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Karamolahi S, Kaviar VH, Haddadi MH, Hashemian M, Feizi J, Sadeghifard N, Khoshnood S. Molecular characterization of Staphylococcus aureus isolated from hospital-acquired infections in Ilam, Iran. Mol Biol Rep 2024; 51:686. [PMID: 38796602 DOI: 10.1007/s11033-024-09580-9] [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: 01/30/2024] [Accepted: 04/22/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This research study was undertaken to investigate antimicrobial resistance patterns and the prevalence of hospital-acquired infections (HAIs). The study focuses on common microorganisms responsible for HAIs and explores emerging challenges posed by antimicrobial drug-resistant isolates. METHODS A comprehensive analysis of 123 patients with HAIs, hospitalized in surgical department and intensive care unit (ICU) at Imam Khomeini Hospital, Ilam, Iran, was conducted over a six-month period. Pathogenic bacterial isolates, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Staphylococcus aureus (VRSA), were isolated and subjected to antibiotic susceptibility testing. RESULTS The study findings revealed a significant prevalence of multidrug-resistant (MDR) isolates, of which 73.3% were MRSA. Notably, 6.7% of S. aureus isolates exhibited resistance to vancomycin, indicating the emergence of VRSA. Respiratory infections were identified as the most prevalent HAI, constituting 34.67% of cases, often arising from extended ICU stays and invasive surgical procedures. Furthermore, patients aged 60 and above, particularly those associated with MDR, exhibited higher vulnerability to HAI. CONCLUSIONS This research sheds light on the intricate interplay between drug resistance and HAI, highlighting the imperative role of rational antibiotic use and infection control in addressing this critical healthcare challenge.
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Affiliation(s)
- Somayeh Karamolahi
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Vahab Hassan Kaviar
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Marzieh Hashemian
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Jalil Feizi
- Department of Infectious Diseases, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Nourkhoda Sadeghifard
- Department of Microbiology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
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Mirbag HH, Tajbakhsh S, Askari A, Yousefi F. Comparison of virulence factors between ESBL and non-ESBL producing Klebsiella pneumoniae isolates. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:39-48. [PMID: 38682061 PMCID: PMC11055437 DOI: 10.18502/ijm.v16i1.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background and Objectives Klebsiella pneumoniae is an opportunistic pathogen responsible for causing nosocomial and community-acquired infections. Its pathogenicity is associated with a variety of virulence factors and antibiotic resistance. The aim of the present study was to compare virulence attributes between ESBL and non-ESBL producing isolates. Materials and Methods A total of 113 K. pneumoniae including 56 ESBL and 57 non ESBL-producers were collected in Bushehr province, Iran, from November 2017 to February 2019. Enzymatic profile, hypermucoviscosity and biofilm formation were investigated phenotypically. In addition, the presence of rmpA, aerobactin, kfu, allS, mrkD, ybtS, entB, iutA, fimH, wabG, wcaG, K1 and K2 genes were detected by PCR and sequencing. Results There was no statistically significant difference in enzymatic profile between ESBL and non-ESBL producers. The prevalence of the hypermocoviscosity was lower among ESBL compared to non-ESBL producers but the intensity of biofilm was higher in the ESBL producers. Among the virulence genes, K1, rmpA, iutA, and aero were observed only in non-ESBLs. Moreover, the carriage of allS, K, K2, rmpA, iutA and aero genes was higher in hypermucoviscous in comparison with non hypermucoviscous isolates. Conclusion The identification of potentially pathogenic isolates plays an important role in preventing their spread as well as the success of their treatment.
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Affiliation(s)
- Hamed Hatami Mirbag
- Department of Microbiology and Parasitology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
- Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Saeed Tajbakhsh
- Department of Microbiology and Parasitology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences, Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Azam Askari
- Department of Microbiology and Parasitology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Forough Yousefi
- Department of Microbiology and Parasitology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences, Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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Seo KW, Do KH, Jung CM, Lee SW, Lee YJ, Lim SK, Lee WK. Comparative genetic characterisation of third-generation cephalosporin-resistant Escherichia coli isolated from integrated and conventional pig farm in Korea. J Glob Antimicrob Resist 2023; 34:74-82. [PMID: 37394034 DOI: 10.1016/j.jgar.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Pig-farming systems consist of integrated or conventional farms, and many antimicrobials are used to treat bacterial infections. The objective of this study was to compare characteristics of third-generation cephalosporin resistance and extended-spectrum β-lactamase (ESBL)/pAmpC β-lactamase-producing Escherichia coli between integrated and conventional farms. METHODS Third-generation cephalosporin-resistant E. coli was collected from integrated and conventional pig farms from 2021 to 2022. Polymerase chain reaction and DNA sequencing were performed for the detection of β-lactamase-encoding genes, molecular analysis, and identification of genetic relationships. To determine the transferability of β-lactamase genes, conjugation assays were conducted. RESULTS Antimicrobial resistance rates were higher in conventional farms than in integrated farms; ESBL- and pAmpC-lactamase-producing E. coli rates were higher in conventional farms (9.8%) than in integrated farms (3.4%). Fifty-two (6.5%) isolates produced ESBL/pAmpC β-lactamase genes. Isolates from integrated farms harboured CTX-15 (3 isolates), CTX-55 (9 isolates), CTX-229 (1 isolate), or CMY-2 (1 isolate) genes; isolates from conventional farms harboured CTX-1 (1 isolate), CTX-14 (6 isolates), CTX-15 (2 isolates), CTX-27 (3 isolates), CTX-55 (14 isolates), CTX-229 (1 isolate), and CMY-2 (11 isolates) genes. Of the 52 ESBL/pAmpC β-lactamase-producing E. coli isolates, class 1 integrons with 11 different gene cassette arrangements were detected in 39 (75.0%) isolates, and class 2 integrons were detected in 3 isolates. The most common sequence type in both integrated and conventional farms was ST5229, followed by ST101, and then ST10. CONCLUSION Third-generation cephalosporin-resistant patterns and molecular characteristics differed between integrated and conventional farms. Our findings suggest that continuous monitoring of third-generation cephalosporin resistance on pig farms is necessary to prevent the dissemination of resistant isolates.
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Affiliation(s)
- Kwang Won Seo
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Kyung-Hyo Do
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
| | - Chang Min Jung
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea; Onnuri Animals Hospital, Cheonan, Korea
| | - Seong Won Lee
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea; Boehringer Ingelheim Animal Health Korea Ltd., Seoul, Korea
| | - Young Ju Lee
- College of Veterinary Medicine & Zoonoses Research Institute, Kyungpook National University, Daegu, Korea
| | - Suk-Kyung Lim
- Animal and Plant Quarantine Agency, Ministry of Agriculture, Food and Rural Affairs, Gimcheon, Korea
| | - Wan-Kyu Lee
- College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea; GutBiomeTech, Cheongju, Korea.
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Development of a Method for the Fast Detection of Extended-Spectrum β-Lactamase- and Plasmid-Mediated AmpC β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae from Dogs and Cats in the USA. Animals (Basel) 2023; 13:ani13040649. [PMID: 36830436 PMCID: PMC9951654 DOI: 10.3390/ani13040649] [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: 01/25/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Antibiotic resistance, such as resistance to beta-lactams and the development of resistance mechanisms, is associated with multifactorial phenomena and not only with the use of third-generation cephalosporins. Many methods have been recommended for the detection of ESBL and pAmpC β-lactamase production but they are very subjective and the appropriate facilities are not available in most laboratories, especially not in clinics. Therefore, for fast clinical antimicrobial selection, we need to rapidly detect ESBL- and pAmpC β-lactamase-producing bacteria using a simple method with samples containing large amounts of bacteria. For the detection of ESBL- and pAmpC phenotypes and genes, the disk diffusion test, DDST and multiplex PCR were conducted. Of the 109 samples, 99 (90.8%) samples were grown in MacConkey broth containing cephalothin, and 71 samples were grown on MacConkey agar containing ceftiofur. Of the 71 samples grown on MacConkey agar containing ceftiofur, 58 Escherichia coli and 19 Klebsiella pneumoniae isolates, in particular, harbored β-lactamase genes. Of the 38 samples that did not grow in MacConkey broth containing cephalothin or on MacConkey agar containing ceftiofur, 32 isolates were identified as E. coli, and 10 isolates were identified as K. pneumoniae; β-lactamase genes were not detected in these E. coli and K. pneumoniae isolates. Of the 78 ESBL- and pAmpC β-lactamase-producing E. coli and K. pneumoniae, 55 (70.5%) isolates carried one or more ESBL genes and 56 (71.8%) isolates carried one or more pAmpC β-lactamase genes. Our method is a fast, and low-cost tool for the screening of frequently encountered ESBL- and pAmpC β-lactamase-producing bacteria and it would assist in diagnosis and improve therapeutic treatment in animal hospitals.
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Yamba K, Lukwesa-Musyani C, Samutela MT, Kapesa C, Hang’ombe MB, Mpabalwani E, Hachaambwa L, Fwoloshi S, Chanda R, Mpundu M, Kashweka G, Nakazwe R, Mudenda S, Muma JB. Phenotypic and genotypic antibiotic susceptibility profiles of Gram-negative bacteria isolated from bloodstream infections at a referral hospital, Lusaka, Zambia. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001414. [PMID: 36963041 PMCID: PMC10021926 DOI: 10.1371/journal.pgph.0001414] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/29/2022] [Indexed: 05/31/2023]
Abstract
Bloodstream infections (BSI) caused by antimicrobial-resistant (AMR) Gram-negative bacteria (GNB) are a significant cause of morbidity and mortality. Third-generation cephalosporins (3GCs) have been used as empiric treatment for BSI and other invasive infections for years; however, their overuse could promote the emergence of extended-spectrum beta-lactamases (ESBLs). Thus, this study aimed to determine the epidemiological, clinical and microbiological features and the effects of antimicrobial resistance on the outcomes of BSIs at a referral hospital in Lusaka, Zambia. This was a six-month prospective facility-based study undertaken at a referral hospital in Lusaka, Zambia. As part of the routine diagnosis and patient care, blood samples for bacteriological culture were collected from patients presenting with fever and processed for pathogen identification and antimicrobial susceptibility testing using the VITEK 2 Compact instrument. ESBLs and plasmid-mediated quinolone resistance (PMQR) associated genes were determined using the polymerase chain reaction method. Patient information was collected using a structured data collection sheet and entered in CSpro 7.6. Data were analysed in WHOnet and STATA version 14. A total of 88 GNB were isolated, of which 76% were Enterobacterales, 14% Acinetobacter baumannii and 8% Pseudomonas aeruginosa. Resistance to third and fourth-generation cephalosporins was 75% and 32%, respectively. Noteworthy was the high prevalence (68%) of inappropriate empirical treatment, carbapenem resistance (7%), multi-drug resistance (83%) and ESBL-producers (76%). In comparison to E. coli as a causative agent of BSI, the odds of death were significantly higher among patients infected with Acinetobacter baumannii (OR = 3.8). The odds of death were also higher in patients that received 3GCs as empiric treatment than in those that received 4GCs or other (none cephalosporin) treatment options. Structured surveillance, yearly antibiogram updates, improved infection control and a well functional antimicrobial stewardship (AMS) program, are of utmost importance in improving appropriate antimicrobial treatment selection and favourable patient outcomes.
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Affiliation(s)
- Kaunda Yamba
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Chileshe Lukwesa-Musyani
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Mulemba Tillika Samutela
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia Lusaka, Zambia
- Department of Paraclinical Studies, University of Zambia, School of Veterinary Medicine, Lusaka, Zambia
| | - Christine Kapesa
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Mudenda Bernard Hang’ombe
- Department of Paraclinical Studies, University of Zambia, School of Veterinary Medicine, Lusaka, Zambia
| | - Evans Mpabalwani
- Department of Paediatrics & Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Lottie Hachaambwa
- Department of Internal Medicine, Infectious Diseases Unit, University Teaching Hospital, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Internal Medicine, Infectious Diseases Unit, University Teaching Hospital, Lusaka, Zambia
| | - Raphael Chanda
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Mirfin Mpundu
- ReAct Africa, Honnington Close, Greystone Park, Harare, Zimbabwe
| | - Glory Kashweka
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Ruth Nakazwe
- Department of Pathology & Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Steward Mudenda
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Hou J, Long X, Wang X, Li L, Mao D, Luo Y, Ren H. Global trend of antimicrobial resistance in common bacterial pathogens in response to antibiotic consumption. JOURNAL OF HAZARDOUS MATERIALS 2023; 442:130042. [PMID: 36182890 DOI: 10.1016/j.jhazmat.2022.130042] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
The emergence of antimicrobial resistance (AMR) is a growing public health threat worldwide and antibiotic consumption is being increasingly recognized as the main selective pressure driving this resistance. However, global trend in antibiotic resistance in response to antibiotic consumption is not fully understood. In this study, we collected national resistance data on specific resistant pathogens considered by the World Health Organization (WHO) as priority and antibiotic consumption data for 61 countries to assess the global trends in antibiotic resistance of those common bacterial pathogens and their association with antibiotic consumption. The low- and middle-income countries (LMICs) represented the largest hotspots of resistance, which presented relatively higher resistance rates in common bacterial pathogens but lower antibiotic consumption rates compared to high-income countries (HICs). Specifically, we developed the Normalized Antibiotic Resistance/Consumption Index (NARCI) and produced global maps of NARCI to roughly assess the appropriateness of antibiotic consumption across countries and to indicate the potentially inappropriate antibiotic consumption in LMICs compared with HICs. Additionally, we linked antibiotic consumption rates and resistance rates of target pathogens, in conjunction with NARCI and the correlation analysis between antibiotic use and resistance, to inform strategies to alleviate the threat of antibiotic resistance worldwide.
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Affiliation(s)
- Jie Hou
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiang Long
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Xiaolong Wang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Linyun Li
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China
| | - Daqing Mao
- School of Medicine, Nankai University, Tianjin 300071, China.
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071, China; State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China.
| | - Hongqiang Ren
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, China
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Sivasankar S, Goldman JL, Hoffman MA. Variation in antibiotic resistance patterns for children and adults treated at 166 non-affiliated US facilities using EHR data. JAC Antimicrob Resist 2023; 5:dlac128. [PMID: 36601546 PMCID: PMC9806600 DOI: 10.1093/jacamr/dlac128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/25/2022] [Indexed: 01/03/2023] Open
Abstract
Background Antibiotic resistance (AR) is a global public health threat. Surveillance of baseline AR and trends and emerging resistance among priority bacterial isolates with respect to the age of the patients and the type of healthcare setting are required due to differences in antimicrobial need and use in these populations. Methods We performed a retrospective study using deidentified electronic health record (EHR) data in the Cerner Health Facts™ data warehouse. Antibiotic susceptibility data were extracted for all bacterial isolates of interest at 166 non-affiliated healthcare facilities reporting microbiology susceptibility results of the FDA recommended antibiotics between the years 2012 to 2017. We assessed and visualized the slope coefficient from linear regression to compare changes in resistance over time for the four patient care groups. Results The trends in resistance rates to clinically relevant antibiotics were influenced by age and care setting. For example, ertapenem-resistant Enterobacter cloacae isolates from children overall increased significantly compared with adults (0.7% to 9.8%, 2.1% to 2.8%, P = 0.00013) and isolates from children in paediatric facilities increased significantly compared with facilities treating adults and children (0.1% to 27.1%, 0.9% to 3.8%, P = 0.0002). Conclusions Large-scale analysis of EHR data from 166 facilities shows that AR patterns for some bug-drug combinations vary by care setting and patient age. We describe novel data visualizations to interpret large-scale EHR data on the prevalence and trends of AR that should influence antimicrobial prescribing and antimicrobial stewardship programme interventions.
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Affiliation(s)
- Shivani Sivasankar
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mark A Hoffman
- Corresponding author. E-mail: ; @markhoffmankc, @ShivaniSivasank
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The Resistance Patterns in E. coli Isolates among Apparently Healthy Adults and Local Drivers of Antimicrobial Resistance: A Mixed-Methods Study in a Suburban Area of Nepal. Trop Med Infect Dis 2022; 7:tropicalmed7070133. [PMID: 35878145 PMCID: PMC9324341 DOI: 10.3390/tropicalmed7070133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
Abstract
Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated from the fecal samples of apparently healthy individuals in Dhulikhel municipality and also explored the local drivers of AMR. We used a mixed-method design with a cross-sectional quantitative component and a descriptive qualitative component, with focus group discussion and key informant interviews as the data collection method. Fecal samples were collected from 424 individuals randomly selected for the study. E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were: lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR.
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Mitman SL, Amato HK, Saraiva-Garcia C, Loayza F, Salinas L, Kurowski K, Marusinec R, Paredes D, Cárdenas P, Trueba G, Graham JP. Risk factors for third-generation cephalosporin-resistant and extended-spectrum β-lactamase-producing Escherichia coli carriage in domestic animals of semirural parishes east of Quito, Ecuador. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000206. [PMID: 36962308 PMCID: PMC10021719 DOI: 10.1371/journal.pgph.0000206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/19/2022] [Indexed: 12/27/2022]
Abstract
Extended-spectrum β-lactamase (ESBL)-producing and other antimicrobial resistant (AR) Escherichia coli threaten human and animal health worldwide. This study examined risk factors for domestic animal colonization with ceftriaxone-resistant (CR) and ESBL-producing E. coli in semirural parishes east of Quito, Ecuador, where small-scale food animal production is common. Survey data regarding household characteristics, animal care, and antimicrobial use were collected from 304 households over three sampling cycles, and 1195 environmental animal fecal samples were assessed for E. coli presence and antimicrobial susceptibility. Multivariable regression analyses were used to assess potential risk factors for CR and ESBL-producing E. coli carriage. Overall, CR and ESBL-producing E. coli were detected in 56% and 10% of all fecal samples, respectively. The odds of CR E. coli carriage were greater among dogs at households that lived within a 5 km radius of more than 5 commercial food animal facilities (OR 1.72, 95% CI 1.15-2.58) and lower among dogs living at households that used antimicrobials for their animal(s) based on veterinary/pharmacy recommendation (OR 0.18, 95% CI 0.04-0.96). Increased odds of canine ESBL-producing E. coli carriage were associated with recent antimicrobial use in any household animal (OR 2.69, 95% CI 1.02-7.10) and purchase of antimicrobials from pet food stores (OR 6.83, 95% CI 1.32-35.35). Food animals at households that owned more than 3 species (OR 0.64, 95% CI 0.42-0.97), that used antimicrobials for growth promotion (OR 0.41, 95% CI 0.19-0.89), and that obtained antimicrobials from pet food stores (OR 0.47, 95% CI 0.25-0.89) had decreased odds of CR E. coli carriage, while food animals at households with more than 5 people (OR 2.22, 95% CI 1.23-3.99) and located within 1 km of a commercial food animal facility (OR 2.57, 95% CI 1.08-6.12) had increased odds of ESBL-producing E. coli carriage. Together, these results highlight the complexity of antimicrobial resistance among domestic animals in this setting.
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Affiliation(s)
- Siena L. Mitman
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
- Division of Environmental Sciences, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Heather K. Amato
- Division of Environmental Sciences, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Carlos Saraiva-Garcia
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Fernanda Loayza
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Liseth Salinas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Kathleen Kurowski
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Rachel Marusinec
- Division of Infectious Diseases and Vaccinology, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | - Diana Paredes
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Paúl Cárdenas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Jay P. Graham
- Division of Environmental Sciences, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
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From Pathophysiological Hypotheses to Case–Control Study Design: Resistance from Antibiotic Exposure in Community-Onset Infections. Antibiotics (Basel) 2022; 11:antibiotics11020201. [PMID: 35203803 PMCID: PMC8868523 DOI: 10.3390/antibiotics11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance is a global public health concern, at least partly due to the misuse of antibiotics. The increasing prevalence of antibiotic-resistant infections in the community has shifted at-risk populations into the general population. Numerous case–control studies attempt to better understand the link between antibiotic use and antibiotic-resistant community-onset infections. We review the designs of such studies, focusing on community-onset bloodstream and urinary tract infections. We highlight their methodological heterogeneity in the key points related to the antibiotic exposure, the population and design. We show the impact of this heterogeneity on study results, through the example of extended-spectrum β-lactamases producing Enterobacteriaceae. Finally, we emphasize the need for the greater standardization of such studies and discuss how the definition of a pathophysiological hypothesis specific to the bacteria–resistance pair studied is an important prerequisite to clarify the design of future studies.
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Sung HS, Lee JW, Bae S, Kwon KT. Comparison of antimicrobial resistances and clinical features in community-onset Escherichia coli and Klebsiella pneumoniae bacteremia. Korean J Intern Med 2021; 36:433-440. [PMID: 32229796 PMCID: PMC7969070 DOI: 10.3904/kjim.2019.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to compare antimicrobial resistance, clinical features, and outcomes of community-onset Escherichia coli (COEC) and Klebsiella pneumoniae (COKP) bacteremia. METHODS The medical records of patients diagnosed with E. coli or K. pneumoniae bacteremia in the emergency department of a 750-bed secondary care hospital in Daegu, Korea from January 2010 to December 2016 were retrospectively reviewed. RESULTS A total of 866 patients with COEC bacteremia and 299 with COKP bacteremia were enrolled. COEC bacteremia, compared to COKP bacteremia, had higher rates of 3rd generation cephalosporin (3GC) (18.8% vs. 8.4%, p < 0.001) and f luoroquinolone (FQ) (30.4% vs. 8.0%, p < 0.001) resistance. The patients with COKP bacteremia had higher Charlson comorbidity indices (CCI) (1.8 ± 2.0 vs. 1.5 ± 1.8, p = 0.035), Pittsburgh bacteremia scores (PBS) (2.0 ± 2.6 vs. 1.3 ± 1.8, p < 0.001), and 30-day mortality (14.44% vs. 8.8%, p = 0.008) than the patients with COEC bacteremia. Age younger than 70 years, male sex, polymicrobial infections, pneumonia, intra-abdominal infection, PBS ≥ 2, and Foley catheter insertion were independent predictive factors for COKP bacteremia compared to COEC bacteremia in the multivariate analysis. CCI, PBS, and intensive care unit admission were independent risk factors for 30-day mortality in the multivariate analysis. CONCLUSION 3GCs and FQs are still useful for the empirical treatment of patients with probable COKP bacteremia. The patients with COKP bacteremia had worse outcomes because of its greater severity and more frequent underlying comorbidities.
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Affiliation(s)
- Hwa Seok Sung
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
- Department of Emergency Medicine, Keimyung University Graduate School, Daegu, Korea
| | - Je Won Lee
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Sohyun Bae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Correspondence to Ki Tae Kwon, M.D. Department of Internal Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea Tel: +82-53-200-2616 Fax: +82-53-200-2027 E-mail:
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12
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Zhen X, Stålsby Lundborg C, Sun X, Hu X, Dong H. Clinical and Economic Impact of Third-Generation Cephalosporin-Resistant Infection or Colonization Caused by Escherichia coli and Klebsiella pneumoniae: A Multicenter Study in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249285. [PMID: 33322649 PMCID: PMC7763446 DOI: 10.3390/ijerph17249285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 01/02/2023]
Abstract
Quantifying economic and clinical outcomes for interventions could help to reduce third-generation cephalosporin resistance and Escherichia coli or Klebsiella pneumoniae. We aimed to compare the differences in clinical and economic burden between third-generation cephalosporin-resistant E. coli (3GCREC) and third-generation cephalosporin-susceptible E. coli (3GCSEC) cases, and between third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and third-generation cephalosporin-susceptible K. pneumoniae (3GCSKP) cases. A retrospective and multicenter study was conducted. We collected data from electronic medical records for patients who had clinical samples positive for E. coli or K. pneumoniae isolates during 2013 and 2015. Propensity score matching (PSM) was conducted to minimize the impact of potential confounding variables, including age, sex, insurance, number of diagnoses, Charlson comorbidity index, admission to intensive care unit, surgery, and comorbidities. We also repeated the PSM including length of stay (LOS) before culture. The main indicators included economic costs, LOS and hospital mortality. The proportions of 3GCREC and 3GCRKP in the sampled hospitals were 44.3% and 32.5%, respectively. In the two PSM methods, 1804 pairs and 1521 pairs were generated, and 1815 pairs and 1617 pairs were obtained, respectively. Compared with susceptible cases, those with 3GCREC and 3GCRKP were associated with significantly increased total hospital cost and excess LOS. Inpatients with 3GCRKP were significantly associated with higher hospital mortality compared with 3GCSKP cases, however, there was no significant difference between 3GCREC and 3GCSEC cases. Cost reduction and outcome improvement could be achieved through a preventative approach in terms of both antimicrobial stewardship and preventing the transmission of organisms.
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Affiliation(s)
- Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, (National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University), Jinan 250012, China;
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (X.S.); (X.H.)
| | | | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (X.S.); (X.H.)
| | - Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (X.S.); (X.H.)
- College of Politics and Public Administration, Qingdao University, Qingdao 266061, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (X.S.); (X.H.)
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, No. N1, Shancheng Avenue, Yiwu 322000, China
- Correspondence: ; Tel.: +86-57188-2060-98; Fax: +86-5718-8206-098
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13
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Rosenberg CR, Fang X, Allison KR. Potentiating aminoglycoside antibiotics to reduce their toxic side effects. PLoS One 2020; 15:e0237948. [PMID: 32877437 PMCID: PMC7467299 DOI: 10.1371/journal.pone.0237948] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
The lack of new antibiotics necessitates the improvement of existing ones, many of which are limited by toxic side effects. Aminoglycosides, antibiotics with excellent activity and low bacterial resistance, are hampered by dose-dependent toxic effects in patients (nephrotoxicity, ototoxicity). High antibiotic concentrations are often required to treat dormant, non-dividing bacteria, though previous studies show that aminoglycosides can be activated against such bacteria by specific metabolites. Here, we employed this mechanism to greatly boost the activity of low concentrations of aminoglycosides against prevalent Gram-negative pathogens (Escherichia coli, Salmonella enterica, and Klebsiella pneumoniae), suggesting that less toxic drug concentrations might be used effectively in patients. We go on to show that this effect improved treatment of biofilms, did not increase aminoglycoside resistance, and was due to the generation of proton-motive force (PMF). By single-cell microscopy, we demonstrate that stationary-phase cells, while non-dividing, actively maintain a growth-arrested state that is not reversed by metabolite addition. Surprisingly, within starved populations, we observed rare cells (3%) that divided without added nutrients. Additionally, we discovered that mannitol could directly protect human kidney cells from aminoglycoside cytotoxicity, independent of the metabolite's effect on bacteria. This work forwards a mechanism-based strategy to improve existing antibiotics by mitigating their toxic side effects.
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Affiliation(s)
- Christopher R. Rosenberg
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Xin Fang
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Kyle R. Allison
- Department of Systems Biology, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
- Emory Antibiotic Resistance Center, Atlanta, GA, United States of America
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14
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Wickramanayake MVKS, Dahanayake PS, Hossain S, De Zoysa M, Heo GJ. Aeromonas spp. Isolated from Pacific Abalone (Haliotis discus hannai) Marketed in Korea: Antimicrobial and Heavy-Metal Resistance Properties. Curr Microbiol 2020; 77:1707-1715. [PMID: 32300925 DOI: 10.1007/s00284-020-01982-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/06/2020] [Indexed: 01/07/2023]
Abstract
Antimicrobial and heavy-metal resistance of 29 Aeromonas spp. (Aeromonas hydrophila n = 9, Aeromonas enteropelogenes n = 14, Aeromonas veronii n = 3, Aeromonas salmonicida n = 2, and Aeromonas sobria n = 1) isolated from Pacific abalone marketed in Korea were analyzed. All isolates were found to be resistant against ampicillin. High level of resistant to cephalothin (86%), rifampicin (73%), imipenem (42%), and oxytetracycline (35%) were also detected. Thirteen (45%) of the isolates showed multiple antimicrobial resistance (MAR) index ≥ 0.2. The PCR assays implied the presence of qnrS, qnrB, qnrA, tetB, tetA, aac (3')- IIa, aac(6')-Ib, aphAI-IAB, blaCTX, blaTEM, and intI1 genes among 76%, 28%, 14%, 17%, 3%, 3%, 41%, 10%, 41%, 28%, and 66% of the isolates, respectively. Class 1 integron gene cassette profiles aadA1(3%) and aadA2 (3%) were also identified. Lead (Pb) resistance was the highest (69%) among 5 heavy metals tested, whereas 38%, 27%, and 20% of the isolates were resistant to Cadmium (Cd), Chromium (Cr), and Copper (Cu), respectively. Heavy-metal resistance genes, CopA, CzcA, and merA were positive in 83%, 75%, and 41% of the isolates, respectively. In conclusion, observed genotypic and phenotypic resistance profiles of Aeromonas spp. against antimicrobials and heavy metals reveal the ability of serving as a source of antimicrobials and heavy-metal-resistant traits.
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Affiliation(s)
- M V K S Wickramanayake
- Laboratory of Aquatic Animal Medicine, Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - P S Dahanayake
- Laboratory of Aquatic Animal Medicine, Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Sabrina Hossain
- Laboratory of Aquatic Animal Medicine, Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea
| | - Mahanama De Zoysa
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungnam National University, Yuseong-gu, Daejeon, 34134, Republic of Korea
| | - Gang-Joon Heo
- Laboratory of Aquatic Animal Medicine, Veterinary Medical Center and College of Veterinary Medicine, Chungbuk National University, Chungdae-ro 1, Seowon-gu, Cheongju, Chungbuk, 28644, Republic of Korea.
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15
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Rothe K, Wantia N, Spinner CD, Schneider J, Lahmer T, Waschulzik B, Schmid RM, Busch DH, Katchanov J. Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013-2018): potential carbapenem-sparing empiric treatment options in light of the new EUCAST recommendations. BMC Infect Dis 2019; 19:1091. [PMID: 31888581 PMCID: PMC6937826 DOI: 10.1186/s12879-019-4721-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022] Open
Abstract
Background This study investigated predominant microorganisms causing community-onset bacteraemia at the medical emergency department (ED) of a tertiary-care university hospital in Germany from 2013 to 2018 and their antimicrobial susceptibility patterns. Methods Antimicrobial resistance patterns in patients with positive blood cultures presenting to an internal medicine ED were retrospectively analysed. Results Blood cultures were obtained at 5191 of 66,879 ED encounters, with 1013 (19.5%) positive results, and true positive results at 740 encounters (diagnostic yield, 14.3%). The most frequently isolated relevant microorganisms were Enterobacterales (n = 439, 59.3%), Staphylococcus aureus (n = 92, 12.4%), Streptococcus pneumoniae (n = 34, 4.6%), Pseudomonas aeruginosa (n = 32, 4.3%), Streptococcus pyogenes (n = 16, 2.2%), Enterococcus faecalis (n = 18, 2.4%), and Enterococcus faecium (n = 12, 1.6%). Antimicrobial susceptibility testing revealed a high proportion of resistance against ampicillin-sulbactam in Enterobacterales (42.2%). The rate of methicillin-resistant Staphylococcus aureus was low (0.4%). Piperacillin-tazobactam therapy provided coverage for 83.2% of all relevant pathogens using conventional breakpoints. Application of the new European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommendations increased the percentage of susceptible isolates to high-dose piperacillin-tazobactam to 92.8% (p < 0.001). Broad-spectrum carbapenems would only cover an additional 4.8%. The addition of vancomycin or linezolid extended coverage by just 1.7%. Conclusions Using an ureidopenicillin-beta-lactamase inhibitor combination at the high dose suggested by the new EUCAST recommendations provided nearly 93% coverage for relevant pathogens in patients with suspected bloodstream infection in our cohort. This might offer a safe option to reduce the empiric use of carbapenems. Our data support the absence of a general need for glycopeptides or oxazolidinones in empiric treatment.
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Affiliation(s)
- Kathrin Rothe
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany. .,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
| | - Nina Wantia
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Christoph D Spinner
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Jochen Schneider
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Tobias Lahmer
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Birgit Waschulzik
- Institute of Medical Informatics, Statistics, and Epidemiology, Technical University of Munich, Munich, Germany
| | - Roland M Schmid
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
| | - Dirk H Busch
- Technical University of Munich, School of Medicine, Institute for Medical Microbiology, Immunology and Hygiene, Trogerstr. 30, 81675, Munich, Germany.,German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Juri Katchanov
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Department of Medicine II, Technical University of Munich, School of Medicine, University Hospital rechts der Isar, Munich, Germany
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Park JY, Heo ST, Kwon KT, Song DY, Lee KJ, Choi JA. MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea. Infect Chemother 2019; 51:399-404. [PMID: 31668026 PMCID: PMC6940374 DOI: 10.3947/ic.2019.51.4.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 01/17/2023] Open
Abstract
Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Taek Heo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Do Young Song
- Department of Laboratory Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kwang Jun Lee
- Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea
| | - Ji Ae Choi
- Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea
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17
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Lin WP, Huang YS, Wang JT, Chen YC, Chang SC. Prevalence of and risk factor for community-onset third-generation cephalosporin-resistant Escherichia coli bacteremia at a medical center in Taiwan. BMC Infect Dis 2019; 19:245. [PMID: 30866828 PMCID: PMC6416853 DOI: 10.1186/s12879-019-3880-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/05/2019] [Indexed: 11/11/2022] Open
Abstract
Background Increased resistance to third-generation cephalosporin (3GC) is a serious concern for community-onset Escherichia coli infection because this resistance easily delays effective treatment. This study surveyed the current antimicrobial resistance pattern among E. coli isolates that cause community-onset bacteremia, with a special focus on the prevalence of and the risk factors for 3GC resistance, and determined factors for poor outcomes among patients with community-onset E. coli bacteremia. Methods This retrospective study was conducted at a tertiary-care teaching hospital in Taiwan. All adult patients with community-onset E. coli bacteremia between January 1, 2015, and December 31, 2015 were enrolled and were divided into two groups depending on whether the E. coli isolate was susceptible to 3GCs. Risk factors for 3GC resistance, 14-day all-cause mortality, and length of hospital stay were analyzed. Results The overall rate of 3GC resistance among E. coli isolates causing community-onset bacteremia was 19.7%, whereas it was 9.6% if only isolates causing community-acquired bacteremia were considered. Independent risk factors for 3GC-resistant community-onset E. coli bacteremia were hospitalization within the past 1 year (odds ratio: 2.4, 95% confidence interval: 1.6–3.7, P < 0.001), exposure to antibiotics within the past 15 days (2.6, 1.4–4.9, P = 0.002), residence in nursing home or long-term care facility (3.6, 1.0–12.3, P = 0.044), presence of underlying genitourinary disease (1.9, 1.2–2.9, P = 0.005), and presence of indwelling implantable intravenous port (2.2, 1.1–4.1, P = 0.021). 3GC resistance was independently associated with increased length of hospital stays (P < 0.001). Conclusion In this study, the prevalence of 3GC resistance was high among both patients with community-onset and those with community-acquired E. coli bacteremia. 3GC resistance is a strong independent risk factor for length of hospital stay. The effectiveness of empirical antibiotic treatment would partially explain the impact of 3GC resistance, but more evidence is needed. The choice of appropriate empirical antibiotics for community-onset E. coli bacteremia might impact outcomes in terms of the length of hospital stay and need to be individualized according to the patient-specific risk for acquiring drug-resistant pathogens.
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Affiliation(s)
- Wu-Pu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yu-Shan Huang
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jann-Tay Wang
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan. .,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
| | - Yee-Chun Chen
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shan-Chwen Chang
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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18
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Shim JB, Seo KW, Kim YB, Jeon HY, Lim SK, Lee YJ. Molecular characteristics of extended-spectrum and plasmid-mediated AmpC β-lactamase-producing Escherichia coli isolated from commercial layer in Korea. Poult Sci 2019; 98:949-956. [PMID: 30239888 DOI: 10.3382/ps/pey417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
In the poultry industry, commercial layer farms play an important role in meeting the protein demand through the supply of eggs. However, the risk of contamination by β-lactamase-producing Escherichia coli in eggs laid by commercial chickens is significant. In this study, we investigated the rate of extended-spectrum β-lactamase (ESBL) and plasmid-mediated AmpC (pAmpC) β-lactamase-producing E. coli isolated from layer hens and characterized their molecular background. Among the 92 cefotaxime-resistant E. coli isolates, 66 (71.7%) were identified as multidrug resistant and 29 showed phenotypic and genotypic characteristics of β-lactamase-producing E. coli. The ESBL/pAmpC genes blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, and blaCMY-2 were detected in 1, 6, 5, and 4 isolates, respectively. The non-ESBL/pAmpC gene blaTEM-1 was found in 16 isolates. Three isolates harbored both blaTEM-1 and blaCTX-M-14 genes. A total of 12 isolates also carried class 1 integrons, with 3 different gene cassette arrangements found in 8 of these isolates. A pulsed-field gel electrophoresis (PFGE) analysis of the 29 β-lactamase-producing E. coli isolates revealed that 4 PFGE patterns were consistent with the β-lactamase gene and layer farm origin, and showed a similar antibiotic resistance pattern. Our results suggest that comprehensive surveillance and more prudent use of third-generation cephalosporins in commercial layer farms is necessary to prevent the dissemination of ESBL/pAmpC-producing E. coli.
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Affiliation(s)
- Jong Bo Shim
- R&D center, Korean Poultry TS Co., Ltd., Icheon 17415, Republic of Korea
| | - Kwang Won Seo
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Yeong Bin Kim
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Hye Young Jeon
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Suk-Kyung Lim
- Animal and Plant Quarantine Agency, Ministry of Agriculture, Food and Rural Affairs, Gimcheon 39660, Republic of Korea
| | - Young Ju Lee
- College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
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Seo KW, Kim YB, Jeon HY, Lim SK, Lee YJ. Comparative genetic characterization of third-generation cephalosporin-resistant Escherichia coli from chicken meat produced by integrated broiler operations in South Korea. Poult Sci 2018; 97:2871-2879. [PMID: 29897533 DOI: 10.3382/ps/pey127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/16/2018] [Indexed: 12/25/2022] Open
Abstract
Vertical integration of the broiler industry allows producers to combine different biosecurity and sanitation practices, housing technologies, and feeding regimens to improve food safety. The objectives of this study were to determine the antimicrobial resistance pattern of β-lactamase-producing E. coli and to compare the characteristics of E. coli recovered from 7 different integrated broiler operations in South Korea. Among 200 chicken meat samples, 101 were observed to be positive for E. coli. However, the prevalence varied from 37.5% to 75.0% in chicken meats from different operations, indicating variation in E. coli occurrence among the operations. Among 101 isolated E. coli from chicken meat, 59 were identified third-generation cephalosporin-resistant E. coli and recovered from 7 different operations. A high proportion of the E. coli isolates were resistant to penicillins (89.8%), quinolones (81.4%). Among 59 third-generation cephalosporin-resistant E. coli isolates, 29 showed phenotypic and genotypic characteristics of β-lactamase-producing E. coli. Prevalence of bla gene, blaCTX-M-1, blaCTX-M-14, blaCMY-2, and blaTEM-1, were identified in 2, 4, 8, and 16 E. coli isolates respectively and only one E. coli had both genes, blaTEM-1 and blaCTX-M-1. Pulsed-field gel electrophoresis (PFGE) analysis was performed on 29 β-lactamase-producing E. coli isolates. In PFGE, E. coli included 7 PFGE patterns showing the same operation and an accorded both resistance to β-lactam antibiotics and presence of the bla-gene. Our findings suggest that E. coli with resistance to third-generation cephalosporins can now be found in association with integrated broiler operations, providing the data to support the development of monitoring and preventing program in integrated operations.
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Affiliation(s)
- Kwang Won Seo
- Department of Public Health, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Yeong Bin Kim
- Department of Public Health, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Hye Young Jeon
- Department of Public Health, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
| | - Suk-Kyung Lim
- Animal and Plant Quarantine Agency, Ministry of Agriculture, Food and Rural Affairs, Gimcheon 39660, Republic of Korea
| | - Young Ju Lee
- Department of Public Health, College of Veterinary Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
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Zhang H, Kong H, Yu Y, Wu A, Duan Q, Jiang X, Zhang S, Sun Z, Ni Y, Wang W, Wang Y, Liao K, Li H, Yang C, Huang W, Gui B, Shan B, Badal R, Yang Q, Xu Y. Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China. BMC Infect Dis 2018; 18:493. [PMID: 30268102 PMCID: PMC6162895 DOI: 10.1186/s12879-018-3405-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/21/2018] [Indexed: 12/15/2022] Open
Abstract
Background To evaluate the susceptibility rates of aerobic and facultative Gram-negative bacterial isolates from Chinese intra-abdominal infections (IAI) and urinary tract infections (UTI) focusing on carbapenems and comparing their effectiveness between 2014 and 2015. Methods A total of 2318 strains in 2015 (1483 from IAI and 835 from UTI) and 2374 strains in 2014 (1438 from IAI and 936 from UTI) were included in the analysis. Antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. Hospital acquired (HA) IAI and UTI were defined as isolates sampled > 48 h and community acquired (CA) as isolates sampled < 48 h after admission. Results The main species derived from IAI and UTI in 2015 were Escherichia coli (50.86%) and Klebsiella pneumoniae (19.20%). Susceptibilities of Escherichia coli IAI and UTI strains to imipenem (IPM) and ertapenem (ETP) were > 90% in 2014 and 2015, while the susceptibilities to IPM and ETP of Klebsiella pneumoniae IAI strains were > 80% in 2014 but dropped to ≤80% in 2015 for UTI strains. Susceptibilities of IAI Enterobacteriaceae strains to IPM and ETP in 2015 were lowest in the colon and abscesses, and Enterobacteriaceae susceptibilities of UTI and IAI isolates to IPM and ETP were lowest in medical, pediatric and surgery intensive care units (ICUs) in 2015. Conclusions IPM and ETP were effective in vitro against Enterobacteriaceae isolated from IAIs and UTIs in 2014 and 2015, but susceptibility to carbapenems in UTIs markedly decreased in 2015. Electronic supplementary material The online version of this article (10.1186/s12879-018-3405-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Zhang
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China
| | - Haishen Kong
- Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China
| | - Yunsong Yu
- Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | - Anhua Wu
- Infection Control Center, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Qiong Duan
- Microbiology Laboratory, Jilin Province People's Hospital, Changchun, 130021, China
| | - Xiaofeng Jiang
- The Fourth Hospital of Harbin Medical University, No. 37 Yiyuan Road, Nangang District, Harbin, China
| | - Shufang Zhang
- Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China
| | - Ziyong Sun
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuxing Ni
- Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Weiping Wang
- Nanjing General Hospital, No. 305 Zhongshan Dong Road, Nanjing, China
| | - Yong Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Kang Liao
- Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Huayin Li
- Zhongshan Hospital Affiliated to Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China
| | - Chunxia Yang
- Beijing Chao-yang Hospital, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Wenxiang Huang
- Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bingdong Gui
- Clinical laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Bin Shan
- First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China
| | - Robert Badal
- Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA
| | - Qiwen Yang
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
| | - Yingchun Xu
- Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
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21
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Kwon KT, Armstrong DG. Microbiology and Antimicrobial Therapy for Diabetic Foot Infections. Infect Chemother 2018; 50:11-20. [PMID: 29637748 PMCID: PMC5895826 DOI: 10.3947/ic.2018.50.1.11] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Indexed: 02/06/2023] Open
Abstract
In addition to being the prime factor associated with amputation, diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, and reduced quality of life. The choice of appropriate antibiotics is very important in order to reduce treatment failure, antimicrobial resistance, adverse events, and costs. We reviewed articles on microbiology and antimicrobial therapy and discuss antibiotic selection in Korean patients with DFIs. Similar to Western countries, Staphylococcus aureus is the most common pathogen, with Streptococcus, Enterococcus, Enterobacteriaceae and Pseudomonas also prevalent in Korea. It is recommended that antibiotics are not prescribed for clinically uninfected wounds and that empirical antibiotics be selected based on the clinical features, disease severity, and local antimicrobial resistance patterns. Narrow-spectrum oral antibiotics can be administered for mild infections and broad-spectrum parenteral antibiotics should be administered for some moderate and severe infections. In cases with risk factors for methicillin-resistant S. aureus or Pseudomonas, empirical antibiotics to cover each pathogen should be considered. The Health Insurance Review and Assessment Service standards should also be considered when choosing empirical antibiotics. In Korea, nationwide studies need to be conducted and DFI guidelines should be developed.
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Affiliation(s)
- Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery of Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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22
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Protic D, Pejovic A, Djukanovic N, Toskovic B, Zdravkovic M, Todorovic Z. Analysis of the third- and fourth-generation cephalosporin use for the treatment of infections caused by Gram-negative bacteria in hospital settings. Int J Clin Pract 2016; 70:1033-1040. [PMID: 28032422 DOI: 10.1111/ijcp.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aims of our study were to assess the prevalence and distribution of Gram-negative (G-) bacteria in hospital isolates, their sensitivity to the third- and fourth-generation cephalosporins (c3 and c4), therapeutic use of c3 and c4 in the treatment of G- infections and drug utilisation data. RESEARCH DESIGN AND METHODS This cross-sectional study collected medical records data from the General Hospital "Gornji Milanovac" (GM) and the University Medical Center "Bezanijska kosa" (BK). The time frame of the study was 12 months. Microbiological and clinical parameters, and c3/c4 drug utilisation were analysed. RESULTS Escherichia coli were the most predominant pathogen in GM and BK, accounting for 43% and 28% of all G- isolates, respectively (GM), 884 G- isolates obtained from 606 patients; BK, 1766 isolates obtained from 1045 patients). Nearly half of the isolates (55% and 43%) were obtained from urine samples collected from the surgical ward (GM), and the internal medicine wards and intensive care unit (BK). On average, the resistance rate of G- strains against c3 and c4 reached 40% and 70%, respectively (lowest in E. coli, 8%-25%; highest in Acinetobacer baumannii, 67%-100%). Resistance rate of Pseudomonas spp. to cefepime and ceftazidime was low/moderate (0%-30% and 19%-47%). In BK, the adult patients were older than in GM (75 vs 66 years), with longer hospital stay (19 vs 10 days) and bacteria were isolated later during hospitalisation (10 vs 2 days). C3 and c4 were more often used in empirical therapy (83% vs 64%) in BK. Ceftazidime and cefepime were used more often in BK than in GM (2.036 vs 69 DDD/y and 586 vs. 126 DDD/y, respectively). CONCLUSION The use of c3 and c4 in the treatment of G- infections in both hospitals should be re-evaluated in accordance with current guidelines and local resistance.
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Affiliation(s)
- Dragana Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksa Pejovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Borislav Toskovic
- University Medical Center "Bezanijska kosa", Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravkovic
- University Medical Center "Bezanijska kosa", Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zoran Todorovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- University Medical Center "Bezanijska kosa", Belgrade, Serbia
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23
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Lin WP, Wang JT, Chang SC, Chang FY, Fung CP, Chuang YC, Chen YS, Shiau YR, Tan MC, Wang HY, Lai JF, Huang IW, Lauderdale TL. The Antimicrobial Susceptibility of Klebsiella pneumoniae from Community Settings in Taiwan, a Trend Analysis. Sci Rep 2016; 6:36280. [PMID: 27824151 PMCID: PMC5099973 DOI: 10.1038/srep36280] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022] Open
Abstract
Drug-resistant Klebsiella pneumoniae, especially extended-spectrum β-lactamase (ESBL)- and/or AmpC β-lactamase-producing strains, is an emerging problem worldwide. However, few data focusing on drug susceptibility of K. pneumoniae from community is available. In this study, we analyzed 1016 K. pneumoniae isolates from outpatients or those visiting emergency rooms collected during 2002–2012 from Taiwan Surveillance of Antimicrobial Resistance program. Significantly decreased susceptibilities to 3rd generation cephalosporins and ciprofloxacin were found during the study period. By 2012, susceptibility to cefotaxime and ciprofloxacin was 83.6% and 81.6%, respectively. The prevalence of ESBL-producers increased from 4.8% in 2002 to 11.9% in 2012 (P = 0.012), while that of AmpC β-lactamase-producers increased from 0% to 9.5% in the same period (P < 0.001). Phylogenic analysis of the ESBL and AmpC-β-lactamase-producers by pulsed-field gel electrophoresis and multi-locus sequence typing revealed wide genetic diversity even among the most common sequence type 11 isolates (33.0%). By multivariate analysis, later study year, elderly, and urine isolates were associated with carriage of ESBL genes, while only urine isolates were associated with carriage of AmpC β-lactamase genes. Further studies are needed to determine which antibiotics are reasonable empirical therapy options for patients presenting with severe sepsis that might be caused by K. pneumoniae.
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Affiliation(s)
- Wu-Pu Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Tri-Service General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Phone Fung
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yin-Ching Chuang
- Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yao-Shen Chen
- Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yih-Ru Shiau
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Mei-Chen Tan
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Hui-Ying Wang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Jui-Fen Lai
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - I-Wen Huang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Tsai-Ling Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
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24
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Jeon HG, Ju HU, Kim GY, Jeong J, Kim MH, Jun JB. Bacteriology and changes in antibiotic susceptibility in adults with community-acquired perforated appendicitis. PLoS One 2014; 9:e111144. [PMID: 25343342 PMCID: PMC4208803 DOI: 10.1371/journal.pone.0111144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 09/29/2014] [Indexed: 12/11/2022] Open
Abstract
This study evaluated bacterial etiology and antibiotic susceptibility in patients diagnosed with community-acquired perforated appendicitis over a 12-year-period. We retrospectively reviewed records of adult patients diagnosed with perforated appendicitis at an 800-bed teaching hospital between January 2000 and December 2011. In total, 415 culture-positive perforated appendicitis cases were analyzed. Escherichia coli was the most common pathogen (277/415, 66.7%), followed by Streptococcus species (61/415, 14.7%). The susceptibility of E. coli to ampicillin, piperacillin/tazobactam, ceftriaxone, cefepime, amikacin, gentamicin, and imipenem was 35.1%, 97.1%, 97.0%, 98.2%, 98.9%, 81.8%, and 100%, respectively. The overall susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 78.7%. During the study period, univariate logistic regression analysis showed a significant decrease in E. coli susceptibility to quinolones (OR = 0.91, 95% CI 0.84-0.99, P = 0.040). We therefore do not recommend quinolones as empirical therapy for community-acquired perforated appendicitis.
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Affiliation(s)
- Hong Gil Jeon
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyeong Uk Ju
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Joseph Jeong
- Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Min-Ho Kim
- Biomedical Research Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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25
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Park SH. Third-generation cephalosporin resistance in gram-negative bacteria in the community: a growing public health concern. Korean J Intern Med 2014; 29:27-30. [PMID: 24574830 PMCID: PMC3932392 DOI: 10.3904/kjim.2014.29.1.27] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 12/28/2013] [Indexed: 12/02/2022] Open
Affiliation(s)
- Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Daejeon, Korea
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