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Silva I, Tacão M, Henriques I. Hidden threats in the plastisphere: Carbapenemase-producing Enterobacterales colonizing microplastics in river water. Sci Total Environ 2024; 922:171268. [PMID: 38423305 DOI: 10.1016/j.scitotenv.2024.171268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Carbapenem resistance poses a significant burden on healthcare systems worldwide. Microplastics (MPs) have emerged as potential contributors to antibiotic resistance spread in the environment. However, the link between MPs and carbapenem resistance remains unexplored. We investigated the prevalence of carbapenem-resistant bacteria colonizing MPs placed in a river. Three replicates of a mixture of polypropylene (PP), polyethylene (PE) and polyethylene terephthalate (PET) and of PET alone were placed both upstream and downstream a wastewater treatment plant (WWTP) discharge. Carbapenem-resistant Enterobacterales (CRE) were further characterized by phenotypic tests and whole-genome sequencing. The abundance of carbapenem-resistant bacteria on MPs increased significantly downstream the WWTP. Their prevalence was higher in the MPs mixture compared to PET alone. CRE strains colonizing MPs included Klebsiella pneumoniae (n = 3), Klebsiella quasipneumoniae (n = 3), Raoultella ornithinolytica (n = 2), Enterobacter kobei (n = 1) and Citrobacter freundii (n = 1), most (n = 8) recovered after the WWTP discharge. All strains exhibited at least one of the tested virulence traits (biofilm formation at 37 °C, haemolytic activity and siderophore production), were multi-drug resistant and carried carbapenemase-encoding genes [blaKPC-3 (n = 5), blaGES-5 (n = 2) or blaKPC-3 + blaGES-5 (n = 3)]. Uncommon phenotypes of resistance to imipenem/relebactam (n = 3) and ceftazidime/avibactam (n = 2) were observed. Two blaKPC-3-positive K. pneumoniae successfully transfer this gene trough conjugation. Genome analysis predicted all strains as human pathogens. The blaKPC-3 was associated with the Tn4401d transposon on a pBK30683-like plasmid in most of the isolates (n = 7). The blaGES-5 was mostly linked to class 3 integrons. A K. pneumoniae strain belonging to the outbreak-causing high-risk clone ST15 carried both blaKPC-3 and blaCTX-M-15. Two K. quasipneumoniae isolates carried the plasmid-mediated colistin resistance gene mcr-9. Our results underscore the role of MPs as vectors for CRE dissemination, particularly following WWTPs discharges. MPs may act as carriers, facilitating the dissemination of carbapenemase-encoding genes and potentially contributing to increased CRE incidence in the environment.
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Affiliation(s)
- Isabel Silva
- Department of Life Sciences, Centre for Functional Ecology, Associate Laboratory TERRA, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal; CESAM (Centre for Environmental and Marine Studies), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Marta Tacão
- CESAM (Centre for Environmental and Marine Studies), University of Aveiro, 3810-193 Aveiro, Portugal; Department of Biology, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Isabel Henriques
- Department of Life Sciences, Centre for Functional Ecology, Associate Laboratory TERRA, Faculty of Sciences and Technology, University of Coimbra, 3000-456 Coimbra, Portugal.
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Kwon KT, Kim Y, Kim SW, Chang HH, Hwang S, Bae S, Nam E. Antimicrobial Use and Carbapenem-Resistant Enterobacterales in Korea: A Nationwide Case-Control Study With Propensity Score Matching. J Korean Med Sci 2024; 39:e132. [PMID: 38622938 PMCID: PMC11018987 DOI: 10.3346/jkms.2024.39.e132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/11/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Nationwide research on the association between carbapenem-resistant Enterobacterales (CREs) and antibiotic use is limited. METHODS This nested case-control study analyzed Korean National Health Insurance claims data from April 2017 to April 2019. Based on the occurrence of CRE, hospitalized patients aged ≥ 18 years were classified into CRE (cases) and control groups. Propensity scores based on age, sex, modified Charlson comorbidity score, insurance type, long-term care facility, intensive care unit stay, and acquisition of vancomycin-resistant Enterococci were used to match the case and control groups (1:3). RESULTS After matching, the study included 6,476 participants (1,619 cases and 4,857 controls). Multivariable logistic regression analysis revealed that the utilization of broad-spectrum antibiotics, such as piperacillin/tazobactam (adjusted odds ratio [aOR], 2.178; 95% confidence interval [CI], 1.829-2.594), third/fourth generation cephalosporins (aOR, 1.764; 95% CI, 1.514-2.056), and carbapenems (aOR, 1.775; 95% CI, 1.454-2.165), as well as the presence of comorbidities (diabetes [aOR, 1.237; 95% CI, 1.061-1.443], hemiplegia or paraplegia [aOR, 1.370; 95% CI, 1.119-1.679], kidney disease [aOR, 1.312; 95% CI, 1.105-1.559], and liver disease [aOR, 1.431; 95% CI, 1.073-1.908]), were significantly associated with the development of CRE. Additionally, the CRE group had higher mortality (8.33 vs. 3.32 incidence rate per 100 person-months, P < 0.001) and a total cost of healthcare utilization per person-month (15,325,491 ± 23,587,378 vs. 5,263,373 ± 14,070,118 KRW, P < 0.001) than the control group. CONCLUSION The utilization of broad-spectrum antibiotics and the presence of comorbidities are associated with increasing development of CRE. This study emphasizes the importance of antimicrobial stewardship in reducing broad-spectrum antibiotic use and CRE disease burden in Korea.
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Affiliation(s)
- Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eunkyung Nam
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Ye D, Li X, Zhao L, Liu S, Jia X, Wang Z, Du J, Ge L, Shen J, Xia X. Oxidized glutathione reverts carbapenem resistance in bla NDM-1-carrying Escherichia coli. EMBO Mol Med 2024:10.1038/s44321-024-00061-x. [PMID: 38565805 DOI: 10.1038/s44321-024-00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
The emergence of drug-resistant Enterobacteriaceae carrying plasmid-mediated β-lactamase genes has become a significant threat to public health. Organisms in the Enterobacteriaceae family containing New Delhi metallo-β-lactamase‑1 (NDM-1) and its variants, which are capable of hydrolyzing nearly all β-lactam antibacterial agents, including carbapenems, are referred to as superbugs and distributed worldwide. Despite efforts over the past decade, the discovery of an NDM-1 inhibitor that can reach the clinic remains a challenge. Here, we identified oxidized glutathione (GSSG) as a metabolic biomarker for blaNDM-1 using a non-targeted metabolomics approach and demonstrated that GSSG supplementation could restore carbapenem susceptibility in Escherichia coli carrying blaNDM-1 in vitro and in vivo. We showed that exogenous GSSG promotes the bactericidal effects of carbapenems by interfering with intracellular redox homeostasis and inhibiting the expression of NDM-1 in drug-resistant E. coli. This study establishes a metabolomics-based strategy to potentiate metabolism-dependent antibiotic efficacy for the treatment of antibiotic-resistant bacteria.
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Affiliation(s)
- Dongyang Ye
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi, China
| | - Xiaowei Li
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Liang Zhao
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Saiwa Liu
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Xixi Jia
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Zhinan Wang
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jingjing Du
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Lirui Ge
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China
| | - Jianzhong Shen
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China.
| | - Xi Xia
- National Key Laboratory of Veterinary Public Health and Safety, College of Veterinary Medicine, China Agricultural University, Beijing, China.
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Findlay J, Raro OHF, Poirel L, Nordmann P. Molecular analysis of metallo-beta-lactamase-producing Pseudomonas aeruginosa in Switzerland 2022-2023. Eur J Clin Microbiol Infect Dis 2024; 43:551-557. [PMID: 38233610 PMCID: PMC10917820 DOI: 10.1007/s10096-024-04752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVES The occurrence of metallo-beta-lactamase-producing Pseudomonas aeruginosa (MBL-PA) isolates is increasing globally, including in Switzerland. The aim of this study was to characterise, phenotypically and genotypically, the MBL-PA isolates submitted to the Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) reference laboratory over a 12-month period from July 2022 to July 2023. METHODS Thirty-nine non-duplicate MBL-PA Isolates were submitted to NARA over the study period from across Switzerland. Susceptibility was determined by broth microdilution according to EUCAST methodology. Whole-genome sequencing was performed on 34 isolates. Sequence types (STs) and resistance genes were ascertained using the Centre for Genomic Epidemiology platform. MBL genes, blaNDM-1, blaIMP-1, and blaVIM-2, were cloned into vector pUCP24 and transformed into P. aeruginosa PA14. RESULTS The most prevalent MBL types identified in this study were VIM (21/39; 53.8%) followed by NDM (11/39; 28.2%), IMP (6/39; 15.4%), and a single isolate produced both VIM and NDM enzymes. WGS identified 13 different STs types among the 39 isolates. They all exhibited resistance to cephalosporins, carbapenems, and the beta-lactam-beta-lactamase inhibitor combinations, ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam, and 8 isolates were cefiderocol (FDC) resistant. Recombinant P. aeruginosa strains producing blaNDM-1, blaIMP-1, and blaVIM-2 exhibited FDC MICs of 16, 8, and 1 mg/L, respectively. CONCLUSIONS This study showed that the MBL-PA in Switzerland could be attributed to the wide dissemination of high-risk clones that accounted for most isolates in this study. Although FDC resistance was only found in 8 isolates, MBL carriage was shown to be a major contributor to this phenotype.
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Affiliation(s)
- Jacqueline Findlay
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland.
| | - Otavio Hallal Ferreira Raro
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
| | - Laurent Poirel
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
- Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) Network, Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
| | - Patrice Nordmann
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Chemin du Musée 18, CH-1700, Fribourg, Switzerland
- Swiss National Reference Center for Emerging Antibiotic Resistance (NARA) Network, Swiss National Reference Center for Emerging Antibiotic Resistance (NARA), University of Fribourg, Fribourg, Switzerland
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Tun T, Baleivanualala SC, Erdmann MB, Gimenez G, Aung HL. An extensively drug-resistant Pseudomonas aeruginosa isolate from Myanmar. J Glob Antimicrob Resist 2024; 36:1-3. [PMID: 37992964 DOI: 10.1016/j.jgar.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) including multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa has emerged as one of the serious public health threats across the globe. Southeast Asia is a 'hot spot' of antimicrobial-resistant bacteria, including MDR P. aeruginosa. Despite Myanmar being located in Southeast Asia and suffering from a high infectious disease burden, data on MDR and XDR P. aeruginosa from Myanmar are limited. In this communication, we report the draft genome of an XDR P. aeruginosa isolate, MMXDRPA001, that was identified during a routine diagnosis in Myanmar. METHODS An MMXDRPA001 isolate colonising a hospitalised patient was characterised by antibiotic resistance profiling following standard methods and whole-genome sequencing using an Illumina MiSeq platform. The generated reads were de novo assembled using SPAdes (v.3.9.1). Annotation was performed by Prokka (v.1.14.0). Sequence type, antimicrobial resistance and virulence-related genes were predicted from the sequence. The phylogenetic relationships of all P. aeruginosa isolates were determined using core genome single-nucleotide polymorphisms (SNPs) analysis utilising Snippy (v.4.6.0) and Gubbins (v.2.3.4). RESULTS P. aeruginosa MMXDRPA001 was resistant to most antipseudomonal β-lactams, aminoglycosides and quinolones. The assembly comprised 145 contigs totalling 6 808 493 bases of sequence and a total of 6183 coding sequences. The isolate belonged to sequence type (ST) 235, contained carbapenemase-encoding gene blaIMP-1 and was clonally related to a previously reported isolate from Thailand. CONCLUSION The identification of an international high-risk clone of ST235 XDR isolate in Myanmar, genomically relating to that from a neighbouring country underscores the need for coordinated AMR surveillance throughout healthcare settings in Myanmar and in the Southeast Asia region.
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Affiliation(s)
- Thanda Tun
- Yangon Central Women's Hospital, Yangon, Myanmar; West Yangon General Hospital, Yangon, Myanmar
| | - Sakiusa Cabe Baleivanualala
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Mareike Britta Erdmann
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Gregory Gimenez
- Department of Pathology, University of Otago, Dunedin, New Zealand
| | - Htin Lin Aung
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.
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Aoto K, Inose R, Kosaka T, Shikata K, Muraki Y. Comparative effectiveness of cefmetazole versus carbapenems and piperacillin/tazobactam as initial therapy for bacteremic acute cholangitis: A retrospective study. J Infect Chemother 2024; 30:213-218. [PMID: 37832824 DOI: 10.1016/j.jiac.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Carbapenems and piperacillin/tazobactam (PIPC/TAZ) are commonly used as the initial therapy to treat extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in acute cholangitis. However, the overuse of these antibiotics contributes to the spread of antimicrobial resistance. Cefmetazole (CMZ) is stable to hydrolysis by ESBLs, so it may be an alternative to carbapenems and PIPC/TAZ. However, the effectiveness of CMZ compared with that of carbapenems and PIPC/TAZ as the initial therapy for acute cholangitis is unknown. METHODS We conducted a retrospective cohort study at a university hospital between April 1, 2014, and December 31, 2022. Patients with bacteremic acute cholangitis who received CMZ, carbapenems, or PIPC/TAZ as the initial therapy were included. The patients were divided into a CMZ group and a carbapenems or PIPC/TAZ (CP) group to compare patient outcomes. RESULTS A total of 99 patients (54 in the CMZ group and 45 in the CP group) were analyzed. The baseline characteristics of the patients were similar and 30-day mortality did not differ between groups (4% vs. 7%, P = 0.66). However, the CMZ group had a shorter length of stay (LOS) (8 days vs. 15 days, P < 0.001) and lower mean antibiotic cost (98.92 USD vs. 269.49 USD, P < 0.001) than the CP group. CONCLUSIONS In bacteremic acute cholangitis, initial therapy with CMZ may contribute to a shorter LOS and lower antibiotic costs than treatment with carbapenems and PIPC/TAZ, without worsening patient outcomes.
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Affiliation(s)
- Kazuhiro Aoto
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan; Laboratory of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5 Misasaginakauchicho, Kyoto Yamashina-ku, Kyoto, 607-8414, Japan.
| | - Ryo Inose
- Laboratory of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5 Misasaginakauchicho, Kyoto Yamashina-ku, Kyoto, 607-8414, Japan.
| | - Tadashi Kosaka
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Keisuke Shikata
- Department of Pharmacy, University Hospital, Kyoto Prefectural University of Medicine, Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Yuichi Muraki
- Laboratory of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, 5 Misasaginakauchicho, Kyoto Yamashina-ku, Kyoto, 607-8414, Japan.
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Fang P, Gao K, Yang J, Li T, Sun Q, Shan Z, Wang Y. Clinical characteristics and risk factors for neonatal bloodstream infection due to carbapenem-resistant Enterobacteriaceae: A single-centre Chinese retrospective study. J Glob Antimicrob Resist 2024; 37:28-36. [PMID: 38412919 DOI: 10.1016/j.jgar.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/09/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To analyse the clinical characteristics and risk factors for bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) in neonates. METHODS This single-centre, retrospective study included all patients with BSIs admitted to a neonatal intensive care unit between 1 January 2015 and 30 April 2022. The clinical and microbiological data of patients were collected; predictors of 30-day mortality in patients with CRE BSIs were also identified in this study. RESULTS Among the 224 neonates with Enterobacteriaceae BSIs, 39.29% (88/224) of the patients developed CRE BSIs. The 30-day mortality rate reached up to 21.59% (19/88). The Quick Sequential Organ Failure Assessment score > 2 (odds ratio [OR] and 95% credibility interval [CI]: 3.852 [1.111-13.356], P < 0.05), prior to more than two kinds of antibiotics use (OR and 95% CI: 9.433 [1.562-56.973], P < 0.05), pneumonia (OR and 95% CI: 3.847 [1.133-13.061], P < 0.05), and caesarean section (OR and 95% CI: 2.678 [1.225-5.857], P < 0.05) were independent risk factors associated with CRE BSIs. Moreover, the risk factors for mortality in neonates with CRE BSIs were significantly associated with neonatal Sequential Organ Failure Assessment score > 6 (OR and 95% CI: 16.335 [1.446-184.517], P < 0.05). CONCLUSION Prior to more than two kinds of antibiotics use, Quick Sequential Organ Failure Assessment score > 2, pneumonia and caesarean section were independent risk factors for CRE BSIs. The Neonatal Sequential Organ Failure Assessment score > 6 was a risk factor for mortality associated with CRE BSIs.
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Affiliation(s)
- Panpan Fang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Kaijie Gao
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China.
| | - Tiewei Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Qianqian Sun
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Zhiming Shan
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yingyuan Wang
- Department of Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
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Zhao Y, Zang B, Wang Q. Prolonged versus intermittent β-lactam infusion in sepsis: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care 2024; 14:30. [PMID: 38368588 PMCID: PMC10874917 DOI: 10.1186/s13613-024-01263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/13/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The two latest studies on prolonged versus intermittent use of β-lactam antibiotics in patients with sepsis did not reach consistent conclusions, further contributing to the controversy surrounding the effectiveness of the prolonged β-lactam antibiotics infusion strategy. We conducted a systemic review and meta-analysis to evaluate the efficacy and safety of prolonged and intermittent β-lactam infusion in adult patients with sepsis. METHODS We systematically searched PubMed, EMBASE, and Cochrane Library databases for original randomized controlled trials comparing prolonged and intermittent β-lactam infusion in sepsis patients. A random-effects model was used to evaluate mortality, clinical success, microbiological success, and adverse events. We also conducted subgroup analyses to explore the impact of various factors on the mortality rates. Relative risk (RR) and corresponding 95% confidence intervals (CIs) were used to calculate the overall effect sizes for dichotomous outcomes. This meta-analysis was registered in PROSPERO (CRD42023463905). RESULTS We assessed 15 studies involving 2130 patients. In our comprehensive assessment, we found a significant reduction in all-cause mortality (RR, 0.83; 95% CI 0.72-0.97; P = 0.02) and a notable improvement in clinical success (RR, 1.16; 95% CI 1.03-1.31; P = 0.02) in the prolonged infusion group compared to the intermittent infusion group, whereas microbiological success did not yield statistically significant results (RR, 1.10; 95% CI 0.98-1.23; P = 0.11). No significant differences in adverse events were observed between the two groups (RR, 0.91; 95% CI 0.64-1.29; P = 0.60). Additionally, remarkable conclusions were drawn from subgroup analyses including studies with sample sizes exceeding 20 individuals per group (RR, 0.84; 95%CI 0.72-0.98; P = 0.03), research conducted post-2010 (RR, 0.84; 95%CI 0.72-0.98; P = 0.03), cases involving infections predominantly caused by Gram-negative bacteria (RR, 0.81; 95%CI 0.68-0.96; P = 0.02), as well as the administration of a loading dose (RR, 0.84; 95% CI 0.72-0.97; P = 0.02) and the use of penicillin (RR, 0.61; 95% CI 0.38-0.98; P = 0.04). CONCLUSIONS Compared to intermittent infusion, prolonged infusion of β-lactam antibiotics significantly decreases all-cause mortality among patients with sepsis and enhances clinical success without increasing adverse events.
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Affiliation(s)
- Yang Zhao
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110000, China
| | - Bin Zang
- Department of Critical Care Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110000, China.
| | - Qian Wang
- Department of Emergency, The Fourth Affiliated Hospital of China Medical University, 4 Chongshan East Road, Shenyang, 110000, China.
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Ohba Y, Hayashi H, Kanda M, Nagano C, Yoshikawa S, Nakajima T, Matsushima Y, Koike H, Hayashi M, Yokoyama T, Sasamoto T. Simultaneous determination of five carbapenems, highly polar antibiotics, in milk by LC-MS/MS. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:151-161. [PMID: 38252707 DOI: 10.1080/19440049.2023.2300338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
The simultaneous determination of five carbapenems (biapenem, doripenem, ertapenem, imipenem, and meropenem) in raw and pasteurised bovine milk samples using LC-MS/MS was achieved and validated. Chromatographic separation was conducted on an InertSustain® AQ-C18 column using 0.1% formic acid in water and acetonitrile as the mobile phase. Target compounds were extracted using acetonitrile/water (20:80, v/v). After the removal of lipids with acetonitrile-saturated hexane, the dissolved protein was denatured with acetic acid. A portion of the supernatant was passed through an Oasis® PRiME HLB cartridge to remove the matrix. This novel method was validated in accordance with the Japanese validation guidelines and exhibited good trueness, ranging from 86.3% to 96.2%, using matrix-matched calibration curves. The relative standard deviation of repeatability ranged from 1.0% to 6.3%, and that of within-laboratory reproducibility ranged from 1.6% to 7.1%. The limit of quantification was 1.0 µg kg-1 for all analytes. None of the 60 milk samples commercially available in Tokyo contained any analytes. This novel method exhibited high-quality performance and can easily be implemented for the routine monitoring of carbapenems, which are highly polar antibiotics in milk.
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Affiliation(s)
- Yumi Ohba
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | | | - Maki Kanda
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Chieko Nagano
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | | | | | | | - Hiroshi Koike
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Momoka Hayashi
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | | | - Takeo Sasamoto
- Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
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Allison Rout J, Yusuf Essack S, Brysiewicz P. Evaluation of intermittent antimicrobial infusion documentation practices in intensive care units: A cross-sectional study. Intensive Crit Care Nurs 2023; 79:103527. [PMID: 37651822 DOI: 10.1016/j.iccn.2023.103527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To observe nurse administration of carbapenem antibiotics, in the context of medication safety measures, in intensive care units. RESEARCH METHODOLOGY/DESIGN A quantitative study was conducted using observation principles. SETTING Three adult private and public Intensive Care Units in the health district of a capital city in KwaZulu-Natal, South Africa. MAIN OUTCOME MEASURES Nurse practices were observed for double-checking of the medication order, medication vial, and method of preparation and administration. Infusion bags were inspected for nurse labelling of medication and patient details. Patient medication treatment charts were inspected for nurse signature. RESULTS Carbapenem infusion administrations (n = 223) to twenty patients were observed. Adherence to the scheduled time occurred in 34.9% administrations, 5.4% doses were not given, and an incorrect dose given on 1.4% administrations. One hundred and forty-four (64.6%) infusion bags were inspected during the administrations: there was no medication label affixed to 21.5% bags, and only 8.3% of bags were labelled with essential details; the patient's name, drug, dose, date, time, signature of the nurse mixing and administering the dose, and signature of the secondary nurse. CONCLUSION There was a lack of compliance with accepted medication risk mitigation measures. Sub-optimal double-checking resulted in the incorrect dose given, missed dose, and non-adherence to scheduled administration time. This has implications for the optimal administration of antimicrobial medications, raising concerns about the efficacy of treatment for critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE Parenteral administration errors pose a challenge in acute care areas. Risk mitigation measures include double-checking of medications. If antimicrobial treatment is not administered at the prescribed dosing intervals, this may have implications for the efficacy of time-dependent broad-spectrum antibiotics such as carbapenems. Medication administration errors involving antimicrobial medications should therefore be considered as high-risk errors, with the potential to contribute towards antimicrobial resistance.
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Affiliation(s)
- Joan Allison Rout
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sabiha Yusuf Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Petra Brysiewicz
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Esposito F, Cardoso B, Sellera FP, Sano E, Fuentes-Castillo D, Fontana H, Fuga B, Moura Q, Sato MI, Brandão CJ, Lincopan N. Expansion of healthcare-associated hypervirulent KPC-2-producing Klebsiella pneumoniae ST11/KL64 beyond hospital settings. One Health 2023; 17:100594. [PMID: 37448770 PMCID: PMC10336671 DOI: 10.1016/j.onehlt.2023.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
The spread of carbapenemase-producing Klebsiella pneumoniae beyond hospital settings is a global critical issue within a public health and One Health perspective. Another worrisome concern is the convergence of virulence and resistance in healthcare-associated lineages of K. pneumoniae leading to unfavorable clinical outcomes. During a surveillance study of WHO critical priority pathogens circulating in an impacted urban river in São Paulo, Brazil, we isolate two hypermucoviscous and multidrug-resistant K. pneumoniae strains (PINH-4250 and PINH-4900) from two different locations near to medical centers. Genomic investigation revealed that both strains belonged to the global high-risk sequence type (ST) ST11, carrying the blaKPC-2 carbapenemase gene, besides other medically important antimicrobial resistance determinants. A broad virulome was predicted and associated with hypervirulent behavior in the Galleria mellonella infection model. Comparative phylogenomic analysis of PINH-4250 and PINH-4900 along to an international collection of publicly available genomes of K. pneumoniae ST11 revealed that both environmental strains were closely related to hospital-associated K. pneumoniae strains recovered from clinical samples between 2006 and 2018, in São Paulo city. Our findings support that healthcare-associated KPC-2-positive K. pneumoniae of ST11 clone has successfully expanded beyond hospital settings. In summary, aquatic environments can become potential sources of international clones of K. pneumoniae displaying carbapenem resistance and hypervirulent behaviors, which is a critical issue within a One Health perspective.
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Affiliation(s)
- Fernanda Esposito
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
- One Health Brazilian Resistance Project (OneBR), Brazil
| | - Brenda Cardoso
- One Health Brazilian Resistance Project (OneBR), Brazil
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Fábio P. Sellera
- One Health Brazilian Resistance Project (OneBR), Brazil
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
- School of Veterinary Medicine, Metropolitan University of Santos, Santos, Brazil
| | - Elder Sano
- One Health Brazilian Resistance Project (OneBR), Brazil
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Danny Fuentes-Castillo
- One Health Brazilian Resistance Project (OneBR), Brazil
- Departamento de Patología y Medicina Preventiva, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - Herrison Fontana
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
- One Health Brazilian Resistance Project (OneBR), Brazil
| | - Bruna Fuga
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
- One Health Brazilian Resistance Project (OneBR), Brazil
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Quézia Moura
- Federal Institute of Education Science and Technology of Espírito Santo, Vila Velha, Brazil
| | - Maria I.Z. Sato
- Environmental Company of São Paulo State (CETESB), São Paulo, Brazil
| | - Carlos J. Brandão
- Environmental Company of São Paulo State (CETESB), São Paulo, Brazil
| | - Nilton Lincopan
- Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil
- One Health Brazilian Resistance Project (OneBR), Brazil
- Department of Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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12
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Son HJ, Bae S, Cho K, Park I, Kim J, Han H, Kim EO, Jung J, Kim SH, Lee SO. Impact of carbapenem-targeted antimicrobial stewardship interventions: an interrupted time-series analysis. J Hosp Infect 2023; 140:132-138. [PMID: 37544365 DOI: 10.1016/j.jhin.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The development of carbapenem-resistant Gram-negative bacilli (CR-GNB) is largely favoured by indiscriminate and prolonged carbapenem use, which is a significant contributing factor. AIM To evaluate the impact of two carbapenem antibiotic stewardship programme interventions on both carbapenem prescriptions and the clinical isolation rates of CR-GNBs, using interrupted time-series analysis. METHODS A time-series analysis was performed using data for carbapenem usage from a tertiary hospital in South Korea from January 2017 to July 2022. Two carbapenem antibiotic stewardship programme interventions were implemented sequentially: (i) a prospective audit and feedback (PAF) from November 2018 to April 2020 (intervention 1), and (ii) preauthorization from May 2020 to August 2020 (intervention 2). Monthly carbapenem usage and incidence of CR-GNB before and after each intervention were compared using an autoregressive integrated moving average model. FINDINGS Implementation of PAF resulted in a significant reduction in carbapenem consumption, followed by an additional decrease after the preauthorization was implemented. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae increased after intervention 1, but there was a significant change from an increasing trend to a stationary trend after intervention 2. The incidence of carbapenem-resistant Pseudomonas aeruginosa, which had increased during the baseline period, became stationary after intervention 1. A significant decrease was observed in the incidence of carbapenem-resistant Acinetobacter baumannii during the implementation of intervention 1 and 2. CONCLUSION This study emphasizes the importance of adopting comprehensive antibiotic management and rigorous infection control to prevent infections caused by antibiotic-resistant bacteria.
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Affiliation(s)
- H-J Son
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Infectious Diseases, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - S Bae
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Antibiotic Support Team, Asan Medical Center, Seoul, South Korea
| | - K Cho
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Antibiotic Support Team, Asan Medical Center, Seoul, South Korea
| | - I Park
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Antibiotic Support Team, Asan Medical Center, Seoul, South Korea
| | - J Kim
- Department of Pharmacy, Asan Medical Center, Seoul, South Korea
| | - H Han
- Department of Pharmacy, Asan Medical Center, Seoul, South Korea
| | - E O Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - J Jung
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - S-H Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - S-O Lee
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Antibiotic Support Team, Asan Medical Center, Seoul, South Korea.
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Hoellinger B, Kaeuffer C, Boyer P, Lefebvre N, Hansmann Y, Robert A, Severac F, Gravet A, Danion F, Ruch Y, Ursenbach A. Cefepime vs carbapenems for treating third-generation cephalosporin-resistant AmpC β-lactamase-hyperproducing Enterobacterales bloodstream infections: a multicenter retrospective study. Int J Infect Dis 2023; 134:273-279. [PMID: 37453486 DOI: 10.1016/j.ijid.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES AmpC β-lactamase-hyperproducing Enterobacterales (ABLHE) bloodstream infections (BSI) are emerging and leading to therapeutic challenges worldwide. Prescriptions of carbapenems may lead to the emergence of resistance. This study aimed to compare cefepime with carbapenems for the treatment of third-generation cephalosporin-resistant ABLHE BSI. METHODS This retrospective multicenter study included patients with ABLHE BSI from two tertiary hospitals in France, between July 2017 and July 2022. Non-AmpC-producing Enterobacterales, extended-spectrum β-lactamase, and carbapenemase-producing Enterobacterales were excluded. Cefepime was prescribed only in case of minimal inhibitory concentration ≤1 mg/l. The primary outcome was 30-day in-hospital mortality from the date of index blood culture. Secondary outcomes were infection recurrence and treatment toxicity. An inverse probability of treatment weighting approach was used to balance the baseline characteristics between the two groups. RESULTS We analyzed 164 BSI, which included 77 in the cefepime group and 87 in the carbapenem group. In the weighted cohort, the 30-day mortality rates were similar between the cefepime group (23.3%) and the carbapenem group (19.6%) with a relative risk of 1.19 (95% confidence interval, 0.61-2.33 P = 0.614). No significant difference in recurrence or toxicity was found between the two groups. CONCLUSION This study adds evidence in favor of the use of cefepime for treating third-generation cephalosporin-resistant ABLHE BSI in case of minimal inhibitory concentration ≤ 1 mg/l, which could spare carbapenems.
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Affiliation(s)
- Baptiste Hoellinger
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France; Hôpital Emile Muller, service de Médecine Interne, Mulhouse, France
| | | | - Pierre Boyer
- CHU de Strasbourg, service de Bactériologie, Strasbourg, France
| | - Nicolas Lefebvre
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France
| | - Yves Hansmann
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France
| | - Amandine Robert
- CHU de Strasbourg, service de Réanimation Médicale Hautepierre, Strasbourg, France
| | - François Severac
- CHU de Strasbourg, Groupe Méthodes en Recherche Clinique (GMRC), Strasbourg, France
| | - Alain Gravet
- Hôpital Emile Muller, laboratoire de microbiologie, Mulhouse, France
| | - François Danion
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France; Inserm UMR_S 1109, Laboratoire d'ImmunoRhumatologie Moléculaire, Strasbourg, France
| | - Yvon Ruch
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France
| | - Axel Ursenbach
- CHU de Strasbourg, service des Maladies Infectieuses et Tropicales, Strasbourg, France.
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14
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Andersson V, Fröberg G, Dahl VN, Chryssanthou E, Giske C, Schön T, Forsman LD. The In vitro activity of carbapenems alone and in combination with β-lactamase inhibitors against difficult-to-treat mycobacteria; Mycobacterium tuberculosis, Mycobacterium abscessus, and Mycobacterium avium complex: A systematic review. Int J Mycobacteriol 2023; 12:211-225. [PMID: 37721224 DOI: 10.4103/ijmy.ijmy_131_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Difficult-to-treat mycobacterial infections are increasing globally. There is an urgent need of new treatment alternatives for multidrug-resistant Mycobacterium tuberculosis (MTB), as well as nontuberculous mycobacteria such as the Mycobacterium abscessus complex (MABC) and Mycobacterium avium complex (MAC). Recently, new carbapenems and combinations of carbapenems with β-lactamase inhibitors have become available, but activity data in vitro against mycobacteria are so far scarce. Therefore, we performed a systematic review collating the minimum inhibitory concentrations (MICs) of carbapenems, with or without a β-lactamase inhibitors for MTB, MABC, and MAC. The databases PubMed and Web of Science were searched for the relevant articles in English up until September 21, 2022. Screening of studies was performed by two independent reviewers. MIC data by recommended methods with at least five individual MICs were included. Data were reported as MIC range, MIC50, modal MIC, and/or histograms when individual MICs were available. The study protocol was registered at PROSPERO (CRD42021258537). After screening, a total of 75 studies with MIC data for carbapenems with or without β-lactamase inhibitors were included in the review. For MTB, the oral carbapenem tebipenem combined with the β-lactamase inhibitor clavulanic acid resulted in the most significant reduction of MICs. For MABC, the addition of avibactam to tebipenem resulted in a 64-fold reduction of modal MIC. Data were insufficient for the analysis of MAC. Carbapenems, and in particular the novel oral compound tebipenem, in combination with clavulanic acid for MTB and avibactam for MABC may be an untapped potential for difficult-to-treat mycobacterial infections.
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Affiliation(s)
- Viktoria Andersson
- Department of Infectious Diseases, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Gabrielle Fröberg
- Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet; Department of Clinical Microbiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Victor Naestholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital; Center for Global Health, Aarhus University (GloHAU), Aarhus; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Erja Chryssanthou
- Department of Clinical Microbiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Christian Giske
- Department of Infectious Diseases, Karolinska University Hospital; Department of Clinical Microbiology, Karolinska University Hospital; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Thomas Schön
- Department of Infectious Diseases, Karolinska University Hospital, Solna, Stockholm; Department of Biomedical and Clinical Sciences, Linköping University; Department of Infectious Diseases, Region Östergötland and Kalmar County Hospital, Linköping University, Linköping, Sweden
| | - Lina Davies Forsman
- Department of Infectious Diseases, Karolinska University Hospital; Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Stockholm, Sweden
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15
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Wagenlehner FME. [New antibiotics for the treatment of urinary tract infections]. Urologie 2023:10.1007/s00120-023-02121-5. [PMID: 37306723 DOI: 10.1007/s00120-023-02121-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections. The clinical phenotypes of UTIs are heterogeneous, ranging from rather benign uncomplicated infections to complicated UTIs and pyelonephritis to severe urosepsis. Antibiotics have become indispensable in modern medicine, but the development of resistance is threatening clinical effectiveness. Antimicrobial resistance rates are locally high in UTIs, however can vary significantly depending on the population studied and the type of study. In addition, between 1990 and 2010, there was a discovery void in the development of new antibiotics that is still having an impact today. In recent years, UTIs have emerged as an infection model for research into novel antibiotics. In the last 10 years, novel gram-negative active drugs have been explored in these groups. On the one hand, novel beta-lactam/beta-lactamase inhibitor combinations were investigated, and there has also been further development of cephalosporins and aminoglycosides.
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Affiliation(s)
- Florian M E Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität Giessen, Rudolf-Buchheim Str. 7, 35392, Giessen, Deutschland.
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16
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Cebron C, Smiljkovic M, Percheron L, Caspar Y, Arata-Bardet J, Mortamet G, Martinod M. Carbapenem prescriptions: Compliance with guidelines in a pediatric hospital. Arch Pediatr 2023:S0929-693X(23)00078-7. [PMID: 37286425 DOI: 10.1016/j.arcped.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study aimed to describe the use of carbapenems in a pediatric tertiary center and to assess its compliance with national and local guidelines. METHODS This retrospective study focused on children who received at least one dose of carbapenems in a tertiary university hospital over a 1-year period (2019). The appropriateness of each prescription was assessed. RESULTS In total, 96 prescriptions were collected for 75 patients (median age 3 years [interquartile range, IQR: 0-9]). Most prescriptions were empirical (n = 77, 80%) and mainly concerned nosocomial infections (n = 69, 72%). At least one risk factor for extended-spectrum beta-lactamases was found in 48% (n = 46) of cases. The median duration of treatment with carbapenems was 5 days and it was over 7 days in 38% (n = 36) of cases. The use of carbapenems was considered appropriate in 95% (18/19) and 70% (54/77) of cases when therapy was guided by culture results or was empirical, respectively. De-escalation of carbapenem treatment within 72 h occurred in 31% (n = 30) of cases. CONCLUSION The use of carbapenems can be optimized in the pediatric population, even when the initial prescription for a carbapenem is considered appropriate.
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Affiliation(s)
- Clara Cebron
- Pediatric Department, Grenoble-Alpes University Hospital, La Tronche, France
| | - Mina Smiljkovic
- Pediatric Department, Grenoble-Alpes University Hospital, La Tronche, France
| | - Lucas Percheron
- Pediatric Department, Toulouse University Hospital, Toulouse, France
| | - Yvan Caspar
- Microbiology, Grenoble-Alpes University Hospital, La Tronche, France
| | - Julie Arata-Bardet
- Pediatric Department, Grenoble-Alpes University Hospital, La Tronche, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, La Tronche, France.
| | - Marie Martinod
- Pediatric Department, Grenoble-Alpes University Hospital, La Tronche, France
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Prayag¹ PS, Patwardhan² SA, Panchakshari S, Sambasivam R, Dhupad S, Soman RN, Prayag AP. Ceftazidime-avibactam with or without Aztreonam vs Polymyxin-based Combination Therapy for Carbapenem-resistant Enterobacteriaceae: A Retrospective Analysis. Indian J Crit Care Med 2023; 27:444-450. [PMID: 37378372 PMCID: PMC10291660 DOI: 10.5005/jp-journals-10071-24481] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Gram-negative sepsis remains one of the most difficult to treat infections in intensive care units (ICUs). Carbapenems are often considered to be robust and reliable options for treating infections due to Gram-negative bacteria. The dominance of carbapenem-resistant enterobacteriaceae (CRE) has emerged as one of the greatest challenges faced by the medical community today. Carbapenem-resistant enterobacteriaceae may be resistant to all beta lactam antimicrobials including carbapenems and often, are even resistant to other classes of drugs. There are limited studies comparing polymyxin-based therapies with ceftazidime-avibactam (CAZ-AVI)-based therapies for treating infections caused by CRE. Methods A retrospective study comparing outcomes between patients with bacteremia caused by CRE treated with polymyxin-based combination therapy and CAZ-AVI-based therapy (with or without aztreonam). Results Of total 104 patients, 78 (75%) were in the CAZ-AVI group. There was no significant difference in the underlying comorbidities between the two groups. The incidence of nephrotoxicity was significantly higher in the polymyxin group (p = 0.017). Ceftazidime-avibactam-based therapy was 66% less likely to be associated with day 14 mortality (p = 0.048) and 67% less likely to be associated with day 28 mortality (p = 0.039) as compared with polymyxin-based therapy. Conclusion Ceftazidime-avibactam-based therapy may be a superior option to polymyxin-based therapy for infections caused by CRE. This can have significant practical applications, in terms of optimizing therapy for the individual patient as well as sparing polymyxins and reducing the use of polymyxins in our hospitals. How to cite this article Prayag PS, Patwardhan SA, Panchakshari S, Sambasivam R, Dhupad S, Soman RN, et al. Ceftazidime-avibactam with or without Aztreonam vs Polymyxin-based Combination Therapy for Carbapenem-resistant Enterobacteriaceae: A Retrospective Analysis. Indian J Crit Care Med 2023;27(6):444-450.
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Affiliation(s)
- Parikshit S Prayag¹
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | | | - Shweta Panchakshari
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Ramya Sambasivam
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Surabhi Dhupad
- Department of Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, India
| | - Rajeev N Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Amrita P Prayag
- Department of In House Research, Deenanath Mangeshkar Hospital, Pune, India
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Martínez DA, Cai J, Lin G, Goodman KE, Paul R, Lessler J, Levin SR, Toerper M, Simner PJ, Milstone AM, Klein EY. Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU. J Hosp Infect 2023; 136:1-7. [PMID: 36907332 PMCID: PMC10315994 DOI: 10.1016/j.jhin.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. OBJECTIVE To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. DESIGN, SETTING AND PARTICIPANTS CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). EXPOSURES The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. MAIN OUTCOMES AND MEASURES The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). RESULTS Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). CONCLUSIONS AND RELEVANCE In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
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Affiliation(s)
- D A Martínez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - J Cai
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - G Lin
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA
| | - K E Goodman
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - R Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S R Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - M Toerper
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P J Simner
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - E Y Klein
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Disease Dynamics, Economics and Policy, Washington, DC, USA; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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Sharma E, Sivakumar M, Kelso C, Zhang S, Shi J, Gao J, Gao S, Zhou X, Jiang G. Effects of sewer biofilms on the degradability of carbapenems in wastewater using laboratory scale bioreactors. Water Res 2023; 233:119796. [PMID: 36863281 DOI: 10.1016/j.watres.2023.119796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/04/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Carbapenems are last-resort antibiotics used to treat bacterial infections unsuccessfully treated by most common categories of antibiotics in humans. Most of their dosage is secreted unchanged as waste, thereby making its way into the urban water system. There are two major knowledge gaps addressed in this study to gain a better understanding of the effects of their residual concentrations on the environment and environmental microbiome: development of a UHPLC-MS/MS method of detection and quantification from raw domestic wastewater via direct injection and study of their stability in sewer environment during the transportation from domestic sewers to wastewater treatment plants. The UHPLC-MS/MS method was developed for four carbapenems: meropenem, doripenem, biapenem and ertapenem, and validation was performed in the range of 0.5-10 μg/L for all analytes, with limit of detection (LOD) and limit of quantification (LOQ) values ranging from 0.2-0.5 μg/L and 0.8-1.6 μg/L respectively. Laboratory scale rising main (RM) and gravity sewer (GS) bioreactors were employed to culture mature biofilms with real wastewater as the feed. Batch tests were conducted in RM and GS sewer bioreactors fed with carbapenem-spiked wastewater to evaluate the stability of carbapenems and compared against those in a control reactor (CTL) without sewer biofilms, over a duration of 12 h. Significantly higher degradation was observed for all carbapenems in RM and GS reactors (60 - 80%) as opposed to CTL reactor (5 - 15%), which indicates that sewer biofilms play a significant role in the degradation. First order kinetics model was applied to the concentration data along with Friedman's test and Dunn's multiple comparisons analysis to establish degradation patterns and differences in the degradation observed in sewer reactors. As per Friedman's test, there was a statistically significant difference in the degradation of carbapenems observed depending on the reactor type (p = 0.0017 - 0.0289). The results from Dunn's test indicate that the degradation in the CTL reactor was statistically different from that observed in either RM (p = 0.0033 - 0.1088) or GS (p = 0.0162 - 0.1088), with the latter two showing insignificant difference in the degradation rates observed (p = 0.2850 - 0.5930). The findings contribute to the understanding about the fate of carbapenems in urban wastewater and the potential application of wastewater-based epidemiology.
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Affiliation(s)
- Elipsha Sharma
- School of Civil, Mining, Environmental & Architectural Engineering, University of Wollongong, Australia
| | - Muttucumaru Sivakumar
- School of Civil, Mining, Environmental & Architectural Engineering, University of Wollongong, Australia
| | - Celine Kelso
- School of Chemistry and Molecular Bioscience, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Australia; Molecular Horizons, University of Wollongong, Australia
| | - Shuxin Zhang
- School of Civil, Mining, Environmental & Architectural Engineering, University of Wollongong, Australia
| | - Jiahua Shi
- Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Australia
| | - Jianfa Gao
- College of Chemistry and Environmental Engineering, Shenzen University, Shenzen, 518060, China
| | - Shuhong Gao
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin, 150090, China
| | - Xu Zhou
- State Key Laboratory of Urban Water Resource and Environment, Harbin Institute of Technology, Harbin, 150090, China
| | - Guangming Jiang
- School of Civil, Mining, Environmental & Architectural Engineering, University of Wollongong, Australia; Illawarra Health and Medical Research Institute (IHMRI), University of Wollongong, Australia.
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20
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Ma W, Zhu B, Wang W, Wang Q, Cui X, Wang Y, Dong X, Li X, Ma J, Cheng F, Shi X, Chen L, Niu S, Hao M. Genetic and enzymatic characterization of two novel bla NDM-36, -37 variants in Escherichia coli strains. Eur J Clin Microbiol Infect Dis 2023; 42:471-480. [PMID: 36810726 PMCID: PMC9998317 DOI: 10.1007/s10096-023-04576-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
The widespread of different NDM variants in clinical Enterobacterales isolates poses a serious public health concern, which requires continuous monitoring. In this study, three E. coli strains carrying two novel blaNDM variants of blaNDM-36, -37 were identified from a patient with refractory urinary tract infection (UTI) in China. We conducted antimicrobial susceptibility testing (AST), enzyme kinetics analysis, conjugation experiment, whole-genome sequencing (WGS), and bioinformatics analysis to characterize the blaNDM-36, -37 enzymes and their carrying strains. The blaNDM-36, -37 harboring E. coli isolates belonged to ST227, O9:H10 serotype and exhibited intermediate or resistance to all β-lactams tested except aztreonam and aztreonam/avibactam. The genes of blaNDM-36, -37 were located on a conjugative IncHI2-type plasmid. NDM-37 differed from NDM-5 by a single amino acid substitution (His261Tyr). NDM-36 differed from NDM-37 by an additional missense mutation (Ala233Val). NDM-36 had increased hydrolytic activity toward ampicillin and cefotaxime relative to NDM-37 and NDM-5, while NDM-37 and NDM-36 had lower catalytic activity toward imipenem but higher activity against meropenem in comparison to NDM-5. This is the first report of co-occurrence of two novel blaNDM variants in E. coli isolated from the same patient. The work provides insights into the enzymatic function and demonstrates the ongoing evolution of NDM enzymes.
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Affiliation(s)
- Wanshan Ma
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Bo Zhu
- Xiamen Key Laboratory of Genetic Testing, Department of Laboratory Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wen Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China
| | - Qian Wang
- Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaodi Cui
- School of Clinical Medicine, Jining Medical University, Jining, China
| | - Yujiao Wang
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Xiutao Dong
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Xiaofeng Li
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Jianping Ma
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Fang Cheng
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Xiaohong Shi
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China
| | - Liang Chen
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ, USA
- Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Siqiang Niu
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, China.
| | - Mingju Hao
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, No. 16766 Jingshi Road, Lixia District, Jinan, China.
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21
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Goic-Barisic I, Music MS, Drcelic M, Tuncbilek S, Akca G, Jakovac S, Tonkić M, Hrenovic J. Molecular characterisation of colistin and carbapenem-resistant clinical isolates of Acinetobacter baumannii from Southeast Europe. J Glob Antimicrob Resist 2023; 33:26-30. [PMID: 36878462 DOI: 10.1016/j.jgar.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVES To characterise 11 colistin- and carbapenem-resistant Acinetobacter baumannii isolates recently emerging in hospital settings. METHODS A. baumannii isolates were collected from hospitalised patients under colistin treatment in three countries of Southeast Europe: Turkey, Croatia, and Bosnia and Herzegovina. Isolates were identified using molecular methods. RESULTS Isolates from Turkey and Croatia belong to the sequence types ST195 or ST281 of the clone lineage 2, while the single isolate from Bosnia and Herzegovina belongs to the ST231 of clone lineage 1. All isolates turned out to be highly resistant to colistin (MIC ≥ 16 mg/L) and have point mutations in pmrCAB operon genes. The colistin-resistant isolate from Bosnia and Herzegovina had a unique P170L point mutation in the pmrB gene and the R125H point mutation in the pmrC gene. The L20S mutation in the pmrA gene was detected only in isolates from Croatia and has never been reported before in isolates from this country. CONCLUSION Colistin resistance in A. baumannii in hospitalised patients receiving colistin treatment is a result of chromosomal mutations. The pattern of point mutations in pmrCAB genes suggests a spread of specific colistin-resistant isolates within the hospital.
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Affiliation(s)
- Ivana Goic-Barisic
- University Hospital of Split, Department of Clinical Microbiology, Split, Croatia; University of Split School of Medicine, Split, Croatia.
| | | | - Marina Drcelic
- University of Zagreb Faculty of Science, Department of Biology, Zagreb, Croatia
| | - Semra Tuncbilek
- Ufuk University Medical School, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Gulcin Akca
- Gazi University Faculty of Dentistry, Department of Medical Microbiology, Ankara, Turkey
| | - Sanja Jakovac
- University Clinical Hospital Mostar, Department of Microbiology and Molecular Diagnostics, Mostar, Bosnia and Herzegovina; University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina
| | - Marija Tonkić
- University Hospital of Split, Department of Clinical Microbiology, Split, Croatia; University of Split School of Medicine, Split, Croatia
| | - Jasna Hrenovic
- University of Zagreb Faculty of Science, Department of Biology, Zagreb, Croatia
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22
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Jun SH, Lee DE, Hwang HR, Kim N, Kwon KT, Kim YK, Lee JC. Clonal evolution and antimicrobial resistance of Acinetobacter baumannii isolates from Korean hospitals over the last decade. Infect Genet Evol 2023; 108:105404. [PMID: 36638876 DOI: 10.1016/j.meegid.2023.105404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
The wide-spread of drug-resistant Acinetobacter baumannii is a global health problem. This study investigated the clonal distribution and antimicrobial resistance of 167 A. baumannii isolates from two Korean university hospitals from 2009 to 2019 by analyzing the sequence types (STs), antimicrobial resistance, and resistance determinants of carbapenems and aminoglycosides. Twenty STs, including 16 pre-existing STs and four unassigned STs, were identified in A. baumannii isolates using the Oxford multilocus sequence typing scheme. Two STs, ST191 (n = 77) and ST451 (n = 40), were prevalent, and majority (n = 153) of the isolates belonged to clonal complex 208. The ST191 isolates were detected during the study period, whereas ST451 isolates were detected after 2016. One hundred forty-seven (87%) of 167 A. baumannii isolates were non-susceptible to carbapenems. The ST191 and ST451 isolates exhibited higher resistance to antimicrobial agents than that of the sporadic ST isolates. Interestingly, ST451 isolates exhibited lower susceptibility to minocycline and tigecycline than the other ST isolates. All carbapenem-non-susceptible A. baumannii isolates, except four, carried the ISAbaI-blaOXA-23 structure. armA was detected in all amikacin-non-susceptible isolates (n = 128) except for one isolate. Five aminoglycoside-modifying enzyme (AME) genes were detected, but their carriage varied between STs; ant(3″)-Ia and aac(6')-Ib were more common in ST191 than in ST451, while aph(3')-Ia was more common in ST451 than in ST191. This study demonstrated the clonal evolution related to antimicrobial resistance in A. baumannii.
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Affiliation(s)
- So Hyun Jun
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea
| | - Da Eun Lee
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea
| | - Hye Ryeong Hwang
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea
| | - Nayeong Kim
- Department of Microbiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ki Tae Kwon
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea; Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Yu Kyung Kim
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea; Department of Laboratory Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Je Chul Lee
- Kyungpook National University Hospital National Culture Collection for Pathogens (KNUH-NCCP), Kyungpook National University Hospital, Daegu, South Korea; Department of Microbiology, School of Medicine, Kyungpook National University, Daegu, South Korea.
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23
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Giuliano G, Raffaelli F, Faliero D, Tamburrini E, Tarantino D, Nurchis MC, Scoppettuolo G. Outpatient parenteral antimicrobial therapy (OPAT) from an emergency model applied during the COVID-19 pandemic to standard of care: Preliminary lessons from our experience. Infect Dis Now 2023; 53:104642. [PMID: 36642101 PMCID: PMC9836987 DOI: 10.1016/j.idnow.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/27/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We wish to report on our experience of OPAT during the first two years of the COVID19 outbreak. PATIENTS AND METHODS We recorded data on all patients treated in the OPAT regimen in 2020 and 2021 and compared overall trends, use of carbapenems and saved days of hospitalization. RESULTS The OPAT model enabled us to ensure the administration of first choice antibiotic therapy to 239 patients with an increase of 21.3% from 2020 to 2021 (108 vs 131). Applying this model, we also recorded a reduction in the use of carbapenems from 33% in 2020 to 26% in 2021 and a total of 3041 recovery days saved in 2021.The clinical cure rate reached 94%. Few adverse events occurred (35/239; 14.6%), and they did not require hospitalization. CONCLUSION OPAT is a safe, efficacious, and cost-effective model that functioned effectively during the COVID-19 crisis and could become the standard of care for the treatment of selected patients.
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Affiliation(s)
- G Giuliano
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - F Raffaelli
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - D Faliero
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - E Tamburrini
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione Malattie Infettive, Dipartimento di sicurezza e bioetica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - D Tarantino
- UOC Farmacia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M C Nurchis
- UOC Igiene Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - G Scoppettuolo
- UOC Malattie Infettive, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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24
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Zhang H, Xu J, Xiao Q, Wang Y, Wang J, Zhu M, Cai Y. Carbapenem-sparing beta-lactam/beta-lactamase inhibitors versus carbapenems for bloodstream infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: a systematic review and meta-analysis. Int J Infect Dis 2023; 128:194-204. [PMID: 36621752 DOI: 10.1016/j.ijid.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Bloodstream infections (BSIs) caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) have become a worldwide public health threat, and beta-lactam/beta-lactamase inhibitor combinations (BLBLIs) are considered as one reliable carbapenem-sparing antibiotic. However, it is still controversial whether BLBLIs are truly noninferior to carbapenems. Therefore, we conducted this meta-analysis to compare the efficacy of BLBLIs with carbapenems for ESBL-PE BSIs. METHODS A systematic search of PubMed, Cochrane Library, and Embase was conducted until December 2021 to enroll studies comparing BLBLIs with carbapenems for ESBL-PE BSIs. A subgroup analysis was performed based on the choice of therapy (empirical, definitive, and mixed therapy). The protocol was registered in the International Prospective Register of Systematic Reviews (#CRD42022316011). RESULTS A total of 2786 patients from one randomized clinical trial and 25 cohorts were included. There was no statistically significant difference between BLBLIs and carbapenems groups in therapeutical response (odds ratio [OR] = 1.19, P = 0.45) and mortality (OR = 1.06, P = 0.68). Furthermore, although the statistical difference was also not found in the subgroup analysis, BLBLIs performed better in definitive therapy than empirical therapy than carbapenems, with a numerically higher therapeutical response (OR = 1.42 vs 0.89) and a mildly lower mortality (OR = 0.85 vs 1.14). CONCLUSION BLBLIs were noninferior to carbapenems for ESBL-PE BSIs, especially in definitive therapy. BLBLIs may be a valid alternative to spare the use of carbapenems.
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Affiliation(s)
- Huan Zhang
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Juan Xu
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Qinyan Xiao
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuhang Wang
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Jin Wang
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Man Zhu
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China
| | - Yun Cai
- Centre of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Centre, Chinese PLA General Hospital, Beijing, China.
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25
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Kagami K, Ishiguro N, Iwasaki S, Usami T, Fukumoto T, Hayasaka K, Oyamada R, Watanabe T, Nakakubo S, Niinuma Y, Hagino T, Abe Y, Fujimoto I, Maekawa H, Fujibayashi R, Fuke S, Asahi K, Ota S, Nagakura T, Okubo T, Asanuma H, Ito T, Okano S, Komatsu E, Sasaki K, Hashimoto K, Washiya K, Kato Y, Kusumi K, Asai Y, Saito Y, Sakai Y, Sakurada M, Sakimoto Y, Ichikawa Y, Kinebuchi T, Kondo D, Kanno S, Kobayashi M, Hirabayashi K, Saitou S, Saito K, Ebina Y, Koshizaki Y, Chiba M, Yasuda A, Sato T, Togashi A, Abe T, Fujita T, Umehara K, Amishima M, Murakami N, Yagi T, Fujimoto S, Tajima T, Sugawara M, Takekuma Y. Correlation between antibiotic use and antibiotic resistance: A multicenter study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system in Hokkaido, Japan. Am J Infect Control 2023; 51:163-171. [PMID: 35671846 DOI: 10.1016/j.ajic.2022.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures in participating medical institutions nationwide and is intended to be used for promotion of AMR measures in participating facilities and their communities. This multicenter study aimed to determine the usefulness of the J-SIPHE system for evaluating the correlation between antibiotic use and antibiotic resistance in Hokkaido, Japan. METHODS Data on antibiotic use and detection rate of major resistant Gram-negative bacteria at 19 hospitals in 2020 were collected from the J-SIPHE system, and data correlations were analyzed using JMP Pro. RESULTS The detection rate of carbapenem-resistant Pseudomonas aeruginosa was significantly positively correlated with carbapenem use (Spearman's ρ = 0.551; P = .015). There were significant positive correlations between the detection rate of fluoroquinolone-resistant Escherichia coli and the use of piperacillin/tazobactam, carbapenems, and quinolones [ρ = 0.518 (P = .023), ρ = 0.76 (P < .001), and ρ = 0.502 (P = .029), respectively]. CONCLUSIONS This is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using this system may be beneficial for promoting AMR measures.
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Affiliation(s)
- Keisuke Kagami
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan.
| | - Nobuhisa Ishiguro
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Sumio Iwasaki
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Takayuki Usami
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Tatsuya Fukumoto
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Kasumi Hayasaka
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Reiko Oyamada
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Tsubasa Watanabe
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Sho Nakakubo
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yusuke Niinuma
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Takashi Hagino
- Infection Control Room, NTT Medical Center Sapporo, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Yoshifumi Abe
- Infection Control Room, NTT Medical Center Sapporo, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Ikuya Fujimoto
- Department of Pharmacy, Kitasapporo Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Hideki Maekawa
- Department of Pharmacy, Hokkaido Gastroenterology Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Ryo Fujibayashi
- Department of Pharmacy, Hokkaido Gastroenterology Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Satoshi Fuke
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Kuniko Asahi
- Department of Infection Control and Prevention, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan; Department of Laboratory Medicine, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Tatsuya Nagakura
- Department of Infection Control and Prevention, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Toshinari Okubo
- Department of Pharmacy, IMS Sapporo Internal Medicine Rehabilitation Hospital, Teine-ku, Sapporo, Hokkaido, Japan
| | - Hideomi Asanuma
- Department of Neonatology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-ku, Sapporo, Hokkaido, Japan
| | - Toshihiro Ito
- Department of Cardiology, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Sho Okano
- Department of Pharmacy, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Erika Komatsu
- Department of Pharmacy, Ebetsu City Hospital, Ebetsu, Hokkaido, Japan
| | - Kota Sasaki
- Department of Clinical Laboratory, Ebetsu City Hospital, Ebetsu, Hokkaido, Japan
| | - Kei Hashimoto
- Department of Pharmacy, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Kazutoshi Washiya
- Department of Pharmacy, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Yumiko Kato
- Department of Infection Control and Prevention, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Katsunori Kusumi
- Department of Pharmacy, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yasufumi Asai
- Department of Cardiology, Hakodate Shintoshi Hospital, Hakodate, Hokkaido, Japan
| | - Yuichi Saito
- Department of Pharmacy, Hakodate Shintoshi Hospital, Hakodate, Hokkaido, Japan
| | - Yoshiyuki Sakai
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Minoru Sakurada
- Department of Pharmacy, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Yuji Sakimoto
- Department of Pharmacy, Yakumo General Hospital, Yakumo Town, Futami-gun, Hokkaido, Japan; Infection Control Room, Yakumo General Hospital, Yakumo Town, Futami-gun, Hokkaido, Japan
| | - Yukari Ichikawa
- Infection Control Management, Asahikawa Red Cross Hospital, Asahikawa, Hokkaido, Japan
| | - Takahiro Kinebuchi
- Department of Laboratory Medicine, Social Welfare Corporation Hokkaido Social Work Association Furano Hospital, Furano, Hokkaido, Japan
| | - Dai Kondo
- Department of Pharmacy, Social Welfare Corporation Hokkaido Social Work Association Furano Hospital, Furano, Hokkaido, Japan
| | - Syuhei Kanno
- Department of Pharmacy, Oji General Hospital, Tomakomai, Hokkaido, Japan; Infection Control Room, Oji General Hospital, Tomakomai, Hokkaido Japan
| | - Minoru Kobayashi
- Infection Control Room, Oji General Hospital, Tomakomai, Hokkaido Japan
| | - Kagami Hirabayashi
- Department of Cardiologists, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan; Department of Infection Control and Prevention, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan
| | - Shinako Saitou
- Department of Infection Control and Prevention, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan; Department of Infection Prevention and Control Certified Nurse, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan
| | - Katsuhiko Saito
- Department of Pharmacy, Nemuro City Hospital, Nemuro, Hokkaido, Japan
| | - Yuuki Ebina
- Department of Pharmacy, Obihiro Kosei General Hospital, Obihiro, Hokkaido, Japan
| | - Yuusuke Koshizaki
- Department of Clinical Laboratory Technology, Obihiro Kosei General Hospital, Obihiro, Hokkaido, Japan
| | - Makoto Chiba
- Department of Pharmacy, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Atsushi Yasuda
- Department of Clinical Laboratory, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Toshiya Sato
- Department of Pediatrics, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan; Department of Infection Prevention Office, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan
| | - Atsuo Togashi
- Department of Pediatrics, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan; Department of Infection Prevention Office, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan
| | - Takashi Abe
- Department of Laboratory Medicine, Takikawa Municipal Hospital, Takikawa, Hokkaido, Japan
| | - Takahiro Fujita
- Department of Infectious Diseases, National Hospital Organization Hokkaido Cancer Center, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Kengo Umehara
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Masaru Amishima
- Office for Infection Control and Prevention, NHO Hokkaido Medical Center, Nishi-ku, Sapporo, Hokkaido, Japan
| | - Nobuo Murakami
- Center for Regional Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan; Gifu General Healthcheckup Centre, Hikie, Gifu, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Shuhei Fujimoto
- Department of Bacteriology and Bacterial Infection, Division of Host Defense Mechanism, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Taichi Tajima
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
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Bulens SN, Reses HE, Ansari UA, Grass JE, Carmon C, Albrecht V, Lawsin A, McAllister G, Daniels J, Lee YK, Yi S, See I, Jacob JT, Bower CW, Wilson L, Vaeth E, Lynfield R, Vagnone PS, Shaw KM, Dumyati G, Tsay R, Phipps EC, Bamberg W, Janelle SJ, Beldavs ZG, Cassidy PM, Kainer M, Muleta D, Mounsey JT, Laufer-Halpin A, Karlsson M, Lutgring JD, Walters MS. Carbapenem-Resistant enterobacterales in individuals with and without health care risk factors -Emerging infections program, United States, 2012-2015. Am J Infect Control 2023; 51:70-77. [PMID: 35909003 PMCID: PMC10881240 DOI: 10.1016/j.ajic.2022.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) are usually healthcare-associated but are also emerging in the community. METHODS Active, population-based surveillance was conducted to identify case-patients with cultures positive for Enterobacterales not susceptible to a carbapenem (excluding ertapenem) and resistant to all third-generation cephalosporins tested at 8 US sites from January 2012 to December 2015. Medical records were used to classify cases as health care-associated, or as community-associated (CA) if a patient had no known health care risk factors and a culture was collected <3 days after hospital admission. Enterobacterales isolates from selected cases were submitted to CDC for whole genome sequencing. RESULTS We identified 1499 CRE cases in 1194 case-patients; 149 cases (10%) in 139 case-patients were CA. The incidence of CRE cases per 100,000 population was 2.96 (95% CI: 2.81, 3.11) overall and 0.29 (95% CI: 0.25, 0.35) for CA-CRE. Most CA-CRE cases were in White persons (73%), females (84%) and identified from urine cultures (98%). Among the 12 sequenced CA-CRE isolates, 5 (42%) harbored a carbapenemase gene. CONCLUSIONS Ten percent of CRE cases were CA; some isolates from CA-CRE cases harbored carbapenemase genes. Continued CRE surveillance in the community is critical to monitor emergence outside of traditional health care settings.
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Affiliation(s)
| | | | - Uzma A Ansari
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Adrian Lawsin
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Sarah Yi
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Isaac See
- Centers for Disease Control and Prevention, Atlanta, GA; Commissioned Corps, U.S. Public Health Service, Rockville, MD
| | - Jesse T Jacob
- Georgia Emerging Infections Program, Decatur, GA; Emory University School of Medicine, Atlanta, GA
| | - Chris W Bower
- Georgia Emerging Infections Program, Decatur, GA; Atlanta Veterans Affairs Medical Center, Decatur, GA; Foundation for Atlanta Veterans Education & Research, Decatur, GA
| | - Lucy Wilson
- Maryland Department of Health, Baltimore, MD
| | | | | | | | | | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, NY
| | - Rebecca Tsay
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, NY
| | - Erin C Phipps
- New Mexico Emerging Infections Program, Santa Fe, NM; University of New Mexico, Albuquerque, NM
| | - Wendy Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Sarah J Janelle
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | | | | | | | | | - Alison Laufer-Halpin
- Centers for Disease Control and Prevention, Atlanta, GA; Commissioned Corps, U.S. Public Health Service, Rockville, MD
| | | | | | - Maroya Spalding Walters
- Centers for Disease Control and Prevention, Atlanta, GA; Commissioned Corps, U.S. Public Health Service, Rockville, MD
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27
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Fawzy RH, Gad GFM, Mohamed HA. Phenotypic and genotypic detection of resistance mechanisms in carbapenem-resistant gram-negative bacteria isolated from Egyptian ICU patients with first emergence of NDM-1 producing Klebsiella oxytoca. Iran J Microbiol 2022; 14:832-840. [PMID: 36721446 PMCID: PMC9867609 DOI: 10.18502/ijm.v14i6.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objectives Carbapenems are considered the last resort to treat several infections, particularly in intensive care units (ICUs). However, increasing carbapenem resistance is problematic because it leads to high morbidity and mortality rates. This study aimed to determine the rate of carbapenem resistance among Gram-negative bacteria collected from patients in ICUs and to identify their resistance mechanisms using phenotypic and genotypic methods. Materials and Methods Antimicrobial susceptibility testing was carried out using the disc diffusion method among 180 Gram-negative bacterial isolates. Productions of carbapenemases, metallo-beta-lactamases (MBLs) and the harboring of carbapenemase-encoding genes, were detected in 40 selected carbapenem-resistant Gram-negative bacteria (CR-GNB). Results Of 40 selected CR-GNB isolates, 28 (70%), and 20 (50%) isolates were phenotypically positive for carbapenemase, and MBL production, respectively. Furthermore, 22 (55%) showed amplification of one or more of the carbapenemase-encoding genes, including bla NDM-1, bla VIM-2, and bla OXA-48. This study described the first emergence of NDM-1 producing Klebsiella oxytoca in Egyptian ICUs. Conclusion High incidence of CR-GNB detected in the ICUs in our study area may be attributed to the overuse of antibiotics, including carbapenems, and improper application of infection control measures. These findings confirm the need for the application of a strict antibiotic stewardship program.
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Affiliation(s)
| | | | - Heba Ahmed Mohamed
- Corresponding author: Heba Ahmed Mohamed, Ph.D, Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University, Minia, Egypt. Tel: +201020296850 Fax: +20862369075
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28
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Karshenas AE, Zahraei Salehi T, Adabi M, Asghari B, Yahyaraeyat R. Prevalence of main quinolones and carbapenems resistance genes in clinical and veterinary Escherichia coli strains. Iran J Microbiol 2022; 14:841-849. [PMID: 36721438 PMCID: PMC9867622 DOI: 10.18502/ijm.v14i6.11259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objectives Antibiotics-resistant Escherichia coli strains are considered one of the most important causes of human and animal infections worldwide. The aim of current study was to detect common resistance (carbapenems and quinolones) genes by PCR. Materials and Methods A total of 100 E. coli strains isolated from human urinary tract infection and 20 isolated strains of aborted sheep embryos were collected. PCR was performed using specific primers to detect the resistance genes. Results Overall, among the quinolones resistance genes, qnrS resistance gene had the highest frequency (48%) and among carbapenem resistance genes, imp resistance gene had the highest frequency (45%). The frequency of resistance genes, IMP (28.45%), KPC (9.5%), VIM (9.15%), NDM (7.20%) were observed in clinical and veterinary strains, respectively. According to the results, 38.6% of E. coli strains had at least one from five genes of resistance to quinolones. The lowest frequency of resistance gene was related to qnrA, which was observed in only 29 (24.2%) strains. Conclusion Monitoring of carbapenem and quinolone resistance in pathogenic E. coli to humans and animals has an important value in revising treatment guidelines and the national public health, and plays an important role in preventing the spread of resistant strains.
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Affiliation(s)
- Ali Ehsan Karshenas
- Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Taghi Zahraei Salehi
- Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran,Corresponding author: Taghi Zahraei Salehi, DVM, Ph.D, Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran. Tel: +98-21-61117052 Fax: +98-21-44865119
| | - Maryam Adabi
- Brucellosis Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Babak Asghari
- Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran,Co-corresponding author: Babak Asghari, Ph.D, Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Tel: +98-9125602565 Fax: +98-8138380130
| | - Ramak Yahyaraeyat
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Fischer P, Pandrea S, Dan Grigorescu M, Stefanescu H, Tefas C, Hadade A, Procopet B, Ionescu D. The threat of carbapenem resistance in Eastern Europe in patients with decompensated cirrhosis admitted to intensive care unit. Dig Liver Dis 2022; 54:1385-91. [PMID: 35732546 DOI: 10.1016/j.dld.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Multidrug-resistant organisms are an increasing concern in patients with decompensated cirrhosis. AIM We aimed to evaluate the prevalence of infections with carbapenem-resistant Enterobacteriaceae in patients with decompensated cirrhosis. METHODS Patients with decompensated cirrhosis admitted to ICU were included. The isolated Enterobacteriaceae strains were tested for carbapenemase-producing genes using the Roche LightMix® Modular VIM/IMP/NDM/GES/KPC/OXA48-carbapenemase detection kit. RESULTS 48 culture-positive infections were registered in 75 patients with acutely decompensated cirrhosis. Thirty patients contracted a second infection. 46% of bacteria isolated at admission and 60% of bacteria responsible for infections identified during ICU-stay were multiresistant. ESBL+ Enterobacteriaceae were predominant at admission, while carbapenem-resistance was dominant in both Enterobacteriaceae and Non-Fermenting-Gram-Negative Bacteria responsible for infections diagnosed during hospitalisation. OXA 48 or KPC type carbapenemases were present in 30% of the analyzed Enterobacteriaceae and in 40% of the phenotypically carbapenem-resistant Klebsiella pneumoniae strains. The length of ICU stay was a risk-factor for a second infection (p=0.04). Previous carbapenem usage was associated with occurence of infections with carbapenem-resistant Gram-negative bacteria during hospitalization (p=0.03). CONCLUSION The prevalence of infections with carbapenem-resistant Enterobacteriaceae is high in patients with decompensated cirrhosis admitted to ICU. Carbapenemase-producing genes in Enterobacteriaceae in our center are blaOXA-48 and blaKPC.
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Wong JLC, David S, Sanchez-Garrido J, Woo JZ, Low WW, Morecchiato F, Giani T, Rossolini GM, Beis K, Brett SJ, Clements A, Aanensen DM, Rouskin S, Frankel G. Recurrent emergence of Klebsiella pneumoniae carbapenem resistance mediated by an inhibitory ompK36 mRNA secondary structure. Proc Natl Acad Sci U S A 2022; 119:e2203593119. [PMID: 36095213 DOI: 10.1073/pnas.2203593119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Outer membrane porins in Gram-negative bacteria facilitate antibiotic influx. In Klebsiella pneumoniae, modifications in the porin OmpK36 are implicated in increasing resistance to carbapenems. An analysis of large K. pneumoniae genome collections, encompassing major healthcare-associated clones, revealed the recurrent emergence of a synonymous cytosine-to-thymine transition at position 25 (25c > t) in ompK36. We show that the 25c > t transition increases carbapenem resistance through depletion of OmpK36 from the outer membrane. The mutation attenuates K. pneumoniae in a murine pneumonia model, which accounts for its limited clonal expansion observed by phylogenetic analysis. However, in the context of carbapenem treatment, the 25c > t transition tips the balance toward treatment failure, thus accounting for its recurrent emergence. Mechanistically, the 25c > t transition mediates an intramolecular messenger RNA (mRNA) interaction between a uracil encoded by 25t and the first adenine within the Shine-Dalgarno sequence. This specific interaction leads to the formation of an RNA stem structure, which obscures the ribosomal binding site thus disrupting translation. While mutations reducing OmpK36 expression via transcriptional silencing are known, we uniquely demonstrate the repeated selection of a synonymous ompK36 mutation mediating translational suppression in response to antibiotic pressure.
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Zhao W, Li W, Du XD, Yao H. Hybrid IncFIA/FIB/FIC(FII) plasmid co-carrying bla NDM-5 and fosA3 from an Escherichia coli ST117 strain of retail chicken. Int J Food Microbiol 2022; 382:109914. [PMID: 36088664 DOI: 10.1016/j.ijfoodmicro.2022.109914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Carbapenems and fosfomycin are important antibiotics used to treat Enterobacteriaceae-associated infections. This study aimed to characterize the co-resistance and co-dissemination mechanism of carbapenem and fosfomycin resistance in an Escherichia coli ST117 strain isolated from retail chicken meat. Antimicrobial susceptibility testing showed that an E. coli CS18F strain had a multidrug resistance profile, including carbapenem and fosfomycin resistance. The presence of blaNDM-5 and fosA3 genes was confirmed by PCR and Sanger sequencing. The blaNDM-5 and fosA3 genes were successfully transferred to the recipient strain E. coli J53 via conjugation, and the transconjugants had elevated minimum inhibitory concentrations (MICs) for meropenem and fosfomycin. Whole genome sequencing (WGS) of E. coli CS18F revealed that blaNDM-5 and fosA3 were colocalized on an IncFIA/FIB/FIC(FII) type plasmid of 189,141 bp, which was designated as pCS18F-NDM-Fos. A novel structure with five IS26 sequences flanking the multiple drug resistance region (MDRR) was identified, and three copies of IS26 were found to be flanked blaNDM-5, fosA3, dfrA12, aadA2, and sul1. Three types of translocation units (TUs) were identified by PCR, containing either the resistance gene blaNDM-5 and an IS26 sequence, fosA3, and an IS26 sequence, or both, indicating their potential co-transfer via TUs. Thus, this is an unprecedented report of the presence of a plasmid co-carrying blaNDM-5 and fosA3 and TUs potentially mediating their simultaneous transfer.
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Affiliation(s)
- Wenbo Zhao
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China
| | - Wenjun Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China
| | - Xiang-Dang Du
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China.
| | - Hong Yao
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China.
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32
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Wells DA, Johnson AJ, Lukas JG, Mason D, Cleveland KO, Bissell A, Hobbs ALV. Criteria Restricting Inappropriate Meropenem Empiricism (CRIME): a quasi-experimental carbapenem restriction pilot at a large academic medical centre. Int J Antimicrob Agents 2022; 60:106661. [PMID: 35988667 DOI: 10.1016/j.ijantimicag.2022.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
The broad-spectrum activity of carbapenems makes them appealing for empirical use; however, they are associated with development of Clostridioides difficile infection (CDI) and multidrug resistance. Selective carbapenem use is vital in maintaining their effectiveness. We examined the impact of meropenem restriction criteria on utilisation and patient outcomes. This quasi-experimental study was conducted at a single academic medical centre after medication use evaluation found frequent inappropriate meropenem utilisation. Antimicrobial stewardship-led restriction criteria were developed and implemented in February 2022. Investigators aimed to determine how restriction criteria affected meropenem utilisation across 8 weeks in the pre- (February-April 2020) versus post-implementation period (February-April 2022). The primary outcome was inappropriateness of meropenem utilisation. Secondary outcomes included days of therapy per 1000 patient-days (DOT/1000 PD), hospital length of stay (LOS), CDI Standardized Infection Ratio (SIR), and acquisition cost. Across the 8-week timeframes, reductions in inappropriate meropenem use (64.5% vs. 12.8%; P < 0.001), duration of therapy [5.8 (3.2-7.3) vs. 2.4 (1.0-5.5) days; P < 0.001] and utilisation (30.5 vs. 8.3 DOT/1000 PD; P < 0.001) pre- versus post-implementation were observed. Total meropenem orders decreased by 65% (P < 0.001). Median hospital LOS also decreased between periods [11.9 (7.8-20.4) vs. 9.2 (5.4-15.2) days], although not statistically significant (P = 0.051). There was no difference in CDI SIR (0.1 vs. 0.1; P = 0.99). Projected annual cost savings were ∼US$57 300. Implementation of antimicrobial stewardship-initiated restriction criteria can reduce inappropriate meropenem utilisation, overall number of orders, and total duration of therapy.
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Affiliation(s)
- Drew A Wells
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA.
| | - Asia J Johnson
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Jack G Lukas
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Darius Mason
- Information Technology, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Kerry O Cleveland
- Infectious Diseases, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA; Division of Infectious Diseases, University of Tennessee Health Science Center, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN, 38104, USA
| | - Aaron Bissell
- Department of Pharmacy, Methodist Le Bonheur Healthcare - University Hospital, 1265 Union Avenue, Memphis, TN, 38104, USA
| | - Athena L V Hobbs
- Cardinal Health Innovative Delivery Solutions, 13651 Dublin Court, Stafford, TX, 77477, USA
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Sun BK, Wang RY, Li B, Fan X, Zhou Y, Gu B, Yan YY. Rapid identification of polypeptide from carbapenem-resistant and susceptible Escherichia coli via Orbitrap-MS and pattern recognition analyses. Chem Biodivers 2022; 19:e202200118. [PMID: 35925667 DOI: 10.1002/cbdv.202200118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022]
Abstract
A rapid and accurate analytical method was established to identify CREC and CSEC. Orbitrap-MS was used to detect the polypeptide of CREC and CSEC strains, and MS data were analyzed by pattern recognition analyses such as hierarchical cluster analysis (HCA), principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA). HCA based on the farthest distance method could well distinguish the two types of E. coli, and the cophenetic correlation coefficient of the farthest distance method was 0.901. Comparing the results of PCA, PLS-DA, and OPLS-DA, OPLS-DA exhibited the highest accuracy in predicting the CREC and CSEC strains. A total of 26 compounds were identified, and six of the compounds were the highly significant difference between the two types of strains. MS combined with pattern recognition can achieve a more comprehensive and efficient statistical analysis of complex biological samples.
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Affiliation(s)
- Bing-Kang Sun
- China University of Mining and Technology, Low Carbon Energy Institute, No. 1, University Road, Xuzhou, CHINA
| | - Rui-Yu Wang
- China University of Mining and Technology, Low Carbon Energy Institute, No. 1, University Road, Xuzhou, CHINA
| | - Bei Li
- China University of Mining and Technology, Low Carbon Energy Institute, No. 1, University Road, Xuzhou, CHINA
| | - Xing Fan
- Shandong University of Science and Technology, 579 Qianwangang Road, 266590, Qingdao, CHINA
| | - Yuan Zhou
- Xuzhou Medical University, College of Medical Technology, 209 Tongshan Road, Xuzhou, CHINA
| | - Bing Gu
- Xuzhou Medical University, College of Medical Technology, No. 209 Tongshan Road, Xuzhou, CHINA
| | - Yang-Yang Yan
- China University of Mining and Technology, Low Carbon Energy Institute, No. 1, University Road, Xuzhou, CHINA
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Massik A, Hibaoui L, Moussa B, Yahyaoui G, Oumokhtar B, Mahmoud M. First report of SPM metallo-β-lactamases producing Acinetobacter baumannii isolates in Morocco. Iran J Microbiol 2022; 14:438-444. [PMID: 36721516 PMCID: PMC9867632 DOI: 10.18502/ijm.v14i4.10229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background and Objectives Carbapenem-resistant Acinetobacter baumannii has recently been identified by the World Health Organization as a critical pathogen. We propose to characterize the molecular characteristics of clinical isolates of A. baumannii resistant to carbapenems collected in a Moroccan hospital. Materials and Methods Seventy carbapenem-resistant A. baumannii isolates from various samples were received at the microbiology laboratory of the Hospital Center. Antibiotic susceptibility was tested by the diffusion disc method and molecular characterization of antimicrobial resistance was performed by PCR and sequencing. Results Carbapenemase genes were detected in our isolates: the OXA-51 gene and the ISbA1 sequence were detected in all isolates (100%), the OXA-23 and OXA-58 genes were detected in 82.85% and 10% of isolates respectively, MBL genes were dominated by VIM 39 isolates (55.7%), followed by GIM 26 isolates (37%), SIM 20 isolates (28.5%), IMP 8 isolates (11, 4%), NDM 3 isolates (4%) and for the first time in Morocco SPM with 4 isolates (5.7%). Conclusion The emergence of resistance of A. baumannii to carbapenems is a serious problem in our hospital which requires the establishment of a prevention strategy and strict respect for hygiene to minimize their dissemination.
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Affiliation(s)
- Abdelhamid Massik
- Laboratory of Microbiology and Molecular Biology, CHU Hassan II, Fez, Morocco,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco,Corresponding author: Abdelhamid Massik, Ph.D, Laboratory of Microbiology and Molecular Biology, CHU Hassan II, Fez, Morocco; Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco. Tel: +98-212626805059
| | - Lahbib Hibaoui
- Laboratory of Microbiology and Molecular Biology, CHU Hassan II, Fez, Morocco,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Benboubker Moussa
- Human Pathologies, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Ghita Yahyaoui
- Laboratory of Microbiology and Molecular Biology, CHU Hassan II, Fez, Morocco
| | - Bouchra Oumokhtar
- Human Pathologies, Biomedicine and Environment Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Mahmoud
- Laboratory of Microbiology and Molecular Biology, CHU Hassan II, Fez, Morocco,Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Elsawah H, Samir A, Elrazzaz M, Ramadan A, Elnaggar A, Taema K. Carbapenems consumption and Klebsiella resistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program. J Infect Prev 2022; 23:142-148. [PMID: 37256159 PMCID: PMC10226057 DOI: 10.1177/17571774211060436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background The high prevalence of carbapenem-resistant Klebsiella imposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiella resistance. Method We retrospectively evaluated critically ill patients with isolated Klebsiella species from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiella clinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiella isolates were classified into sensitive, extended spectrum beta-lactamase (ESBL) producer, and carbapenem-resistant Klebsiella (CRK), respectively. Our primary outcome was the change in carbapenems consumption after implementing the program, while the secondary outcomes were the changes in the incidence of CRK. Results The study included 205 patients with isolated Klebsiella species during the study period. The antibiotic stewardship program started in March 2018. Out of the 205 patients, 61 patients (29.8%) represented the pre-intervention sample, and 144 patients (70.2%) represented the post-intervention sample. Applying the antibiotic stewardship program was associated with a significant decrease in the carbapenems consumption from 38.9 to 26.6 defined daily dose/1000 patient-days (p = 0.02). The incidence of CRK was decreased from 85.25% of total Klebsiella isolates to 48.6% (p < 0.001). Klebsiella species were more likely to be in a lower category of resistance after applying the program with an odds ratio of 6.3 (2.88-13.73) using ordinal logistic regression. Conclusion Applying the antibiotic stewardship program could reduce the unnecessary carbapenems use in the ICU with a subsequent decrease in the emergence of the Klebsiella-resistant strains.
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Affiliation(s)
- Hozaifa Elsawah
- Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt
| | | | | | | | | | - Khaled Taema
- Critical Care Department, Kasr Alainy Hospitals, Cairo University, Egypt
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Yekani M, Rezaee MA, Beheshtirouy S, Baghi HB, Bazmani A, Farzinazar A, Memar MY, Sóki J. Carbapenem resistance in Bacteroides fragilis: A review of molecular mechanisms. Anaerobe 2022; 76:102606. [PMID: 35738484 DOI: 10.1016/j.anaerobe.2022.102606] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
Abstract
Carbapenems are an applicable subclass of β-lactam drugs in the antibiotic therapy of anaerobic infections, especially for poly-microbial cases, due to their broad antimicrobial spectrum on aerobic and anaerobic bacteria. Bacteroides fragilis is the most commonly recovered anaerobic bacteria in the clinical laboratories from mono- and poly-microbial infections. B. fragilis is relatively non-susceptible to different antibiotics, including β-lactams, tetracyclines, fluoroquinolones, and macrolides. Carbapenems are among the most effective drugs against B. fragilis strains with high-level resistance to different antibiotics. Increased antibiotic resistance of B. fragilis strains has been reported following the overuse of an antimicrobial agent. Earlier contact with carbapenems is linked with increased resistance to them that limits the options for treatment of B. fragilis caused infections, especially in cases caused by multidrug-resistant strains. Several molecular mechanisms of resistance to carbapenems have been described for different carbapenem-resistant bacteria. Understanding the mechanisms of resistance to antimicrobial agents is necessary for selecting alternative antimicrobial agents and the application of control strategies. In the present study, we reviewed the mechanisms contributing to resistance to carbapenems in B. fragilis strains.
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Affiliation(s)
- Mina Yekani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Samad Beheshtirouy
- Cardiothoracic Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Ahad Bazmani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Farzinazar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Yousef Memar
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - József Sóki
- Institute of Medical Microbiology, Albert Szent-Györgyi Health Centre and School of of Medicine, University of Szeged, Szeged, Hungary.
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Soares de Moraes L, Gomes Magalhaes GL, Material Soncini JG, Pelisson M, Eches Perugini MR, Vespero EC. High mortality from carbapenem-resistant Klebsiella pneumoniae bloodstream infection. Microb Pathog 2022; 167:105519. [PMID: 35483557 DOI: 10.1016/j.micpath.2022.105519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
Abstract
In this study, it was evaluated clinical data of 107 patients with bloodstream infection (BSI) by Klebsiella pneumoniae and performed phenotypic and molecular analyzes in 50.5% (54/107) of the samples, those that showed a resistance profile to carbapenemics. The blaKPC gene was present in 90.4% (49/54) of the samples, blaNDM gene in one sample and, in 7.4% (4/54) of the samples, no carbapenemase gene was found. In the similarity analysis, it was found 4 main clones and 11 samples were not genetically related. The median age of the patients was 58 (40-70) years old and 60.7% (65/107) were male. When comparing two groups of patients with BSI due to K. pneumoniae with and without resistance to carbapenems, the variables ICU permanence, renal failure (IR), previous use of antimicrobials, Charlson's comorbidity index (ICCi), some invasive procedures and death showed a statistically significant difference (p < 0.05). And when relating death as a dependent variable, IR, liver failure and patients with BSI XDR or PDR, were predictors of increased mortality. Our study showed a higher mortality rate in patients with BSI due to carbapenem-resistant pneumonia with additional resistance or not to polymyxins.
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Affiliation(s)
- Luana Soares de Moraes
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Gerusa Luciana Gomes Magalhaes
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - João Gabriel Material Soncini
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Marsileni Pelisson
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Marcia Regina Eches Perugini
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil
| | - Eliana Carolina Vespero
- Clinical and Laboratory Microbiology, Department of Pathology, Clinical and Toxicological Analysis, State University of Londrina, Paraná, Brazil.
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Komatsu T, Inagaki R, Azuma S, Mochida S, Sato Y, Seto Y, Nihonyanagi S, Hoshiyama T, Wada T, Takayama Y, Atsuda K. Evaluation of a carbapenem antimicrobial stewardship program and clinical outcomes in a Japanese hospital. J Infect Chemother 2022; 28:884-889. [PMID: 35331613 DOI: 10.1016/j.jiac.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Microorganisms can evolve and become resistant to antimicrobials, and this is known as antimicrobial resistance (AMR). Inappropriate use of antibiotics contributes to AMR, and antimicrobial stewardship programs have been developed to mitigate AMR. The Appropriate Use of Carbapenems Program was implemented in March 2019 in a university hospital and its effect was evaluated. METHODS We conducted a prospective audit and feedback on carbapenems at the time of prescription daily. Additionally, we compared a monthly survey of the total days of therapy (DOTs) per 1000 patient-days for carbapenems, piperacillin/tazobactam, and fluoroquinolones. The susceptibility of Pseudomonas aeruginosa to meropenem, piperacillin/tazobactam, and levofloxacin was tested before (January 2018 to February 2019) and after (March 2019 to December 2020) the intervention. RESULTS The monthly median DOTs of carbapenem usage decreased after the intervention; carbapenem use immediately declined during the intervention period. The monthly median DOTs of piperacillin/tazobactam and fluoroquinolones also decreased and continued to decline significantly after the intervention. Susceptibility of P. aeruginosa to meropenem, piperacillin/tazobactam, and levofloxacin did not change significantly during the study. CONCLUSION The implementation of the Appropriate Use of Carbapenems Program was effective in reducing the use of broad-spectrum antibiotics and maintaining the antibiotic susceptibility of P. aeruginosa.
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Affiliation(s)
- Toshiaki Komatsu
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Ryosuke Inagaki
- Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Shintaro Azuma
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Shunya Mochida
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Yosuke Sato
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Yoshinori Seto
- Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Shin Nihonyanagi
- Department of Infection Control and Prevention, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Takayuki Hoshiyama
- Department of Infection Control and Prevention, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan; Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, 252-0375, Japan.
| | - Tatsuhiko Wada
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, 252-0375, Japan.
| | - Yoko Takayama
- Department of Infection Control and Prevention, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan; Department of Infection Control and Infectious Diseases, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Koichiro Atsuda
- Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan.
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Di Mento G, Gona F, Russelli G, Cuscino N, Barbera F, Carreca AP, Di Carlo D, Cardinale F, Monaco F, Campanella M, Mularoni A, Grossi P, Conaldi PG, Douradinha B. A retrospective molecular epidemiological scenario of carbapenemase-producing Klebsiella pneumoniae clinical isolates in a Sicilian transplantation hospital shows a swift polyclonal divergence among sequence types, resistome and virulome. Microbiol Res 2021; 256:126959. [PMID: 34995971 DOI: 10.1016/j.micres.2021.126959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/24/2022]
Abstract
In this work, we assessed and characterized the epidemiological scenario of carbapenem-resistant Klebsiella pneumoniae strains (CR-Kp) at IRCCS-ISMETT, a transplantation hospital in Palermo, Italy, from 2008 to 2017. A total of 288 K. pneumoniae clinical isolates were selected based on their resistance to carbapenems. Molecular characterization was also done in terms of the presence of virulence and resistance genes. All patients were inpatients from our facility and clinical isolates were collected from several sources, either from infection or colonization cases. We observed that, in agreement with the Italian epidemiological scenario, initially only ST258 and ST512 clade II (but not from clade I) were identified from 2008 to 2011. From 2012 onwards, other STs have been observed, including the clinically relevant ST101 and ST307, but also others not previously observed in other Italian health settings, such as ST220 and ST753. The presence of genes involved in resistance and virulence was confirmed, and a heterogeneous genetic resistance profile throughout the years was observed. Our work highlights that resistance genes are rapidly disseminating between different and novel K. pneumoniae clones which, combined with resistance to multiple antibiotics, can derive into more aggressive and pathogenic multidrug-resistant strains of clinical importance. Our results stress the importance of continuous surveillance of CR Enterobacterales in health facilities so that novel STs carrying resistance and virulence genes that may become increasingly pathogenic can be identified and adequate therapies to adopted to avoid their dissemination and derived pathologies.
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Affiliation(s)
- Giuseppina Di Mento
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Floriana Gona
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Giovanna Russelli
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Nicola Cuscino
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Floriana Barbera
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Anna Paola Carreca
- Unità di Medicina Rigenerativa ed Immunologia, Fondazione Ri.MED, Palermo, Italy
| | - Daniele Di Carlo
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Francesca Cardinale
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Francesco Monaco
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Maria Campanella
- Dipartimento per la Cura e lo Studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Alessandra Mularoni
- Dipartimento per la Cura e lo Studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Paolo Grossi
- Dipartimento di Malattie Infettive e Tropicali, Università di Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Pier Giulio Conaldi
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Bruno Douradinha
- Dipartimento di Ricerca, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy; Unità di Medicina Rigenerativa ed Immunologia, Fondazione Ri.MED, Palermo, Italy.
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Chen B, Berglund B, Wang S, Börjesson S, Bi Z, Nilsson M, Yin H, Zheng B, Xiao Y, Bi Z, Nilsson LE. Rapid increase in occurrence of carbapenem-resistant Enterobacteriaceae in healthy rural residents in Shandong province, China, from 2015 to 2017. J Glob Antimicrob Resist 2021; 28:38-42. [PMID: 34896338 DOI: 10.1016/j.jgar.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/03/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The global increase of carbapenem-resistant Enterobacteriaceae (CRE) is a growing concern. Infections caused by CRE are associated with increased mortality and length of hospital stay, emphasizing the health and economic burden posed by these pathogens. Although CRE can inhabit the human gut asymptomatically, colonization with CRE is associated with increased risk of CRE infection and mortality. In this study, we investigated the occurrence and characteristics of CRE in fecal samples from healthy persons in 12 villages in Shandong, China. METHODS Screening for CRE in fecal samples was performed by selective cultivation. MICs of meropenem were determined with the agar dilution method. Multilocus sequence type (MLST) and carbapenemase gene carriage of the isolates were determined with whole-genome sequencing. Genetic relatedness of E. coli isolates was determined by core genome MLST. RESULTS CRE carriage increased from 2.4% to 13% from 2015 to 2017. Most CRE isolates (93%) were E. coli and all carried NDM-type carbapenemases. The STs among the E. coli were diverse. The single most common was the highly epidemic strain ST167, which was only observed among isolates from 2017. CONCLUSION We report a rapid increase in occurrence of CRE from 2.4% to 13% among fecal samples collected from healthy rural residents of Shandong province, China, from 2015 to 2017. Colonization with CRE is known to increase the risk of CRE infection and the worrying deterioration of the epidemiological situation in the region reported here indicate a need for further monitoring and possible interventions.
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Affiliation(s)
- Baoli Chen
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Björn Berglund
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shuang Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Stefan Börjesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), Uppsala, Sweden
| | - Zhenqiang Bi
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Maud Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hong Yin
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA), Uppsala, Sweden; Shandong Academy of Clinical Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yonghong Xiao
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenwang Bi
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Lennart E Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Li J, Xu Q, Chen H, Tang L, Yang K, Wang L, Lu X, Rao Y. Pharmacist-led quality control circle in sustained reduction of carbapenem-resistance at a Chinese tertiary teaching hospital. Ann Palliat Med 2021; 10:11558-11565. [PMID: 34872281 DOI: 10.21037/apm-21-2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The spread of carbapenem-resistant Gram-negative bacteria poses a substantial threat to morbidity and mortality worldwide, which is mainly attributed to the overuse of carbapenem. This study aimed to evaluate the use of a quality control circle (QCC) in controlling the overuse of carbapenems and improving the state of carbapenem resistance at a Chinese tertiary teaching hospital. METHODS A pharmacist-led multidisciplinary QCC project was carried out and the plan-do-check-act (PDCA) method was applied for 12 months. The data on carbapenem consumption, bacterial identification, and antibacterial susceptibility testing were collected to evaluate the effect of this project. RESULTS The antibiotics use density (AUD) of carbapenems exhibited a decreasing trend over time (P<0.001), and the AUD of meropenem, imipenem, and biapenem decreased by 30.20%, 42.45%, and 78.05% after the intervention, respectively. The total AUD of carbapenems decreased from 7.37 to 3.96, which included the decrease in the irrational use of carbapenems by 1.61, accounting for 47.21% of the total. Moreover, the positive correlations were discovered between the resistance rate of carbapenem-resistant Klebsiella pneumonia (CRKP)/Acinetobacter baumannii (CRAB) and the AUD of carbapenems (P<0.05). The resistance rate of CRKP and CRAB decreased from 51.93% and 89.21% to 32.94% and 60.66%, respectively, following QCC project implementation. CONCLUSIONS This is the first study to highlight the success of a multifaceted intervention QCC project and PDCA method, which led to a significant reduction in the AUD and resistance rate of carbapenems. QCC is a feasible and effective management tool for improving the quality of carbapenem use in medical institutions.
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Affiliation(s)
- Jun Li
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Xu
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiyong Chen
- Department of Medical Administration, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lingling Tang
- Department of Hospital Infection Management, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Yang
- Department of Urology Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linrun Wang
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyang Lu
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuefeng Rao
- Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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de Carvalho Hessel Dias VM, Tuon F, de Jesus Capelo P, Telles JP, Fortaleza CMCB, Pellegrino Baena C. Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: an extra challenge for healthcare institutions. J Hosp Infect 2021; 120:43-47. [PMID: 34808311 PMCID: PMC8603865 DOI: 10.1016/j.jhin.2021.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/20/2022]
Abstract
The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) per 1000 patient-days increased in 2020 and this finding had a strong positive correlation with the incidence density of COVID-19 by the Spearman test. Polymyxin consumption also increased in 2020 but without significant correlation with CRAB or COVID-19 incidence density, presumably due to empirical and untargeted prescribing as a consequence of concern about CRAB infections. These findings are a warning to infection control programmes and antimicrobial stewardship.
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Affiliation(s)
- V M de Carvalho Hessel Dias
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Hospital Marcelino Champagnat, Curitiba, Paraná, Brazil.
| | - F Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - J P Telles
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | | | - C Pellegrino Baena
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil; Hospital Marcelino Champagnat, Curitiba, Paraná, Brazil
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Sóki J, Wybo I, Wirth R, Hajdú E, Matuz M, Burián K. A comparison of the antimicrobial resistance of fecal Bacteroides isolates and assessment of the composition of the intestinal microbiotas of carbapenem-treated and non-treated persons from Belgium and Hungary. Anaerobe 2021; 73:102480. [PMID: 34800619 DOI: 10.1016/j.anaerobe.2021.102480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
The antimicrobial susceptibilities of Bacteroides strains isolated from the feces of imipenem-treated patients from Belgium and Hungary were compared with those isolated from the normal microbiota from these two and five other European countries and assessed. Of the 10 antibiotics tested, highly significant differences were found with cefoxitin (decrease for Belgium and for this two and the five countries from the previous study), clindamycin (decrease for Belgium and for this two and the five countries from the previous study) and moxifloxacin (increase for Belgium and for this two and the five countries from the previous study) relative to normal microbiota strains reported earlier. Imipenem treatment brought about modest, but notable differences in the compositions of the microbiomes where there was less diversity in the treated group relative to the non-treated group.
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Affiliation(s)
- József Sóki
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Ingrid Wybo
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel,Vrije Universiteit Brussel, Belgium
| | - Roland Wirth
- Department of Biotechnology, Faculty of Sciences and Informatics, University of Szeged, Szeged, Hungary
| | - Edit Hajdú
- Division of Infectious Diseases, First Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Pauquet E, Coppry M, Sarlangue J, Rogues AM. Carbapenem stewardship program in a French university children's hospital. Arch Pediatr 2021; 28:621-625. [PMID: 34686425 DOI: 10.1016/j.arcped.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Carbapenems, last-resort antibiotics, are widely used as first-line treatment in patients carrying extended-spectrum beta-lactamases (ESBL) Enterobacteriaceae, including in a pediatric setting. We aimed to implement an antibiotic stewardship program (ASP) to improve the use of carbapenems. METHODS We implemented an ASP at the Bordeaux Children's University Hospital with 6-month audits on prescribing practice before and after an intervention (revision of antibiotic treatment protocols, a half-day educational session with feedback of the first study period). The number of carbapenem prescriptions was analyzed and two criteria were used to assess conformity of the indication for carbapenem prescription and conformity of the reassessment. A logistic regression was used to assess the overall compliance of carbapenem prescriptions over the two periods adjusted for ESBL carriage. RESULTS A total of 57 patients were included with 37 carbapenem prescriptions before the intervention and 23 after. Overall carbapenem consumption decreased from 0.54 prescriptions per 100 admissions to 0.32 (p = 0.06). Conformity increased during the study for indication (46-87%, p = 0.004) and for reassessment (48-78%, p = 0.04) and was significantly associated with the second study period, after adjustment for ESBL carriage. CONCLUSION Our intervention contributed to a significant improvement in the compliance to indications for carbapenem indication and in the reassessment of the prescription.
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Affiliation(s)
- E Pauquet
- Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France.
| | - M Coppry
- Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - J Sarlangue
- Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - A-M Rogues
- Centre Hospitalier Universitaire de Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
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Solomou N, Minella M, Vione D, Psillakis E. UVC-induced degradation of cilastatin in natural water and treated wastewater. Chemosphere 2021; 280:130668. [PMID: 33962299 DOI: 10.1016/j.chemosphere.2021.130668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 06/12/2023]
Abstract
This work reports for the first time the UVC photodegradation of cilastatin, a renal dehydropeptidase inhibitor co-adminstered with the imipenem antibiotic. Initially, solutions of cilastatin at varying concentrations were prepared in ultra-pure water and the direct photolysis of cilastatin was monitored under 254-nm irradiation. Degradation was slower at higher initial cilastatin concentrations, due to absorption saturation. Of the different eluting photoproducts, only one was tentatively identified as oxidized cilastatin bearing a sulfoxide group. UV-254 photolysis occurred faster at lower pH values, because the protonated forms of the molecule (H3A+, H2A) have both higher absorption coefficients and higher photolysis quantum yields than the non-protonated ones (HA-, A2-). The direct photolysis of cilastatin does not involve •OH, as excluded by experiments in which t-butanol was added as •OH scavenger, whereas the presence of humic acids inhibited photolysis due to competition for radiation absorption. The same explanation partially accounts for the observation that the photolysis kinetics of cilastatin was slower in tap water, river water and treated wastewater samples compared to ultra-pure water. Moreover, the direct photolysis quantum yield was also lower in water matrices compared to ultra-pure water. Similar findings reported for triclosan and the herbicide 2-methyl-4-chlorophenoxyacetic acid in previous studies might suggest that the water matrix components could carry out either physical quenching of cilastatin's excited states or back-reduction to cilastatin of the partially oxidized degradation intermediates. Overall, the present results demonstrate that UVC irradiation is a fast and efficient process for the degradation of cilastatin in natural water and treated wastewater.
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Affiliation(s)
- Nicoleta Solomou
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, GR-73100, Chania, Crete, Greece
| | - Marco Minella
- Department of Chemistry, University of Torino, Via P. Giuria 5, 10125, Torino, Italy
| | - Davide Vione
- Department of Chemistry, University of Torino, Via P. Giuria 5, 10125, Torino, Italy.
| | - Elefteria Psillakis
- Laboratory of Aquatic Chemistry, School of Environmental Engineering, Technical University of Crete, GR-73100, Chania, Crete, Greece.
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Namaei MH, Yousefi M, Askari P, Roshanravan B, Hashemi A, Rezaei Y. High prevalence of multidrug-resistant non-fermentative Gram-negative bacilli harboring bla IMP-1 and bla VIM-1 metallo-beta-lactamase genes in Birjand, south-east Iran. Iran J Microbiol 2021; 13:470-479. [PMID: 34557275 PMCID: PMC8421574 DOI: 10.18502/ijm.v13i4.6971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Non-fermentative Gram-negative Bacilli (NFGNB) is known as a major cause of healthcare-associated infections with high levels of antibiotic resistance. The aim of this study was to investigate the antibiotic resistance profiles and molecular characteristics of metallo-beta-lactamase (MBL)-producing NFGNB. Materials and Methods: In this cross-sectional study, the antibiotic resistance profile of 122 clinical NFGNB isolates was determined by the Kirby-Bauer disk diffusion and microdilution broth methods. Bacterial isolates were investigated for the detection of MBLs production using the combination disk diffusion Test (CDDT). The existence of blaIMP, blaVIM, and blaNDM genes in all carbapenem-resistant isolates was determined employing polymerase chain reaction (PCR) assays. Results: High resistance in Pseudomonas aeruginosa was reported to cefotaxime and minocycline, whereas Acinetobacter baumannii isolates were highly resistant to all antibiotics except colistin. Multidrug resistance (MDR)-NFGNB (66% vs. 12.5%, P=0.0004) and extensively drug resistant (XDR)-NFGNB (55.7% vs. 12.5%, P=0.001) isolates were significantly more common in hospitalized patients than in outpatients. The production of MBL was seen in 40% of P. aeruginosa and 93.3% of A. baumannii isolates. It was found that 33.3% and 46.7% of carbapenem-resistant P. aeruginosa isolates, and 13.3% and 28.9% of carbapenem-resistant A. baumannii isolates were harboring blaIMP-1 and blaVIM-1 genes, respectively. The incidence of MDR (98.2% vs. 28.3%, P<0.001) and XDR (96.4% vs. 11.7%, P<0.001) in MBL-producing NFGNB isolates was significantly higher than non-MBL-producing isolates. Conclusion: This study demonstrated a higher rate of resistance among NFGNB isolates with an additional burden of MBL production within them, warranting a need for robust microbiological surveillance and accurate detection of MBL producers among the NFGNB.
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Affiliation(s)
- Mohammad Hasan Namaei
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Masoud Yousefi
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Parvin Askari
- Department of Microbiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Babak Roshanravan
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Rezaei
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
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Ansari M, Aryal SC, Rai G, Rai KR, Pyakurel S, Bhandari B, Sah AK, Rai SK. Prevalence of multidrug-resistance and bla VIM and bla IMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal. Iran J Microbiol 2021; 13:303-311. [PMID: 34540168 PMCID: PMC8416584 DOI: 10.18502/ijm.v13i3.6392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background and Objectives Carbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. The main objective of this study was to determine the prevalence of carbapenemase (bla VIM and bla IMP ) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Materials and Methods A total of 1,151 clinical samples were collected from the patients visiting Annapurna Neurological Institute and Allied Science and Annapurna Research Centre, Kathmandu, between June 2017 and January 2018. Antibiotic susceptibility testing (AST) was performed on the Enterobacteriaceae, P. aeruginosa and A. baumannii isolates using the Kirby-Bauer disk diffusion method. The modified Hodge test (MHT) was performed on the carbapenem-resistant isolates to confirm carbapenemase production. DNA was extracted and then screened for bla VIM and bla IMP genes by multiplex PCR. Results Of the total 1,151 clinical samples, 253 (22.0%) showed positive growth. Of them, 226 (89.3%) were identified as Enterobacteriaceae, P. aeruginosa, and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Out of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 carbapenem-resistant isolates, 67 (69.1%) showed the modified Hodge test (MHT) positive results. bla VIM and bla IMP were detected in 40 and 38 isolates respectively using multiplex PCR assay. Conclusion This study determined a high prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa, and A. baumannii as detected by the presence of bla VIM and bla IMP genes. This study recommends the use of rapid and advanced diagnostic tools along with conventional phenotypic detection methods in the clinical settings for early detection and management of drug-resistant pathogens to improve treatment strategies.
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Affiliation(s)
- Mehraj Ansari
- Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal
| | | | - Ganesh Rai
- Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal
| | - Kul Raj Rai
- Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal
| | - Susil Pyakurel
- Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal
| | - Bina Bhandari
- Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Anil Kumar Sah
- Department of Microbiology, Annapurna Research Centre, Kathmandu, Nepal
| | - Shiba Kumar Rai
- Depatment of Microbiology, Shi-Gan International College of Sciences and Technology, Kathmandu, Nepal.,Department of Microbiology, Nepal Medical College, Kathmandu, Nepal
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Vahhabi A, Hasani A, Rezaee MA, Baradaran B, Hasani A, Kafil HS, Soltani E. Carbapenem resistance in Acinetobacter baumannii clinical isolates from northwest Iran: high prevalence of OXA genes in sync. Iran J Microbiol 2021; 13:282-293. [PMID: 34540166 PMCID: PMC8416588 DOI: 10.18502/ijm.v13i3.6388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Carbapenem treatment for Acinetobacter baumannii infections presently faces threats owing to the production of several types of carbapenemase enzymes, prevalence of which varies among different countries. We explored the current trend of antibiotic resistance in A. baumannii clinical isolates from North West Iran, sought the mechanism of carbapenem resistance and addressed the sequence type groups in carbapenem resistant A. baumannii (CRAB). Materials and Methods A. baumannii (n=112) isolates were recovered from various clinical specimens of patients admitted in internal, surgery, burn, infectious diseases and various ICUs wards. Genetically confirmed A. baumannii isolates were screened for carbapenem resistance by the Kirby-Bauer and E-test and the presence of bla MBL, bla OXA-like, ISAba1 genes by PCR. Sequence groups were identified by multiplex PCR. Results Multidrug-resistance (MDR) was a characteristic feature of all A. baumannii isolates. Frequency of oxacillinase genes in combination including bla OXA-51-like/bla OXA-23-like, bla OXA-51-like/blaOXA-24/40-likeand bla OXA-51-like/bla OXA-23-like/bla OXA-24/40-like was 82.1%, 36.6% and 25.8% respectively. Blending of oxacillinase and MBL genes was evident in eight bla OXA-23-like positive and 7 bla OXA-24-like positive isolates thereby depicting synchronous etiology of carbapenem resistance. Amongst CRAB isolates, 97.3% contained ISAba1 element and 50.9% belonged to the European clone II. Conclusion Synchronicity among bla OXA-like with bla MBL and ISAba1 gene was a hallmark of this investigation. Though origin or route of transmission was not elucidated in this study but co-existence among OXA and MBL producing genes is a therapeutic concern demanding strict surveillance strategies and control programs to halt the dissemination of these isolates in the hospital setting.
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Affiliation(s)
- Abolfazl Vahhabi
- Immunology Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alka Hasani
- Immunology Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Clinical Research Development Unit, Sina Educational, Research and Treatment Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Baradaran
- Immunology Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Hasani
- Department of Clinical Biochemistry and Laboratory Sciences, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elgar Soltani
- Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Clinical Research Development Unit, Sina Educational, Research and Treatment Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Lin YC, Cao X, Mo YC, Xie CP, Zhang YF, Li N, Chen HL. Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin. IDCases 2021; 26:e01276. [PMID: 34522614 DOI: 10.1016/j.idcr.2021.e01276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/22/2022] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP) with a high mucus phenotype, can cause liver abscess and extrahepatic invasive infection. The morbidity of hvKP infections has increased recently. Here we describe a case report of septicemia caused by hvKP due to the term septic arthritis of right knee joint in a 29-year-old male. The patient was persistent fever with a peak temperature at 40.6 °C. However, based on the drug sensitivity, the treatment failed frequently. The patient did not improve clinically on susceptible monotherapy antimicrobial. Combination therapy with meropenem and rifampicin (RFP) lead to clinical improvement and discharge.
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Key Words
- BSIs, bloodstream infections
- Bacteremia
- CK, creatine kinase
- CK-MB, MB isoenzyme of creatine kinase
- Carbapenems
- GLU, glucose in the blood
- Hs-CRP, hypersensitive C-reactive protein
- Hypervirulent Klebsiella pneumoniae
- KPLA, Klebsiella pneumoniae liver abscess
- Liver abscess
- RFP, Rifampicin
- Rifampicin
- hvKP, hypervirulent Klebsiella pneumoniae
- magA, mucus related gene A
- rmpA, regulator of mucoid phenotype A
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Luo H, Xiao Y, Hang Y, Chen Y, Zhu H, Fang X, Cao X, Zou S, Hu X, Xiong J, Zhong Q, Hu L. Comparison of therapy with β-lactam/β-lactamase inhibitor combinations or carbapenems for bacteraemia of nonurinary source caused by ESBL-producing Escherichia coli or Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob 2021; 20:63. [PMID: 34488786 PMCID: PMC8422674 DOI: 10.1186/s12941-021-00471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has become a public health concern. This study aimed to compare the clinical outcomes of patients with nonurinary source bacteraemia caused by ESBL-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (ESBL-producing EK) receiving β-lactam/β-lactamase inhibitor combinations (BLICs) versus carbapenem treatment and assess the risk factors of mortality with these two drugs. Methods We conducted a retrospective single-centre study of adult hospitalised patients with ESBL-producing EK bloodstream infection (BSI) from nonurinary source at our centre over a 4-year period. One hundred and eighty patients who received BLICs or carbapenems were included in the analysis. The outcome variables were 14-day treatment failure and 30-day mortality. For more reliable results, propensity score analysis was performed to compare the efficacy of the two drugs and analyse their risk factors for 30-day mortality. Results Out of 180 patients, 114 received BLICs, and 66 received carbapenem therapy. Compared to carbapenem-treated patients, those treated with BLICs were older and had higher age-adjusted Charlson comorbidity index, but they had shorter stay in the hospital. Additionally, their Pitt bacteraemia score, SOFA score, rate of leukaemia, and immune compromise were lower. After propensity score matching (PSM), the baseline characteristics of patients in the two treatment groups were balanced. BLICs were associated with a higher 14-day treatment failure rate (20.6%, 13/63) than carbapenems (16.3%, 7/43), although the difference was not significant in either univariate analysis (P = 0.429) or multivariate analysis (P = 0.122). And the 30-day mortality rate in BTG (11.1%, 7/63) and CTG (11.6%, 5/43) did not significantly differ (univariate analysis, P = 0.926; multivariate analysis, P = 0.420). In the multivariate analysis, after PSM, leukaemia was the only independent predictor of mortality in both BTG and CTG. Conclusions Our study showed that BLICs had higher 14-day treatment failure rate compared with carbapenems, although there were no statistically significant differences because of the small number of patients, therefore, further evaluation of the efficacy of BLICs is needed.
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Affiliation(s)
- Hong Luo
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yanping Xiao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yaping Hang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yanhui Chen
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Hongying Zhu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xueyao Fang
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xingwei Cao
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shan Zou
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Xiaoyan Hu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jianqiu Xiong
- Department of Nursing, The Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Qiaoshi Zhong
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China.
| | - Longhua Hu
- Department of Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Mingde Road No. 1, Nanchang, 330006, Jiangxi, People's Republic of China.
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