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Hagiya H, Otsuka F. Increased evidence for no benefit of contact precautions in preventing extended-spectrum β-lactamases-producing Enterobacteriaceae: Systematic scoping review. Am J Infect Control 2023; 51:1056-1062. [PMID: 36736903 DOI: 10.1016/j.ajic.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL-E) is a critical antimicrobial resistance pathogen, to which we need to pay the greatest attention. This study was aimed at uncovering the present evidence for the preventive effectiveness of contact precautions for patients colonized or infected with ESBL-E. METHODS According to the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, we searched MEDLINE for articles with relevant keywords from the beginning of 2010 to October 18, 2022. RESULTS Of the 355 articles found, 9, including 8 observational studies and 1 randomized controlled trial, were selected. Safety of discontinuing contact precautions was evaluated mainly in acute-care and long-term care hospitals. Consistently, all authors concluded that contact precautions can be safely discontinued in patients colonized or infected with ESBL-E. CONCLUSION The clinical impact of discontinuing contact precautions for patients with ESBL-E is minimal and can be safely withdrawn at acute, noncritical, adult care wards. Relevant data from pediatric and geriatric wards, as well as intensive care units, were insufficient and should be investigated in future research.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan.
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 7008558, Japan
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Chen J, Hu C, Wang R, Li F, Sun G, Yang M, Chu Y. Shift in the Dominant Sequence Type of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection from ST11 to ST15 at a Medical Center in Northeast China, 2015-2020. Infect Drug Resist 2021; 14:1855-1863. [PMID: 34054300 PMCID: PMC8158045 DOI: 10.2147/idr.s311968] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/24/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection at a medical center in northeast China, especially after coronavirus disease (COVID-19) pandemic. Methods Fifty-one patients were diagnosed with CRKP bloodstream infection between January 2015 and December 2020, among which 42 isolates were available for further study. Species identification and antibiotic susceptibilities were tested with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and VITEK 2 systems. Carbapenemase genes, virulence genes and MLST genes were detected by polymerase chain reaction. Moreover, the string test and serum killing assay were performed to evaluate the virulence of the CRKP isolates. Results During the six-year period, the detection rate of CRKP in bloodstream infection showed an increasing trend, with the intensive care unit, hematology and respiratory medicine wards mainly affected. Molecular epidemiology analyses showed that KPC-2 was the dominant carbapenemase gene. In addition, the dominant sequence type (ST) of CRKP shifted from ST11 to ST15 strains, which were all sensitive to amikacin in contrast to the ST11 stains. Furthermore, ST15 CRKP strains were positive for the KfuB virulence gene and more resistant to serum killing compared to the ST11 CRKP strains. Nonetheless, the mortality rate of patients infected with ST11 and ST15 CRKP did not show any significant differences. Conclusion A shift in the dominant sequence type of CRKP bloodstream infections from ST11 to ST15 was observed during the years 2015–2020. Compared to ST11, the ST15 CRKP strains showed amikacin sensitivity, positivity for KfuB gene, and serum resistance, which may indicate stronger virulence.
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Affiliation(s)
- Jingjing Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Chang Hu
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Ruixuan Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Fushun Li
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Guoquan Sun
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Min Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
| | - Yunzhuo Chu
- Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.,Labortory Medicine Innovation Unit, Chinese Academy of Medical Sciences, Shenyang, People's Republic of China
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Chmielewska SJ, Skłodowski K, Depciuch J, Deptuła P, Piktel E, Fiedoruk K, Kot P, Paprocka P, Fortunka K, Wollny T, Wolak P, Parlinska-Wojtan M, Savage PB, Bucki R. Bactericidal Properties of Rod-, Peanut-, and Star-Shaped Gold Nanoparticles Coated with Ceragenin CSA-131 against Multidrug-Resistant Bacterial Strains. Pharmaceutics 2021; 13:425. [PMID: 33809901 PMCID: PMC8004255 DOI: 10.3390/pharmaceutics13030425] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The ever-growing number of infections caused by multidrug-resistant (MDR) bacterial strains requires an increased effort to develop new antibiotics. Herein, we demonstrate that a new class of gold nanoparticles (Au NPs), defined by shape and conjugated with ceragenin CSA-131 (cationic steroid antimicrobial), display strong bactericidal activity against intractable superbugs. METHODS For the purpose of research, we developed nanosystems with rod- (AuR NPs@CSA-131), peanut-(AuP NPs@CSA-131) and star-shaped (AuS NPs@CSA-131) metal cores. Those nanosystems were evaluated against bacterial strains representing various groups of MDR (multidrug-resistant) Gram-positive (MRSA, MRSE, and MLSb) and Gram-negative (ESBL, AmpC, and CR) pathogens. Assessment of MICs (minimum inhibitory concentrations)/MBCs (minimum bactericidal concentrations) and killing assays were performed as a measure of their antibacterial activity. In addition to a comprehensive analysis of bacterial responses involving the generation of ROS (reactive oxygen species), plasma membrane permeabilization and depolarization, as well as the release of protein content, were performed to investigate the molecular mechanisms of action of the nanosystems. Finally, their hemocompatibility was assessed by a hemolysis assay. RESULTS All of the tested nanosystems exerted potent bactericidal activity in a manner resulting in the generation of ROS, followed by damage of the bacterial membranes and the leakage of intracellular content. Notably, the killing action occurred with all of the bacterial strains evaluated, including those known to be drug resistant, and at concentrations that did not impact the growth of host cells. CONCLUSIONS Conjugation of CSA-131 with Au NPs by covalent bond between the COOH group from MHDA and NH3 from CSA-131 potentiates the antimicrobial activity of this ceragenin if compared to its action alone. Results validate the development of AuR NPs@CSA-131, AuP NPs@CSA-131, and AuS NPs@CSA-131 as potential novel nanoantibiotics that might effectively eradicate MDR bacteria.
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Affiliation(s)
- Sylwia Joanna Chmielewska
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
| | - Karol Skłodowski
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
| | - Joanna Depciuch
- Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Krakow, Poland; (J.D.); (M.P.-W.)
| | - Piotr Deptuła
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
| | - Ewelina Piktel
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
| | - Krzysztof Fiedoruk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
| | - Patrycja Kot
- Department of Microbiology and Immunology, Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University in Kielce, 25-365 Kielce, Poland; (P.K.); (P.P.); (K.F.); (P.W.)
| | - Paulina Paprocka
- Department of Microbiology and Immunology, Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University in Kielce, 25-365 Kielce, Poland; (P.K.); (P.P.); (K.F.); (P.W.)
| | - Kamila Fortunka
- Department of Microbiology and Immunology, Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University in Kielce, 25-365 Kielce, Poland; (P.K.); (P.P.); (K.F.); (P.W.)
| | - Tomasz Wollny
- Holy Cross Cancer Center, Kielce, 25-734 Kielce, Poland;
| | - Przemysław Wolak
- Department of Microbiology and Immunology, Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University in Kielce, 25-365 Kielce, Poland; (P.K.); (P.P.); (K.F.); (P.W.)
| | | | - Paul B. Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT 84602, USA;
| | - Robert Bucki
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Bialystok, 15-222 Bialystok, Poland; (S.J.C.); (K.S.); (P.D.); (E.P.); (K.F.)
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