeruginosa, A baumannii, and S aureus are the main pathogens in respiratory samples. Although the resistance rates of some multidrug-resistant strains have decreased, ESBL-producing Enterobacteriaceae, carbapenem-resistant bacteria have still increased. Therefore, it is necessary to strengthen the monitoring of pathogen resistance, promote rational use of antibiotics, and promptly report findings.
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Affiliation(s)
- Tongdeng You
- Department of Clinical Laboratory, Fuzhou Changle District People’s Hospital, Fujian Province, China
| | - Ke Shi
- Department of Clinical Laboratory, Fuzhou Changle District People’s Hospital, Fujian Province, China
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Zhang X, Zhu Y, Gao Y, Li W, Wang Y, Li Y. Evaluation and analysis of multidrug resistance- and hypervirulence-associated genes in carbapenem-resistant Pseudomonas aeruginosa strains among children in an area of China for five consecutive years. Front Microbiol 2023; 14:1280012. [PMID: 37901827 PMCID: PMC10602738 DOI: 10.3389/fmicb.2023.1280012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a growing threat. It is urgent to investigate the multidrug resistance and high virulence of CRPA to provide a basis for infection control and rational use of antibiotics. Methods A retrospective study of 56 nonduplicated CRPA isolates was conducted. Results CRPA mainly came from the intensive care unit (ICU) and was mostly isolated from sputum samples. The carbapenem resistance rates of P. aeruginosa were 21.37% (2016), 10.62, 5.88, 10 and 13.87% from 2016 to 2020, respectively. Carbapenem-resistant enzymes and aminoglycoside-modifying enzyme-encoding genes were detected in all isolates, and extended-spectrum β-lactamase and cephalosporin enzyme-encoding genes were present in 96.43 and 80.38% of isolates, respectively. The detection rate of OprM showed a statistically significant difference (p < 0.05) between the ICU and other wards. Genes related to biofilms, membrane channel proteins, I integrons and efflux systems were detected in all isolates, with detection rates greater than 90%. CRPA was strongly virulent, and over 80% of isolates carried hypervirulence-associated genes (exoU, exoS, exoT, and exoY). The drug resistance rates of cefepime and piperacillin/tazobactam showed a statistically significant difference (p < 0.05) between strains with exoU (+) and exoU (-) (p < 0.05). Notably, out of the 7 individuals who died, 4 had extensively drug-resistant P. aeruginosa (57.14%). Discussion The detection rates of various resistance and virulence genes were high, and the coexistence phenomenon was serious. In clinical practice, antibiotics should be used reasonably based on different drug resistance genes to ensure the rationality and safety of patient medication.
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Affiliation(s)
- Xin Zhang
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
- Clinical Medical College of Pediatrics, Soochow University, Suzhou, Jiangsu, China
| | - Yunfen Zhu
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Gao
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
| | - Wei Li
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
| | - Yunzhong Wang
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
- Clinical Medical College of Pediatrics, Soochow University, Suzhou, Jiangsu, China
| | - Yang Li
- Department of Clinical Laboratory, Children’s Hospital of Soochow University, Suzhou, China
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
- Clinical Medical College of Pediatrics, Soochow University, Suzhou, Jiangsu, China
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Zińczuk A, Rorat M, Simon K, Jurek T. Unpacking the Complexity of COVID-19 Fatalities: Adverse Events as Contributing Factors-A Single-Center, Retrospective Analysis of the First Two Years of the Pandemic. Viruses 2023; 15:1430. [PMID: 37515118 PMCID: PMC10383259 DOI: 10.3390/v15071430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
In a retrospective analysis of 477 fatal COVID-19 cases hospitalised at a single medical centre during the period from 6 March 2020 to 30 June 2022, several factors defining those patients at admission were assessed, as well as the course of the hospitalisation and factors contributing to death. There was a predominance of men (59.3% (283)) burdened by comorbidities, with increased inflammation at admission. Patients aged ≥ 81 years were significantly more likely to be admitted to and die in infectious diseases units (IDU) due to respiratory failure, their hospital stays were shorter, and they were most likely not to receive specialist treatment. The most common COVID-19 complications included acute kidney injury in 31.2% (149) patients and thromboembolic complications in 23.5% (112). The course of hospitalisation was complicated by healthcare-associated infections (HAI) in 33.3% (159) of cases, more often in those treated with baricitinib (p < 0.001). The initial use of an antibiotic, although common (94.8% (452)), was unwarranted in almost half of the cases (47.6% (215)). Complications of hospitalisation (46.1% (220)) and adverse events involving staff (49.7% (237)) were found in almost half of the patients. In 88.7% (423) of the cases, death was due to respiratory failure in the course of SARS-CoV-2 infection. Adverse events during hospitalisation should be considered as an additional factor that, in addition to the infection itself, may have influenced the death of patients.
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Affiliation(s)
- Aleksander Zińczuk
- Department of Forensic Medicine, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Krzysztof Simon
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 50-369 Wroclaw, Poland
| | - Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, 50-369 Wroclaw, Poland
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Pace MC, Corrente A, Passavanti MB, Sansone P, Petrou S, Leone S, Fiore M. Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit. World J Clin Cases 2023; 11:2874-2889. [PMID: 37215420 PMCID: PMC10198073 DOI: 10.12998/wjcc.v11.i13.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/07/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Intensive care units (ICU) for various reasons, including the increasing age of admitted patients, comorbidities, and increasingly complex surgical procedures (e.g., transplants), have become "the epicenter" of nosocomial infections, these are characterized by the presence of multidrug-resistant organisms (MDROs) as the cause of infection. Therefore, the perfect match of fragile patients and MDROs, as the cause of infection, makes ICU mortality very high. Furthermore, carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs; unfortunately, nowadays carbapenem resistance, mainly among Gram-negative pathogens, is a matter of the highest concern for worldwide public health. This comprehensive review aims to outline the problem from the intensivist's perspective, focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs (Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales) to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases.
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Affiliation(s)
- Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Antonio Corrente
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples 80138, Italy
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Device and surgical procedure-related infections in Canadian acute care hospitals, 2017-2021. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:221-234. [PMID: 38419908 PMCID: PMC10901258 DOI: 10.14745/ccdr.v49i05a08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021. Methods Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Results Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days, p=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries, p=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and Staphylococcus aureus (17%) were the most frequently isolated pathogens. Conclusion Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.
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Lyu J, Chen H, Bao J, Liu S, Chen Y, Cui X, Guo C, Gu B, Li L. Clinical Distribution and Drug Resistance of Pseudomonas aeruginosa in Guangzhou, China from 2017 to 2021. J Clin Med 2023; 12:jcm12031189. [PMID: 36769837 PMCID: PMC9917919 DOI: 10.3390/jcm12031189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/05/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023] Open
Abstract
The aim of the current study was to analyse the distribution of antimicrobial drug resistance (AMR) among Pseudomonas aeruginosa (P. aeruginosa, PA) isolates from Guangdong Provincial People's Hospital (GDPH) from 2017 to 2021, and the impact of the COVID-19 outbreak on changes in the clinical distribution and drug resistance rate of P. aeruginosa to establish guidelines for empiric therapy. Electronic clinical data registry records from 2017 to 2021 were retrospectively analysed to study the AMR among P. aeruginosa strains from GDPH. The strains were identified by VITEK 2 Compact and MALDI-TOF MS, MIC method or Kirby-Bauer method for antibiotic susceptibility testing. The results were interpreted according to the CLSI 2020 standard, and the data were analysed using WHONET 5.6 and SPSS 23.0 software. A total of 3036 P. aeruginosa strains were detected in the hospital from 2017 to 2021, and they were primarily distributed in the ICU (n = 1207, 39.8%). The most frequent specimens were respiratory tract samples (59.6%). The detection rate for P. aeruginosa in 5 years was highest in September, and the population distribution was primarily male(68.2%). For the trend in the drug resistance rate, the 5-year drug resistance rate of imipenem (22.4%), aztreonam (21.5%) and meropenem (19.3%) remained at high levels. The resistance rate of cefepime decreased from 9.4% to 4.8%, showing a decreasing trend year by year (p < 0.001). The antibiotics with low resistance rates were aminoglycoside antibiotics, which were gentamicin (4.4%), tobramycin (4.3%), and amikacin (1.4%), but amikacin showed an increasing trend year by year (p = 0.008). Our analysis indicated that the detection rate of clinically resistant P. aeruginosa strains showed an upwards trend, and the number of multidrug-resistant (MDR) strains increased year by year, which will lead to stronger pathogenicity and mortality. However, after the outbreak of COVID-19 in 2020, the growth trend in the number of MDR bacteria slowed, presumably due to the strict epidemic prevention and control measures in China. This observation suggests that we should reasonably use antibiotics and treatment programs in the prevention and control of P. aeruginosa infection. Additionally, health prevention and control after the outbreak of the COVID-19 epidemic (such as wearing masks, washing hands with disinfectant, etc., which reduced the prevalence of drug resistance) led to a slowdown in the growth of the drug resistance rate of P. aeruginosa in hospitals, effectively reducing the occurrence and development of drug resistance, and saving patient's treatment costs and time.
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Affiliation(s)
- Jingwen Lyu
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Huimin Chen
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Jinwei Bao
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China
| | - Suling Liu
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Yiling Chen
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China
| | - Xuxia Cui
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
| | - Caixia Guo
- The Fourth Affiliated Hospital of Guangzhou Medical University, Guangzhou 511316, China
- Correspondence: (C.G.); (B.G.); (L.L.)
| | - Bing Gu
- Department of Clinical Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, China
- Correspondence: (C.G.); (B.G.); (L.L.)
| | - Lu Li
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523808, China
- Correspondence: (C.G.); (B.G.); (L.L.)
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Pipite A, Lockhart PJ, McLenachan PA, Christi K, Kumar D, Prasad S, Subramani R. Isolation, antibacterial screening, and identification of bioactive cave dwelling bacteria in Fiji. Front Microbiol 2022; 13:1012867. [PMID: 36605510 PMCID: PMC9807670 DOI: 10.3389/fmicb.2022.1012867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Bacteria are well known producers of bioactive secondary metabolites, including some of the most effective antibiotics in use today. While the caves of Oceania are still largely under-explored, they form oligotrophic and extreme environments that are a promising source for identifying novel species of bacteria with biologically active compounds. By using selective media that mimicked a cave environment, and pretreatments that suppressed the growth of fast-growing bacteria, we have cultured genetically diverse bacteria from a limestone cave in Fiji. Partial 16S rRNA gene sequences from isolates were determined and compared with 16S rRNA gene sequences in EzBioCloud and SILVA data bases. Fifty-five isolates purified from culture had Actinomycete-like morphologies and these were investigated for antibacterial activity. Initial screening using a cross streak test with pathogenic bacteria indicated that 34 of the isolates had antibacterial properties. The best matches for the isolates are bacteria with potential uses in the manufacture of antibiotics and pesticides, in bioremediation of toxic waste, in biomining, in producing bioplastics, and in plant growth promotion. Nineteen bacteria were confirmed as Actinomycetes. Thirteen were from the genus Streptomyces and six from genera considered to be rare Actinomycetes from Pseudonocardia, Kocuria, Micromonospora, Nonomuraea. Ten isolates were Firmicutes from the genera Bacillus, Lysinbacillus, Psychrobacillus and Fontibacillus. Two were Proteobacteria from the genera Mesorhizobium and Cupriavidus. Our findings identify a potentially rich source of microbes for applications in biotechnologies.
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Affiliation(s)
- Atanas Pipite
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences (SAGEONS), The University of the South Pacific, Suva, Fiji,*Correspondence: Atanas Pipite,
| | - Peter J. Lockhart
- School of Natural Sciences, Massey University, Palmerston North, New Zealand,Peter J. Lockhart,
| | | | - Ketan Christi
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences (SAGEONS), The University of the South Pacific, Suva, Fiji
| | - Dinesh Kumar
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences (SAGEONS), The University of the South Pacific, Suva, Fiji
| | - Surendra Prasad
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences (SAGEONS), The University of the South Pacific, Suva, Fiji
| | - Ramesh Subramani
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences (SAGEONS), The University of the South Pacific, Suva, Fiji
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11
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Li L, Li Y, Yang J, Xie X, Chen H. The immune responses to different Uropathogens call individual interventions for bladder infection. Front Immunol 2022; 13:953354. [PMID: 36081496 PMCID: PMC9445553 DOI: 10.3389/fimmu.2022.953354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Urinary tract infection (UTI) caused by uropathogens is the most common infectious disease and significantly affects all aspects of the quality of life of the patients. However, uropathogens are increasingly becoming antibiotic-resistant, which threatens the only effective treatment option available-antibiotic, resulting in higher medical costs, prolonged hospital stays, and increased mortality. Currently, people are turning their attention to the immune responses, hoping to find effective immunotherapeutic interventions which can be alternatives to the overuse of antibiotic drugs. Bladder infections are caused by the main nine uropathogens and the bladder executes different immune responses depending on the type of uropathogens. It is essential to understand the immune responses to diverse uropathogens in bladder infection for guiding the design and development of immunotherapeutic interventions. This review firstly sorts out and comparatively analyzes the immune responses to the main nine uropathogens in bladder infection, and summarizes their similarities and differences. Based on these immune responses, we innovatively propose that different microbial bladder infections should adopt corresponding immunomodulatory interventions, and the same immunomodulatory intervention can also be applied to diverse microbial infections if they share the same effective therapeutic targets.
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Affiliation(s)
- Linlong Li
- The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Yangyang Li
- The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Jiali Yang
- The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
| | - Xiang Xie
- The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
- Public Center of Experimental Technology, Model Animal and Human Disease Research of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
- *Correspondence: Xiang Xie, ; Huan Chen,
| | - Huan Chen
- The School of Basic Medical Sciences, Southwest Medical University, Luzhou, China
- Nucleic Acid Medicine of Luzhou Key Laboratory, Southwest Medical University, Luzhou, China
- *Correspondence: Xiang Xie, ; Huan Chen,
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The Resistome of ESKAPEE Pathogens in Untreated and Treated Wastewater: A Polish Case Study. Biomolecules 2022; 12:biom12081160. [PMID: 36009054 PMCID: PMC9405806 DOI: 10.3390/biom12081160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to quantify ESKAPEE bacteria, genes encoding resistance to antibiotics targeting this group of pathogens, as well as integrase genes in municipal wastewater and river water. Environmental DNA was extracted from the collected samples and used in deep sequencing with the Illumina TruSeq kit. The abundance of bacterial genera and species belonging to the ESKAPEE group, 400 ARGs associated with this microbial group, and three classes of integrase genes were determined. A taxonomic analysis revealed that Acinetobacter was the dominant bacterial genus, whereas Acinetobacter baumannii and Escherichia coli were the dominant bacterial species. The analyzed samples were characterized by the highest concentrations of the following ARGs: blaGES, blaOXA-58, blaTEM, qnrB, and qnrS. Acinetobacter baumannii, E. coli, and genes encoding resistance to β-lactams (blaVEB-1, blaIMP-1, blaGES, blaOXA-58, blaCTX-M, and blaTEM) and fluoroquinolones (qnrS) were detected in samples of river water collected downstream from the wastewater discharge point. The correlation analysis revealed a strong relationship between A. baumannii (bacterial species regarded as an emerging human pathogen) and genes encoding resistance to all tested groups of antimicrobials. The transmission of the studied bacteria (in particular A. baumannii) and ARGs to the aquatic environment poses a public health risk.
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Duszynska W, Idziak M, Smardz K, Burkot A, Grotowska M, Rojek S. Frequency, Etiology, Mortality, Cost, and Prevention of Respiratory Tract Infections—Prospective, One Center Study. J Clin Med 2022; 11:jcm11133764. [PMID: 35807049 PMCID: PMC9267472 DOI: 10.3390/jcm11133764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Ventilator-associated pneumonia (VAP) is the most monitored form of respiratory tract infections (RTIs). A small number of epidemiological studies have monitored community-acquired pneumonia (CAP), non-ventilator hospital-acquired pneumonia (NV-HAP) and ventilator-associated tracheobronchitis (VAT) in intensive care units (ICUs). The objective of this study was to assess the frequency, etiology, mortality, and additional costs of RTIs. Methods: One-year prospective RTI surveillance at a 30-bed ICU. The study assessed the rates and microbiological profiles of CAP, VAP, NV-HAP, VAT, and VAP prevention factors, the impact of VAP and NV-HAP on the length of ICU stays, and the additional costs of RTI treatment and mortality. Results: Among 578 patients, RTIs were found in 30%. The CAP, NV-HAP, VAP, and VAT rates/100 admissions were 5.9, 9.0, 8.65, and 6.05, respectively. The VAP incidence density/1000 MV-days was 10.8. The most common pathogen of RTI was Acinetobacter baumannii MDR. ICU stays were extended by VAP and NV-HAP for 17.8 and 3.7 days, respectively, and these RTIs increased the cost of therapy by 13,029 and 2708 EUR per patient, respectively. The mortality rate was higher by 11.55% in patients with VAP than those without device-associated and healthcare-associated infections (p = 0.0861). Conclusions: RTIs are a serious epidemiological problem in patients who are admitted and treated in ICU, as they may affect one-third of patients. Hospital-acquired RTIs extend hospitalization time, increase the cost of treatment, and worsen outcomes.
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Affiliation(s)
- Wieslawa Duszynska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
- Correspondence: ; Tel.: +48-717332302
| | - Marta Idziak
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Klaudia Smardz
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Anna Burkot
- The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (K.S.); (A.B.)
| | - Malgorzata Grotowska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland; (M.I.); (M.G.)
| | - Stanislaw Rojek
- Department of Anaesthesiology and Intensive Therapy, Specialist Hospital in Walbrzych, A. Sokolowskiego Street 4, 58-309 Walbrzych, Poland;
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Roy MC, Nam K, Kim J, Stanley D, Kim Y. Thromboxane Mobilizes Insect Blood Cells to Infection Foci. Front Immunol 2022; 12:791319. [PMID: 34987515 PMCID: PMC8720849 DOI: 10.3389/fimmu.2021.791319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/18/2021] [Indexed: 01/18/2023] Open
Abstract
Innate immune responses are effective for insect survival to defend against entomopathogens including a fungal pathogen, Metarhizium rileyi, that infects a lepidopteran Spodoptera exigua. In particular, the fungal virulence was attenuated by cellular immune responses, in which the conidia were phagocytosed by hemocytes (insect blood cells) and hyphal growth was inhibited by hemocyte encapsulation. However, the chemokine signal to drive hemocytes to the infection foci was little understood. The hemocyte behaviors appeared to be guided by a Ca2+ signal stimulating cell aggregation to the infection foci. The induction of the Ca2+ signal was significantly inhibited by the cyclooxygenase (COX) inhibitor. Under the inhibitory condition, the addition of thromboxane A2 or B2 (TXA2 or TXB2) among COX products was the most effective to recover the Ca2+ signal and hemocyte aggregation. TXB2 alone induced a microaggregation behavior of hemocytes under in vitro conditions. Indeed, TXB2 titer was significantly increased in the plasma of the infected larvae. The elevated TXB2 level was further supported by the induction of phospholipase A2 (PLA2) activity in the hemocytes and subsequent up-regulation of COX-like peroxinectins (SePOX-F and SePOX-H) in response to the fungal infection. Finally, the expression of a thromboxane synthase (Se-TXAS) gene was highly expressed in the hemocytes. RNA interference (RNAi) of Se-TXAS expression inhibited the Ca2+ signal and hemocyte aggregation around fungal hyphae, which were rescued by the addition of TXB2. Without any ortholog to mammalian thromboxane receptors, a prostaglandin receptor was essential to mediate TXB2 signal to elevate the Ca2+ signal and mediate hemocyte aggregation behavior. Specific inhibitor assays suggest that the downstream signal after binding TXB2 to the receptor follows the Ca2+-induced Ca2+ release pathway from the endoplasmic reticulum of the hemocytes. These results suggest that hemocyte aggregation induced by the fungal infection is triggered by TXB2via a Ca2+ signal through a PG receptor.
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Affiliation(s)
- Miltan Chandra Roy
- Department of Plant Medicals, Andong National University, Andong, South Korea
| | - Kiwoong Nam
- DGIMI, Univ Montpellier, INRAE, Montpellier, France
| | - Jaesu Kim
- Department of Agricultural Convergence Technology, Jeonbuk National University, Jeonju, South Korea
| | - David Stanley
- Biological Control of Insect Research Laboratory, United States Department of Agriculture-Agricultural Research Station (USDA/ARS), Columbia, MO, United States
| | - Yonggyun Kim
- Department of Plant Medicals, Andong National University, Andong, South Korea
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Poletajew S, Pawlik K, Bonder-Nowicka A, Pakuszewski A, Nyk Ł, Kryst P. Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland. Antibiotics (Basel) 2021; 10:antibiotics10101232. [PMID: 34680812 PMCID: PMC8532629 DOI: 10.3390/antibiotics10101232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology.
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Affiliation(s)
- Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
- Correspondence: ; Tel.: +48-225690148; Fax: +48-225690150
| | - Katarzyna Pawlik
- Infection Control Team, Bielanski Hospital, 80 Cegłowska St., 00809 Warsaw, Poland;
| | - Anna Bonder-Nowicka
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Artur Pakuszewski
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Łukasz Nyk
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
| | - Piotr Kryst
- Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809 Warsaw, Poland; (A.B.-N.); (A.P.); (Ł.N.); (P.K.)
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Amanati A, Sajedianfard S, Khajeh S, Ghasempour S, Mehrangiz S, Nematolahi S, Shahhosein Z. Bloodstream infections in adult patients with malignancy, epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance. BMC Infect Dis 2021; 21:636. [PMID: 34215207 PMCID: PMC8254331 DOI: 10.1186/s12879-021-06243-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. Methods We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. Results 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015–2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. Conclusions The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06243-z.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Somayeh Khajeh
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran
| | | | - Salma Mehrangiz
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran
| | | | - Zahra Shahhosein
- Shiraz University of Medical Sciences, Shiraz, 7193711351, Iran.
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Distribution and Antimicrobial Susceptibility of Gram-Positive and Gram-Negative Pathogens Isolated from Patients Hospitalized in a Tertiary Teaching Hospital in Southwestern China. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.111682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Bacteria are the most common causes of clinical infectious diseases. The distribution and antimicrobial resistance (AMR) rates of bacteria provide important guidelines for clinical antibacterial treatment; however, the information in this region is still missing. Objectives: This study aimed to evaluate the changes in the distribution and AMR rates of clinical isolates from inpatients. Methods: We conducted a retrospective cross-sectional analysis of the distribution and antimicrobial susceptibility of all non-duplicate Gram-negative bacterial (GNB) and Gram-positive bacterial (GPB) isolates collected from January 1, 2013, to December 31, 2018, in our hospital. Results: In total, 56,535 and 3,518 non-repetitive isolates were detected in the whole hospital and intensive care units (ICUs), respectively. The isolates included GPB (26.3% and 18.4%, respectively) and GNB (73.7% and 81.6%, respectively). The five dominant bacteria were the same in the whole hospital and ICUs, but Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii percentages were different. The detection rates of all isolates and five dominant bacteria were significantly different between the ICUs and the whole hospital (P < 0.05). The detection rate of extended-spectrum β-lactamase (ESBL)-E. coli (54.1%) was significantly higher than that of K. pneumoniae (26.1%). The detection rates of carbapenem-resistant (CR) and extensively drug-resistant (XDR)-A. baumannii were the highest in both the ICUs (87.1% and 21.8%, respectively) and the whole hospital (65.5% and 12.9%, respectively). The methicillin-resistant S. aureus (MRSA) detection rate was high (26.5%) but showed a significant decreasing trend (P < 0.05). The detection rates of ESBL and XDR-E. coli, CRAB, and XDR-S. aureus were significantly different between the ICUs and the whole hospital (P < 0.05). Gram-negative bacteria were highly susceptible to amikacin (> 90%) and tigecycline (> 98%). Staphylococcus aureus showed 100% susceptibility to vancomycin and linezolid. Acinetobacter baumannii had the highest resistance to imipenem (62.8%) and meropenem (64.0%). Except for A. baumannii and E. coli (P < 0.05), the AMR levels and the trends of the other isolates were similar between the ICUs and the whole hospital (P > 0.05). Conclusions: Currently, the appropriate antimicrobial agents in our hospital include amikacin and tigecycline for the treatment of GNB infections and vancomycin and linezolid for the treatment of GPB infections. Moreover, it is still necessary to monitor AMR in the ICUs and the whole hospital simultaneously.
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Chmielarczyk A, Pomorska-Wesołowska M, Romaniszyn D, Wójkowska-Mach J. Healthcare-Associated Laboratory-Confirmed Bloodstream Infections-Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2785. [PMID: 33803428 PMCID: PMC7967254 DOI: 10.3390/ijerph18052785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Regardless of the country, advancements in medical care and infection prevention and control of bloodstream infections (BSIs) are an enormous burden of modern medicine. OBJECTIVES The aim of our study was to describe the epidemiology and drug-resistance of laboratory-confirmed BSI (LC-BSIs) among adult patients of 16 hospitals in the south of Poland. PATIENTS AND METHODS Data on 4218 LC-BSIs were collected between 2016-2019. The identification of the strains was performed using MALDI-TOF. Resistance mechanisms were investigated according to European Committee on Antimicrobial Susceptibility Testing, EUCAST recommendations. RESULTS Blood cultures were collected from 8899 patients, and LC-BSIs were confirmed in 47.4%. The prevalence of Gram-positive bacteria was 70.9%, Gram-negative 27.8% and yeast 1.4%. The most frequently isolated genus was Staphylococcus (50% of all LC-BSIs), with a domination of coagulase-negative staphylococci, while Escherichia coli (13.7%) was the most frequent Gram-negative bacterium. Over 4 years, 108 (2.6%) bacteria were isolated only once, including species from the human microbiota as well as environmental and zoonotic microorganisms. The highest methicillin resistant Staphylococcus aureus (MRSA) prevalence was in intensive care units (ICUs) (55.6%) but S. aureus with resistance to macrolides, lincosamides and streptogramins B (MLSB) in surgery was 66.7%. The highest prevalence of E. faecalis with a high-level aminoglycoside resistance (HLAR) mechanism was in ICUs, (84.6%), while E. faecium-HLAR in surgery was 83.3%. All cocci were fully glycopeptide-sensitive. Carbapenem-resistant Gram-negative bacilli were detected only in non-fermentative bacilli group, with prevalence 70% and more. CONCLUSIONS The BSI microbiology in Polish hospitals was similar to those reported in other studies, but the prevalence of MRSA and enterococci-HLAR was higher than expected, as was the prevalence of carbapenem-resistant non-fermentative bacilli. Modern diagnostic techniques, such as MALDI-TOF, guarantee reliable diagnosis.
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Affiliation(s)
- Agnieszka Chmielarczyk
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
| | - Monika Pomorska-Wesołowska
- Department of Microbiology, Analytical and Microbiological Laboratory of Ruda Slaska, KORLAB NZOZ, 41-700 Ruda Slaska, Poland;
| | - Dorota Romaniszyn
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 31-121 Krakow, Poland; (A.C.); (D.R.)
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Grisold AJ, Luxner J, Bedenić B, Diab-Elschahawi M, Berktold M, Wechsler-Fördös A, Zarfel GE. Diversity of Oxacillinases and Sequence Types in Carbapenem-Resistant Acinetobacter baumannii from Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042171. [PMID: 33672170 PMCID: PMC7926329 DOI: 10.3390/ijerph18042171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii is a significant health problem worldwide. A multicenter study on A. baumannii was performed to investigate the molecular epidemiology and genetic background of carbapenem resistance of A. baumannii isolates collected from 2014–2017 in Austria. In total, 117 non-repetitive Acinetobacter spp. assigned to A. baumannii (n = 114) and A. pittii (n = 3) were collected from four centers in Austria. The isolates were uniformly resistant to piperacillin/tazobactam, ceftazidime, and carbapenems, and resistance to imipenem and meropenem was 97.4% and 98.2%, respectively. The most prominent OXA-types were OXA-58-like (46.5%) and OXA-23-like (41.2%), followed by OXA-24-like (10.5%), with notable regional differences. Carbapenem-hydrolyzing class D carbapenemases (CHDLs) were the only carbapenemases found in A.baumannii isolates in Austria since no metallo-β-lactamases (MBLs) nor KPC or GES carbapenemases were detected in any of the isolates. One-third of the isolates harbored multiple CHDLs. The population structure of A. baumannii isolates from Austria was found to be very diverse, while a total of twenty-three different sequence types (STs) were identified. The most frequent was ST195 found in 15.8%, followed by ST218 and ST231 equally found in 11.4% of isolates. Two new ST types, ST2025 and ST2026, were detected. In one A. pittii isolate, blaOXA-143-like was detected for the first time in Austria.
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Affiliation(s)
- Andrea J. Grisold
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
- Correspondence: ; Tel.: +43-316-385-73630
| | - Josefa Luxner
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
| | - Branka Bedenić
- Department of Microbiology, University Hospital Center Zagreb, 10000 Zagreb, Croatia;
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;
| | - Michael Berktold
- Institute of Hygiene and Microbiology, Medical University Innsbruck, Schöpfstrasse 41, A-6020 Innsbruck, Austria;
| | | | - Gernot E. Zarfel
- D&R Institute of Hygiene, Microbiology and Environmental Medicine, Medical University Graz, Neue Stiftingtalstrasse 6, A-8010 Graz, Austria; (J.L.); (G.E.Z.)
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