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Walkty A, Karlowsky JA, Lagacé-Wiens PRS, Baxter MR, Adam HJ, Bay DC, Zhanel GG. Moving towards a standardized definition of antimicrobial resistance: a comparison of the antimicrobial susceptibility profile of difficult-to-treat resistance (DTR) versus multidrug-resistant (MDR) Pseudomonas aeruginosa clinical isolates (CANWARD, 2016-2021). Diagn Microbiol Infect Dis 2024; 108:116130. [PMID: 38006710 DOI: 10.1016/j.diagmicrobio.2023.116130] [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: 08/14/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 11/27/2023]
Abstract
Pseudomonas aeruginosa clinical isolates demonstrating difficult-to-treat resistance (DTR) and multidrug-resistant (MDR) phenotypes were evaluated by broth microdilution. Susceptibility was lower for all antimicrobials versus DTR relative to MDR isolates. Ceftazidime-avibactam, ceftolozane-tazobactam, and imipenem-relebactam susceptibility was 35.9%, 64.5%, and 47.0% for DTR isolates and 60.5%, 80.6%, and 71.5% for MDR isolates.
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Affiliation(s)
- A Walkty
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Shared Health, Winnipeg, Canada.
| | - J A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Shared Health, Winnipeg, Canada
| | - P R S Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Shared Health, Winnipeg, Canada
| | - M R Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - H J Adam
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada; Shared Health, Winnipeg, Canada
| | - D C Bay
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - G G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Walkty A, Karlowsky JA, Lagacé-Wiens PRS, Golden AR, Baxter MR, Denisuik AJ, McCracken M, Mulvey MR, Adam HJ, Zhanel GG. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac027. [PMID: 35321395 PMCID: PMC8935204 DOI: 10.1093/jacamr/dlac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J. A. Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Shared Health, Winnipeg, Canada
| | - P. R. S. Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Shared Health, Winnipeg, Canada
| | - A. R. Golden
- Public Health Agency of Canada – National Microbiology Laboratory, Winnipeg, Canada
| | - M. R. Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - A. J. Denisuik
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - M. McCracken
- Public Health Agency of Canada – National Microbiology Laboratory, Winnipeg, Canada
| | - M. R. Mulvey
- Public Health Agency of Canada – National Microbiology Laboratory, Winnipeg, Canada
| | - H. J. Adam
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Shared Health, Winnipeg, Canada
| | - G. G. Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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Lagacé-Wiens PRS, Adam HJ, Laing NM, Baxter MR, Martin I, Mulvey MR, Karlowsky JA, Hoban DJ, Zhanel GG. Antimicrobial susceptibility of clinical isolates of Neisseria gonorrhoeae to alternative antimicrobials with therapeutic potential. J Antimicrob Chemother 2018; 72:2273-2277. [PMID: 28505331 DOI: 10.1093/jac/dkx147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background The prevalence of MDR Neisseria gonorrhoeae is increasing globally and represents a public health emergency. Development and approval of new anti-gonococcal agents may take years. As a concurrent approach to developing new antimicrobials, the laboratory and clinical evaluation of currently licensed antimicrobials not widely used for the treatment of gonorrhoea may provide new options for the treatment of gonococcal infections. Objectives To determine the in vitro activity of nine alternative, currently licensed and late-development antimicrobials with the potential to treat gonococcal infections against 112 clinical isolates of N. gonorrhoeae resistant to one or multiple antimicrobials. Methods The MICs of conventional anti-gonococcal antimicrobials (penicillin, ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline and spectinomycin) and alternative antimicrobials (ertapenem, gentamicin, netilmicin, tigecycline, eravacycline, fosfomycin, linezolid, ceftazidime/avibactam and ceftaroline) were determined by agar dilution. Results Ertapenem and the novel cephalosporins demonstrated similar MIC values to the third-generation cephalosporins, but increased MICs were observed for isolates with increased cefixime and ceftriaxone MICs. Tigecycline and eravacycline had MIC values below expected serum concentrations for all isolates tested. The aminoglycosides gentamicin and netilmicin were generally more potent than spectinomycin, with netilmicin demonstrating the greatest potency. Fosfomycin MICs were elevated compared with other agents, but remained within the MIC range for susceptible organisms, while linezolid MICs were generally higher than those for organisms considered resistant. Conclusions Among potentially therapeutically useful alternative agents, the aminoglycosides, eravacycline, tigecycline and fosfomycin had good in vitro activity. The novel cephalosporins and ertapenem had comparable activity to cefixime and ceftriaxone.
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Affiliation(s)
- P R S Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4.,Department of Clinical Microbiology, Diagnostic Services Manitoba, L4025-409 Taché Ave., Winnipeg, Manitoba, Canada, R2H 2A6
| | - H J Adam
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4.,Department of Clinical Microbiology, Diagnostic Services Manitoba, L4025-409 Taché Ave., Winnipeg, Manitoba, Canada, R2H 2A6
| | - N M Laing
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4
| | - M R Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4
| | - I Martin
- Streptococcus and STI Unit, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, Manitoba, Canada, R3E 3R2
| | - M R Mulvey
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4.,Streptococcus and STI Unit, National Microbiology Laboratory, 1015 Arlington St., Winnipeg, Manitoba, Canada, R3E 3R2
| | - J A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4.,Department of Clinical Microbiology, Diagnostic Services Manitoba, L4025-409 Taché Ave., Winnipeg, Manitoba, Canada, R2H 2A6
| | - D J Hoban
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4.,Department of Clinical Microbiology, Diagnostic Services Manitoba, L4025-409 Taché Ave., Winnipeg, Manitoba, Canada, R2H 2A6
| | - G G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, 771 Bannatyne Ave., Winnipeg, Manitoba, Canada, R3E 3N4
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Walkty A, Lagacé-Wiens PRS, Manickam K, Adam H, Pieroni P, Alfa M, Karlowsky JA. Re-evaluation of rejection criteria for endotracheal tube (ETT) specimens from adult patients. J Med Microbiol 2012; 61:1306-1310. [PMID: 22700550 DOI: 10.1099/jmm.0.042333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to determine optimal criteria for microbiology laboratory screening of endotracheal tube (ETT) specimens submitted for bacterial culture from adult patients. ETT specimens from adult patients that were received by two microbiology laboratories were prospectively evaluated and subdivided into one of three study arms with the following criteria: <10 squamous epithelial cells (SECs) per low-power field with bacteria seen on Gram staining (arm 1), >10 SECs per low-power field with bacteria seen on Gram staining (arm 2) and <10 SECs per low-power field with no bacteria seen on Gram staining (arm 3). A fourth study arm (>10 SECs per low-power field with no bacteria seen on Gram staining) was planned but this arm was terminated due to the paucity of specimens meeting these criteria. Isolate evaluation was performed using standard microbiology protocols. A limited chart review was undertaken at one of the institutions, only reviewing patients from which a potential pathogen was recovered on culture. In total, 141 ETT specimens were evaluated. A potential respiratory pathogen was recovered from 54, 37 and 10 % of specimens in study arms 1, 2, and 3, respectively (P<0.0001, comparing between arm 1 and arm 3). For the 23 patients included in the chart review from whom a potential pathogen was recovered on culture, respiratory infection was considered to be present in 50 % (6/12) of patients in arm 1, 66.6 % (6/9) of patients in arm 2 and 100 % (2/2) of patients in arm 3. Therapy was rarely altered based on culture results. In this study, the ETT specimens submitted for bacterial culture were of limited benefit to clinicians. The data presented here support the use of an absence of bacteria on Gram staining as a rejection criterion for ETT specimens. The criterion of >10 SECs per low-power field should be further evaluated in a prospective study of patients with an unequivocal clinical diagnosis of pneumonia.
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Affiliation(s)
- A Walkty
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
- Department of Medicine, Health Sciences Centre, Winnipeg, MB, Canada
| | - P R S Lagacé-Wiens
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - K Manickam
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - H Adam
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - P Pieroni
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - M Alfa
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
| | - J A Karlowsky
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada
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Walkty A, Lagacé-Wiens PRS, Karlowsky JA, Hoban DJ, Manickam K, Adam H, Pieroni P, Alfa M. Change in antimicrobial susceptibility of Escherichia coli urinary tract isolates at a single institution over a period of 10 years. Can J Microbiol 2012; 58:345-9. [PMID: 22369590 DOI: 10.1139/w2012-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urinary tract infections are common. Few published studies have demonstrated the change in Escherichia coli urinary isolate antimicrobial susceptibility over time within a given area and (or) population. The purpose of this study was to evaluate the change in susceptibility of E. coli clinical isolates obtained from urine specimens at a single institution over a period of 10 years. The microbiology laboratory information system at St. Boniface Hospital (Winnipeg, Manitoba, Canada) was searched retrospectively from 1 January 2000 to 31 December 2009, for all E. coli isolates from either a midstream or catheter urine source that had susceptibility testing performed. Only one isolate per patient was included during the entire study period. Antimicrobial susceptibility testing was carried out with either a Microscan instrument (pre-April 2004) or a Vitek instrument (May 2004 onwards). In total, 7353 E. coli urinary isolates were included for evaluation. Ciprofloxacin susceptibility declined significantly, from 99% in 2000 to 85% in 2009 (p < 0.0001). A small but statistically significant decline in susceptibility was also observed for ampicillin, cefazolin, trimethoprim-sulfamethoxazole, gentamicin, and nitrofurantoin. These data suggest that certain antimicrobials recommended for the treatment of urinary tract infections (ciprofloxacin, trimethoprim-sulfamethoxazole) may no longer be optimal.
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Affiliation(s)
- A Walkty
- Departments of Medicine and Clinical Microbiology, Health Sciences Centre, MS673B-820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada.
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