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Teethaisong Y, Evans K, Nakouti I, Tiamyom K, Ketudat-Cairns JR, Hobbs G, Eumkeb G. The performance of a resazurin chromogenic agar plate with a combined disc method for rapid screening of extended-spectrum-β-lactamases, AmpC β-lactamases and co-β-lactamases in Enterobacteriaceae. Microbiol Immunol 2017; 61:297-304. [PMID: 28685856 DOI: 10.1111/1348-0421.12499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/12/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
A promising means of rapid screening of extended-spectrum-β-lactamase (ESBL), AmpC β-lactamase, and co-production of ESBL and AmpC that combines resazurin chromogenic agar (RCA) with a combined disc method is here reported. Cefpodoxime (CPD) discs with and without clavulanic acid (CA), cloxacillin (CX) and CA+CX were evaluated against 86 molecularly confirmed β-lactamase-producing Enterobacteriaceae, including 15 ESBLs, 32 AmpCs, nine co-producers of ESBL and AmpC and 30 carbapenemase producers. The CA and CX synergy test successfully detected all ESBL producers (100% sensitivity and 98.6% specificity) and all AmpC producers (100% sensitivity and 96.36% specificity). This assay also performed well in screening for co-existence of ESBL and AmpC (88.89% sensitivity and 100% specificity). The RCA assay is simple and inexpensive and provides results within 7 hr. It can be performed in any microbiological laboratory, in particular, in geographic regions in which ESBL, AmpC or co-β-lactamase-producing Enterobacteriaceae are endemic.
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Affiliation(s)
- Yothin Teethaisong
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
- School of Preclinic, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, 30000, Thailand
| | - Katie Evans
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Ismini Nakouti
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Kanokwan Tiamyom
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - James R Ketudat-Cairns
- School of Chemistry, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, 30000, Thailand
| | - Glyn Hobbs
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Griangsak Eumkeb
- School of Preclinic, Institute of Science, Suranaree University of Technology, Nakhon Ratchasima, 30000, Thailand
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Namikawa H, Yamada K, Fujimoto H, Oinuma KI, Tochino Y, Takemoto Y, Kaneko Y, Shuto T, Kakeya H. Clinical Characteristics of Bacteremia Caused by Extended-spectrum Beta-lactamase-producing Escherichia coli at a Tertiary Hospital. Intern Med 2017; 56:1807-1815. [PMID: 28717075 PMCID: PMC5548672 DOI: 10.2169/internalmedicine.56.7702] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective In recent years, infection caused by extended-spectrum beta-lactamase (ESBL)-producing organisms has become an important issue. However, comparative studies of the bacteremia caused by ESBL Enterobacteriaceae and non-ESBL Enterobacteriaceae are extremely rare in Japan. This study aimed to assess the risk factors and prognosis of patients with bacteremia due to ESBL Escherichia coli (E. coli). Methods The medical records of 31 patients with ESBL E. coli bacteremia and 98 patients with non-ESBL E. coli bacteremia who had been admitted to Osaka City University Hospital between January 2011 and June 2015 were retrospectively reviewed. The patient backgrounds, risk factors for infection, and prognosis were evaluated. Results The male-to-female ratio, mean age, underlying disease, leukocyte count, and C-reactive protein (CRP) level did not differ between the patients in the ESBL E. coli bacteremia and non-ESBL E. coli bacteremia groups. The mean Sequential Organ Failure Assessment (SOFA) score for patients with ESBL and non-ESBL E. coli bacteremia were 3.6 and 3.8, respectively. Further, the mortality did not differ between the two groups (9.7% vs 9.2%). However, the independent predictors associated with ESBL E. coli bacteremia according to a multivariate analysis were the use of immunosuppressive drugs or corticosteroids (p=0.048) and quinolones (p=0.005) prior to isolation. The mortality did not differ between the carbapenem and tazobactam/piperacillin (TAZ/PIPC) or cefmetazole (CMZ) groups for the patients with ESBL E. coli bacteremia. Conclusion Whenever we encountered patients with a history of immunosuppressive drug, corticosteroid, quinolone administration, it was necessary to perform antibiotic therapy while keeping the risk of ESBL E. coli in mind.
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Affiliation(s)
- Hiroki Namikawa
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Japan
- Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Japan
| | - Hiroki Fujimoto
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Japan
| | - Ken-Ichi Oinuma
- Department of Bacteriology, Osaka City University, Graduate School of Medicine, Japan
| | - Yoshihiro Tochino
- Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, Japan
| | - Yasuhiko Takemoto
- Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, Japan
| | - Yukihiro Kaneko
- Department of Bacteriology, Osaka City University, Graduate School of Medicine, Japan
| | - Taichi Shuto
- Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka City University, Graduate School of Medicine, Japan
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El-Jade MR, Parcina M, Schmithausen RM, Stein C, Meilaender A, Hoerauf A, Molitor E, Bekeredjian-Ding I. ESBL Detection: Comparison of a Commercially Available Chromogenic Test for Third Generation Cephalosporine Resistance and Automated Susceptibility Testing in Enterobactericeae. PLoS One 2016; 11:e0160203. [PMID: 27494134 PMCID: PMC4975492 DOI: 10.1371/journal.pone.0160203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/17/2016] [Indexed: 11/24/2022] Open
Abstract
Rapid detection and reporting of third generation cephalosporine resistance (3GC-R) and of extended spectrum betalactamases in Enterobacteriaceae (ESBL-E) is a diagnostic and therapeutic priority to avoid inefficacy of the initial antibiotic regimen. In this study we evaluated a commercially available chromogenic screen for 3GC-R as a predictive and/or confirmatory test for ESBL and AmpC activity in clinical and veterinary Enterobacteriaceae isolates. The test was highly reliable in the prediction of cefotaxime and cefpodoxime resistance, but there was no correlation with ceftazidime and piperacillin/tazobactam minimal inhibitory concentrations. All human and porcine ESBL-E tested were detected with exception of one genetically positive but phenotypically negative isolate. By contrast, AmpC detection rates lay below 30%. Notably, exclusion of piperacillin/tazobactam resistant, 3GC susceptible K1+ Klebsiella isolates increased the sensitivity and specificity of the test for ESBL detection. Our data further imply that in regions with low prevalence of AmpC and K1 positive E. coli strains chromogenic testing for 3GC-R can substitute for more time consuming ESBL confirmative testing in E. coli isolates tested positive by Phoenix or VITEK2 ESBL screen. We, therefore, suggest a diagnostic algorithm that distinguishes 3GC-R screening from primary culture and species-dependent confirmatory ESBL testing by βLACTATM and discuss the implications of MIC distribution results on the choice of antibiotic regimen.
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Affiliation(s)
- Mohamed Ramadan El-Jade
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Marijo Parcina
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Ricarda Maria Schmithausen
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
- Institute of Animal Science, Preventive Health Management Group, University of Bonn, Katzenburgweg 7–9, D-53115, Bonn, Germany
| | - Christoph Stein
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
- Division of Microbiology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51–59, D-63225, Langen, Germany
| | - Alina Meilaender
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Ernst Molitor
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
| | - Isabelle Bekeredjian-Ding
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn, Sigmund-Freud-Str. 25, D-53105, Bonn, Germany
- Division of Microbiology, Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51–59, D-63225, Langen, Germany
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Clinical features and molecular epidemiology of plasmid-mediated DHA-type AmpC β-lactamase-producing Klebsiella pneumoniae blood culture isolates, Hong Kong. J Glob Antimicrob Resist 2016; 7:37-42. [PMID: 27568104 DOI: 10.1016/j.jgar.2016.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/31/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022] Open
Abstract
Knowledge of risk factors and clinical characteristics of bacteraemia caused by plasmid-mediated AmpC β-lactamase (pAmpC)-producing Klebsiella pneumoniae (pAmpC-Kp) is not well described. This was a retrospective cohort study of patients with K. pneumoniae bacteraemia in three Hong Kong regional hospitals. Demographic and clinical data were retrieved from medical records. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for molecular epidemiology. A total of 109 patients were included, divided into four groups: bacteraemia due to K. pneumoniae with (i) DHA-type pAmpC (n=23), (ii) extended-spectrum β-lactamase (ESBL) (n=37), (iii) DHA-type pAmpC+ESBL (n=26) and (iv) controls (n=23). Nursing home residence was independently associated with pAmpC-Kp bacteraemia compared with ESBL-Kp bacteraemia [adjusted odds ratio (aOR)=7.13, 95% confidence interval (CI) 1.36-37.54] and controls (aOR=41.47, 95% CI 4.55-377.75). Compared with controls, patients with pAmpC-Kp bacteraemia also suffered from more severe illness [median Acute Physiology and Chronic Health Evaluation (APACHE) II scores 16 and 25, respectively; P=0.006]. Importantly, the pAmpC group received discordant empirical antimicrobial therapy more frequently (OR=24.00, 95% CI 5.01-114.97), resulting in higher 7-day mortality (OR=20.17, 95% CI 2.32-175.67) and 30-day mortality (OR 4.68, 95% CI 1.29-16.98). PFGE detected six pulsotypes, corresponding to the predominant sequence type 11. Severity of illness and mortality of patients with bacteraemia caused by pAmpC-Kp were high. Patients who are nursing home residents presenting nosocomial sepsis should be treated with broad-spectrum antimicrobials.
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Korytny A, Riesenberg K, Saidel-Odes L, Schlaeffer F, Borer A. Bloodstream infections caused by multi-drug resistant Proteus mirabilis: Epidemiology, risk factors and impact of multi-drug resistance. Infect Dis (Lond) 2016; 48:428-31. [PMID: 26763474 DOI: 10.3109/23744235.2015.1129551] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of antimicrobial co-resistance among ESBL-producing Enterobactereaceae is extremely high in Israel. Multidrug-resistant Proteus mirabilis strains (MDR-PM), resistant to almost all antibiotic classes have been described. The aim was to determine the risk factors for bloodstream infections caused by MDR-PM and clinical outcomes. METHODS A retrospective case-control study. Adult patients with PM bacteremia during 7 years were identified retrospectively and their files reviewed for demographics, underlying diseases, Charlson Comorbidity Index, treatment and outcome. RESULTS One hundred and eighty patients with PM-bloodstream infection (BSI) were included; 90 cases with MDR-PM and 90 controls with sensitive PM (S-PM). Compared to controls, cases more frequently were from nursing homes, had recurrent hospital admissions in the past year and received antibiotic therapy in the previous 3 months, were bedridden and suffered from peripheral vascular disease and peptic ulcer disease (p < 0.001). Two-thirds of the MDR-PM isolates were ESBL-producers vs 4.4% of S-PM isolates (p < 0.001, OR = 47.6, 95% CI = 15.9-142.6). In-hospital crude mortality rate of patients with MDR-PM BSI was 37.7% vs 23.3% in those with S-PM BSI (p = 0.0359, OR = 2, 95% CI = 1.4-3.81). CONCLUSIONS PM bacteremia in elderly and functionally-dependent patients is likely to be caused by nearly pan-resistant PM strains in the institution; 51.8% of the patients received inappropriate empiric antibiotic treatment. The crude mortality rate of patients with MDR-PM BSI was significantly higher than that of patients with S-PM BSI.
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Affiliation(s)
- Alexander Korytny
- a Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Klaris Riesenberg
- a Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Lisa Saidel-Odes
- a Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Fransisc Schlaeffer
- a Infectious Diseases Institute, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Abraham Borer
- b Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
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