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Bushuven S, Bentele M, Bentele S, Trifunovic-Koenig M, Lederle S, Gerber B, Bansbach J, Friebel J, Ganter J, Nachtigall I, Scheithauer S. Hand hygiene in emergencies: Multiprofessional perceptions from a mixed methods based online survey in Germany. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 6:100207. [PMID: 38783870 PMCID: PMC11111829 DOI: 10.1016/j.ijnsa.2024.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Despite high vulnerability to infection, hand disinfection compliance in emergencies is low. This is regularly justified as the disinfection procedure delays life support, and instead, wearing disposable gloves is preferred. Simulation studies showed higher achievable compliance than detected in real-life situations. This study aimed to explore healthcare providers' attitudes toward hand disinfection and using gloves in emergencies. Methods We conducted an anonymous online survey in Germany on the attitude and subjective behavior in the five moments of hand hygiene in a closed environment and an open convenience sampling survey. Statistics included paired student's t-tests corrected for multiple testing. For qualitative analysis, we employed a single-coder approach. Results In 400 participants, we detected low priority of WHO-1 (before touching a patient) and WHO-2 (before clean/aseptic procedure) hand hygiene moments, despite knowing the risks of omission of hand disinfection. For all moments, self-assessment exceeded the assessment of colleagues (p < 0.001). For WHO-3, we detected a lower disinfection priority for wearing gloves compared to contaminated bare hands. Qualitative analyses revealed five themes: basic conditions, didactic implementations, cognitive load, and uncertainty about feasibility and efficacy. Discussion Considering bias, the study's subjective nature, the unknown role of emergency-related infections contributing to hospital-acquired infections, and different experiences of healthcare providers, we conclude that hand disinfection before emergencies is de-prioritized and justified by the emergency situation regardless of the objective feasibility. Conclusion This study reveals subjective and objective barriers to implementation of WHO-1 and WHO-2 moments of hand disinfection to be further evaluated and addressed in educational programs.
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Affiliation(s)
- Stefan Bushuven
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
- Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany
| | - Michael Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Institute for Anesthesiology, Intensive Care, Emergency Medicine, and Pain Therapy, Hegau Bodensee Hospital Singen, Germany
| | - Stefanie Bentele
- Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
- Department for Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | | | - Sven Lederle
- St Johns Ambulance, Local Association Singen am Hohentwiel, Singen, Germany
| | - Bianka Gerber
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Julian Friebel
- Emergency Medical Services Department, Berlin Fire and Rescue Service, Berlin, Germany
- Department of Cardiology Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC),Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julian Ganter
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Irit Nachtigall
- Helios, Region East Infectious Diseases and Antibiotic Stewardship and Medical School Berlin, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Germany
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He C, Wu S, Wang X, Li L, Yan Z. Surveillance and Resistance of Community-Onset Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumonia in Oral and Maxillofacial Surgery Site Infections. Surg Infect (Larchmt) 2024; 25:247-252. [PMID: 38588519 DOI: 10.1089/sur.2023.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Background: The prevalence of community-onset infections of extended spectrum β-lactamase (ESBL)-producing strains has increased globally, yet surveillance and resistance in patients with oral and maxillofacial surgery site infections is less investigated. Patients and Methods: A retrospective cohort study was performed to investigate risk factors and resistance of ESBL-producing Escherichia coli (ESBL-EC) and ESBL-producing Klebsiella pneumonia (ESBL-KP) among community-onset patients with oral and maxillofacial surgery during January 2010 to December 2016. Demographic features, predisposing factors, clinical outcomes, and antibiotic agent costs were analyzed. Antimicrobial susceptibility testing of nine antimicrobial agents against ESBL-KP and ESBL-EC were measured. Results: Among 2,183 cultures from infection sites in patients with oral and maxillofacial surgery site (45 cases [2.06%]) were confirmed with community-onset ESBL-KP (24; 1.10%) or ESBL-EC (21; 0.96%) infection. Multivariable analysis showed the independent risk factors for ESBL-producing bacterial infection were prior history of hospitalization (adjusted odds ratio [aOR], 10.984; 95% confidence interval [CI], 5.965-59.879; p = 0.025) and malignant condition (aOR, 3.373; 95% CI 2.947-7.634; p = 0.024). Based on antimicrobial susceptibility testing, 57.8% ESBL-KP and ESBL-EC were found receiving inappropriate antimicrobial therapy, and antibiotic agent costs were higher than non-ESBL-producing bacterial infections ($493.8 ± $367.3 vs. $304.1 ± $334.7; p = 0.031). Conclusions: Infections caused by ESBL-KP and ESBL-EC among patients in sites with oral and maxillofacial surgery are associated with prior history of hospitalization and malignant conditions. Prompt detection and appropriate antibiotic administration for community-onset infections of ESBLs are necessary for such populations.
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Affiliation(s)
- Chun He
- Department of Clinical Laboratory, Peking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Shuangshuang Wu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Xu Wang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Linman Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Zhimin Yan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology and National Center for Stomatology and National Clinical Research Center for Oral Diseases and National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
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Quang HV, Nhung LTK, Thuy PTT, Quyen PC, Huy LB, Dung HS. Blood-Stream Infections: Causative Agents, Antibiotic Resistance and Associated Factors in Older Patients. Mater Sociomed 2024; 36:82-89. [PMID: 38590604 PMCID: PMC10999148 DOI: 10.5455/msm.2024.36.82-89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Background The rate of multi-drug antibiotic resistance in nosocomial bloodstream infections in elderly patients is increasing. This study examined the data for bloodstream infections to gain a better understanding of bacterial antibiotic resistance. Methods This was a retrospective study of 817 patients with the first positive blood culture between January 1, 2016 and December 31, 2019. Results Moyen's age was 77.4 ± 9.8 years, male (52.4%) and SOFA 5.0 ± 4. ESBL(+) rate was 78/817 (9.5%). ESBL(+) rate for Escherichia coli and Klebsiella pneumoniae was 69/141 (48.9%) and 9/52 (17.3%), respectively. The most common isolates were Escherichia coli (17.3%), Stenotrophomonas maltophilia (13.7%), and Staphylococcus species (23.1%). The rate of septic shock and mortality accounted for 22.3% and 28.9%, respectively. Escherichia coli is highly sensitive to carbapenem, and resistant (>50%) with quinolone and aminoside. Klebsiella pneumoniae and Pseudomonas aeruginosa were highly sensitive to carbapenem. Acinetobacter baumannii was resistant to meropenem (75%). Stenotrophomonas maltophilia was sensitive to quinolone (13.8 %), and highly resistant to remaining antibiotics. Methicillin-resistant Staphylococcus aureus had a low resistance rate for vancomycin, teicoplanin, and linezolid. Multivariate analysis showed that the significant factors associated with mortality were age >75; SOFA >7; respiratory infection; intensive care unit treatment and presentation with septic shock. Conclusion The mortality rate was still high, especially for antibiotic-resistant agents.
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Affiliation(s)
- Hoang-Van Quang
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le-Thi Kim Nhung
- Department of Internal Medicine, Medical Faculty, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam
| | | | - Phan Chau Quyen
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Le Bao Huy
- Department of Emergency Medicine, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Ho Si Dung
- ICU Department, Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
- Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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Sakai M, Sakai T, Nagata Y, Komai H, Miyake Y, Watariguchi T, Kawabata A, Ohtsu F. Effect of rapid cefpodoxime disk screening for early detection of third-generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae bacteremia. J Pharm Health Care Sci 2023; 9:43. [PMID: 38037095 PMCID: PMC10691134 DOI: 10.1186/s40780-023-00313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Several methods have been reported for detecting resistance genes or phenotypic testing on the day of positive blood culture in Escherichia coli or Klebsiella pneumoniae bacteremia. However, some facilities have not introduced these methods because of costs or other reasons. Toyota Kosei Hospital introduced cefpodoxime (CPDX) rapid screening on May 7, 2018, to enable early detection of third-generation cephalosporin resistance. In this study, we aimed to evaluate the effects of intervention with an Antimicrobial Stewardship Team using CPDX rapid screening. METHODS Cefotaxime (CTX)-resistant E. coli or K. pneumoniae bacteremia cases were selected retrospectively and divided into two groups: the pre-CPDX screening (June 1, 2015, to May 6, 2018) and CPDX screening groups (July 7, 2018, to August 31, 2021). The primary outcome was the proportion of cases in which modifications were made to the administration of susceptible antimicrobial agents within 24 h of blood culture-positive reports. RESULTS Overall, 63 patients in the pre-CPDX screening group and 84 patients in the CPDX screening group were eligible for analysis. The proportion of patients who modified to susceptible antimicrobial agents within 24 h of blood culture-positive reports was significantly increased in the CPDX screening group compared to that in the pre-CPDX screening group (6.3% vs. 22.6%, p = 0.010). CONCLUSION The results demonstrated that in CTX-resistant E. coli or K. pneumoniae bacteremia, CPDX rapid screening increased the proportion of early initiation of appropriate antimicrobial agents.
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Affiliation(s)
- Mikiyasu Sakai
- Graduate School of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku-Ku, Nagoya, Aichi, 468-8503, Japan.
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan.
| | - Takamasa Sakai
- Drug Informatics, Faculty of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku-Ku, Nagoya, Aichi, 468-8503, Japan
| | - Yuki Nagata
- Department of Clinical Laboratory, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
| | - Hiroko Komai
- Department of Infection Control, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
| | - Toshitaka Watariguchi
- Department of General Internal Medicine, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
| | - Atsushi Kawabata
- Department of Infection Control, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
- Department of Infectious Disease, Toyota Kosei Hospital, 500-1, Ibobara, Toyota, Jousui-Cho, 470-0396, Japan
| | - Fumiko Ohtsu
- Drug Informatics, Faculty of Pharmacy, Meijo University, 150 Yagotoyama, Tempaku-Ku, Nagoya, Aichi, 468-8503, Japan
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Kashihara E, Sada RM, Tsugihashi Y, Obayashi H, Nakamura A, Abe N, Miyake H, Akebo H. Efficacy and Safety of Cefmetazole for Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Enterobacterales vs Carbapenems: A Retrospective Study. Open Forum Infect Dis 2023; 10:ofad502. [PMID: 37901123 PMCID: PMC10603591 DOI: 10.1093/ofid/ofad502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/31/2023] Open
Abstract
Background Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales have become a global concern owing to increased infections, high mortality, and limited antibiotic treatment options. Carbapenems (CPMs) are effective against ESBL-producing Enterobacterales, but their overuse leads to the emergence of multidrug-resistant bacteria. Cefmetazole (CMZ) is effective in vitro; however, its clinical efficacy remains unclear. Methods We retrospectively reviewed patients who were treated with CMZ or CPMs for bacteremia caused by ESBL-producing Enterobacterales between 1 April 2014 and 31 September 2022 at Tenri Hospital. The primary outcome measure was 90-day mortality. We also evaluated resistance genes and sequence types of ESBL-producing Enterobacterales. Results In total, 156 patients were enrolled in this study. Ninety patients (58%) received CMZ therapy. Patients in the CMZ group were significantly older than those in the CPM group (median [IQR], 79 years [71-86] vs 74 years [64-83]; P = .001). The severity of the Pitt bacteremia score of the CMZ group was lower than that in the CPM group (0 [0-2] vs 2 [0-2], P = .042). Six patients (7%) in the CMZ group and 10 (15%) in the CPM group died by day 90 (P = .110). Charlson Comorbidity Index and prevalence of sequence 131 between the groups were statistically insignificant. Conclusions Our findings suggest that CMZ is a well-tolerated alternative to CPM for treating bacteremia caused by ESBL-producing Enterobacterales.
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Affiliation(s)
- Eriko Kashihara
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
| | - Ryuichi Minoda Sada
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukio Tsugihashi
- Medical Home Care Center, Tenri Hospital Shirakawa Branch, Nara, Japan
| | | | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri University, Tenri, Japan
| | - Noriyuki Abe
- Department of Clinical Microbiology, Clinical Laboratory Medicine, Tenri Hospital, Tenri, Japan
| | - Hirofumi Miyake
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
| | - Hiroyuki Akebo
- Department of General Internal Medicine, Tenri Hospital, Nara, Japan
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Lyu ZY, Zhen JH, Meng QY, Zhou W, An JY, Dong F. Bacterial Etiology and Antimicrobial Resistance Pattern of Pediatric Bloodstream Infections in Beijing, 2015-2019. Infect Drug Resist 2023; 16:6297-6308. [PMID: 37780532 PMCID: PMC10540788 DOI: 10.2147/idr.s426000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Bloodstream infections (BSIs) was an essential cause of morbidity and mortality in children. Empiric broad-spectrum treatment of BSIs may be costly and unable to effectively eliminate the correct pathogenic microbes, resulting in downstream antimicrobial resistance. The purpose was to provide evidence for diagnosis and treatment of bloodstream infections in pediatrics, by revealing the pathogen distribution and antibiotic resistance pattern of BSIs. Methods In this 5-year study, a total of 2544 pathogenic bacteria stains, isolated from 2368 patients with BSI, were retrospectively analyzed, to define the species distribution and the antimicrobial resistance pattern in Beijing. Results The most frequently isolated pathogenic bacteria were K. pneumoniae (12.1%), S. aureus (11.5%), E. coli (11.2%), and E. faecium (11.2%). Hematological malignancies were the most common disease among patients with underlying conditions. Methicillin resistance was detected in 30.0% of S. aureus and 81.7% of coagulase-negative Staphylococcus (CoNS), respectively. The detection rates of carbapenem-resistant-E. coli (CRECO) and carbapenem-resistant-K. pneumoniae (CRKPN) were 10.8% and 50.8%, respectively. In terms of 122 isolates of S. pneumonia, 5 isolates (4.1%) were penicillin-resistant Streptococcus pneumoniae (PRSP); meanwhile, 50 isolates (41.0%) were penicillin-intermediate Streptococcus pneumoniae (PISP). Among the non-fermentative gram-negative bacilli isolates, 22.8% and 26.9% of the P. aeruginosa, were resistant to imipenem and meropenem. Furthermore, the resistance rates of A. baumannii to imipenem and meropenem both were 54.5%. Conclusion In the study, we demonstrated the characteristics of bloodstream infections and antimicrobial susceptibility pattern of pediatrics in Beijing. Gram positive bacteria were the main pathogens of BSIs. CoNS strains presented even higher resistance to multiple antibiotics, including methicillin, than S. aureus. K. pneumoniae and E. coli represent the most common isolated gram-negative bacteria and exhibited high resistance to a variety of antimicrobial agents. Therefore, it was of critical importance to implement appropriate antimicrobial medication according to pathogen distribution and drug susceptibility test.
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Affiliation(s)
- Zhi-yong Lyu
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Jing-hui Zhen
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Qing-ying Meng
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Wei Zhou
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Jing-yun An
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
| | - Fang Dong
- Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, People’s Republic of China
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Uhland FC, Li XZ, Mulvey MR, Reid-Smith R, Sherk LM, Ziraldo H, Jin G, Young KM, Reist M, Carson CA. Extended Spectrum β-Lactamase-Producing Enterobacterales of Shrimp and Salmon Available for Purchase by Consumers in Canada-A Risk Profile Using the Codex Framework. Antibiotics (Basel) 2023; 12:1412. [PMID: 37760708 PMCID: PMC10525137 DOI: 10.3390/antibiotics12091412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/24/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
The extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-EB) encompass several important human pathogens and are found on the World Health Organization (WHO) priority pathogens list of antibiotic-resistant bacteria. They are a group of organisms which demonstrate resistance to third-generation cephalosporins (3GC) and their presence has been documented worldwide, including in aquaculture and the aquatic environment. This risk profile was developed following the Codex Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance with the objectives of describing the current state of knowledge of ESBL-EB in relation to retail shrimp and salmon available to consumers in Canada, the primary aquacultured species consumed in Canada. The risk profile found that Enterobacterales and ESBL-EB have been found in multiple aquatic environments, as well as multiple host species and production levels. Although the information available did not permit the conclusion as to whether there is a human health risk related to ESBLs in Enterobacterales in salmon and shrimp available for consumption by Canadians, ESBL-EB in imported seafood available at the retail level in Canada have been found. Surveillance activities to detect ESBL-EB in seafood are needed; salmon and shrimp could be used in initial surveillance activities, representing domestic and imported products.
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Affiliation(s)
- F. Carl Uhland
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Xian-Zhi Li
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Michael R. Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Richard Reid-Smith
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Lauren M. Sherk
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Hilary Ziraldo
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Grace Jin
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
| | - Kaitlin M. Young
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada
| | - Mark Reist
- Veterinary Drugs Directorate, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - Carolee A. Carson
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1H 7M7, Canada
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Rödenbeck M, Ayobami O, Eckmanns T, Pletz MW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill 2023; 28:2200672. [PMID: 37199987 PMCID: PMC10197495 DOI: 10.2807/1560-7917.es.2023.28.20.2200672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 05/19/2023] Open
Abstract
BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide.AimWe aimed to summarise the German AMR situation for clinicians and microbiologists.MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016-2021) and the case fatality rates (2010-2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively.ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886-0.891; p < 0.0001), while vancomycin resistance in Enterococcus faecium (VRE) bloodstream infections increased (OR = 1.18; (95% CI: 1.16-1.21); p < 0.0001) with a pooled proportion of 34.9%. Case fatality rates for MRSA and VRE were higher than for their susceptible strains (OR = 2.29; 95% CI: 1.91-2.75 and 1.69; 95% CI: 1.22-2.33, respectively). Carbapenem resistance in Gram-negative pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter spp. and Escherichia coli) was low to moderate (< 9%), but resistance against third-generation cephalosporins and fluoroquinolones was moderate to high (5-25%). Pseudomonas aeruginosa exhibited high resistance against carbapenems (17.0%; 95% CI: 11.9-22.8), third-generation cephalosporins (10.1%; 95% CI: 6.6-14.2) and fluoroquinolones (24.9%; 95% CI: 19.3-30.9). Statistical heterogeneity was high (I2 > 70%) across studies reporting resistance proportions.ConclusionContinuous efforts in AMR surveillance and infection prevention and control as well as antibiotic stewardship are needed to limit the spread of AMR in Germany.
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Affiliation(s)
- Maria Rödenbeck
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Olaniyi Ayobami
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Robby Markwart
- InfectoGnostics Research Campus Jena, Jena, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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Dohmen W, Liakopoulos A, Bonten MJM, Mevius DJ, Heederik DJJ. Longitudinal Study of Dynamic Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Pigs and Humans Living and/or Working on Pig Farms. Microbiol Spectr 2023; 11:e0294722. [PMID: 36648229 PMCID: PMC9927210 DOI: 10.1128/spectrum.02947-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/01/2022] [Indexed: 01/18/2023] Open
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales have been increasingly isolated from pigs, highlighting their potential for transmission to humans living and/or working within pig farms. As longitudinal data on the prevalence and the molecular characteristics of such isolates from the high-risk farming population remain scarce, we performed a long-term study on 39 Dutch pig farms. Fecal samples from pigs, farmers, family members, and employees were collected during four sampling occasions with a 6-month period. The presence of ESBL-producing Enterobacterales and their molecular characteristics (ESBL gene, plasmid, and sequence types) were determined by standard methods. Data on personal and farm characteristics were collected using questionnaires. ESBL-producing Escherichia coli was present in pigs at least once for 18 of 39 farms and in 17 of 146 farmers, family members, and/or employees. Among these 417 E. coli isolates, blaCTX-M-1 was the most frequently observed ESBL gene in pigs (n = 261) and humans (n = 25). Despite the great variety in plasmid (sub)types and E. coli sequence types (STs), we observed genetic similarity between human- and pig-derived isolates in (i) ESBL gene, plasmid (sub)type, and ST, suggesting potential clonal transmission in seven farms, and (ii) only ESBL gene and plasmid (sub)type, highlighting the possibility of horizontal transfer in four farms. Five pig farmers carried ESBL producers repeatedly, of whom two carried an identical combination of gene, plasmid (sub)type, and ST over time. Human ESBL carriage was associated with both presence of ESBL producers in pigs and average number of hours working on the pig farm per week, while prolonged human carriage was observed only incidentally. IMPORTANCE Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli represents a public health hazard due to reduced therapeutic options for the treatment of infections. Although direct contact with pigs is considered a risk factor for human ESBL-producing E. coli carriage through occupational exposure, nationwide data regarding the occurrence of such isolates among pigs and humans living and/or working on farms remain scarce. Therefore, we determined (i) the longitudinal dynamics in prevalence and molecular characteristics of ESBL-producing E. coli in Dutch pig farmers and their pigs over time and (ii) the potential transmission events between these reservoirs based on genetic relatedness and epidemiological associations in longitudinal data. Our data suggesting the possibility of clonal and horizontal dissemination of ESBL-producing Escherichia coli between pigs and pig farmers can be used to inform targeted intervention strategies to decrease the within-farm human exposure to ESBL-producing E. coli.
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Affiliation(s)
- Wietske Dohmen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Apostolos Liakopoulos
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dik J. Mevius
- Department of Bacteriology and Epidemiology, Wageningen Bioveterinary Research, Lelystad, The Netherlands
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Dick J. J. Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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10
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Bushuven S, Bansbach J, Bentele M, Bentele S, Gerber B, Reinoso-Schiller N, Scheithauer S. Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study. Front Med (Lausanne) 2023; 9:1025449. [PMID: 36687411 PMCID: PMC9853186 DOI: 10.3389/fmed.2022.1025449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023] Open
Abstract
Background and aim There are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations. Materials and methods In 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated. Results A total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time. Conclusion To the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.
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Affiliation(s)
- Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany,Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany,Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany,*Correspondence: Stefan Bushuven ✉
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Bentele
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany,Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany
| | - Stefanie Bentele
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany,Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany,Department of Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Bianka Gerber
- Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany
| | - Nicolas Reinoso-Schiller
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany
| | - Simone Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany
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11
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Ham SY, Jung H, Song KH, Jeong H, Jung J, Moon SM, Park JS, Kim NH, Jang ES, Kim JW, Jeong SH, Kim ES, Kim HB. Interspecies differences in clinical characteristics and risk factors for third-generation cephalosporin resistance between Escherichia coli and Klebsiella pneumoniae bloodstream infection in patients with liver cirrhosis. Eur J Clin Microbiol Infect Dis 2022; 41:1459-1465. [PMID: 36227508 DOI: 10.1007/s10096-022-04508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
This retrospective study aimed to clarify the interspecies differences in the clinical characteristics and risk factors of bloodstream infection (BSI) due to third-generation cephalosporin-resistant (3GC-R) Escherichia coli (EC) and Klebsiella pneumoniae (KP) in patients with liver cirrhosis (LC). KP BSI had more comorbidities and higher treatment failure rate than EC BSI. Non-alcoholic LC was a risk factor for treatment failure in EC, whereas it was not associated with KP. Risk factors for BSI due to 3GC-R strain were nosocomial infection in EC, and β-lactam/fluoroquinolone treatment ≤ 30 days in KP. These results could help predict outcomes of BSI and improve clinical practice.
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Affiliation(s)
- Sin Young Ham
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Korea Veterans Hospital, Seoul, the Republic of Korea
| | - Hyungul Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Hyeonju Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Song Mi Moon
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, the Republic of Korea
| | - Nak-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea
| | - Eun Sun Jang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Jin-Wook Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Sook-Hyang Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea.
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, the Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, the Republic of Korea
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12
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Bouchand C, Andréo A, Le Gallou F, Corvec S, Bourigault C, Lepelletier D. Retrospective analysis of a large single cohort of Enterobacteriaceae producing extended-spectrum B-lactamase (E-ESBL) patients: incidence, microbiology, and mortality. Eur J Clin Microbiol Infect Dis 2022; 41:1237-1243. [PMID: 36056207 DOI: 10.1007/s10096-022-04489-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
We conducted a retrospective study from 2005 to 2019 to describe the epidemiology and mortality of enterobacterial producing extended-spectrum β-lactamase (E-ESBL) infections in our university hospital over a 17-year period of time. Clinical and microbiological data were extracted from different software used for continuous surveillance. Stool samples from systematic screening for E-ESBL colonization were excluded from the study. The incidence rate of infected patient was calculated by E-ESBL species and by year. A comparison of mortality rate in patients with bloodstream infections versus other types of infections was conducted using a Kaplan-Meier method survival curves. A log rank test (with a risk of 5%) was carried out. A total of 3324 patients with E-ESBL infection were included with an increased incidence density per 1000 days of hospitalization from 0.03 in 2005 to 0.47 in 2019. Escherichia coli was the most frequently isolated pathogen (64%). Global mortality rate was significantly higher with E. coli than with Klebsiella spp. and Enterobacter spp. (p < 0.001). Mortality was higher in patients with E-ESBL bloodstream infection than in patients with other type of E-ESBL infection (p < 0.001). Our study showed a significant increase of the E-ESBL incidence density over a 17-year period survey with a higher mortality in patients with E-ESBL bacteremia. This highlights the need to continue efforts to control the spread of these multi-resistant bacteria in our institution.
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Affiliation(s)
- Camille Bouchand
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Anaïs Andréo
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Florence Le Gallou
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Stéphane Corvec
- Laboratory of Bacteriology, Nantes University Hospital, R44093, Nantes, France
| | - Céline Bourigault
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France
| | - Didier Lepelletier
- Hospital Hygiene Department, Nantes University Hospital, 5, rue du Prof. Yves Boquien, R44093, Nantes, France. .,IIcimed 1155 Laboratory, Institut de Recherche en Santé 2, Nantes Université, R44035, Nantes, France.
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13
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GÜLER E, HÜRDOĞANOĞLU U, FARHAN ALMASOODİ LH, ÇAKIR N, SÜER K. Distribution of Microorganisms and Antibiotic Resistance Rates Isolated From Blood Cultures: 5-Year Evaluation in a University Hospital in Northern Cyprus. KONURALP TIP DERGISI 2021. [DOI: 10.18521/ktd.949209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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14
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Begier E, Rosenthal NA, Gurtman A, Kartashov A, Donald RGK, Lockhart SP. Epidemiology of Invasive Escherichia coli Infection and Antibiotic Resistance Status Among Patients Treated in US Hospitals: 2009-2016. Clin Infect Dis 2021; 73:565-574. [PMID: 33420788 DOI: 10.1093/cid/ciab005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Published data is limited on the prevalence and risk of recurrence of extraintestinal invasive Escherichia coli infections (IEIs) in the United States. METHODS The analysis included all inpatient and hospital-based outpatient visits occurring between 2009 and 2016 at hospitals with continuous microbiology data submission to the Premier Healthcare Database for 90 days before and 12 months after the admission or visit. IEI was defined as having positive E. coli culture from a normally sterile site (eg, blood, cerebrospinal fluid). The prevalence of IEI, 12-month risk of recurrent IEI, and antibiotic resistance were assessed. RESULTS Overall, 144 944 725 hospital visits among 37 207 510 patients were analyzed, and 71 909 IEI events occurred in 67 583 patients, corresponding to an IEI prevalence of 0.50 events per 1000 visits and 1.82 events per 1000 patients. Recurrence was common: 26.9 per 1000 patients had a recurrent IEI in the 12 months after their infection. Most infections were community acquired (66.4%), and urosepsis was most common clinical syndrome (66.0%). The 30-day risk of IEI among patients undergoing transrectal ultrasound-guided prostate biopsy was high: 5.03 events per 1000 patients. Among all IEI cases with antibiotic susceptibility testing, 9.18% were resistant to extended-spectrum cephalosporins, 28.22% to fluoroquinolones, and 0.14% to carbapenems. Resistance to extended-spectrum cephalosporins increased from 5.46% to 12.97% during the 8-year study period. CONCLUSIONS This real-world study indicates a substantial burden of IEI and recurrent IEI exists in the United States, as well as increasing resistance to extended-spectrum cephalosporins. Future research should explore risk factors of recurrent IEI aiming to effectively prevent such infections.
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Affiliation(s)
- Elizabeth Begier
- Vaccine Clinical Research and Development, Pfizer, Pearl River, New York, USA
| | - Ning A Rosenthal
- Premier Applied Sciences, Premier Healthcare Solutions, Charlotte, North Carolina, USA
| | - Alejandra Gurtman
- Vaccine Clinical Research and Development, Pfizer, Pearl River, New York, USA
| | - Alex Kartashov
- Premier Applied Sciences, Premier Healthcare Solutions, Charlotte, North Carolina, USA
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15
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Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res 2021; 33:689-701. [PMID: 31656032 DOI: 10.1007/s40520-019-01375-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
The incidence of infections increases with age and results in a higher risk of morbidity and mortality. This rise is not mainly related to chronological age per se but has been linked mostly to individual factors such as immunosenescence; the presence of comorbidities; the occurrence of geriatric syndromes such as poor nutrition, polypharmacy, and cognitive disorders; and the presence of functional impairment concomitant with environmental, healthcare-related and microbiological factors such as the increasing risk of multidrug-resistant microorganisms. The geriatric concept of frailty introduces a new approach for considering the risk of infection; this concept highlights the importance of functional status and is a more comprehensive and multicomponent approach that may help to reverse the vulnerability to stress. The aim of this article is to provide some typical hallmarks of infections among older adults in comparison to younger individuals. The main differences among the older population that are presented are an increased prevalence of infections and potential risk factors, a higher risk of carrying multidrug-resistant microorganisms, an increase in barriers to a prompt diagnosis related to atypical presentations and challenges with diagnostic tools, a higher risk of under- and over-diagnosis, a worse prognosis with a higher risk of acute and chronic complications and a particular need for better communication among all healthcare sectors as they are closely linked together.
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Affiliation(s)
- Didier Schoevaerdts
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium.
| | - François-Xavier Sibille
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
| | - Gaetan Gavazzi
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
- Service Gériatrie Clinique, Centre Hospitalo-Universitaire Grenoble-Alpes, Avenue Central 621, 38400, Saint-Martin-d'Hères, France
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16
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Sung HS, Lee JW, Bae S, Kwon KT. Comparison of antimicrobial resistances and clinical features in community-onset Escherichia coli and Klebsiella pneumoniae bacteremia. Korean J Intern Med 2021; 36:433-440. [PMID: 32229796 PMCID: PMC7969070 DOI: 10.3904/kjim.2019.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/07/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to compare antimicrobial resistance, clinical features, and outcomes of community-onset Escherichia coli (COEC) and Klebsiella pneumoniae (COKP) bacteremia. METHODS The medical records of patients diagnosed with E. coli or K. pneumoniae bacteremia in the emergency department of a 750-bed secondary care hospital in Daegu, Korea from January 2010 to December 2016 were retrospectively reviewed. RESULTS A total of 866 patients with COEC bacteremia and 299 with COKP bacteremia were enrolled. COEC bacteremia, compared to COKP bacteremia, had higher rates of 3rd generation cephalosporin (3GC) (18.8% vs. 8.4%, p < 0.001) and f luoroquinolone (FQ) (30.4% vs. 8.0%, p < 0.001) resistance. The patients with COKP bacteremia had higher Charlson comorbidity indices (CCI) (1.8 ± 2.0 vs. 1.5 ± 1.8, p = 0.035), Pittsburgh bacteremia scores (PBS) (2.0 ± 2.6 vs. 1.3 ± 1.8, p < 0.001), and 30-day mortality (14.44% vs. 8.8%, p = 0.008) than the patients with COEC bacteremia. Age younger than 70 years, male sex, polymicrobial infections, pneumonia, intra-abdominal infection, PBS ≥ 2, and Foley catheter insertion were independent predictive factors for COKP bacteremia compared to COEC bacteremia in the multivariate analysis. CCI, PBS, and intensive care unit admission were independent risk factors for 30-day mortality in the multivariate analysis. CONCLUSION 3GCs and FQs are still useful for the empirical treatment of patients with probable COKP bacteremia. The patients with COKP bacteremia had worse outcomes because of its greater severity and more frequent underlying comorbidities.
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Affiliation(s)
- Hwa Seok Sung
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
- Department of Emergency Medicine, Keimyung University Graduate School, Daegu, Korea
| | - Je Won Lee
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Sohyun Bae
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Correspondence to Ki Tae Kwon, M.D. Department of Internal Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea Tel: +82-53-200-2616 Fax: +82-53-200-2027 E-mail:
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17
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McDonald KL, Garland S, Carson CA, Gibbens K, Parmley EJ, Finley R, MacKinnon MC. Measures used to assess the burden of ESBL-producing Escherichia coli infections in humans: a scoping review. JAC Antimicrob Resist 2021; 3:dlaa104. [PMID: 34223063 DOI: 10.1093/jacamr/dlaa104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background ESBL-producing bacteria pose a serious challenge to both clinical care and public health. There is no standard measure of the burden of illness (BOI) of ESBL-producing Escherichia coli (ESBL-EC) in the published literature, indicating a need to synthesize available BOI data to provide an overall understanding of the impact of ESBL-EC infections on human health. Objectives To summarize the characteristics of BOI reporting in the ESBL-EC literature to (i) describe how BOI associated with antimicrobial resistance (AMR) is measured and reported; (ii) summarize differences in other aspects of reporting between studies; and (iii) highlight the common themes in research objectives and their relation to ESBL-EC BOI. Methods and results Two literature searches, run in 2013 and 2018, were conducted to capture published studies evaluating the BOI associated with ESBL-EC infections in humans. These searches identified 1723 potentially relevant titles and abstracts. After relevance screening of titles and abstracts and review of full texts, 27 studies were included for qualitative data synthesis. This review identified variability in the reporting and use of BOI measures, study characteristics, definitions and laboratory methods for identifying ESBL-EC infections. Conclusions Decision makers often require BOI data to make science-based decisions for the implementation of surveillance activities or risk reduction policies. Similarly, AMR BOI measures are important components of risk analyses and economic evaluations of AMR. This review highlights many limitations to current ESBL-EC BOI reporting, which, if improved upon, will ensure data accessibility and usefulness for ESBL-EC BOI researchers, decision makers and clinicians.
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Affiliation(s)
- Kathryn L McDonald
- Public Health Agency of Canada, Guelph, Ontario, Canada.,University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Garland
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | | | | | - E Jane Parmley
- Public Health Agency of Canada, Guelph, Ontario, Canada.,University of Guelph, Guelph, Ontario, Canada
| | - Rita Finley
- Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Melissa C MacKinnon
- Public Health Agency of Canada, Guelph, Ontario, Canada.,University of Guelph, Guelph, Ontario, Canada
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18
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MacKinnon MC, Sargeant JM, Pearl DL, Reid-Smith RJ, Carson CA, Parmley EJ, McEwen SA. Evaluation of the health and healthcare system burden due to antimicrobial-resistant Escherichia coli infections in humans: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2020; 9:200. [PMID: 33303015 PMCID: PMC7726913 DOI: 10.1186/s13756-020-00863-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Assessment of the burden of disease due to antimicrobial-resistant Escherichia coli infections facilitates understanding the scale of the problem and potential impacts, and comparison to other diseases, which allows prioritization of research, surveillance, and funding. Using systematic review and meta-analysis methodology, the objectives were to evaluate whether humans with antimicrobial-resistant E. coli infections experience increases in measures of health or healthcare system burden when compared to susceptible E. coli infections. METHODS Comprehensive literature searches were performed in four primary and seven grey literature databases. Analytic observational studies of human E. coli infections that assessed the impact of resistance to third/fourth/fifth-generation cephalosporins, resistance to quinolones, and/or multidrug resistance on mortality, treatment failure, length of hospital stay and/or healthcare costs were included. Two researchers independently performed screening, data extraction, and risk of bias assessment. When possible, random effect meta-analyses followed by assessment of the confidence in the cumulative evidence were performed for mortality and length of hospital stay outcomes, and narrative syntheses were performed for treatment failure and healthcare costs. RESULTS Literature searches identified 14,759 de-duplicated records and 76 articles were included. Based on 30-day and all-cause mortality meta-analyses, regardless of the type of resistance, there was a significant increase in the odds of dying with resistant E. coli infections compared to susceptible infections. A summary mean difference was not presented for total length of hospital stay meta-analyses due to substantial to considerable heterogeneity. Since small numbers of studies contributed to meta-analyses for bacterium-attributable mortality and post-infection length of hospital stay, the summary results should be considered with caution. Studies contributing results for treatment failure and healthcare costs had considerable variability in definitions and reporting. CONCLUSIONS Overall, resistant E. coli infections were associated with significant 30-day and all-cause mortality burden. More research and/or improved reporting are necessary to facilitate quantitative syntheses of bacterium-attributable mortality, length of hospital stay, and hospital costs. Protocol Registration PROSPERO CRD42018111197.
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Affiliation(s)
- M C MacKinnon
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada. .,Food-Borne Disease and Antimicrobial Resistance Surveillance Division, Centre of Food-borne Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada.
| | - J M Sargeant
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, ON, Canada
| | - D L Pearl
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - R J Reid-Smith
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada.,Food-Borne Disease and Antimicrobial Resistance Surveillance Division, Centre of Food-borne Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - C A Carson
- Food-Borne Disease and Antimicrobial Resistance Surveillance Division, Centre of Food-borne Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - E J Parmley
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - S A McEwen
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
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19
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Chen Q, Ma G, Cao H, Yang X, Jiang Y. Risk factors and diagnostic markers for Escherichia coli bloodstream infection in older patients. Arch Gerontol Geriatr 2020; 93:104315. [PMID: 33310397 DOI: 10.1016/j.archger.2020.104315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate risk factors for Escherichia coli (E. coli) bloodstream infection (BSI) in older patients and the diagnostic accuracy of laboratory parameters. METHODS The electronic medical records of patients aged 60 years and above who were admitted with a serious condition were extracted. Propensity score matching (PSM) was used to ensure that the included patients had similar baseline clinical features. Multiple regression analysis was used to identify risk factors for E. coli BSI and extended-spectrum β-lactamase (ESBL)-producing E. coli BSI. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic utility of relevant laboratory indicators. RESULTS After PSM, 508 patients were included: 254 patients with E. coli BSI and 254 control patients. Bile duct stone (adjusted odds ratio [aOR] 5.131), kidney stone (aOR 3.678), and urinary system infection (aOR 3.173) were independent risk factors for E. coli BSI. Prior exposure to cephems (aOR 3.782) and drainage tube placement (aOR 2.572) were independent risk factors for ESBL-producing E. coli BSI. Serum procalcitonin (PCT) yielded the highest area under the curve (0.783) and the best cut-off value (1.3 ng/ml). CONCLUSION Bile duct stone, kidney stone, and urinary system infection must be detected and treated early, in order to prevent E. coli BSI in older patients. Further, administration of cephems and invasive procedures must be undertaken with caution, in order to reduce the risk of BSI with ESBL-producing E. coli. Finally, serum PCT level has potential as diagnostic marker for E. coli BSI in older individuals.
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Affiliation(s)
- Qiang Chen
- Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China
| | - Guifeng Ma
- Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China
| | - Huijun Cao
- Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China; Department of Microbiology and Immunology, Guizhou Medical University Affiliated Hospital, Guiyang, China
| | - Xiaoyu Yang
- Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China
| | - Yan Jiang
- Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China; Department of Microbiology and Immunology, Guizhou Medical University Affiliated Hospital, Guiyang, China; Laboratory Animal Center, Guizhou Medical University, Guiyang, China.
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20
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Pradelli L, Klek S, Mayer K, Omar Alsaleh AJ, Rosenthal MD, Heller AR, Muscaritoli M. Cost-Effectiveness of Parenteral Nutrition Containing ω-3 Fatty Acids in Hospitalized Adult Patients From 5 European Countries and the US. JPEN J Parenter Enteral Nutr 2020; 45:999-1008. [PMID: 32713007 PMCID: PMC8451886 DOI: 10.1002/jpen.1972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023]
Abstract
Background ω‐3 Fatty acid (FA)–containing parenteral nutrition (PN) is associated with improvements in patient outcomes and with reductions in hospital length of stay (HLOS) vs standard PN regimens (containing non–ω‐3 FA lipid emulsions). We present a cost‐effectiveness analysis of ω‐3 FA–containing PN vs standard PN in 5 European countries (France, Germany, Italy, Spain, UK) and the US. Methods This pharmacoeconomic model was based on estimates of ω‐3 efficacy reported in a recent meta‐analysis and data from country‐specific sources. It utilized a probabilistic discrete event simulation model to compare ω‐3 FA–containing PN with standard PN in a population of critically ill and general ward patients. The influence of model parameters was evaluated using probabilistic and deterministic sensitivity analyses. Results Overall costs were reduced with ω‐3 FA–containing PN in all 6 countries compared with standard PN, ranging from €1741 (±€1284) in Italy to €5576 (±€4193) in the US. Expenses for infections and HLOS were lower in all countries for ω‐3 FA–containing PN vs standard PN, with the largest cost differences for both in the US (infection: €825 ± €4001; HLOS: €4879 ± €1208) and the smallest savings in the UK for infections and in Spain for HLOS (€63 ± €426 and €1636 ± €372, respectively). Conclusion This cost‐effectiveness analysis in 6 countries demonstrates that the superior clinical efficacy of ω‐3 FA–containing PN translates into significant decreases in mean treatment cost, rendering it an attractive cost‐saving alternative to standard PN across different healthcare systems.
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Affiliation(s)
| | - Stanislaw Klek
- Department of General and Oncology Surgery with Intestinal Failure Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Konstantin Mayer
- ViDia Hospitals, Department of Pulmonary and Sleep Medicine, Karlsruhe, Germany
| | | | - Martin D Rosenthal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Axel R Heller
- Department of Anesthesiology and Intensive Care Medicine, University of Augsburg, Augsburg, Germany
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21
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Chen FC, Ho YN, Cheng HH, Wu CH, Change MW, Su CM. Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections? Int J Immunopathol Pharmacol 2020; 34:2058738420942375. [PMID: 32698638 PMCID: PMC7378707 DOI: 10.1177/2058738420942375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Extended-spectrum β-lactamase (ESBL)-positive bloodstream infection (BSI) is on
the rise worldwide. The purpose of this study is to evaluate the impact of
inappropriate initial antibiotic therapy (IIAT) on in-hospital mortality of
patients in the emergency department (ED) with Escherichia coli
and Klebsiella pneumoniae BSIs. This retrospective
single-center cohort study included all adult patients with E.
coli and K. pneumoniae BSIs between January 2007
and December 2013, who had undergone a blood culture test and initiation of
antibiotics within 6 h of ED registration time. Multiple logistic regression was
used to adjust for bacterial species, IIAT, time to antibiotics, age, sex, quick
Sepsis Related Organ Failure Assessment (qSOFA) score ⩾ 2, and comorbidities. A
total of 3533 patients were enrolled (2967 alive and 566 deceased, in-hospital
mortality rate 16%). The patients with K. pneumoniae
ESBL-positive BSI had the highest mortality rate. Non-survivors had qSOFA
scores ⩾ 2 (33.6% vs 9.5%, P < 0.001), more IIAT (15.0% vs
10.7%, P = 0.004), but shorter mean time to antibiotics (1.70
vs 1.84 h, P < 0.001). A qSOFA score ⩾ 2 is the most
significant predictor for in-hospital mortality; however, IIAT and time to
antibiotics were not significant predictors in multiple logistic regression
analysis. In subgroup analysis divided by qSOFA scores, IIAT was still not a
significant predictor. Severity of the disease (qSOFA score ⩾ 2) is the key
factor influencing in-hospital mortality of patients with E.
coli and K. pneumoniae BSIs. The time to
antibiotics and IIAT were not significant predictors because they in turn were
affected by disease severity.
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Affiliation(s)
- Fu-Cheng Chen
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung
| | - Hsien-Hung Cheng
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung
| | - Chien-Hung Wu
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung
| | - Meng-Wei Change
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung
| | - Chih-Min Su
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung.,School of Medicine, Chung Shan Medical University, Taichung
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22
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Mitsuboshi S, Tsuruma N, Watanabe K, Takahashi S, Ito A, Nakashita M, Suzuki M, Kobayashi K, Tsugita M. Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Organisms: a Multicenter Cohort Study. Jpn J Infect Dis 2020; 73:288-292. [PMID: 32115542 DOI: 10.7883/yoken.jjid.2019.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 5-year multicenter retrospective cohort study was conducted across six hospitals in Niigata, Japan. Patients (n = 179) with bacteremia due to extended-spectrum β-lactamase (ESBL)producing organisms were included in the study. The rates of appropriate carbapenem prescription were 61% (n = 41) in patients aged 65-84 years and 89% (n = 31) in those aged ≥ 85 years. Patients aged ≥ 85 years were significantly more likely to receive carbapenem than their younger counterparts. After propensity score matching, 65 patients were assigned to two groups based on age (65-84 years or ≥ 85 years). Multivariate regression analysis showed that other sites of infection had a positive association with 30-day mortality (odds ratio [OR], 27.50; 95% confidence interval [CI], 2.90-260.00) and biliary tract infection tended to have a positive association with 30-day mortality (OR, 8.90; 95% CI, 0.88- 89.90) compared with urinary tract infection. However, an age ≥ 85 years was not associated with 30-day mortality. Elderly patients aged ≥ 85 years were more likely to be treated with carbapenem; however, old age was not associated with 30-day mortality when bacteremia was caused by ESBLproducing organisms. These results may help clinicians justify withholding carbapenem in patients aged ≥ 85 years.
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Affiliation(s)
| | - Naoki Tsuruma
- Department of Pharmacy, JA Niigata Kouseiren Sado General Hospital, Japan
| | - Kazuya Watanabe
- Department of Pharmacy, Kashiwazaki General Hospital and Medical Center, Japan
| | | | - Atsuko Ito
- Department of Pharmacy, Niigata City General Hospital, Japan
| | | | | | | | - Masami Tsugita
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Japan
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23
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Tao X, Wang H, Min C, Yu T, Luo Y, Li J, Hu Y, Yan Q, Liu WE, Zou M. A retrospective study on Escherichia coli bacteremia in immunocompromised patients: Microbiological features, clinical characteristics, and risk factors for shock and death. J Clin Lab Anal 2020; 34:e23319. [PMID: 32267010 PMCID: PMC7439330 DOI: 10.1002/jcla.23319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/08/2020] [Accepted: 03/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate clinical features, bacterial characteristics, and risk factors for shock and mortality of immunocompromised patients with Escherichia coli bacteremia. Methods A nearly 6‐year retrospective study of E coli bacteremia in 188 immunocompromised patients at Xiangya Hospital was conducted. Demographic, clinical, and laboratory data were documented. Phylogenetic background and virulence factors of E coli isolates were detected by polymerase chain reaction. Risk factors for shock and mortality were also investigated. Results Of all 188 E coli isolates, most prevalent virulence factors were fimH (91.0%), followed by traT (68.6%) and iutA (67.0%), while papG allele I, gafD, and cdtB were not detected. Phylogenetic group D was dominant (42.0%) among all isolates, and group B2 accounted for 17.6%, while group A and B1 accounted for 28.2% and 12.2%, respectively. In univariate analysis, ibeA and cnf1 were associated with mortality, which were not found in multivariate regression analysis. 22.3% of patients suffered shock, and 30‐day mortality rate was 21.3%. MDR (HR 2.956; 95% CI, 1.091‐8.012) was the only risk factor for shock, while adult (HR 0.239; 95% CI, 0.108‐0.527) was a protective factor. Multivariate analysis revealed that shock (HR 4.268; 95% CI, 2.208‐8.248; P < .001) and Charlson index > 2 (HR 2.073; 95% CI, 1.087‐3.952; P = .027) were associated with fatal outcome. Conclusions Escherichia coli bacteremia was highly lethal in immunocompromised patients, and host‐related factors played major roles in poor prognosis, while bacterial determinants had little effect on outcome. This study also provided additional information about the virulence and phylogenetic group characteristics of E coli bacteremia.
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Affiliation(s)
- Xiaoyan Tao
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Haichen Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Changhang Min
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Yu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Luo
- Faculty of Laboratory Medicine, Xiangya School of Medicine, Central South University, Changsha, China
| | - Jun Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Yongmei Hu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Wen' En Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxiang Zou
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
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24
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Shamsrizi P, Gladstone BP, Carrara E, Luise D, Cona A, Bovo C, Tacconelli E. Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis. BMJ Open 2020; 10:e030266. [PMID: 31964661 PMCID: PMC7044956 DOI: 10.1136/bmjopen-2019-030266] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the variation of effect estimates in the analysis of mortality and length of stay (LOS) in patients with infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. DESIGN Systematic review and meta-analysis METHODS: Literature search for clinical studies from 1 January 1960 to 1 October 2018 was conducted in PubMed. Primary outcomes were risk ratios (RRs) of all-cause and attributable mortality and weighted mean differences (WMDs) in LOS in patients with bloodstream infections (BSIs) and non-invasive infections. Any change in the effect estimates was assessed by grouping studies according to design, setting, economy-based country classification, reporting period, microbiological aetiology, infection type and adjustment for appropriateness of empirical treatment. The impact of ESBL production was calculated using random-effect meta-analysis and heterogeneity was evaluated by I2 statistics and metaregression. RESULTS Eighty-four studies including 22 030 patients and 149 outcome measures were included in the meta-analysis. Most studies were retrospective cohorts from high-income countries, providing unadjusted estimates. ESBL production in patients with BSIs (56 studies) increased the RR for all-cause mortality by a factor of 1.70 (95% CI 1.52 to 1.90; p<0.001), attributable mortality (16 studies) by 1.75 (95% CI 1.448 to 2.108; p<0.001) and WMD in the intensive care unit by 3.07 days (95% CI 1.61 to 4.54; p<0.001). WMD in hospital LOS was significantly higher in BSIs (4.41 days; 95% CI 3.37 to 5.46; p<0.001) and non-invasive (2.19 days; 95% CI 1.56 to 2.81; p<0.001). Subgroup analyses showed variation of estimates by study design, population, strain and assessment of appropriateness of empiric treatment. High heterogeneity was observed in all analyses. CONCLUSIONS Current evidence of the clinical burden of infections caused by ESBL-producing bacteria is highly heterogeneous and based mainly on unadjusted estimates derived from retrospective studies. Despite these limitations, ESBL production in strains causing BSIs seems associated with higher all-cause and attributable mortality and longer hospitalisation.
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Affiliation(s)
- Parichehr Shamsrizi
- Division of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany
| | - Beryl Primrose Gladstone
- Division of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany
| | - Elena Carrara
- Division of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany
- Division of Infectious Disease, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Dora Luise
- Division of Infectious Disease, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
| | - Andrea Cona
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, Milano, Italy
| | - Chiara Bovo
- Medical Direction, Integrated University Hospital of Verona, Verona, Italy
| | - Evelina Tacconelli
- Division of Infectious Disease, Department of Internal Medicine I Gastroenterology Hepatology and Infectious Diseases, University Hospital Tubingen, Tubingen, Germany
- Division of Infectious Disease, Department of Diagnostic and Public Health, Integrated University Hospital of Verona, Verona, Italy
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25
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Hung PN, Quyet D, Thanh KC, Pho DC, Tien TV, Dung QA, Linh DD, Tan HT, Dinh TC, Bac ND, Nam LV. Antibiotic Resistance Profile and Diversity of Subtypes Genes in Escherichia coli Causing Bloodstream Infection in Northern Vietnam. Open Access Maced J Med Sci 2019; 7:4393-4398. [PMID: 32215101 PMCID: PMC7084042 DOI: 10.3889/oamjms.2019.842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Evaluating the antibiotic susceptibility and resistance genes is essential in the clinical management of bloodstream infections (BSIs). But there are still limited studies in Northern Vietnam. AIM: The aim of the study was to determine the antibiotic resistance profile and characteristics of subtypes genes in Escherichia coli causing BSIs in Northern Vietnam. METHODS: The cross-sectional study was done in the period from December 2012 to June 2014 in two tertiary hospitals in Northern Vietnam. Tests were performed at the lab of the hospital. RESULTS: In 56 E. coli strains isolating 39.29 % produced ESBL. 100% of the isolates harbored blaTEM gene, but none of them had the blaPER gene. The prevalence of ESBL producers and ESBL non-producers in blaCTX-M gene was 81.82%, and 73.53%, in blaSHV gene was 18.18% and 35.29%. Sequencing results showed three blaTEM subtypes (blaTEM 1, 79, 82), four blaCTX-M subtypes (blaCTX-M-15, 73, 98, 161), and eight blaSHV subtypes (blaSHV 5, 7, 12, 15, 24, 33, 57, 77). Antibiotic resistance was higher in ampicillin (85.71%), trimethoprim/sulfamethoxazole (64.29%) and cephazolin (50%). Antibiotics were still highly susceptible including doripenem (96.43%), ertapenem (94.64%), amikacin (96.43%), and cefepime (89.29%). CONCLUSION: In Escherichia coli causing BSIs, antibiotic resistance was higher in ampicillin, trimethoprim/sulfamethoxazole and cephazolin. Antibiotics was highly susceptible including doripenem, ertapenem, amikacin, and cefepime.
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Affiliation(s)
- Pham Ngoc Hung
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam.,Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Quyet
- Department of Tuberculosis and Lung Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Kieu Chi Thanh
- Department of Hospital Infection Control, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Dinh Cong Pho
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tran Viet Tien
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
| | - Quan Anh Dung
- Faculty of Medicine, Vietnam Military Medical University, Hanoi, Vietnam
| | - Do Dieu Linh
- Faculty of Medicine, Hai Phong Medical University, 72A Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Ha The Tan
- Department of Epidemiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - Thien Chu Dinh
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Nguyen Duy Bac
- Department of Training, Vietnam Military Medical University, Hanoi, Vietnam
| | - Le Van Nam
- Department of Infectious Diseases, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam
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26
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Denkel LA, Maechler F, Schwab F, Kola A, Weber A, Gastmeier P, Pfäfflin F, Weber S, Werner G, Pfeifer Y, Pietsch M, Leistner R. Infections caused by extended-spectrum β-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae. Clin Microbiol Infect 2019; 26:1046-1051. [PMID: 31809805 DOI: 10.1016/j.cmi.2019.11.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). METHODS This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. RESULTS Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16-3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17-6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62-5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64-6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068-2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. CONCLUSIONS Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.
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Affiliation(s)
- L A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Maechler
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Kola
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Weber
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Pfäfflin
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - S Weber
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine and Medical Centre University of Freiburg, Freiburg, Germany
| | - G Werner
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Y Pfeifer
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - M Pietsch
- Unit of Enteropathogenic Bacteria and Legionella, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - R Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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27
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Kern WV, Rieg S. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect 2019; 26:151-157. [PMID: 31712069 DOI: 10.1016/j.cmi.2019.10.031] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bloodstream infections comprise a wide variety of pathogens and clinical syndromes with considerable overlap with similar syndromes of non-bacteraemic infections and diverse risk factors, therapeutic implications and outcomes. Yet, this heterogeneous 'entity' has the advantage to be pathogen-defined compared with the broad and even more heterogeneous entity 'sepsis', and so has become helpful for clinicians and epidemiologists for research and surveillance purposes. The increasing availability of population-based and large multicentre well-defined cohort studies should allow us to assess with much confidence and in detail its burden, the significance of antimicrobial resistance, and areas of uncertainty regarding further epidemiological evolution and optimized treatment regimens. AIM To review key aspects of bloodstream infection epidemiology and burden, and summarize recent news and questions concerning critical developments. SOURCES Peer-reviewed articles based on the search terms 'bloodstream infection' and 'bacteremia' combined with the terms 'epidemiology' and 'burden'. The emphasis was on new information from studies in adult patients and on the added burden due to pathogen resistance to first- and second-line antimicrobial agents. CONTENT Topics covered include recent developments in the epidemiology of bloodstream infection due to key pathogens and published information about the relevance of resistance for patient outcomes. IMPLICATIONS Despite the availability of population-based studies and an increasing number of large well-defined multicentre cohort studies, more surveillance and systematic data on bloodstream infection epidemiology at regional level and in resource-limited settings may be needed to better design new methods for prevention and define the need for and further develop optimized therapeutic strategies.
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Affiliation(s)
- W V Kern
- Division of Infectious Diseases, Department of Medicine II, Albert-Ludwigs-University Faculty of Medicine and Medical Centre, Freiburg, Germany; ESCMID Study Group on Bloodstream Infection, Endocarditis and Sepsis, Basel, Switzerland.
| | - S Rieg
- Division of Infectious Diseases, Department of Medicine II, Albert-Ludwigs-University Faculty of Medicine and Medical Centre, Freiburg, Germany
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Rohde AM, Wiese-Posselt M, Zweigner J, Schwab F, Mischnik A, Seifert H, Gastmeier P, Kern WV. High admission prevalence of fluoroquinolone resistance in third-generation cephalosporin-resistant Enterobacteriaceae in German university hospitals. J Antimicrob Chemother 2019; 73:1688-1691. [PMID: 29490046 DOI: 10.1093/jac/dky040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/19/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives Fluoroquinolone resistance (FQR) in third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE) presents serious limitations to antibiotic therapy. The aim of this study was to investigate whether the FQR proportion among 3GCRE differs between community-acquired (CA) and hospital-acquired (HA) isolates. Methods In a prospective observational study covering 2014 and 2015, we monitored the occurrence of 3GCRE in adult hospitalized patients in six German university hospitals. 3GCRE clinical isolates were subdivided into CA and HA. Multivariable analysis identified factors associated with in vitro non-susceptibility to ciprofloxacin. Results The dataset included 5721 3GCRE isolates of which 52.9% were HA and 52.7% exhibited FQR. Interestingly, the FQR proportion was higher in CA 3GCRE than in HA 3GCRE (overall, 60.1% versus 46.2%, respectively, P < 0.001). Multivariable analysis adjusting for age confirmed community acquisition as a risk factor for FQR [adjusted rate ratio (aRR) 1.33, 95% CI 1.17-1.53]. Escherichia coli and Klebsiella spp. were associated with a much higher FQR proportion than other Enterobacteriaceae species (aRR 8.14, 95% CI 6.86-9.65 and aRR 7.62 with 95% CI 6.74-8.61, respectively). Conclusions The high FQR proportion observed among CA 3GCRE, particularly in E. coli and Klebsiella spp., indicates that selection pressure in the outpatient setting needs to be addressed with antibiotic stewardship and other interventions in order to limit further spread of MDR.
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Affiliation(s)
- Anna M Rohde
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Miriam Wiese-Posselt
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Janine Zweigner
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany.,Institute of Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - Frank Schwab
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Alexander Mischnik
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Division of Infectious Diseases, Department of Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harald Seifert
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - Petra Gastmeier
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Charité - Universitätsmedizin Berlin corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Winfried V Kern
- German Center for Infection Research (DZIF), Braunschweig, Germany.,Division of Infectious Diseases, Department of Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Tian L, Zhang Z, Sun Z. Antimicrobial resistance trends in bloodstream infections at a large teaching hospital in China: a 20-year surveillance study (1998-2017). Antimicrob Resist Infect Control 2019; 8:86. [PMID: 31161033 PMCID: PMC6540536 DOI: 10.1186/s13756-019-0545-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Bacterial bloodstream infections (BSIs) cause high morbidity and mortality worldwide in humans, but the pathogenic spectrum varies from region to region. Long-term monitoring of the pathogenic spectrum and changes in bacterial antibiotic resistance is hugely important for effective clinical therapy and infection control. This study examined the data for BSIs in Tongji Hospital, one of the largest teaching hospitals in China, in an attempt to gain better understanding of bacterial antibiotic resistance in China, focusing on central China. Methods Data from Tongji Hospital for a 20-year period (1998–2017) were used for a retrospective analysis to understand the pathogenic spectrum of BSIs and the changes occurring in antimicrobial resistance in central China. The disk diffusion and E test methods were used for antimicrobial susceptibility testing according to Clinical & Laboratory Standards Institute methodologies, and the data were analyzed by WHONET 5.6 software. Results The isolated pathogens mainly came from hospitalized patients not treated in intensive care units (ICUs), and accounted for 81.5% of the total (9130/11200). The most common Gram-negative and Gram-positive bacterial BSI-causing pathogens were Escherichia coli and Staphylococcus aureus, respectively. The detection rate for methicillin-resistant S. aureus (MRSA) in the hospitalized non-ICU patients increased from 8.4% in 1998–2002 to 63% in 2013–2017, while the detection rate for carbapenem-resistant (CR) Klebsiella pneumoniae was below 5% in 1998–2012 but increased to 34.9% in 2013–2017. In contrast, worryingly, the detection rate for CR K. pneumoniae in ICU patients increased from 0% in 2013 to 75% in 2016. E. coli displayed the highest sensitivity rates to imipenem, meropenem and amikacin, all of which were > 90%, followed by cefoxitin at > 80%, and cefoperazone/sulbactam at > 70%. K. pneumoniae isolates were most sensitive to imipenem, meropenem and amikacin antibiotics, with sensitivity rates exceeding 60%. S. aureus isolates were most sensitive to vancomycin, teicoplanin and trimethoprim/sulfamethoxazole, with sensitivity rates exceeding 90%. Conclusions BSIs caused by CR K. pneumoniae clearly posed a severe challenge to infection control and treatment of ICU and non-ICU patients in this retrospective study, while MRSA was an issue for non-ICU patients.
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Affiliation(s)
- Lei Tian
- 1Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Zhen Zhang
- 2Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
| | - Ziyong Sun
- 1Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province China
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Prevel R, Boyer A, M'Zali F, Lasheras A, Zahar JR, Rogues AM, Gruson D. Is systematic fecal carriage screening of extended-spectrum beta-lactamase-producing Enterobacteriaceae still useful in intensive care unit: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:170. [PMID: 31088542 PMCID: PMC6518813 DOI: 10.1186/s13054-019-2460-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are disseminating worldwide leading to increased hospital length of stay and mortality in intensive care units (ICU). ESBL-E dissemination was first due to outbreaks in hospital settings which led to the implementation of systematic fecal carriage screening to improve hygiene procedures by contact precautions. ESBLs have since spread in the community, and the relevance of contact precautions is questioned. ESBL-E dissemination led to an overuse of carbapenems triggering the emergence of carbapenem-resistant Enterobacteriaceae. Empirical antimicrobial therapy based on ESBL-E fecal carriage has been proposed but is debated as it could increase the consumption of carbapenems among ESBL-E carriers without any clinical benefit. Finally, selective decontamination among ESBL-E fecal carriers is evoked to decrease the risk for subsequent ESBL-E infection, but its efficacy remains debated. We propose to systematically review the evidence to recommend or not such systematic ESBL-E fecal carriage screening in adult ICU. METHODS Every article focusing on ESBL-E and ICU available on the MEDLINE database was assessed. Articles were included if focusing on cross-transmission, efficacy of hygiene procedures, link between ESBL-E colonization and infection or guidance of empirical therapy or selective decontamination efficacy. RESULTS Among 330 articles referenced on PubMed, 39 abstracts were selected for full-text assessment and 25 studies were included. Systematic screening of ESBL-E fecal carriage to guide contact precautions do not seem to decrease the rate of ESBL-E cross-transmission. It has a very good negative predictive value for subsequent ESBL-E infections but a positive predictive value between 40 and 50% and so does not help to spare carbapenems. Cessation of ESBL-E carriage systematic screening could decrease the use of carbapenems in ICU without any clinical harm. Nevertheless, further studies are needed to validate these results from monocentric before-after study. Selective decontamination strategy applied to ESBL-E fecal carriers could be helpful, but available data are conflicting. CONCLUSION Current knowledge lacks of high-quality evidence to strongly recommend in favor of or against a systematic ESBL-E fecal carriage screening policy for ICU patients in a non-outbreak situation. Further evaluation of selective decontamination or fecal microbiota transplantation among ESBL-E fecal carriers is needed.
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Affiliation(s)
- Renaud Prevel
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France. .,UMR 5234 CNRS, Bordeaux University, F-33000, Bordeaux, France. .,, Bordeaux, France.
| | - Alexandre Boyer
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France
| | - Fatima M'Zali
- UMR 5234 CNRS, Bordeaux University, F-33000, Bordeaux, France
| | - Agnès Lasheras
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000, Bordeaux, France
| | - Jean-Ralph Zahar
- Unité INSERM - IAME UMR 1137, Université Paris-13, Bobigny, France
| | - Anne-Marie Rogues
- Univ. Bordeaux, CHU Bordeaux, Hygiène hospitalière, F-33000, Bordeaux, France.,Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000, Bordeaux, France
| | - Didier Gruson
- CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, F-33000, Bordeaux, France
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Role of place of acquisition and inappropriate empirical antibiotic therapy on the outcome of extended-spectrum β-lactamase-producing Enterobacteriaceae infections. Int J Antimicrob Agents 2019; 54:49-54. [PMID: 30986523 DOI: 10.1016/j.ijantimicag.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/05/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022]
Abstract
The impact of inappropriate empirical antibiotic therapy (IEAT) on the outcome of severe infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-Ent) remains unclear. Current evidence is limited by study design and lack of confounder control. The main objective of this study was to define the outcome of severe infections due to ESBL-Ent according to clinical parameters and place of infection acquisition. Adult hospitalised patients with ESBL-Ent infections were included in a 3-year multicentre prospective study. Primary outcomes were IEAT rates and crude mortality of severe infections, adjusted by place of acquisition [community-acquired infection (CAI), healthcare-associated infection (HCAI) and hospital-acquired infection (HAI)]. Among 729 patients, 519 (71.2%) were diagnosed with HAI, 176 (24.1%) with HCAI and 34 (4.7%) with CAI. Moreover, 32.9% of patients received IEAT; higher rates of IEAT were observed in pneumonia (23%) and deep surgical site infections (19%). HCAIs were more frequently associated with IEAT than HAIs (48.3% vs. 27.9%; OR = 1.7, 95% CI 1.2-2.4). The overall mortality rate for severe infections (n = 264) was 12.1% and was significantly higher in HCAIs (20%) than HAIs (10%) (RR = 2.3, 95% CI 1.01-5.3). IEAT significantly increased the risk of mortality in bloodstream infections (RR = 8.3, 95% CI 2-46.3). Rates of IEAT and overall mortality of ESBL-Ent severe infections were higher in HCAIs than HAIs. Prompt diagnosis of patients with severe HCAIs due to ESBL-Ent is essential since these infections receive high rates of IEAT and significantly higher mortality than HAIs [ClinicalTrials.gov Identifier: NCT00404625].
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Tian L, Sun Z, Zhang Z. Antimicrobial resistance of pathogens causing nosocomial bloodstream infection in Hubei Province, China, from 2014 to 2016: a multicenter retrospective study. BMC Public Health 2018; 18:1121. [PMID: 30219056 PMCID: PMC6138887 DOI: 10.1186/s12889-018-6013-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on the pathogens responsible for nosocomial bloodstream infection (BSI) and their antimicrobial resistance (AMR) in Hubei province are limited. This study was conducted to determine the major pathogens causing BSI and to characterize their AMR. METHODS Data from the China Antimicrobial Resistance Surveillance System (CARSS) from 2014 to 2016 were analyzed retrospectively. RESULTS Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were the most common pathogens responsible for nosocomial BSI. Individuals aged 0-5 years and ≥ 40 years old were the major demographics at risk of infection by E. coli, K. pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacter cloacae, while individuals aged 0-5 years were the major demographic at risk of infection by S. aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae and Stenotrophomonas maltophilia. The frequencies of E. coli and K. pneumoniae isolates resistant to cefotaxime were 59.1% and 24.3%, respectively, and the frequencies of resistant isolates to ceftazidime were 42.9% and 27.2%, respectively. From 2014 to 2016, the frequency of extended-spectrum β-lactamase (ESBL)-positive E. coli declined from 29.07 to 24.5%, and the frequency of ESBL-positive K. pneumoniae declined from 18.64 to 12.33%. The frequency of carbapenem-resistant (CR) E. coli was below 0.5%, but 1-10% of K. pneumoniae isolates were CR. CONCLUSIONS The emergence of methicillin-resistant S. aureus and the expansion of ESBL and fluoroquinolone resistance among Gram-negative Enterobacteriaceae increased AMR severity. Carbapenemase-producing K. pneumoniae isolates responsible for nosocomial BSI increased year over year and effective infection control measures should be taken to prevent them from spreading.
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Affiliation(s)
- Lei Tian
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Ziyong Sun
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhen Zhang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Heng ST, Chen SL, Wong JGX, Lye DC, Ng TM. No association between resistance mutations, empiric antibiotic, and mortality in ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae bacteremia. Sci Rep 2018; 8:12785. [PMID: 30143706 PMCID: PMC6109088 DOI: 10.1038/s41598-018-31081-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/06/2018] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to correlate resistance mutations of extended spectrum beta-lactamases (ESBL) and AmpC beta-lactamases and virulence factors (VF) with 30-day mortality in patients treated with either piperacillin-tazobactam or carbapenems. A post-hoc analysis on 123 patients with ceftriaxone-resistant Escherichia coli and Klebsiella pneumoniae bacteremia treated empirically with piperacillin-tazobactam and carbapenems was performed. Beta-lactamase resistance mutations and VF were identified by whole genome sequencing (WGS). The primary endpoint was 30-day mortality. Multivariate analyses were performed using logistic regression. WGS showed diverse multilocus sequence types (MLST) in 43 K. pneumoniae strains, while ST131 predominated in E. coli strains (57/80). CTX-M was most commonly detected (76/80 [95%] of E. coli; 39/43 [91%] of K pneumoniae.), followed by OXA (53/80 [66%] of E. coli; 34/43 [79%] of K. pneumoniae). A significant correlation was found between the number of genes encoding third-generation cephalosporin-resistant beta-lactamases and 30-day mortality (p = 0.045). The positive association was not significant after controlling for empiric carbapenem, Pitt score 3 and K. pneumoniae (OR 2.43, P = 0.073). None of the VF was associated with 30-day mortality. No association was found between 30-day mortality and any ESBL and AmpC beta-lactamases or VF when piperacillin-tazobactam or carbapenems were given. No significant association between 30-day mortality and active empiric therapy was found.
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Affiliation(s)
- Shi Thong Heng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Swaine L Chen
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Joshua G X Wong
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - David C Lye
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tat Ming Ng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
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Naylor NR, Atun R, Zhu N, Kulasabanathan K, Silva S, Chatterjee A, Knight GM, Robotham JV. Estimating the burden of antimicrobial resistance: a systematic literature review. Antimicrob Resist Infect Control 2018; 7:58. [PMID: 29713465 PMCID: PMC5918775 DOI: 10.1186/s13756-018-0336-y] [Citation(s) in RCA: 283] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/14/2018] [Indexed: 01/02/2023] Open
Abstract
Background Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to paramaterise cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base. Methods MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Philips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD. Results Out of 5187 unique retrievals, 214 studies were included. One hundred eighty-seven studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively. Conclusions This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review. Trial registration This systematic review is registered with PROSPERO (PROSPERO CRD42016037510).
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Affiliation(s)
- Nichola R. Naylor
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Rifat Atun
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
- Harvard University, 665 Huntington Avenue, Boston, MA 02115 USA
| | - Nina Zhu
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Kavian Kulasabanathan
- Imperial College London, Sir Alexander Fleming Building, South Kensington Campus, London, UK
| | - Sachin Silva
- Harvard University, 665 Huntington Avenue, Boston, MA 02115 USA
| | - Anuja Chatterjee
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Gwenan M. Knight
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
| | - Julie V. Robotham
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College, Hammersmith Campus, London, W12 0NN UK
- Modelling and Economics Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ UK
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Rizk NA, Kanafani ZA, Tabaja HZ, Kanj SS. Extended infusion of beta-lactam antibiotics: optimizing therapy in critically-ill patients in the era of antimicrobial resistance. Expert Rev Anti Infect Ther 2017; 15:645-652. [PMID: 28657373 DOI: 10.1080/14787210.2017.1348894] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Beta-lactams are at the cornerstone of therapy in critical care settings, but their clinical efficacy is challenged by the rise in bacterial resistance. Infections with multi-drug resistant organisms are frequent in intensive care units, posing significant therapeutic challenges. The problem is compounded by a dearth in the development of new antibiotics. In addition, critically-ill patients have unique physiologic characteristics that alter the drugs pharmacokinetics and pharmacodynamics. Areas covered: The prolonged infusion of antibiotics (extended infusion [EI] and continuous infusion [CI]) has been the focus of research in the last decade. As beta-lactams have time-dependent killing characteristics that are altered in critically-ill patients, prolonged infusion is an attractive approach to maximize their drug delivery and efficacy. Several studies have compared traditional dosing to EI/CI of beta-lactams with regard to clinical efficacy. Clinical data are primarily composed of retrospective studies and some randomized controlled trials. Several reports show promising results. Expert commentary: Reviewing the currently available evidence, we conclude that EI/CI is probably beneficial in the treatment of critically-ill patients in whom an organism has been identified, particularly those with respiratory infections. Further studies are needed to evaluate the efficacy of EI/CI in the management of infections with resistant organisms.
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Affiliation(s)
- Nesrine A Rizk
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Zeina A Kanafani
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Hussam Z Tabaja
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
| | - Souha S Kanj
- a Division of Infectious Diseases, Department of Internal Medicine , American University of Beirut Medical Center , Beirut , Lebanon
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Razazi K, Mekontso Dessap A, Carteaux G, Jansen C, Decousser JW, de Prost N, Brun-Buisson C. Frequency, associated factors and outcome of multi-drug-resistant intensive care unit-acquired pneumonia among patients colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae. Ann Intensive Care 2017; 7:61. [PMID: 28608133 PMCID: PMC5468364 DOI: 10.1186/s13613-017-0283-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/26/2017] [Indexed: 02/01/2023] Open
Abstract
Background We assessed prevalence, associated factors and prognosis of extended-spectrum beta-lactamase-producing Enterobacteriaceae pneumonia acquired in intensive care unit (ESBL-PE pneumonia) among carriers. Variables associated with nosocomial pneumonia caused by carbapenem-resistant bacteria (CRB) were also assessed. Methods A 6-year prospective study (May 2009–March 2015) in the medical ICU of an 850-bed university-affiliated hospital was conducted. Results Of the 6303 patients admitted, 843 (13.4%) had ESBL-PE carriage detected. Among carriers, 111 (13%) patients developed ICU-acquired pneumonia of whom 48 (43%) had ESBL-PE pneumonia (6% of carriers). By multivariable analysis, SAPS II at admission >43 [OR 2.81 (1.16–6.79)] and colonization with Enterobacter sp. or K. pneumoniae species [OR 10.96 (2.93–41.0)] were independent predictive factors for ESBL-PE pneumonia in colonized patients, whereas receipt of >2 days of amoxicillin/clavulanic acid during the ICU stay [OR 0.24 (0.08–0.71)] was protective. Patients with ESBL-PE pneumonia had a higher SOFA score (p = 0.037) and more frequent septic shock at pneumonia onset (p = 0.047). However, ESBL-PE pneumonia was not an independent predictor of mortality. Twenty-five patients had pneumonia caused by CRB. Chronic renal insufficiency, administration of third-generation cephalosporin within the past 3 months, acute respiratory distress syndrome before pneumonia and prior therapy with a carbapenem or fluoroquinolones were associated with CRB pneumonia in this selected population. Conclusions Although few ESBL-PE carriers developed ESBL-PE pneumonia overall, a high proportion of pneumonia were caused by ESBL-PE in carriers developing ICUAP. ESBL-PE pneumonia was not an independent predictor of mortality. As pneumonia caused by CRB is increasing, knowledge of factors associated with ESBL-PE or CRB pneumonia may help empiric therapy of pneumonia among ESBL-PE carriers. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0283-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keyvan Razazi
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France. .,Université Paris Est Creteil, IMRB, GRC CARMAS, 94010, Créteil, France.
| | - Armand Mekontso Dessap
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Université Paris Est Creteil, IMRB, GRC CARMAS, 94010, Créteil, France
| | - Guillaume Carteaux
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Université Paris Est Creteil, IMRB, GRC CARMAS, 94010, Créteil, France
| | - Chloé Jansen
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Contrôle, Epidémiologie et Prévention de l'Infection, CEPI, 94010, Créteil, France
| | - Jean-Winoc Decousser
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Département de Virologie, Bactériologie, Parasitologie-Mycologie, 94010, Créteil, France
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Université Paris Est Creteil, IMRB, GRC CARMAS, 94010, Créteil, France
| | - Christian Brun-Buisson
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Université Paris Est Creteil, IMRB, GRC CARMAS, 94010, Créteil, France
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Clinical predictors and outcomes of Klebsiella pneumoniae bacteraemia in a regional hospital in Hong Kong. J Hosp Infect 2017; 97:35-41. [PMID: 28602703 DOI: 10.1016/j.jhin.2017.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/04/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Klebsiella pneumoniae (KP) infection is associated with high morbidity and mortality. Multidrug resistance, especially extended-spectrum β-lactamase (ESBL) production, in KP is endemic worldwide. AIM To evaluate the clinical characteristics and outcomes of patients with KP bacteraemia in critical care and general ward settings. METHODS Adult patients admitted to a regional hospital in Hong Kong from January 1st, 2009 to June 30th, 2016 (7.5 years) with KP bacteraemia were included. Demographics, clinical features, microbiological characteristics, and outcomes were analysed. FINDINGS Among 853 patients, 178 (20.9%) required critical care and 176 (20.6%) died within 30 days of hospital admission. Thirty-day survivors were younger (P<0.001), had milder disease (defined by Sequential Organ Failure Assessment score) (P<0.001), presented with hepatobiliary sepsis (P<0.001) or urosepsis (P<0.001), less septic shock (P=0.013), fewer invasive organ supports (P<0.001), and had appropriate empirical antibiotics (P<0.001). Cox regression analysis showed that respiratory tract infection (hazard ratio: 2.99; 95% confidence interval: 2.061-4.337; P≤0.001), gastrointestinal tract infection (excluding hepatobiliary system) (2.763; 1.761-4.337; P≤0.001), mechanical ventilation (2.202; 1.506-3.221; P≤0.001), medical case (1.830; 1.253-2.672; P=0.002), inappropriate empirical antibiotics (1.716; 1.267-2.324; P≤0.001), female (1.699; 1.251-2.307; P<0.001), age >65 years (1.692; 1.160-2.467; P=0.006), and presence of solid tumour (1.457; 1.056-2.009; P=0.022) were independent risk factors for 30-day mortality. Unexpectedly, diabetes mellitus was associated with better 30-day survival (P=0.002). A total of 102 patients (12.0%) had infections with ESBL-producing strains, which were not associated with higher 30-day mortality. CONCLUSION KP bacteraemia is associated with high 30-day mortality. Site of infection, patients' comorbidities and appropriate use of empirical antibiotic are important predictors of patients' outcomes.
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Tschudin-Sutter S, Lucet JC, Mutters NT, Tacconelli E, Zahar JR, Harbarth S. Contact Precautions for Preventing Nosocomial Transmission of Extended-Spectrum β Lactamase–Producing Escherichia coli: A Point/Counterpoint Review. Clin Infect Dis 2017; 65:342-347. [DOI: 10.1093/cid/cix258] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/29/2017] [Indexed: 01/10/2023] Open
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Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections. Antimicrob Agents Chemother 2017; 61:AAC.01709-16. [PMID: 27993852 DOI: 10.1128/aac.01709-16] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022] Open
Abstract
The clinical and economic impacts of bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria are incompletely understood. From 2009 to 2015, all adult inpatients with Gram-negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram-negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram-negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio, 1.60; 95% confidence interval [CI], 1.19 to 2.16; P = 0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] versus 0.2% [1/599]; P = 0.02) and longer hospital stay (median, 10.0 versus 8.0 days; P = 0.0005). Unadjusted rates of in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P = 0.12). Unadjusted mean costs were 1.62 times higher in MDR than in non-MDR BSI ($59,266 versus $36,452; P = 0.003). This finding persisted after adjustment for patient factors and appropriate empirical antibiotic therapy (means ratio, 1.18; 95% CI, 1.03 to 1.36; P = 0.01). Adjusted analysis of patient subpopulations revealed that the increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio, 1.41; 95% CI, 1.10 to 1.82; P = 0.008). MDR Gram-negative BSI are associated with recurrent BSI, longer hospital stays, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost.
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Brady M, Oza A, Cunney R, Burns K. Attributable mortality of hospital-acquired bloodstream infections in Ireland. J Hosp Infect 2017; 96:35-41. [PMID: 28359546 DOI: 10.1016/j.jhin.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/04/2017] [Indexed: 12/22/2022]
Abstract
AIM To estimate the attributable mortality of hospital-acquired bloodstream infections (HA-BSI) in Ireland. METHODS A retrospective case-cohort study was conducted, based on notifications from Irish microbiology laboratories and administrative patient records from six Irish hospitals from January 2007 to December 2013. Probabilistic linkage was used to link 1252 cases of bloodstream infection from a cohort of 343,189 hospitalized patients. Independent predictors of mortality were determined using a multi-variable logistic regression model, and included: patient age, emergency or re-admission to hospital, length of stay in an intensive care unit, number of procedures, number of diagnoses, major diagnostic category and presence of HA-BSI. RESULTS Attributable mortality was calculated from the crude mortality of case subjects after adjusting for other predictors of mortality, and was found to be 15.3% (95% confidence interval 14.8-15.8%). The study was further stratified according to the causative organism, including: Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae, and, where available, their antimicrobial resistance patterns. The highest attributable mortality among these organisms was reported for E. faecium at 18.1% and the lowest attributable mortality was reported for E. coli at 13.6%. A significantly higher attributable mortality was found for antimicrobial resistance patterns of some organisms, most notably for meticillin-resistant S. aureus at 19.5%, vs meticillin-susceptible S. aureus at 13.3%. CONCLUSIONS HA-BSI is an important cause of mortality, and attributable mortality differs significantly among causative organisms and antimicrobial resistance patterns.
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Affiliation(s)
- M Brady
- Health Protection Surveillance Centre, Dublin, Ireland; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
| | - A Oza
- Health Protection Surveillance Centre, Dublin, Ireland
| | - R Cunney
- Health Protection Surveillance Centre, Dublin, Ireland; Department of Clinical Microbiology, Children's University Hospital, Dublin, Ireland
| | - K Burns
- Health Protection Surveillance Centre, Dublin, Ireland; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Castellanos LR, Donado-Godoy P, León M, Clavijo V, Arevalo A, Bernal JF, Timmerman AJ, Mevius DJ, Wagenaar JA, Hordijk J. High Heterogeneity of Escherichia coli Sequence Types Harbouring ESBL/AmpC Genes on IncI1 Plasmids in the Colombian Poultry Chain. PLoS One 2017; 12:e0170777. [PMID: 28125687 PMCID: PMC5268450 DOI: 10.1371/journal.pone.0170777] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Escherichia coli producing ESBL/AmpC enzymes are unwanted in animal production chains as they may pose a risk to human and animal health. Molecular characterization of plasmids and strains carrying genes that encode these enzymes is essential to understand their local and global spread. Objectives To investigate the diversity of genes, plasmids and strains in ESBL/AmpC-producing E. coli from the Colombian poultry chain isolated within the Colombian Integrated Program for Antimicrobial Resistance Surveillance (Coipars). Methods A total of 541 non-clinical E. coli strains from epidemiologically independent samples and randomly isolated between 2008 and 2013 within the Coipars program were tested for antimicrobial susceptibility. Poultry isolates resistant to cefotaxime (MIC ≥ 4 mg/L) were screened for ESBL/AmpC genes including blaCTX-M, blaSHV, blaTEM, blaCMY and blaOXA. Plasmid and strain characterization was performed for a selection of the ESBL/AmpC-producing isolates. Plasmids were purified and transformed into E. coli DH10B cells or transferred by conjugation to E. coli W3110. When applicable, PCR Based Replicon Typing (PBRT), plasmid Multi Locus Sequence Typing (pMLST), plasmid Double Locus Sequence Typing (pDLST) and/or plasmid Replicon Sequence Typing (pRST) was performed on resulting transformants and conjugants. Multi Locus Sequence Typing (MLST) was used for strain characterization. Results In total, 132 of 541 isolates were resistant to cefotaxime and 122 were found to carry ESBL/AmpC genes. Ninety-two harboured blaCMY-2 (75%), fourteen blaSHV-12 (11%), three blaSHV-5 (2%), five blaCTX-M-2 (4%), one blaCTX-M-15 (1%), one blaCTX-M-8 (1%), four a combination of blaCMY-2 and blaSHV-12 (4%) and two a combination of blaCMY-2 and blaSHV-5 (2%). A selection of 39 ESBL/AmpC-producing isolates was characterized at the plasmid and strain level. ESBL/AmpC genes from 36 isolates were transferable by transformation or conjugation of which 22 were located on IncI1 plasmids. These IncI1 plasmids harboured predominantly blaCMY-2 (16/22), and to a lesser extend blaSHV-12 (5/22) and blaCTX-M-8 (1/22). Other plasmid families associated with ESBL/AmpC-genes were IncK (4/33), IncHI2 (3/33), IncA/C (2/33), IncΒ/O (1/33) and a non-typeable replicon (1/33). Subtyping of IncI1 and IncHI2 demonstrated IncI1/ST12 was predominantly associated with blaCMY-2 (12/16) and IncHI2/ST7 with blaCTX-M-2 (2/3). Finally, 31 different STs were detected among the 39 selected isolates. Conclusions Resistance to extended spectrum cephalosporins in E. coli from Colombian poultry is mainly caused by blaCMY-2 and blaSHV-12. The high diversity of strain Sequence Types and the dissemination of homogeneous IncI1/ST12 plasmids suggest that spread of the resistance is mainly mediated by horizontal gene transfer.
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Affiliation(s)
- Luis Ricardo Castellanos
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Colombian Integrated Program for Antimicrobial Resistance Surveillance – Coipars, Corporación Colombiana de Investigación Agropecuaria - Corpoica, Cundinamarca, Colombia
| | - Pilar Donado-Godoy
- Colombian Integrated Program for Antimicrobial Resistance Surveillance – Coipars, Corporación Colombiana de Investigación Agropecuaria - Corpoica, Cundinamarca, Colombia
| | - Maribel León
- Instituto Colombiano Agropecuario - ICA, Bogotá, Colombia
| | - Viviana Clavijo
- Colombian Integrated Program for Antimicrobial Resistance Surveillance – Coipars, Corporación Colombiana de Investigación Agropecuaria - Corpoica, Cundinamarca, Colombia
- Department of Biological Sciences, Los Andes University, Bogotá, Colombia
| | - Alejandra Arevalo
- Colombian Integrated Program for Antimicrobial Resistance Surveillance – Coipars, Corporación Colombiana de Investigación Agropecuaria - Corpoica, Cundinamarca, Colombia
| | - Johan F. Bernal
- Colombian Integrated Program for Antimicrobial Resistance Surveillance – Coipars, Corporación Colombiana de Investigación Agropecuaria - Corpoica, Cundinamarca, Colombia
| | - Arjen J. Timmerman
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Dik J. Mevius
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Wageningen Bioveterinary Research, Lelystad, the Netherlands
| | - Jaap A. Wagenaar
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- Wageningen Bioveterinary Research, Lelystad, the Netherlands
| | - Joost Hordijk
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
- * E-mail:
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Zahar JR, Lesprit P, Ruckly S, Eden A, Hikombo H, Bernard L, Harbarth S, Timsit JF, Brun-Buisson C. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae. Int J Antimicrob Agents 2016; 49:67-73. [PMID: 27890442 DOI: 10.1016/j.ijantimicag.2016.09.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/03/2016] [Accepted: 09/24/2016] [Indexed: 01/09/2023]
Abstract
Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.
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Affiliation(s)
- Jean-Ralph Zahar
- Infection Control Unit, Avicenne University Hospital, APHP, Paris-Nord University (UFR SMBH), Bobigny, France; IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France
| | - Philippe Lesprit
- Antibiotic Team, Department of Biology, Hôpital Foch, Suresnes, France
| | - Stephane Ruckly
- IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France; Department of Biostatistics, Outcomerea, Bobigny, France
| | - Aurelia Eden
- Infectious and Tropical Diseases Department, Perpignan General Hospital, Perpignan, France
| | - Hitoto Hikombo
- Infectious and Tropical Diseases Department, Le Mans General Hospital, Le Mans, France
| | - Louis Bernard
- Internal Medicine and Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-François Timsit
- IAME U1137 Decision Science in Infectious Diseases, Inserm, Paris Diderot University, Paris, France; Department of Biostatistics, Outcomerea, Bobigny, France; Medical and Infectious Diseases ICU, APHP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Christian Brun-Buisson
- Medical Intensive Care Unit and Infection Control Unit, Henri Mondor University Hospital, APHP, Paris-Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
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Leistner R, Bloch A, Gastmeier P, Schwab F. E. coli bacteremia in comparison to K. pneumoniae bacteremia: influence of pathogen species and ESBL production on 7-day mortality. Antimicrob Resist Infect Control 2016; 5:37. [PMID: 27777758 PMCID: PMC5070161 DOI: 10.1186/s13756-016-0138-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/03/2016] [Indexed: 12/04/2022] Open
Abstract
In a previous study, we demonstrated prolonged length of hospital stay in cases of extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae bacteremia compared to bacteremia cases due to E. coli (ESBL-positive and –negative) and ESBL-negative K. pneumoniae. The overall mortality was significantly higher in bacteremia cases resulting from ESBL-positive pathogens but also in K. pneumoniae cases disregarding ESBL-production. In order to examine whether pathogen species rather than multidrug resistance might affect mortality risk, we reanalyzed our dataset that includes 1.851 cases of bacteremia.
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Affiliation(s)
- R Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - A Bloch
- Department of Medical and Financial Controlling, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
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Fukuchi T, Iwata K, Kobayashi S, Nakamura T, Ohji G. Cefmetazole for bacteremia caused by ESBL-producing enterobacteriaceae comparing with carbapenems. BMC Infect Dis 2016; 16:427. [PMID: 27538488 PMCID: PMC4991070 DOI: 10.1186/s12879-016-1770-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 08/10/2016] [Indexed: 01/06/2023] Open
Abstract
Background ESBL (Extended spectrum beta-lactamase) producing enterobacteriaceae are challenging organisms with little treatment options. Carbapenems are frequently used, but the emergence of carbapenem resistant enterobacteriaceae is a concerning issue, which may hinder the use of carbapenems. Although cephamycins such as cefoxitin, cefmetazole or cefotetan are effective against ESBL-producers in vitro, there are few clinical data demonstrating effects against bacteremia caused by these organisms. Methods We performed a retrospective observational study on cases of bacteremia caused by ESBL-producers to investigate the efficacy of cefmetazole compared with carbapenems. We also evaluated whether the trend of antibiotic choice changed over years. Results Sixty-nine patients (male 34, age 69.2 ± 14.4), including two relapse cases, were reviewed for this analysis. The most common causative organisms were Escherichia coli (64, 93 %), followed by Klebsiella pneumoniae and K. oxytoca (2 each, 4 %). The group that received carbapenem therapy (43, 62 %) had increased severity in the Pittsburgh Bacteremic score than the group that received cefmetazole therapy, (1.5 ± 1.5 vs 2.5 ± 2.1, p = 0.048), while analysis of other factors didn’t reveal any statistical differences. Five patients in the carbapenem group and one patient in the cefmetazole group died during the observation period (p = 0.24). CTX-M-9 were predominant in this series (59 %). Infectious disease physicians initially recommended carbapenems at the beginning of the current research period, which gradually changed over time favoring the use of cefmetazole instead (p = 0.002). Conclusion Cefmetazole may be safely given to patients with bacteremia caused by ESBL-producers as a definitive therapy, if one can select out relatively stable patients.
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Affiliation(s)
- Takahiko Fukuchi
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan. .,Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.
| | - Kentaro Iwata
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.,Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Saori Kobayashi
- Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Tatsuya Nakamura
- Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan
| | - Goh Ohji
- Division of Infectious Diseases Therapeutics, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.,Department of Microbiology and Infectious Disease, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan.,Department of Clinical Laboratory, Kobe University Hospital, 7-5-2 Kusunokicho, Chuoku, Kobe, Hyogo, 650-0017, Japan
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Sakellariou C, Gürntke S, Steinmetz I, Kohler C, Pfeifer Y, Gastmeier P, Schwab F, Kola A, Deja M, Leistner R. Sepsis Caused by Extended-Spectrum Beta-Lactamase (ESBL)-Positive K. pneumoniae and E. coli: Comparison of Severity of Sepsis, Delay of Anti-Infective Therapy and ESBL Genotype. PLoS One 2016; 11:e0158039. [PMID: 27442425 PMCID: PMC4956035 DOI: 10.1371/journal.pone.0158039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/09/2016] [Indexed: 12/22/2022] Open
Abstract
Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are associated with increased mortality. Outcome differences due to various species of ESBL-E or ESBL genotypes are not well investigated. We conducted a cohort study to assess risk factors for mortality in cases of ESBL-E bacteremia (K. pneumoniae or E. coli) and the risk factors for sepsis with organ failure. All consecutive patients of our institution from 2008 to 2011 with bacteremia due to ESBL-E were included. Basic epidemiological data, underlying comorbidities, origin of bacteremia, severity of sepsis and delay of appropriate anti-infective treatment were collected. Isolates were PCR-screened for the presence of ESBL genes and plasmid-mediated AmpC β-lactamases. Cox proportional hazard regression on mortality and multivariable logistic regression on risk factors for sepsis with organ failure was conducted. 219 cases were included in the analysis: 73.1% due to E. coli, 26.9% due to K. pneumoniae. There was no significant difference in hospital mortality (ESBL-E. coli, 23.8% vs. ESBL-K. pneumoniae 27.1%, p = 0.724). However, the risk of sepsis with organ failure was associated in cases of K. pneumoniae bacteremia (OR 4.5, p<0.001) and patients with liver disease (OR 3.4, p = 0.004) or renal disease (OR 6.8, p<0.001). We found significant differences in clinical presentation of ESBL-E bacteremia due to K. pneumoniae compared to E. coli. As K. pneumoniae cases showed a more serious clinical presentation as E. coli cases and were associated with different risk factors, treatment and prevention strategies should be adjusted accordingly.
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Affiliation(s)
- Christian Sakellariou
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Stephan Gürntke
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Ivo Steinmetz
- Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany
| | - Christian Kohler
- Friedrich Loffler Institute of Medical Microbiology, Universitaetsmedizin Greifswald, Martin-Luther-Str.6, 17475, Greifswald, Germany
| | - Yvonne Pfeifer
- Robert Koch Institute, FG13 Nosocomial Pathogens and Antibiotic Resistance, 38855, Wernigerode, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitaetsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
- * E-mail:
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46
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Gröschel MI, Omansen TF, de Lange W, van der Werf TS, Lokate M, Bathoorn E, Akkerman OW, Stienstra Y. Multidrug-Resistant Tuberculosis Complicated by Nosocomial Infection with Multidrug-Resistant Enterobacteriaceae. Am J Trop Med Hyg 2016; 94:517-8. [PMID: 26755567 DOI: 10.4269/ajtmh.15-0690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/25/2015] [Indexed: 11/07/2022] Open
Abstract
Treatment of mycobacterial diseases such as tuberculosis (TB) entails long and intense antimicrobial therapy. TB patients are at risk of coinfection with other multidrug-resistant bacteria, such as those from Enterobacteriaceae family, because of antimicrobial selection pressure and nosocomial transmission during prolonged hospital admission. Here, we report on two patients treated for multidrug-resistant TB, who developed severe sepsis due to an extended spectrum β-lactamase producing organism. Diagnostic culture identified the venous access port as source, and upon surgical removal and antimicrobial therapy rapid clinical improvement was achieved. Increased awareness and knowledge on the prevalence of multi-resistant Enterobacteriaceae is needed, notably in TB centers, to provide a safe hospital environment to our patients.
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Affiliation(s)
- Matthias I Gröschel
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Till F Omansen
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiel de Lange
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjip S van der Werf
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariëtte Lokate
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Onno W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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47
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Seboxa T, Amogne W, Abebe W, Tsegaye T, Azazh A, Hailu W, Fufa K, Grude N, Henriksen TH. High Mortality from Blood Stream Infection in Addis Ababa, Ethiopia, Is Due to Antimicrobial Resistance. PLoS One 2015; 10:e0144944. [PMID: 26670718 PMCID: PMC4682922 DOI: 10.1371/journal.pone.0144944] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/26/2015] [Indexed: 01/21/2023] Open
Abstract
Background Managing blood stream infection in Africa is hampered by lack of bacteriological support needed for antimicrobial stewardship, and background data needed for empirical treatment. A combined pro- and retrospective approach was used to overcome thresholds in clinical research in Africa. Methods Outcome and characteristics including age, HIV infection, pancytopenia and bacteriological results were studied in 292 adult patients with two or more SIRS criteria using univariate and confirming multivariate logistic regression models. Expected randomly distributed resistance covariation was compared with observed co-resistance among gram-negative enteric bacteria in 92 paediatric blood culture isolates that had been harvested in the same hospital during the same period of time. Results Mortality was fivefold increased among patients with positive blood culture results [50.0% vs. 9.8%; OR 11.24 (4.38–25.88), p < 0.0001], and for this group of patients mortality was significantly associated with antimicrobial resistance [OR 23.28 (3.3–164.4), p = 0.002]. All 11 patients with Enterobacteriaceae resistant to 3rd. generation cephalosporins died. Eighty-nine patients had pancytopenia grade 3–4. Among patients with negative blood culture results, mortality was significantly associated with pancytopenia [OR 3.12 (1.32–7.39), p = 0.01]. HIV positivity was not associated with increased mortality. Antimicrobial resistance that concerned gram-negative enteric bacteria, regardless of species, was characterized by co-resistance between third generation cephalosporins, gentamicin, chloramphenicol, and co-trimoxazole. Conclusion Mortality was strongly associated with growth of bacteria resistant to empirical treatment, and these patients were dead or dying when bacteriological reports arrived. Because of co-resistance, alternative efficient antibiotics would not have been available in Ethiopia for 8/11 Enterobacteriaceae-infected patients with isolates resistant to third generation cephalosporins. Strong and significant resistance covariation between 3rd. generation cephalosporins, chloramphenicol, gentamicin, and co-trimoxazole was identified. Pronounced pancytopenia was common and associated with increased mortality. HIV positive patients had no excess mortality.
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Affiliation(s)
- Teshale Seboxa
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency and Critical Care Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workagegnehu Hailu
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Fufa
- Department of Microbiology, Black Lion Hospital, Addis Ababa, Ethiopia
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tönsberg, Norway
| | - Thor-Henrik Henriksen
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Medical Department, Vestfold Hospital Trust, Tönsberg, Norway
- * E-mail:
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48
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Martelius T, Jalava J, Kärki T, Möttönen T, Ollgren J, Lyytikäinen O. Nosocomial bloodstream infections caused by Escherichia coli and Klebsiella pneumoniae resistant to third-generation cephalosporins, Finland, 1999-2013: Trends, patient characteristics and mortality. Infect Dis (Lond) 2015; 48:229-34. [PMID: 26577519 DOI: 10.3109/23744235.2015.1109135] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few systematically collected multi-centre surveillance data on nosocomial bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae have been published. AIM To evaluate trends, patient characteristics and mortality of such infections, nosocomial BSI data reported by the 4-17 hospitals participating in the prospective laboratory-based surveillance during 1999-2013 were analysed. METHODS Data were collected by local infection control nurses, patient-days were obtained from the hospital's administrative database, and dates of deaths from the population registry. Resistance to third-generation cephalosporins was further examined in the national reference laboratory. FINDINGS A total of 16 028 nosocomial BSIs were identified; 2217 (14%) were caused by E. coli and 661 (4%) by K. pneumoniae; 207 (7%) were non-susceptible to third-generation cephalosporins, with an increasing trend from 0% in 1999 to 17% in 2013. Patient characteristics did not differ significantly between BSIs caused by third-generation susceptible and resistant E. coli and K. pneumonia, but the case fatality tended to be higher. Most (88%) of the isolates reported as non-susceptible to third-generation cephalosporins had ESBL phenotype, CTX-M (79%) being the most common enzyme. CONCLUSION A sharp increase in nosocomial BSIs caused by ESBL producing bacteria was observed. Identification of patients for screening pose a challenge, emphasising the role of infection control guidelines and antibiotic policy in prevention.
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Affiliation(s)
- Timi Martelius
- a Department of Infectious Diseases , Inflammation Centre, Helsinki University Hospital and University of Helsinki, Inflammation Centre , Helsinki , Finland ;,b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Jari Jalava
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Tommi Kärki
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Teemu Möttönen
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Jukka Ollgren
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
| | - Outi Lyytikäinen
- b Institute of Health and Welfare , Department of Infectious Disease Surveillance and Control , Helsinki , Finland
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