1
|
Kelly SA, O'Connell NH, Thompson TP, Dillon L, Wu J, Creevey C, Powell J, Gilmore BF, Dunne CP. A novel characterized multi-drug-resistant Pseudocitrobacter sp. isolated from a patient colonized while admitted to a tertiary teaching hospital. J Hosp Infect 2024; 145:193-202. [PMID: 38215945 DOI: 10.1016/j.jhin.2023.12.010] [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: 09/07/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Reports of nosocomial infections typically describe recognised microorganisms. Here, a novel bacterial species was isolated, based on rectal swab screening for carbapenemases post-admission, then phenotypically and genetically characterized. METHODS Sensititre, Vitek and API kits, MALDI and Illumina MiSeq were employed before profiles and phylogeny were compared with other related species. FINDINGS Determined to be a possible Enterobacterales, the isolate was found to have 99.7% 16s rRNA identity to Pseudocitrobacter corydidari; an Asian cockroach-associated species. Given the highly conserved/low variability of 16S rRNA genes in Enterobacterales, average nucleotide identity (ANI) analysis compared the new isolate's genome with those of 18 Enterobacteriaceae species, including confirmed species of Pseudocitrobacter and unnamed Pseudocitrobacter species in the SILVA database. Of these, Pseudocitrobactercorydidari had the highest ANI at 0.9562. The published genome of the only known isolate of P.corydidari does not include Antimicrobial Resistance Genes (ARGs), with exception of potential drug efflux transporters. In contrast, our clinical isolate bears recognised antimicrobial resistance genes, including Klebsiella pneumoniae carbapenemase. The associated genome suggests resistance to carbapenems, β-lactams, sulfonamides, fluoroquinolones, macrolides, aminoglycosides and cephalosporins. Phenotypic antimicrobial resistance was confirmed. CONCLUSION Evident variations in ARG profiles, human colonization and origin in a clinically relevant niche that is geographically, physically and chemically disparate lend credibility for divergent evolution or, less likely, parallel evolution with P. corydidari. Genome data for this new species have been submitted to GENBANK using the proposed nomenclature Pseudocitrobacter limerickensis. The patient was colonized, rather than infected, and did not require antimicrobial treatment.
Collapse
Affiliation(s)
- S A Kelly
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity, University of Limerick, Limerick, Ireland
| | - T P Thompson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - L Dillon
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J Wu
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C Creevey
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity, University of Limerick, Limerick, Ireland
| | - B F Gilmore
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity, University of Limerick, Limerick, Ireland.
| |
Collapse
|
2
|
Cinthi M, Coccitto SN, Pocognoli A, Zeni G, Mazzariol A, Di Gregorio A, Vignaroli C, Brenciani A, Giovanetti E. Persistence and evolution of linezolid- and methicillin-resistant Staphylococcus epidermidis ST2 and ST5 clones in an Italian hospital. J Glob Antimicrob Resist 2024; 36:358-364. [PMID: 38331029 DOI: 10.1016/j.jgar.2024.01.020] [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: 08/09/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES Staphylococcus epidermidis is a member of the human skin microbiome. However, in recent decades, multidrug-resistant and hospital-adapted S. epidermidis clones are increasingly involved in severe human infections associated with medical devices and in immunocompromised patients. In 2016, we reported that a linezolid- and methicillin-resistant S. epidermidis ST2 clone, bearing the G2576T mutation, was endemic in an Italian hospital since 2004. This study aimed to retrospectively analyse 34 linezolid- and methicillin-resistant S. epidermidis (LR-MRSE) strains collected from 2018 to 2021 from the same hospital. METHODS LR-MRSE were typed by Pulsed-Field Gel Electrophoresis and multilocus sequence typing and screened for transferable linezolid resistance genes. Representative LR-MRSE were subjected to whole-genome sequencing (WGS) and their resistomes, including the presence of ribosomal mechanisms of linezolid resistance and of rpoB gene mutations conferring rifampin resistance, were investigated. RESULTS ST2 lineage was still prevalent (19/34; 55.9%), but, over time, ST5 clone has been widespread too (15/34; 44.1%). Thirteen of the 34 isolates (38.2%) were positive for the cfr gene. Whole-genome sequencing analysis of relevant LR-MRSE displayed complex resistomes for the presence of several acquired antibiotic resistance genes, including the SCCmec type III (3A) and SCCmec type IV (2B) in ST2 and ST5 isolates, respectively. Bioinformatics and polymerase chain reaction (PCR) mapping also showed a plasmid-location of the cfr gene and the occurrence of previously undetected mutations in L3 (ST2 lineage) and L4 (ST3 lineage) ribosomal proteins and substitutions in the rpoB gene. CONCLUSION The occurrence of LR-MRSE should be carefully monitored in order to prevent the spread of this difficult-to-treat pathogen and to preserve the efficacy of linezolid.
Collapse
Affiliation(s)
- Marzia Cinthi
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Sonia Nina Coccitto
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Antonella Pocognoli
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria, 'Ospedali Riuniti', Ancona, Italy
| | - Guido Zeni
- Department of Diagnostics and Public Health, Verona University, Verona, Italy
| | - Annarita Mazzariol
- Department of Diagnostics and Public Health, Verona University, Verona, Italy
| | - Alessandra Di Gregorio
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Carla Vignaroli
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Brenciani
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy.
| | - Eleonora Giovanetti
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
3
|
Powell J, Daly M, O'Connell NH, Dunne CP. Seek and you shall find: Yersinia enterocolitica in Ireland's drinking water. Ir J Med Sci 2024:10.1007/s11845-024-03641-5. [PMID: 38381378 DOI: 10.1007/s11845-024-03641-5] [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: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Three Yersinia species were identified from samples of drinking water from diverse geographic regions of Ireland. Conventional commercial biochemical identification systems classified them as Yersinia enterocolitica. Since this organism is the most common cause of bacterial gastroenteritis in some countries, further investigation was warranted. The aim of the study was to provide a microbial characterisation of three Yersinia species, to determine their pathogenicity, and to review the incidence rate of Yersinia enterocolitica detection in our region. METHODS Organism identification was performed using conventional commercial diagnostic systems MALDI-TOF, API 20E, API 50CHE, TREK Sensititre GNID and Vitek 2 GN, and whole genome sequencing (WGS) was performed. Historical data for detections was extracted from the lab system for 2008 to 2023. RESULTS All three isolates gave "good" identifications of Yersinia enterocolitica on conventional systems. Further analysis by WGS matched two of the isolates with recently described Yersinia proxima, and the third was a member of the non-pathogenic Yersinia enterocolitica clade 1Aa. DISCUSSION Our analysis of these three isolates deemed them to be Yersinia species not known currently to be pathogenic, but determining this necessitated the use of next-generation sequencing and advanced bioinformatics. Our work highlights the importance of having this technology available to public laboratories, either locally or in a national reference laboratory. The introduction of molecular technologies for the detection of Yersinia species may increase the rate of detections. Accurate identification of significant pathogens in environmental, public health and clinical microbiology laboratories is critically important for the protection of society.
Collapse
Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4I), University of Limerick, Limerick, Ireland
| | - Maureen Daly
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4I), University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4I), University of Limerick, Limerick, Ireland.
- School of Medicine, University of Limerick, Limerick, Ireland.
| |
Collapse
|
4
|
Powell J, Crowley CM, Minihan B, Imcha M, O’Connell NH, Philip RK, Dunne CP. The microbial pathology of maternal perinatal sepsis: A single-institution retrospective five-year review. PLoS One 2023; 18:e0295210. [PMID: 38150416 PMCID: PMC10752550 DOI: 10.1371/journal.pone.0295210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023] Open
Abstract
INTRODUCTION Greater than half of in-hospital maternal deaths are caused by sepsis, a condition that occurs when infection exceeds local tissue containment and results in organ dysfunction. Determining the source of infection can be challenging. Microbiological cultures of the uterine cavity are often difficult to obtain, so antimicrobial susceptibility results may not be available to guide treatment. The aim of this retrospective study was to assess the potential clinical value of microbiology samples used in the maternal "septic screen" of patients in an Irish maternity hospital. METHODS A review was completed of all maternal "septic screen" (i.e., high vaginal swabs, placenta swabs, blood cultures, throat swabs and urine samples) microbiology results from July 2016 to December 2021. RESULTS In the relevant period, 845 patients were subject to a "septic screen", of whom 430 also had a placental swab collected. These 430 patients comprise our study population. 2% of blood cultures yielded potential pathogens, compared with 37%, 33%, 9% and 7% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. 95% of blood cultures were sterile, compared with 52%, 0%, 0% and 53% respectively for placental swabs, high vaginal swabs, throat swabs and urine specimens. CONCLUSION Of the five microbiological specimen types examined, placental swabs yielded the highest number of potential pathogens. Our results suggest that placental swabs are useful specimens for detecting potential pathogens from the uterine cavity, the most common source of perinatal infections.
Collapse
Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Clare M. Crowley
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Brid Minihan
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Mendinaro Imcha
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Nuala H. O’Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Roy K. Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
- University of Limerick School of Medicine, Limerick, Ireland
| | - Colum P. Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| |
Collapse
|
5
|
Kelly SA, O'Connell NH, Thompson TP, Dillon L, Wu J, Creevey C, Kiely P, Slevin B, Powell J, Gilmore BF, Dunne CP. Large-scale characterization of hospital wastewater system microbiomes and clinical isolates from infected patients: profiling of multi-drug-resistant microbial species. J Hosp Infect 2023; 141:152-166. [PMID: 37696473 DOI: 10.1016/j.jhin.2023.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) and infectious agents exhibiting antimicrobial resistance (AMR) are challenges globally. Environmental patient-facing wastewater apparatus including handwashing sinks, showers and toilets are increasingly identified as sources of infectious agents and AMR genes. AIM To provide large-scale metagenomics analysis of wastewater systems in a large teaching hospital in the Republic of Ireland experiencing multi-drug-resistant HAI outbreaks. METHODS Wastewater pipe sections (N=20) were removed immediately prior to refurbishment of a medical ward where HAIs had been endemic. These comprised toilet U-bends, and sink and shower drains. Following DNA extraction, each pipe section underwent metagenomic analysis. FINDINGS Diverse taxonomic and resistome profiles were observed, with members of phyla Proteobacteria and Actinobacteria dominating (38.23 ± 5.68% and 15.78 ± 3.53%, respectively). Genomes of five clinical isolates were analysed. These AMR bacterial isolates were from patients >48 h post-admission to the ward. Genomic analysis determined that the isolates bore a high number of antimicrobial resistance genes (ARGs). CONCLUSION Comparison of resistome profiles of isolates and wastewater metagenomes revealed high degrees of similarity, with many identical ARGs shared, suggesting probable acquisition post-admission. The highest numbers of ARGs observed were those encoding resistance to clinically significant and commonly used antibiotic classes. Average nucleotide identity analysis confirmed the presence of highly similar or identical genomes in clinical isolates and wastewater pipes. These unique large-scale analyses reinforce the need for regular cleaning and decontamination of patient-facing hospital wastewater pipes and effective infection control policies to prevent transmission of nosocomial infection and emergence of AMR within potential wastewater reservoirs.
Collapse
Affiliation(s)
- S A Kelly
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - T P Thompson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - L Dillon
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J Wu
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C Creevey
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - P Kiely
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B Slevin
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B F Gilmore
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland.
| |
Collapse
|
6
|
Daly M, Powell J, O'Connell NH, Murphy L, Dunne CP. Antimicrobial Resistance Is Prevalent in E. coli and Other Enterobacterales Isolated from Public and Private Drinking Water Supplies in the Republic of Ireland. Microorganisms 2023; 11:1224. [PMID: 37317198 DOI: 10.3390/microorganisms11051224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 06/16/2023] Open
Abstract
High levels of bacterial antimicrobial resistance (AMR) have been reported in many environmental studies conducted in Ireland and elsewhere. The inappropriate use of antibiotics in both human and animal healthcare as well as concentrations of residual antibiotics being released into the environment from wastewaters are thought to be contributing factors. Few reports of AMR in drinking water-associated microbes are available for Ireland or internationally. We analysed 201 enterobacterales from group water schemes and public and private water supplies, only the latter having been surveyed in Ireland previously. The organisms were identified using conventional or molecular techniques. Antimicrobial susceptibility testing for a range of antibiotics was performed using the ARIS 2X interpreted in accordance with EUCAST guidelines. A total of 53 Escherichia coli isolates, 37 Serratia species, 32 Enterobacter species and enterobacterales from seven other genera were identified. A total of 55% of isolates were amoxicillin resistant, and 22% were amoxicillin-clavulanic acid resistant. A lower level of resistance (<10%) was observed to aztreonam, chloramphenicol, ciprofloxacin, gentamicin, ceftriaxone and trimethoprim-sulfamethoxazole. No resistance to amikacin, piperacillin/tazobactam, ertapenem or meropenem was detected. The level of AMR detected in this study was low but not insignificant and justifies ongoing surveillance of drinking water as a potential source of antimicrobial resistance.
Collapse
Affiliation(s)
- Maureen Daly
- Department of Clinical Microbiology, University Hospital Limerick, V94 F858 Limerick, Ireland
- Biomedical Sciences Research Institute, University of Ulster, Coleraine BT52 1SA, UK
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, V94 F858 Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, V94 F858 Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Liz Murphy
- Public Health Laboratory, Raheen Business Park, V94 H9YE Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| |
Collapse
|
7
|
Powell J, Porter E, Rafferty S, Field S, O'Connell NH, Dunne CP. Dermatology mycology diagnostics in Ireland: National deficits identified in 2022 that are relevant internationally. Mycoses 2023; 66:249-257. [PMID: 36448403 PMCID: PMC10107536 DOI: 10.1111/myc.13549] [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: 10/07/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Conventional testing methods for dermatophytes are time-consuming, and resource limitations in our institution have prompted curtailed access to these diagnostics. OBJECTIVES Evaluation of our hospital's dermatological mycology diagnostic services and similar services nationally. METHODS This was a retrospective observational study on skin, hair and nail mycology samples in our institution comparing twenty five-year periods (2011-2015 and 2016-2021), including analysis of dermatology clinic data and correspondence related to fungal infection. A survey of national public hospitals' laboratories was conducted to evaluate their mycology testing capabilities. RESULTS The total 5 year test count prior to curtailment was 4851 specimens comprising 90% (n = 4344) from general practice and 6% (n = 290) from dermatology clinics. For the 5 years post curtailment, 64.5% (582/903) of specimens were from dermatology clinics. Dermatology clinic data demonstrated doubling of attendances (for all conditions) and of correspondence related to fungal infection. During this time also, national dermatological antifungal purchasing increased 11%. Ten of 28 Irish public hospital laboratories reported the provision of in-house dermatological mycology testing, and none had routine availability of susceptibility or molecular testing of dermatophytes. CONCLUSION This study is the first to report an appraisal of dermatological fungal diagnostic services in Ireland. Insufficient testing capacity implies that patients are either being treated for fungal infection without appropriate diagnostic confirmation, or being left untreated because of the lack of access to diagnostics. The introduction of molecular detection methods and susceptibility systems would enhance testing capabilities and reduce the requirement for the external referral.
Collapse
Affiliation(s)
- James Powell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Emma Porter
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Siobhan Rafferty
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Sinead Field
- Department of Dermatology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland.,School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland
| |
Collapse
|
8
|
O'Connell N, Gasior S, Slevin B, Power L, Barrett S, Bhutta S, Minihan B, Powell J, Dunne C. Microbial epidemiology and clinical risk factors of carbapenemase-producing Enterobacterales amongst Irish patients from first detection in 2009 until 2020. Infect Prev Pract 2022; 4:100230. [PMID: 35935263 PMCID: PMC9352914 DOI: 10.1016/j.infpip.2022.100230] [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: 05/11/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Carbapenemase producing Enterobacterales (CPE) are major public health threats. Aim To review microbial epidemiology of CPE, as well as clinical risk factors and infections, amongst CPE positive patients over 12 years in an Irish tertiary hospital. Methods Retrospective observational study of data extracted from a laboratory CPE database, electronic healthcare records and manual review of patient charts. Common risk factors, treatment regimens for all CPE related infections, and clinical outcomes were ascertained. Findings Among CPE strains isolated from 460 patients, Klebsiella pneumoniae carbapenemase (KPC) was the carbapenemase most frequently detected, accounting for 87.4% (459) of all CPE enzymes. Citrobacter species 177 (33.7%) were the most common species harbouring this enzyme. 428 CPE positive patients (93%) were identified in the acute hospital setting; the most common risk factor for CPE acquisition was history of hospitalisation, observed in 305 (66%) cases. Thirty patients (6.5%) had confirmed infections post-acquisition, of which four were bloodstream infections. There were 19 subsequent episodes of non CPE-related bacteraemia in this cohort. All causal mortality at 30 days was 41 patients (8.9%). However, clinical review determined that CPE was an indirect associative factor in 8 patient deaths. Conclusions In this tertiary hospital setting, microbial epidemiology is changing; with both OXA-48 enzymes and KPC-producing Citrobacter species becoming more prevalent. Whilst the burden of CPE related infections, especially bacteraemia, was low over the study period, it remains critical that basic infection prevention and control practices are adhered to lest the observed changes in epidemiology result in an increase in clinical manifestations.
Collapse
Affiliation(s)
- N.H. O'Connell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - S. Gasior
- School of Medicine, University of Limerick, Limerick, Ireland
| | - B. Slevin
- Department of Infection Prevention and Control, ULHG, Limerick, Ireland
| | - L. Power
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - S. Barrett
- Department of Pharmacy, ULHG, Limerick, Ireland
| | - S.I. Bhutta
- Department of Gastroenterology, ULHG, Limerick, Ireland
| | - B. Minihan
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
| | - J. Powell
- Department of Clinical Microbiology University Limerick Hospital Group (ULHG), Limerick, Ireland
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C.P. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
- Corresponding author. Address: Foundation Chair and Director of Research, School of Medicine, University of Limerick, Ireland. Tel.: +35361234703.
| |
Collapse
|
9
|
Habibi N, Uddin S, Behbehani M, Al Salameen F, Razzack NA, Zakir F, Shajan A, Alam F. Bacterial and fungal communities in indoor aerosols from two Kuwaiti hospitals. Front Microbiol 2022; 13:955913. [PMID: 35966680 PMCID: PMC9366136 DOI: 10.3389/fmicb.2022.955913] [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: 05/29/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
The airborne transmission of COVID-19 has drawn immense attention to bioaerosols. The topic is highly relevant in the indoor hospital environment where vulnerable patients are treated and healthcare workers are exposed to various pathogenic and non-pathogenic microbes. Knowledge of the microbial communities in such settings will enable precautionary measures to prevent any hospital-mediated outbreak and better assess occupational exposure of the healthcare workers. This study presents a baseline of the bacterial and fungal population of two major hospitals in Kuwait dealing with COVID patients, and in a non-hospital setting through targeted amplicon sequencing. The predominant bacteria of bioaerosols were Variovorax (9.44%), Parvibaculum (8.27%), Pseudonocardia (8.04%), Taonella (5.74%), Arthrospira (4.58%), Comamonas (3.84%), Methylibium (3.13%), Sphingobium (4.46%), Zoogloea (2.20%), and Sphingopyxis (2.56%). ESKAPEE pathogens, such as Pseudomonas, Acinetobacter, Staphylococcus, Enterococcus, and Escherichia, were also found in lower abundances. The fungi were represented by Wilcoxinia rehmii (64.38%), Aspergillus ruber (9.11%), Penicillium desertorum (3.89%), Leptobacillium leptobactrum (3.20%), Humicola grisea (2.99%), Ganoderma sichuanense (1.42%), Malassezia restricta (0.74%), Heterophoma sylvatica (0.49%), Fusarium proliferatum (0.46%), and Saccharomyces cerevisiae (0.23%). Some common and unique operational taxonomic units (OTUs) of bacteria and fungi were also recorded at each site; this inter-site variability shows that exhaled air can be a source of this variation. The alpha-diversity indices suggested variance in species richness and abundance in hospitals than in non-hospital sites. The community structure of bacteria varied spatially (ANOSIM r 2 = 0.181-0.243; p < 0.05) between the hospital and non-hospital sites, whereas fungi were more or less homogenous. Key taxa specific to the hospitals were Defluvicoccales, fungi, Ganodermataceae, Heterophoma, and H. sylvatica compared to Actinobacteria, Leptobacillium, L. leptobacillium, and Cordycipitaceae at the non-hospital site (LefSe, FDR q ≤ 0.05). The hospital/non-hospital MD index > 1 indicated shifts in the microbial communities of indoor air in hospitals. These findings highlight the need for regular surveillance of indoor hospital environments to prevent future outbreaks.
Collapse
Affiliation(s)
| | - Saif Uddin
- Environment and Life Science Research Centre, Kuwait Institute for Scientific Research, Kuwait City, Kuwait
| | | | | | | | | | | | | |
Collapse
|
10
|
Solo-Peleteiro A, Diéguez P, Pérez-Rodríguez MT, Galárraga RA, Pérez-Landeiro A, Álvarez-Fernández M. Cerebrospinal fluid drainage-related ventriculitis due to multidrug-resistant microorganisms. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:322-325. [PMID: 35680350 DOI: 10.1016/j.eimce.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The aim of the study was to analyze the clinical and microbiological characteristics of adult patients with cerebrospinal fluid (CSF) drainage-related ventriculitis. METHODS Retrospective study from January 2010 to June 2019 performed in the Complexo Hospitalario Universitario de Vigo (Spain). Cases of CSF drainage-related ventriculitis in patients ≥18-year-old were gathered. Clinical characteristics of patients, type of drainage devices, management and microbiological isolates were analyzed. RESULTS Ninety-one episodes of CSF drainage-related ventriculitis were identified. The most frequent organisms isolated were Gram-positive cocci (65%), mainly Staphylococcus epidermidis (48%). Multidrug-resistant microorganisms were detected in 21 episodes (23%). In multivariate analysis, the independent factors related with multidrug-resistant ventriculitis were the length of hospital stay >14 days (HR 6.7; 95%CI 1.75-25.86, p=0.006) and previous antimicrobial therapy (HR 5.58; 95%CI 1.44-21.65, p=0.013). CONCLUSIONS Our study shows a large number of drainage-related ventriculitis episodes caused by multidrug-resistant organisms and reinforce the importance of a judicious use of antibiotics.
Collapse
Affiliation(s)
- Adriana Solo-Peleteiro
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - Patricia Diéguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain; Instituto de Investigación Biomédica Galicia Sur, Spain.
| | - Raul A Galárraga
- Department of Neurosurgery, Complexo Hospitalario Universitario de Vigo, Spain
| | | | - Maximiliano Álvarez-Fernández
- Instituto de Investigación Biomédica Galicia Sur, Spain; Department of Microbiology, Complexo Hospitalario Universitario de Vigo, Spain
| |
Collapse
|
11
|
Minihan B, McAuliffe E, Powell J, Wong SL, Wilkie K, Murphy C, Maher A, Power L, O'Connell NH, Dunne CP. Association between tocilizumab treatment of hyperinflammatory patients with COVID-19 in a critical care setting and elevated incidence of hospital-acquired bacterial and invasive fungal infections. J Hosp Infect 2022; 126:29-36. [PMID: 35472487 PMCID: PMC9033628 DOI: 10.1016/j.jhin.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/29/2022]
Abstract
Background Tocilizumab is an interleukin-6 inhibitor that reduces mortality and the need for invasive mechanical ventilation, while increasing the possibility of successful hospital discharge for hyperinflammatory patients with severe coronavirus disease 2019 (COVID-19). No increase in adverse events or serious infections has been reported previously. Aim To describe the characteristics and outcomes of patients with severe COVID-19 in critical care who received tocilizumab, and to compare mortality and length of hospital stay for patients who received tocilizumab (N=41) with those who did not (N=33). Methods Retrospective review of data related to patients with COVID-19 who received tocilizumab in a critical care setting from 1st January to 31st December 2021. Findings Amongst COVID-19 survivors, those who had received tocilizumab had longer intensive care unit (ICU) stays (median length 21 vs 9 days) and hospital stays (45 vs 34 days) compared with those who had not received tocilizumab. Thirty-day mortality (29% vs 36%; P=0.5196) and 60-day mortality (37% and 42%; P=0.6138) were not significantly lower in patients who received tocilizumab. Serious bacterial and fungal infections occurred at higher frequency amongst patients who received tocilizumab [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.04–6.86; P=0.042], and at significantly higher frequency than in non-COVID-19 ICU admissions (OR 5.26, 95% CI 3.08–9.00; P<0.0001). Conclusions In this single-centre study, patients in critical care with severe COVID-19 who received tocilizumab had a greater number of serious bacterial and fungal infections, but this may not have been a direct effect of tocilizumab treatment.
Collapse
Affiliation(s)
- B Minihan
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - E McAuliffe
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - S L Wong
- Department of Anaesthesia and Critical Care, University Hospital Limerick, Limerick, Ireland
| | - K Wilkie
- Department of Anaesthesia and Critical Care, University Hospital Limerick, Limerick, Ireland
| | - C Murphy
- Department of Anaesthesia and Critical Care, University Hospital Limerick, Limerick, Ireland
| | - A Maher
- Department of Pharmacy, University Hospital Limerick, Limerick, Ireland
| | - L Power
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland.
| |
Collapse
|
12
|
Dembicka KM, Powell J, O'Connell NH, Hennessy N, Brennan G, Dunne CP. Prevalence of linezolid-resistant organisms among patients admitted to a tertiary hospital for critical care or dialysis. Ir J Med Sci 2021; 191:1745-1750. [PMID: 34505273 PMCID: PMC9308576 DOI: 10.1007/s11845-021-02773-2] [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: 07/13/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Linezolid is an oxazolidinone antimicrobial regarded as a "last resort" antimicrobial, used typically for treatment of Gram-positive bacterial infections. It is acknowledged that prevalence of resistance to linezolid is increasing in Europe. In Ireland, a number of outbreaks of linezolid-resistant isolates have been reported, including an outbreak at the location for this study, the Intensive Care Unit (ICU) of University Hospital Limerick (UHL). METHODS The Chromagar™ Lin-R selective medium was validated using a panel of linezolid-sensitive and linezolid-resistant strains. Subsequently, the prevalence exercise focused on a convenience sample of patients (n = 159) in critical care wards, ICU (n = 23) and High-Dependency Unit (HDU, n = 51), in addition to patients undergoing dialysis therapy (n = 77). Eight additional patients had specimens collected when attending more than one location. Growth on Chromagar™ Lin-R agar was followed by drug sensitivity testing by disc diffusion and minimum inhibitory concentration (MIC) testing. RESULTS A validation exercise was performed on 23 isolates: seven target and sixteen non-target organisms. Isolates performed as intended (100% sensitivity, 100% specificity). For the prevalence study, of 398 tests, 40 resulted in growth of non-target organisms (specificity approx. 90%). A sole patient (1/159) was identified as colonized by a linezolid-resistant Staphylococcus epidermidis, a prevalence of 0.63%. Molecular investigation confirmed presence of the G2576T mutation in the 23S rRNA. CONCLUSION While this point prevalence study identified extremely low carriage of linezolid-resistant bacteria, it remains prudent to maintain vigilance as reports of outbreaks associated with linezolid-resistant S. epidermidis (LRSE) in European critical care units are increasing.
Collapse
Affiliation(s)
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland
| | - Noreen Hennessy
- Public Health Laboratory, Raheen Business Park, Limerick, Ireland
| | - Grainne Brennan
- National MRSA Reference Laboratory, St James's Hospital, Dublin, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4I) and School of Medicine, University of Limerick, Limerick, Ireland.
| |
Collapse
|
13
|
Papan C, Schröder M, Hoffmann M, Knoll H, Last K, Albrecht F, Geisel J, Fink T, Gärtner BC, Mellmann A, Volk T, Berger FK, Becker SL. Combined antibiotic stewardship and infection control measures to contain the spread of linezolid-resistant Staphylococcus epidermidis in an intensive care unit. Antimicrob Resist Infect Control 2021; 10:99. [PMID: 34193293 PMCID: PMC8242281 DOI: 10.1186/s13756-021-00970-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background The unrestricted use of linezolid has been linked to the emergence of linezolid-resistant Staphylococcus epidermidis (LRSE). We report the effects of combined antibiotic stewardship and infection control measures on the spread of LRSE in an intensive care unit (ICU). Methods Microbiological data were reviewed to identify all LRSE detected in clinical samples at an ICU in southwest Germany. Quantitative data on the use of antibiotics with Gram-positive coverage were obtained in defined daily doses (DDD) per 100 patient-days (PD). In addition to infection control measures, an antibiotic stewardship intervention was started in May 2019, focusing on linezolid restriction and promoting vancomycin, wherever needed. We compared data from the pre-intervention period (May 2018–April 2019) to the post-intervention period (May 2019–April 2020). Whole-genome sequencing (WGS) was performed to determine the genetic relatedness of LRSE isolates. Results In the pre-intervention period, LRSE were isolated from 31 patients (17 in blood cultures). The average consumption of linezolid and daptomycin decreased from 7.5 DDD/100 PD and 12.3 DDD/100 PD per month in the pre-intervention period to 2.5 DDD/100 PD and 5.7 DDD/100 PD per month in the post-intervention period (p = 0.0022 and 0.0205), respectively. Conversely, vancomycin consumption increased from 0.2 DDD/100 PD per month to 4.7 DDD/100 PD per month (p < 0.0001). In the post-intervention period, LRSE were detected in 6 patients (4 in blood cultures) (p = 0.0065). WGS revealed the predominance of one single clone. Conclusions Complementing infection control measures by targeted antibiotic stewardship interventions was beneficial in containing the spread of LRSE in an ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00970-3.
Collapse
Affiliation(s)
- Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany.
| | - Matthias Schröder
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany
| | | | - Heike Knoll
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany
| | - Katharina Last
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany
| | - Frederic Albrecht
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany
| | - Jürgen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University, Homburg, Germany
| | - Tobias Fink
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany
| | - Barbara C Gärtner
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany
| | | | - Thomas Volk
- Department of Anesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, Homburg, Germany
| | - Fabian K Berger
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, 66421, Homburg, Germany
| |
Collapse
|
14
|
Teoh T, Powell J, Kelly J, McDonnell C, Whelan R, O'Connell N, Dunne C. Outcomes of point-of-care testing for influenza in the emergency department of a tertiary referral hospital in Ireland. J Hosp Infect 2021; 110:45-51. [DOI: 10.1016/j.jhin.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
|
15
|
Cole K, Atkins B, Llewelyn M, Paul J. Genomic investigation of clinically significant coagulase-negative staphylococci. J Med Microbiol 2021; 70. [PMID: 33704043 DOI: 10.1099/jmm.0.001337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction. Coagulase-negative staphylococci have been recognized both as emerging pathogens and contaminants of clinical samples. High-resolution genomic investigation may provide insights into their clinical significance.Aims. To review the literature regarding coagulase-negative staphylococcal infection and the utility of genomic methods to aid diagnosis and management, and to identify promising areas for future research.Methodology. We searched Google Scholar with the terms (Staphylococcus) AND (sequencing OR (infection)). We prioritized papers that addressed coagulase-negative staphylococci, genomic analysis, or infection.Results. A number of studies have investigated specimen-related, phenotypic and genetic factors associated with colonization, infection and virulence, but diagnosis remains problematic.Conclusion. Genomic investigation provides insights into the genetic diversity and natural history of colonization and infection. Such information allows the development of new methodologies to identify and compare relatedness and predict antimicrobial resistance. Future clinical studies that employ suitable sampling frames coupled with the application of high-resolution whole-genome sequencing may aid the development of more discriminatory diagnostic approaches to coagulase-staphylococcal infection.
Collapse
Affiliation(s)
- Kevin Cole
- Brighton and Sussex Medical School, Brighton, UK.,Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK
| | | | - Martin Llewelyn
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - John Paul
- Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
16
|
Solo-Peleteiro A, Diéguez P, Pérez-Rodríguez MT, Galárraga RA, Pérez-Landeiro A, Álvarez-Fernández M. Cerebrospinal fluid drainage-related ventriculitis due to multidrug-resistant microorganisms. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00012-4. [PMID: 33593611 DOI: 10.1016/j.eimc.2020.12.010] [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: 11/04/2020] [Revised: 12/26/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of the study was to analyze the clinical and microbiological characteristics of adult patients with cerebrospinal fluid (CSF) drainage-related ventriculitis. METHODS Retrospective study from January 2010 to June 2019 performed in the Complexo Hospitalario Universitario de Vigo (Spain). Cases of CSF drainage-related ventriculitis in patients ≥18-year-old were gathered. Clinical characteristics of patients, type of drainage devices, management and microbiological isolates were analyzed. RESULTS Ninety-one episodes of CSF drainage-related ventriculitis were identified. The most frequent organisms isolated were Gram-positive cocci (65%), mainly Staphylococcus epidermidis (48%). Multidrug-resistant microorganisms were detected in 21 episodes (23%). In multivariate analysis, the independent factors related with multidrug-resistant ventriculitis were the length of hospital stay >14 days (HR 6.7; 95%CI 1.75-25.86, p=0.006) and previous antimicrobial therapy (HR 5.58; 95%CI 1.44-21.65, p=0.013). CONCLUSIONS Our study shows a large number of drainage-related ventriculitis episodes caused by multidrug-resistant organisms and reinforce the importance of a judicious use of antibiotics.
Collapse
Affiliation(s)
- Adriana Solo-Peleteiro
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - Patricia Diéguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain; Instituto de Investigación Biomédica Galicia Sur, Spain.
| | - Raul A Galárraga
- Department of Neurosurgery, Complexo Hospitalario Universitario de Vigo, Spain
| | | | - Maximiliano Álvarez-Fernández
- Instituto de Investigación Biomédica Galicia Sur, Spain; Department of Microbiology, Complexo Hospitalario Universitario de Vigo, Spain
| |
Collapse
|
17
|
Zalewska A, Wilson J, Kennedy S, Lockhart M, MacLeod M, Malcolm W. Epidemiological Analysis of Antimicrobial Resistance in Staphylococcus epidermidis in Scotland, 2014-2018. Microb Drug Resist 2020; 27:485-491. [PMID: 32799636 DOI: 10.1089/mdr.2019.0502] [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: 01/28/2023] Open
Abstract
Aims: This study aimed to investigate recent national surveillance trends in Staphylococcus epidermidis antibiotic resistance in Scotland and to draw conclusions on the potential clinical and public health impact of multidrug-resistant isolates. Results: Resistance in S. epidermidis isolates to individual agents was broadly stable over the past 5 years. Isolates from sterile sites, and therefore those most likely to be associated with clinical infection, were found to be more resistant to the majority of reported agents, than isolates from nonsterile sites. Increased resistance to a number of important antibiotics was observed in rifampicin-, vancomycin-, and daptomycin-resistant isolates, suggesting limited treatment options for infections caused by these isolates. Conclusions: Although S. epidermidis resistance to individual agents has been broadly stable over the past 5 years nationally, of particular concern is the association of multidrug resistance in rifampicin-resistant isolates, which has been reported elsewhere. This has the potential to result in treatment failures in significant device-related infections.
Collapse
Affiliation(s)
| | | | | | | | - Mairi MacLeod
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | |
Collapse
|
18
|
Kosecka-Strojek M, Sadowy E, Gawryszewska I, Klepacka J, Tomasik T, Michalik M, Hryniewicz W, Miedzobrodzki J. Emergence of linezolid-resistant Staphylococcus epidermidis in the tertiary children's hospital in Cracow, Poland. Eur J Clin Microbiol Infect Dis 2020; 39:1717-1725. [PMID: 32350737 PMCID: PMC7427702 DOI: 10.1007/s10096-020-03893-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
Coagulase-negative staphylococci, ubiquitous commensals of human skin, and mucous membranes represent important pathogens for immunocompromised patients and neonates. The increasing antibiotic resistance among Staphylococcus epidermidis is an emerging problem worldwide. In particular, the linezolid-resistant S. epidermidis (LRSE) strains are observed in Europe since 2014. The aim of our study was to genetically characterize 11 LRSE isolates, recovered mostly from blood in the University Children’s Hospital in Krakow, Poland, between 2015 and 2017. For identification of the isolates at the species level, we used 16S rRNA sequencing and RFLP of the saoC gene. Isolates were characterized phenotypically by determining their antimicrobial resistance patterns and using molecular methods such as PFGE, MLST, SCCmec typing, detection of the ica operon, and analysis of antimicrobial resistance determinants. All isolates were multidrug-resistant, including resistance to methicillin, and exhibited so-called PhLOPSA phenotype. In PFGE, all isolates (excluding one from a catheter) represented identical patterns, were identified as ST2, and harbored the ica operon, responsible for biofilm formation. Linezolid resistance was associated with acquisition of A157R mutation in the ribosomal protein L3 and the presence of cfr gene. All isolates revealed new SCCmec cassette element composition. Recently, pediatric patients with serious staphylococcal infections are often treated with linezolid. The increasing linezolid resistance in bacterial strains becomes a real threat for patients, and monitoring such infections combined with surveillance and infection prevention programs is very important to decrease number of linezolid-resistant staphylococcal strains.
Collapse
Affiliation(s)
- Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Krakow, Poland
| | - Ewa Sadowy
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - Iwona Gawryszewska
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - Joanna Klepacka
- Department of Clinical Microbiology, Children's University Hospital, Jagiellonian University, Krakow, Poland
| | - Tomasz Tomasik
- Department of Clinical Microbiology, Children's University Hospital, Jagiellonian University, Krakow, Poland
| | | | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Jacek Miedzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Krakow, Poland.
| |
Collapse
|
19
|
Dunne CP, Askew PD, Papadopoulos T, Gouveia IC, Ahonen M, Modic M, Azevedo NF, Schulte S, Cosemans P, Kahru A, Murzyn K, Keevil CW, Riool M, Keinänen-Toivola MM. Antimicrobial coating innovations to prevent infectious disease: a consensus view from the AMiCl COST Action. J Hosp Infect 2020; 105:116-118. [PMID: 32278702 PMCID: PMC7194850 DOI: 10.1016/j.jhin.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 01/02/2023]
Affiliation(s)
- C P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
| | - P D Askew
- Industrial Microbiological Services Ltd (IMSL), Hampshire, UK
| | - T Papadopoulos
- Department of Microbiology and Infectious Diseases, School of Veterinary Medicine, Aristotle University, Thessaloniki, Greece
| | - I C Gouveia
- FibEnTech Research Unit, Faculty of Engineering, University of Beira Interior, Covilhã, Portugal
| | - M Ahonen
- Faculty of Technology, Satakunta University of Applied Sciences, Rauma, Finland
| | - M Modic
- Laboratory for Gaseous Electronics, Institute 'Jožef Stefan', Ljubljana, Slovenia
| | - N F Azevedo
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - S Schulte
- Evonik Resource Efficiency GmbH, Goldschmidtstrasse 100, 45127 Essen, Germany
| | | | - A Kahru
- Laboratory of Environmental Toxicology, National Institute of Chemical Physics and Biophysics, Tallinn, Estonia
| | - K Murzyn
- LifeScience Krakow Klaster, Ul, Bobrzynskiego, 14 30-348 Krakow, Poland
| | - C W Keevil
- Environmental Healthcare Unit, Biological Sciences, University of Southampton, Southampton, UK
| | - M Riool
- Department of Medical Microbiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | | |
Collapse
|
20
|
Mostyn A, Lenihan M, O'Sullivan D, Woods S, O'Hara M, Powell J, Power L, O'Connell NH, Dunne CP. Assessment of the FilmArray® multiplex PCR system and associated meningitis/encephalitis panel in the diagnostic service of a tertiary hospital. Infect Prev Pract 2020; 2:100042. [PMID: 34368693 PMCID: PMC8336197 DOI: 10.1016/j.infpip.2020.100042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/02/2020] [Indexed: 11/19/2022] Open
Abstract
Rapid and accurate diagnosis of meningitis/encephalitis (M/E) is essential for successful patient outcomes. The FilmArray® meningitis/encephalitis Panel (MEP) is a multiplexed PCR test for simultaneous, rapid detection of pathogens directly from cerebrospinal fluid (CSF) samples. 94 prospectively collected CSF specimens from patients with clinical suspicion of infective M/E underwent testing for 14 pathogens simultaneously, including Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, and Varicella zoster. MEP demonstrated 95% agreement with current PCR methods, resulting in 16 diagnosed cases of M/E. Typically, the FilmArray® MEP results were delivered within approximately one hour, contrasting with current practices taking up to 5.6 days. Given the significant morbidity and mortality associated with delayed diagnosis of central nervous system infections, the FilmArray® MEP is a useful addition to the diagnostic capabilities of a clinical microbiology department.
Collapse
Affiliation(s)
- Amanda Mostyn
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Marie Lenihan
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Donnchadh O'Sullivan
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Sara Woods
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Maureen O'Hara
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Lorraine Power
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Colum P Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| |
Collapse
|
21
|
Dunne CP, Ryan P, Connolly R, Dunne SS, Kaballo MA, Powell J, Woulfe B, O'Connell NH, Gupta RK. Management of Staphylococcus aureus bacteraemia (SAB) in the oncology patient: Further evidence supports prompt removal of central venous catheters and shorter duration of intravenous antimicrobial therapy. Infect Prev Pract 2020; 2:100037. [PMID: 34368689 PMCID: PMC8335915 DOI: 10.1016/j.infpip.2020.100037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/06/2020] [Indexed: 11/27/2022] Open
Abstract
Background Staphylococcus aureus bacteraemia (SAB) is associated with relatively high risk of complications and high levels of mortality. Internationally, SAB management guidelines lack consensus and especially so regarding oncology patients. This is likely a reflection of insufficient randomised control trials (RCT) and the diversity of SAB patient populations. However, there are 2011 guidelines recommending a minimum of 14 days of appropriate IV antibiotic therapy for SAB. Objective We wished to determine whether our practice of shortened duration of intravenous antimicrobial therapy in favour of oral administration proved as effective as recommended guidelines in a mixed oncology patient cohort. Methods Retrospective review of patient records that included any SAB episode among oncology patients from January 2002 to December 2015. Medical chart reviews were undertaken to determine patient demographics, clinical management & antimicrobial therapy, duration of stay, presence of a central venous catheter (CVC) and outcome. Results Our CVC removal rate was just 73% in SAB where CVC was the identified source of infection, with an attributable mortality rate (<4%) far lower than would be expected. Antimicrobial therapy durations were considerably lower (10 days) than current recommendations of 14 days IV therapy. The recurrence rate of 15% was also significantly lower than has been reported previously. Conclusions Our observations contribute new insights concerning the management of SAB in oncology patients. Our findings suggest that therapeutic approaches should perhaps remain individualised and reflective of patient characteristics taking into consideration the complex nature of oncology patients.
Collapse
Affiliation(s)
- Colum P Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Phelim Ryan
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Roisin Connolly
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Suzanne S Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Mohammed A Kaballo
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Bernie Woulfe
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.,Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Rajnish K Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| |
Collapse
|
22
|
Spindler N, Biereigel C, Pieroh P, Schroeter T, Misfeld M, Josten C, Borger M, Rodloff AC, Langer S. Clinical and Microbiological Analysis of Deep Sternal Wound Infections in Fifty-Two Consecutive Patients. Surg Infect (Larchmt) 2019; 21:370-377. [PMID: 31809233 DOI: 10.1089/sur.2018.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Mediastinitis after cardiac surgery can lead to devastating consequences such as deep sternal wound infections (DSWI). Staphylococcus epidermidis and other coagulase-negative staphylococci belong to the physiological skin flora and therefore generally are not considered pathogenic agents. Thus, local resistance patterns of these bacterial species often recovered from wound specimens generally are ignored while choosing antibiotics for peri-operative prophylaxis in cardiac surgery as well as in the selection of empiric antibiotic therapy of DSWI. Methods: During the period May 2012-May 2013, 52 patients suffering from DSWI were treated at our institution. For every patient, deep tissue samples were obtained during surgical debridement procedures and submitted to microbiologic analysis. The frequency of and the time to occurrence of a DSWI was recorded, and baseline data, previous operative interventions, complications, and the technique used for soft tissue reconstruction, as well as the microbiologic results and individual risk factors, were documented. Results: There were 32 male patients (62%) and 20 female. The patients' age at the time of revision was a mean of 67 ± 11.5 years (range 35-83 years). There was bacterial growth in 31 cases (60%), the predominant species being S. epidermidis (20 patients; 65%). Extended antibiotic therapy was indispensable to controlling the infection. Conclusion: The local resistance patterns of antibiotics should have a greater influence on the standardized prophylaxis or empirical therapy of DSWI and need to be discussed specifically for this high-risk population. Because of its multi-resistance spectrum, S. epidermidis must be classified as a potential pathogen. In the cases reported here, extended antibiotic therapy was necessary to support wound healing and thus good patient outcomes.
Collapse
Affiliation(s)
- Nick Spindler
- Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany
| | - Corinna Biereigel
- Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany
| | - Phillipp Pieroh
- Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany.,Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Schroeter
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Arne C Rodloff
- Institute of Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Langer
- Department of Orthopedic Surgery, Traumatology, and Plastic Surgery and University Hospital Leipzig, Leipzig, Germany
| |
Collapse
|
23
|
Rodríguez-Lucas C, Rodicio MR, Càmara J, Domínguez MÁ, Alaguero M, Fernández J. Long-term endemic situation caused by a linezolid- and meticillin-resistant clone of Staphylococcus epidermidis in a tertiary hospital. J Hosp Infect 2019; 105:64-69. [PMID: 31634538 DOI: 10.1016/j.jhin.2019.10.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Linezolid (LZD)-resistant Staphylococcus epidermidis (LRSE) are increasing, and are mainly associated with outbreaks in hospital wards with high LZD consumption. AIM To investigate the frequency of LRSE in a tertiary hospital in the context of LZD use. METHODS The frequency of LRSE and the data on LZD usage [expressed as defined daily dose (DDD) per 100 patient-days], from 2011 to 2017, were analysed retrospectively. Selected LRSE were typed by pulsed-field gel electrophoresis (PFGE) and screened for transferable LZD resistance genes. Representative isolates were typed by multi-locus sequence typing, and ribosomal mechanisms of LZD resistance were investigated. FINDINGS In total, 435 LRSE were detected, with frequencies ranging from 13.56% to 32.93% in the intensive care unit (ICU) where LZD consumption was high (6.34-8.10 DDDs), and from 2.48 to 6.80% in the remaining wards where LZD use was considerably lower (0.63-2.49 DDDs). The first 44 LRSE isolates recovered (June 2013-June 2014) were closely related according to PFGE patterns, and all except one were resistant to meticillin due to mecA production. Selected isolates belonged to ST2, carried SCCmec III, and had the G2576T mutation in the V domain of each of the six copies of the 23S rRNA gene. Five of the 44 isolates (11.36%) were positive for the cfr gene. CONCLUSION An ST2 LZD- and meticillin-resistant clone was found in the ICU and also in wards with low consumption of LZD. This highlights the need to implement and maintain infection control measures as well as antimicrobial stewardship programmes in all hospital units in order to preserve the efficacy of LZD.
Collapse
Affiliation(s)
- C Rodríguez-Lucas
- Unidad de Microbiología, Hospital El Bierzo, Ponferrada, Spain; Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - M R Rodicio
- Departamento de Biología Funcional, Área de Microbiología, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - J Càmara
- Servicio de Microbiología, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Spain
| | - M Á Domínguez
- Servicio de Microbiología, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, Barcelona, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - M Alaguero
- Servicio de Farmacia Hospitalaria, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Fernández
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain.
| |
Collapse
|
24
|
Deshpande LM, Castanheira M, Flamm RK, Mendes RE. Evolving oxazolidinone resistance mechanisms in a worldwide collection of enterococcal clinical isolates: results from the SENTRY Antimicrobial Surveillance Program. J Antimicrob Chemother 2019; 73:2314-2322. [PMID: 29878213 DOI: 10.1093/jac/dky188] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/18/2018] [Indexed: 01/28/2023] Open
Abstract
Objectives This study evaluated the oxazolidinone resistance mechanisms among a global collection of enterococcal clinical isolates. The epidemiology of optrA-carrying isolates and the optrA genetic context were determined. Methods Enterococcal isolates (26 648) from the SENTRY Antimicrobial Surveillance Program (2008-16) were identified by MALDI-TOF MS and MICs were determined by broth microdilution. Isolates with linezolid MICs of ≥4 mg/L were screened for resistance mechanisms. Isolates carrying optrA had their genome sequenced for genetic context and epidemiology information. Results Thirty-six Enterococcus faecalis and 66 Enterococcus faecium had linezolid MICs of ≥4 mg/L (0.38% of surveillance enterococci). E. faecalis had a linezolid MIC range of 4-16 mg/L, while E. faecium displayed higher values (4-64 mg/L). Nine E. faecalis had G2576T mutations and optrA was detected in 26 (72.2%) isolates from the Asia-Pacific region, North America, Latin America and Europe; 3 isolates also produced Cfr [Thailand (1)] or Cfr(B) [Panama (2)]. All E. faecium isolates had G2576T alterations, while three isolates from the USA had concomitant presence of cfr(B). The optrA gene was plasmid- and chromosome-located in 22 and 3 E. faecalis, respectively. One isolate signalled hybridization on plasmid and chromosome. The genetic context of optrA varied. E. faecalis belonging to the same clonal complex were detected in distinct geographical regions. Also, genetically distinct isolates from Ireland had an identical optrA context, indicating plasmid dissemination. Conclusions Alterations in 23S rRNA remained the main oxazolidinone resistance mechanism in E. faecium, while optrA prevailed in E. faecalis. These results demonstrate global dissemination of optrA and warrant surveillance for monitoring.
Collapse
Affiliation(s)
| | | | - R K Flamm
- JMI Laboratories, North Liberty, IA, USA
| | - R E Mendes
- JMI Laboratories, North Liberty, IA, USA
| |
Collapse
|
25
|
Mittal G, Bhandari V, Gaind R, Rani V, Chopra S, Dawar R, Sardana R, Verma PK. Linezolid resistant coagulase negative staphylococci (LRCoNS) with novel mutations causing blood stream infections (BSI) in India. BMC Infect Dis 2019; 19:717. [PMID: 31412801 PMCID: PMC6694603 DOI: 10.1186/s12879-019-4368-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background Coagulase-negative Staphylococci (CoNS) have emerged as a major causative agent of blood-stream infections (BSI). Linezolid (LZD) is currently used for treating glycopeptide and methicillin-resistant staphylococci. It is important to understand the resistance mechanism and probable transmission of LZD resistant (LR) CoNS within the hospital. Methods Clinically significant LRCoNS from patients with BSI were characterized using MALDI-TOF and 16S rRNA gene sequence analysis. Antimicrobial susceptibility and MIC of vancomycin and LZD were determined. LZD resistance mechanisms using PCR for the cfr gene and mutation in the V domain of the 23S rRNA gene were studied. Results The MIC of LZD ranged from 8 to 32 μg/ml. LR was observed in three different CoNS species from diverse locations within the hospital. The cfr gene was identified in all the isolates. Sequence analysis of V domain region of 23S rRNA gene confirmed mutation in single copy among 12/15 isolates with novel mutations: G2614 T and C2384T. All infections were nosocomially acquired and LZD resistance was emerging in the absence of prior LZD use. Horizontal spread of resistant isolates and cfr gene among diverse species were the probable mechanisms of transmission. Conclusion The study highlights the novel mutations associated with LRCoNS and the importance of surveillance & transmission pathway within the hospital. It also systematically discusses the published information on LRCoNS.
Collapse
Affiliation(s)
- Gajanand Mittal
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Vasundhra Bhandari
- National Institute of Animal Biotechnology-DBT, Hyderabad, 500049, India
| | - Rajni Gaind
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India.
| | - Vandana Rani
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Shimpi Chopra
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| | - Reetika Dawar
- Indraprastha Apollo Hospital, New Delhi, 110076, India
| | - Raman Sardana
- Indraprastha Apollo Hospital, New Delhi, 110076, India
| | - P K Verma
- Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, 110029, India
| |
Collapse
|
26
|
Weßels C, Strommenger B, Klare I, Bender J, Messler S, Mattner F, Krakau M, Werner G, Layer F. Emergence and control of linezolid-resistant Staphylococcus epidermidis in an ICU of a German hospital. J Antimicrob Chemother 2019; 73:1185-1193. [PMID: 29438544 DOI: 10.1093/jac/dky010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate an outbreak of linezolid-resistant Staphylococcus epidermidis (LRSE) in an interdisciplinary ICU, linezolid consumption and infection control measures taken. Methods Routine surveillance of nosocomial infections revealed colonization and infection with LRSE affecting 14 patients during a 15 month period. LRSE isolates were analysed with respect to their clonal relatedness, antimicrobial susceptibility, the presence of cfr and/or mutations in the 23S rRNA, rplC, rplD and rplV genes. cfr plasmids were characterized by Illumina sequencing. Medical records were reviewed and antibiotic consumption was determined. Results Molecular typing identified the presence of three different LRSE clusters: PFGE type I/ST168 (n = 5), PFGE type II/ST5 (n = 10) and PFGE type III/ST2 (n = 1). Ten strains harboured the cfr gene; we also detected mutations in the respective ribosomal protein genes. WGS revealed an almost identical 39 kb cfr plasmid obtained from strains of different genetic background (ST2, ST5, ST168) that shows high similarity to the recently published LRSE plasmid p12-02300. Due to an increase in the number of patients treated for infections with MRSA, a significant increase in linezolid usage was noted from January to July 2014 (from 5.55 to 20.41 DDDs/100 patient-days). Conclusions Here, we report the molecular epidemiology of LRSE in an ICU. Our results suggest the selection of resistant mutants under linezolid treatment as well as the spread of cfr-carrying plasmids. The reduction of linezolid usage and the strengthening of contact precautions proved to be effective infection control measures.
Collapse
Affiliation(s)
- Christina Weßels
- Institute of Hospital Hygiene, City of Cologne Hospitals, Cologne, Germany
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Ingo Klare
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Jennifer Bender
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Sabine Messler
- Labor im Sommershof, Praxis für Laboratoriumsmedizin Dr. med. Christiane Boogen, Cologne, Germany
| | - Frauke Mattner
- Institute of Hospital Hygiene, City of Cologne Hospitals, Cologne, Germany
| | - Michael Krakau
- Department of Internal Medicine, City of Cologne Hospitals, Cologne, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division 13: Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| |
Collapse
|
27
|
Low Prevalence of Gram-Positive Isolates Showing Elevated Lefamulin MIC Results during the SENTRY Surveillance Program for 2015-2016 and Characterization of Resistance Mechanisms. Antimicrob Agents Chemother 2019; 63:AAC.02158-18. [PMID: 30670418 DOI: 10.1128/aac.02158-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/18/2019] [Indexed: 12/31/2022] Open
Abstract
This study investigated the molecular mechanisms possibly associated with non-wild-type MICs for lefamulin among staphylococci and streptococci included in the lefamulin surveillance program from 2015 to 2016. A total of 2,919 Staphylococcus aureus, 276 coagulase-negative staphylococci (CoNS), 3,923 Streptococcus pneumoniae, 389 β-hemolytic, and 178 viridans group streptococci isolates were included in the surveillance studies. Eleven (0.3% of all S. aureus) S. aureus isolates with lefamulin MICs above the staphylococcal epidemiological cutoff (ECOFF) value (>0.25 μg/ml) were selected for this study. Eight (72.7%) S. aureus (lefamulin MIC, 0.5 to 4 μg/ml) isolates carried vga(A or E), one isolate (MIC, 32 μg/ml) carried lsa(E), one isolate (MIC, 16 μg/ml) had an alteration in L4, and one strain (MIC, 0.5 μg/ml) did not carry any of the investigated resistance mechanisms. A total of 14 (5.1% of all CoNS) CoNS isolates had lefamulin MICs (0.5 to >32 μg/ml) above the ECOFF. Similar to S. aureus, 8 (57.1%) CoNS (lefamulin MIC, 1 to 8 μg/ml) isolates carried vga(A or B), while 2 isolates (MIC, 4 to 32 μg/ml) carried cfr High genetic diversity was observed among staphylococci, although 3 S. aureus isolates belonged to sequence type 398 (ST398). Among the 3 Streptococcus agalactiae and 3 viridans group streptococci (0.1% of all streptococci surveyed) isolates selected for additional characterization, all but 1 isolate carried lsa(E). This study documents a low occurrence of surveillance isolates exhibiting a non-wild-type MIC for lefamulin, and among these isolates, vga and lsa(E) prevailed in staphylococci and streptococci, respectively.
Collapse
|
28
|
Bai B, Hu K, Zeng J, Yao W, Li D, Pu Z, Chen Z, Cheng H, Zheng J, Pan W, Lin Z, Xie L, Deng Q, Yu Z. Linezolid Consumption Facilitates the Development of Linezolid Resistance in Enterococcus faecalis in a Tertiary-Care Hospital: A 5-Year Surveillance Study. Microb Drug Resist 2019; 25:791-798. [PMID: 30762463 DOI: 10.1089/mdr.2018.0005] [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] [Indexed: 10/27/2022] Open
Abstract
Although case reports and clinical studies of linezolid (LZD)-resistant Enterococcus faecalis (LREF) have gradually increased in recent years, the relationship between LZD resistance and antibiotic consumption in hospital settings still remains unclear. In this study, we aimed to investigate the dynamic relationship between the yearly detection frequency of LREF clinical isolates and yearly consumption of LZD and vancomycin (VCM) over a 5-year period in a Chinese hospital setting. Antibiotic consumption data (LZD and VCM) from 2011 to 2015 were obtained from a computerized database and recalculated as the defined daily doses (DDDs) per 100 bed-days (DBD). All 268 E. faecalis clinical isolates were retrospectively collected from 2011 to 2015 in this hospital. LZD resistance mechanism and multilocus sequence typing of E. faecalis were determined by PCR. The annual detection frequency of LREF clinical isolates tested in this hospital was shown with 1.89% (1/53), 2% (1/50), 2.04% (1/49), 0% (0/45), and 7.04% (5/71), respectively, and the detection frequency of LZD-nonsusceptible E. faecalis (LNSEF; n = 59, including LZD-resistant and intermediate isolates) was determined with 26.42% (14/53), 34% (17/50), 16.33% (8/49), 22.22% (10/45), and 14.08% (10/71), respectively. Spearman correlation analysis revealed that LZD DBD significantly correlated positively with the detection frequency of LREF (r = 0.886, p = 0.019). Moreover, VCM DBD significantly correlated positively with the frequency of LNSEF (r = 0.943, p = 0.005). Furthermore, the detection frequency of optrA-positive E. faecalis also correlated positively with high LZD consumption load in this hospital setting. Conclusively, high LZD consumption load facilitates the development of LZD resistance and promotes the selection of optrA-positive E. faecalis clinical isolates under antibiotic pressure in a hospital setting.
Collapse
Affiliation(s)
- Bing Bai
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Kaitao Hu
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Jun Zeng
- 3 Department of Digestive Diseases, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiming Yao
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Duoyun Li
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Zhangya Pu
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Zhong Chen
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Hang Cheng
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Jinxin Zheng
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China.,4 Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science and Institutes of Biomedical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Weiguang Pan
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Zhiwei Lin
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China.,4 Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, School of Basic Medical Science and Institutes of Biomedical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Lixia Xie
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China.,5 Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas
| | - Qiwen Deng
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China
| | - Zhijian Yu
- 1 Department of Infectious Diseases and Shenzhen Key Lab of Endogenous Infection, Shenzhen Nanshan Hospital of Shenzhen University, Nanshan District, Shenzhen, China.,2 Quality Control Center of Hospital Infection Management of Shenzhen, Shenzhen, China.,5 Department of Pharmacy Practice and Translational Research, University of Houston, Houston, Texas
| |
Collapse
|
29
|
Higher intake of coagulase-negative staphylococci from maternal milk promotes gut colonization with mecA-negative Staphylococcus epidermidis in preterm neonates. J Perinatol 2018; 38:1344-1352. [PMID: 30076401 DOI: 10.1038/s41372-018-0183-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/27/2018] [Accepted: 07/11/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to determine factors associated with gut colonization of preterm neonates with coagulase-negative staphylococci (CoNS) from maternal milk (MM). STUDY DESIGN CoNS isolated from weekly collected stool and MM of hospitalized preterm (n = 49) and healthy term neonates (n = 20) were genotyped. Colonization-related factors were determined by Cox proportional hazards regression. RESULT Gut colonization with mecA-negative Staphylococcus epidermidis from MM was less prevalent (40.8% vs. 95%) and delayed (median age 15.5 vs. 2 days) in preterm compared with term neonates. Enhanced colonization was associated with higher intake of CoNS from MM (hazard ratio (95% confidence interval) 1.006 (1.00-1.01) for 106 colony-forming units), lower proportion of mecA-positive predominant NICU strains in gut (0.09 (0.01-0.49) for 1%) and lower incidence of late-onset CoNS sepsis (5% vs. 34% in those without colonization). CONCLUSION Enteral feeding with larger proportion of unpasteurized MM and limiting spread of predominant strains may promote colonization with CoNS from MM.
Collapse
|
30
|
Dortet L, Glaser P, Kassis-Chikhani N, Girlich D, Ichai P, Boudon M, Samuel D, Creton E, Imanci D, Bonnin R, Fortineau N, Naas T. Long-lasting successful dissemination of resistance to oxazolidinones in MDR Staphylococcus epidermidis clinical isolates in a tertiary care hospital in France. J Antimicrob Chemother 2018; 73:41-51. [PMID: 29092052 PMCID: PMC5890688 DOI: 10.1093/jac/dkx370] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/10/2017] [Indexed: 01/16/2023] Open
Abstract
Objectives Patient- and procedure-related changes in modern medicine have turned CoNS into one of the major nosocomial pathogens. Treatments of CoNS infections are challenging owing to the large proportion of MDR strains and oxazolidinones often remain the last active antimicrobial molecules. Here, we have investigated a long-lasting outbreak (2010-13) due to methicillin- and linezolid-resistant (LR) CoNS (n = 168), involving 72 carriers and 49 infected patients. Methods Antimicrobial susceptibilities were tested by the disc diffusion method and MICs were determined by broth microdilution or Etest. The clonal relationship of LR Staphylococcus epidermidis (LRSE) was first determined using a semi-automated repetitive element palindromic PCR (rep-PCR) method. Then, WGS was performed on all cfr-positive LRSE (n = 30) and LRSE isolates representative of each rep-PCR-defined clone (n = 17). Self-transferability of cfr-carrying plasmids was analysed by filter-mating experiments. Results This outbreak was caused by the dissemination of three clones (ST2, ST5 and ST22) of LRSE. In these clones, linezolid resistance was caused by (i) mutations in the chromosome-located genes encoding the 23S RNA and L3 and L4 ribosomal proteins, but also by (ii) the dissemination of two different self-conjugative plasmids carrying the cfr gene encoding a 23S RNA methylase. By monitoring linezolid prescriptions in two neighbouring hospitals, we highlighted that the spread of LR-CoNS was strongly associated with linezolid use. Conclusions Physicians should be aware that plasmid-encoded linezolid resistance has started to disseminate among CoNS and that rational use of oxazolidinones is critical to preserve these molecules as efficient treatment options for MDR Gram-positive pathogens.
Collapse
Affiliation(s)
- Laurent Dortet
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Philippe Glaser
- Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France.,UMR 3525, CNRS, 75015 Paris, France
| | - Najiby Kassis-Chikhani
- Department of Hygiene, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Delphine Girlich
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Philippe Ichai
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Marc Boudon
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Didier Samuel
- Intensive Care Unit, Hepatobiliary Center, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Elodie Creton
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Dilek Imanci
- Department of Molecular Genetics and Hormonology, Assistance Publique/Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Rémy Bonnin
- EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Nicolas Fortineau
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| | - Thierry Naas
- Department of Bacteriology-Parasitology-Hygiene, Bicêtre Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,EA7361 'Structure, dynamic, function and expression of broad spectrum β-lactamases', Paris-Sud University, LabEx Lermit, Faculty of Medicine, Le Kremlin-Bicêtre, France.,Associated French National Reference Center for Antibiotic Resistance, Le Kremlin-Bicêtre, France.,Joint Research Unit EERA 'Evolution and Ecology of Resistance to Antibiotics', Institut Pasteur-APHP-University Paris Sud, Paris, France
| |
Collapse
|
31
|
Dunne CP, Kingston L, Slevin B, O'Connell NH. Hand hygiene and compliance behaviours are the under-appreciated human factors pivotal to reducing hospital-acquired infections. J Hosp Infect 2018; 98:328-330. [PMID: 29486215 DOI: 10.1016/j.jhin.2018.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Affiliation(s)
- C P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - B Slevin
- University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - N H O'Connell
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland; University Hospital Limerick, Dooradoyle, Limerick, Ireland
| |
Collapse
|
32
|
Nosocomial ventriculitis caused by a meticillin- and linezolid-resistant clone of Staphylococcus epidermidis in neurosurgical patients. J Hosp Infect 2018; 100:406-410. [PMID: 29458065 DOI: 10.1016/j.jhin.2018.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postneurosurgical ventriculitis is mainly caused by coagulase-negative staphylococci. The rate of linezolid-resistant Staphylococcus epidermidis (LRSE) is increasing worldwide. AIMS To report clinical, epidemiological and microbiological data from a series of ventriculitis cases caused by LRSE in a Spanish hospital between 2013 and 2016. METHODS Cases of LRSE ventriculitis were reviewed retrospectively in a Spanish hospital over a four-year period. Clinical/epidemiological data of the infected patients were reviewed, the isolates involved were typed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing, and the molecular bases of linezolid resistance were determined. FINDINGS Five cases of LRSE ventriculitis were detected. The patients suffered from cerebral haemorrhage or head trauma that required the placement of an external ventricular drain; spent a relatively long time in the intensive care unit (ICU) (10-26 days); and three out of the five patients had previously been treated with linezolid. All LRSE had the same PFGE pattern, belonged to ST2, and shared an identical mechanism of linezolid resistance. Specifically, all had the G2576T mutation in the V domain of each of the six copies of the 23S rRNA gene, together with the Q136L and M156T mutations and the 71GGR72 insertion in the L3 and L4 ribosomal proteins, respectively. CONCLUSION The high ratio of linezolid consumption in the ICU (7.72-8.10 defined daily dose/100 patient-days) could have selected this resistant clone, which has probably become endemic in the ICU where it could have colonized admitted patients. Infection control and antimicrobial stewardship interventions are essential to prevent the dissemination of this difficult-to-treat pathogen, and to preserve the therapeutic efficacy of linezolid.
Collapse
|
33
|
Dodou HV, de Morais Batista AH, Sales GWP, de Medeiros SC, Rodrigues ML, Nogueira PCN, Silveira ER, Nogueira NAP. Violacein antimicrobial activity on Staphylococcus epidermidis and synergistic effect on commercially available antibiotics. J Appl Microbiol 2018; 123:853-860. [PMID: 28744944 DOI: 10.1111/jam.13547] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/16/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Abstract
AIMS The study aimed to assess whether violacein has antimicrobial activity on Staphylococcus epidermidis and synergistically modulates the action of commercially available antimicrobial drugs. METHODS AND RESULTS Violacein showed excellent antimicrobial activity on biofilm-forming and nonbiofilm-forming S. epidermidis strains (ATCC 35984) (ATCC 12228), with bacteriostatic (MIC = 20 μg ml-1 and 10 μg ml-1 respectively) and bactericidal effects (MBC = 20 μg ml-1 for both strains), observed in short periods of exposure. The violacein bactericidal concentration led to S. epidermidis death after 2-3 h of exposure. Additionally, violacein synergistically modulated the activity of different antimicrobial classes on S. epidermidis ATCC 12228 (81·8%; n = 9) and on S. epidermidis ATCC 35984 (54·5%; n = 6), reducing the MIC of these antibiotics by up to 16-fold. CONCLUSION Violacein shows excellent antimicrobial activity on S. epidermidis strains. SIGNIFICANCE AND IMPACT OF THE STUDY Violacein shows the potential for the development of a new drug for the treatment of infections caused by S. epidermidis.
Collapse
Affiliation(s)
- H V Dodou
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| | - A H de Morais Batista
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| | - G W P Sales
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| | - S C de Medeiros
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| | - M L Rodrigues
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| | - P C N Nogueira
- Department of Organic Chemistry, Federal University of Ceará, Fortaleza, Brazil
| | - E R Silveira
- Department of Organic Chemistry, Federal University of Ceará, Fortaleza, Brazil
| | - N A P Nogueira
- Department of Clinical and Toxicological Analysis, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. RECENT FINDINGS Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. SUMMARY Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.
Collapse
|
35
|
Kingston LM, Slevin BL, O'Connell NH, Dunne CP. Hand hygiene: Attitudes and practices of nurses, a comparison between 2007 and 2015. Am J Infect Control 2017; 45:1300-1307. [PMID: 29050908 DOI: 10.1016/j.ajic.2017.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hand hygiene reduces health care-associated infections significantly. However, international evidence suggests that practices are suboptimal. The objective of this study was to compare and contrast hand hygiene attitudes and practices and alcohol-based handrub (ABHR) use among nurses between 2007 and 2015. METHODS In 2007, a random sample of nurses in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all nurses employed in a university hospital group, including the setting of the original study. Data were analyzed quantitatively and qualitatively using appropriate software. RESULTS Attitudes to hand hygiene were positive and >90% of respondents' self-reported compliance before and after patient contact. However, 13% fewer in 2015 (42%) reported using ABHR >90% of the time compared with in 2007 (55%). Of nurses with <2 years' experience, 90% reported using ABHR >50% of the time compared with 73% of nurses with 2-5 years' experience. Barriers to ABHR improved, but remained high (skin sensitivity: 2007: 23%, 2015: 17%; skin damage: 2007: 18%, 2015: 13%; poor user acceptability and tolerance: 2007 and 2015: 25%). CONCLUSIONS Use of positive role models, the adoption of a positive social and cultural norm within the organization, and the provision of continuing professional development opportunities may prove useful strategies in harnessing good practice among graduate nurses and in preventing negative socialization from occurring.
Collapse
|
36
|
Dunne CP, Keinänen-Toivola MM, Kahru A, Teunissen B, Olmez H, Gouveia I, Melo L, Murzyn K, Modic M, Ahonen M, Askew P, Papadopoulos T, Adlhart C, Crijns FRL. Anti-microbial coating innovations to prevent infectious diseases (AMiCI): Cost action ca15114. Bioengineered 2017; 8:679-685. [PMID: 28453429 PMCID: PMC5736330 DOI: 10.1080/21655979.2017.1323593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
Worldwide, millions of patients are affected annually by healthcare-associated infection (HCAI), impacting up to 80,000 patients in European Hospitals on any given day. This represents not only public health risk, but also an economic burden. Complementing routine hand hygiene practices, cleaning and disinfection, antimicrobial coatings hold promise based, in essence, on the application of materials and chemicals with persistent bactericidal or -static properties onto surfaces or in textiles used in healthcare environments. The focus of considerable commercial investment and academic research energies, such antimicrobial coating-based approaches are widely believed to have potential in reduction of microbial numbers on surfaces in clinical settings. This belief exists despite definitive evidence as to their efficacy and is based somewhat on positive studies involving, for example, copper, silver or gold ions, titanium or organosilane, albeit under laboratory conditions. The literature describes successful delay and/or prevention of recontamination following conventional cleaning and disinfection by problematic microbes such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE), among others. However, there is a scarcity of studies assessing antimicrobial surfaces other than copper in the clinical environment, and a complete lack of published data regarding the successful implementation of these materials on clinically significant outcomes (including HCAI). Through its Cooperation in Science and Technology program (COST), the European Commission has funded a 4-year initiative to establish a network of stakeholders involved in development, regulation and use of novel anti-microbial coatings for prevention of HCAI. The network (AMiCI) comprises participants of more than 60 universities, research institutes and companies across 29 European countries and, to-date, represents the most comprehensive consortium targeting use of these emergent technologies in healthcare settings. More specifically, the network will prioritise coordinated research on the effects (both positive and negative) of antimicrobial coatings in healthcare sectors; know-how regarding availability and mechanisms of action of (nano)-coatings; possible adverse effects of such materials (e.g., potential emergence of microbial resistance or emission of toxic agents into the environment); standardised performance assessments for antimicrobial coatings; identification and dissemination of best practices by hospitals, other clinical facilities, regulators and manufacturers.
Collapse
Affiliation(s)
- Colum P. Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - Anne Kahru
- Laboratory of Environmental Toxicology, National Institute of Chemical Physics and Biophysics, Tallinn, Estonia
- Academy of Sciences, Tallinn, Estonia
| | | | - Hulya Olmez
- TÜBİTAK MAM Material Institute, Gebze, Kocaeli, Turkey
| | - Isabel Gouveia
- FibEntech - Fiber Materials and Environmental Technologies Research Unit, University of Beira Interior, Covilhã, Portugal
| | - Luis Melo
- Faculty of Engineering, University of Beira Interior, Covilhã, Portugal
| | | | - Martina Modic
- Department of Surface Engineering and Electronics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Merja Ahonen
- Satakunta University of Applied Sciences, Rauma, Finland
| | - Pete Askew
- Industrial Microbiological Services Ltd (IMSL), Hants, United Kingdom
| | - Theofilos Papadopoulos
- Laboratory of Microbiology and Infectious Diseases, School of Veterinary Medicine, Aristotle University, Auth Campus, Thessaloniki, Greece
| | | | | |
Collapse
|
37
|
Raza S, Sanober G, Rungrotmongkol T, Azam SS. The Vitality of Swivel Domain Motion in Performance of Enzyme I of Phosphotransferase System; A Comprehensive Molecular Dynamic Study. J Mol Liq 2017. [DOI: 10.1016/j.molliq.2017.07.086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
38
|
Pfaller MA, Mendes RE, Streit JM, Hogan PA, Flamm RK. ZAAPS Program results for 2015: an activity and spectrum analysis of linezolid using clinical isolates from medical centres in 32 countries. J Antimicrob Chemother 2017; 72:3093-3099. [DOI: 10.1093/jac/dkx251] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/27/2017] [Indexed: 12/25/2022] Open
|
39
|
Inkster T, Coia J, Meunier D, Doumith M, Martin K, Pike R, Imrie L, Kane H, Hay M, Wiuff C, Wilson J, Deighan C, Hopkins KL, Woodford N, Hill R. First outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit. J Hosp Infect 2017; 97:397-402. [PMID: 28698020 DOI: 10.1016/j.jhin.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023]
Abstract
AIM To describe an outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit. METHODS Isolates of linezolid-resistant E. faecium were typed by pulsed-field gel electrophoresis (PFGE), and examined by polymerase chain reaction (PCR) and sequencing for the transmissible cfr gene that confers resistance to linezolid. Enhanced environmental cleaning, initial and weekly screening of all patients, and monitoring of adherence to standard infection control precautions were implemented. FINDINGS Five patients with pre-existing renal disease were found to have rectal colonization with linezolid-resistant E. faecium over a two-week period. The index case was a 57-year-old male from India who had travelled to the UK. One patient also had a linezolid-resistant E. faecium of a different PFGE profile isolated from a heel wound. All isolates were confirmed to harbour the cfr gene by PCR and Sanger sequencing, and all were resistant to glycopeptides (VanA phenotype). CONCLUSIONS This article describes the first UK outbreak with a single strain of linezolid- and glycopeptide-resistant E. faecium harbouring the cfr gene, affecting five patients in a nephrology unit. Following the implementation of aggressive infection control measures, no further cases were detected beyond a two-week period.
Collapse
Affiliation(s)
- T Inkster
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - J Coia
- Glasgow Royal Infirmary, Glasgow, UK
| | - D Meunier
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - M Doumith
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - K Martin
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - R Pike
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - L Imrie
- Health Protection Scotland, Glasgow, UK
| | - H Kane
- Health Protection Scotland, Glasgow, UK
| | - M Hay
- Glasgow Royal Infirmary, Glasgow, UK
| | - C Wiuff
- Health Protection Scotland, Glasgow, UK
| | - J Wilson
- Health Protection Scotland, Glasgow, UK
| | - C Deighan
- Glasgow Royal Infirmary, Glasgow, UK
| | - K L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - R Hill
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| |
Collapse
|
40
|
O'Connell NH, Tansey P, Dunne SS, Dunne CP. Timely publishing of experiences and sharing of knowledge. J Hosp Infect 2017; 97:315-316. [PMID: 28669675 DOI: 10.1016/j.jhin.2017.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022]
Affiliation(s)
- N H O'Connell
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland; University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - P Tansey
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - S S Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
| |
Collapse
|
41
|
Pfaller MA, Mendes RE, Streit JM, Hogan PA, Flamm RK. Five-Year Summary of In Vitro Activity and Resistance Mechanisms of Linezolid against Clinically Important Gram-Positive Cocci in the United States from the LEADER Surveillance Program (2011 to 2015). Antimicrob Agents Chemother 2017; 61:e00609-17. [PMID: 28483950 PMCID: PMC5487612 DOI: 10.1128/aac.00609-17] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 04/27/2017] [Indexed: 11/20/2022] Open
Abstract
This report describes linezolid susceptibility testing results for 6,741 Gram-positive pathogens from 60 U.S. sites collected during 2015 for the LEADER Program. In addition, the report summarizes linezolid in vitro activity, resistance mechanisms, and molecular typing obtained for 2011 to 2015. During 2015, linezolid showed potent activity in testing against Staphylococcus aureus, inhibiting >99.9% of 3,031 isolates at ≤2 µg/ml. Similarly, linezolid showed coverage against 99.2% of coagulase-negative staphylococci, 99.7% of enterococci, and 100.0% of Streptococcus pneumoniae, virdans group, and beta-hemolytic streptococcus isolates tested. The overall linezolid resistance rate remained a modest <1% from 2011 to 2015. Staphylococci, especially Staphylococcus epidermidis, showed a range of linezolid resistance mechanisms. Increased annual trends for the presence of cfr among Staphylococcus aureus isolates were not observed, but 64.3% (9/14) of the isolates with decreased susceptibility (MIC, ≥4 µg/ml) to linezolid carried this transferrable gene (2011 to 2015). The cfr gene was detected in 21.9% (7/32) of linezolid-resistant staphylococci other than S. aureus from 2011 to 2015. The optrA gene was noted in half (2/4) of the population of linezolid-nonsusceptible Enterococcus faecalis isolates from 2011 to 2015, while linezolid-nonsusceptible Enterococcus faecium isolates showed alterations predominantly (16/16) in the 23S rRNA gene (G2576T). This report confirms a long record of linezolid activity against Gram-positive isolates in the United States since regulatory approval in 2000 and reports the oxazolidinones evolving resistance mechanisms.
Collapse
Affiliation(s)
- Michael A Pfaller
- JMI Laboratories, North Liberty, Iowa, USA
- University of Iowa, Iowa City, Iowa, USA
| | | | | | | | | |
Collapse
|
42
|
Argudín MA, Deplano A, Meghraoui A, Dodémont M, Heinrichs A, Denis O, Nonhoff C, Roisin S. Bacteria from Animals as a Pool of Antimicrobial Resistance Genes. Antibiotics (Basel) 2017; 6:antibiotics6020012. [PMID: 28587316 PMCID: PMC5485445 DOI: 10.3390/antibiotics6020012] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 01/14/2023] Open
Abstract
Antimicrobial agents are used in both veterinary and human medicine. The intensive use of antimicrobials in animals may promote the fixation of antimicrobial resistance genes in bacteria, which may be zoonotic or capable to transfer these genes to human-adapted pathogens or to human gut microbiota via direct contact, food or the environment. This review summarizes the current knowledge of the use of antimicrobial agents in animal health and explores the role of bacteria from animals as a pool of antimicrobial resistance genes for human bacteria. This review focused in relevant examples within the ESC(K)APE (Enterococcus faecium, Staphylococcus aureus, Clostridium difficile (Klebsiella pneumoniae), Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) group of bacterial pathogens that are the leading cause of nosocomial infections throughout the world.
Collapse
Affiliation(s)
- Maria Angeles Argudín
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Ariane Deplano
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Alaeddine Meghraoui
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Magali Dodémont
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Amelie Heinrichs
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Olivier Denis
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
- Ecole de Santé Publique, Université Libre de Bruxelles, Avenue Franklin Roosevelt 50, 1050 Bruxelles, Belgium.
| | - Claire Nonhoff
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| | - Sandrine Roisin
- National Reference Centre-Staphylococcus aureus, Department of Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
| |
Collapse
|
43
|
Identification of plausible drug targets by investigating the druggable genome of MDR Staphylococcus epidermidis. GENE REPORTS 2017. [DOI: 10.1016/j.genrep.2017.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
44
|
Kingston LM, Slevin BL, O'Connell NH, Dunne CP. Attitudes and practices of Irish hospital-based physicians towards hand hygiene and hand rubbing using alcohol-based hand rub: a comparison between 2007 and 2015. J Hosp Infect 2017; 97:17-25. [PMID: 28532815 DOI: 10.1016/j.jhin.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/15/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance. AIM To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. METHODS In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey. FINDINGS Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they 'almost always' used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products. CONCLUSION Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009.
Collapse
Affiliation(s)
- L M Kingston
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
| | - B L Slevin
- Infection Prevention and Control Team, University Hospital Limerick, Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| |
Collapse
|
45
|
Becoming patient-centred: sobering insight into CPE-positive patients' experiences of clinical care. J Hosp Infect 2017; 96:129-130. [PMID: 28434628 DOI: 10.1016/j.jhin.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/22/2022]
|
46
|
Zahedi Bialvaei A, Rahbar M, Yousefi M, Asgharzadeh M, Samadi Kafil H. Linezolid: a promising option in the treatment of Gram-positives. J Antimicrob Chemother 2016; 72:354-364. [PMID: 27999068 DOI: 10.1093/jac/dkw450] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Linezolid, an oxazolidinone antimicrobial agent that acts by inhibiting protein synthesis in a unique fashion, is used in the treatment of community-acquired pneumonia, skin and soft-tissue infections and other infections caused by Gram-positive bacteria including VRE and methicillin-resistant staphylococci. Currently, linezolid resistance among these pathogens remains low, commonly <1.0%, although the prevalence of antibiotic resistance is increasing in many countries. Therefore, the development of resistance by clinical isolates should prompt increased attention of clinical laboratories to routinely perform linezolid susceptibility testing for this important agent and should be taken into account when considering its therapeutic use. Considering the importance of linezolid in the treatment of infections caused by Gram-positive bacteria, this review was undertaken to optimize the clinical use of this antibiotic.
Collapse
Affiliation(s)
| | - Mohammad Rahbar
- Department of Microbiology, Iranian Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Yousefi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asgharzadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
47
|
Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study. BMC Infect Dis 2016; 16:743. [PMID: 27938344 PMCID: PMC5148920 DOI: 10.1186/s12879-016-2094-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 12/06/2016] [Indexed: 01/22/2023] Open
Abstract
Background During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU). Methods Over 12 months in 2006–2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates. Results We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes. Conclusions Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2094-x) contains supplementary material, which is available to authorized users.
Collapse
|
48
|
Soeorg H, Huik K, Parm Ü, Ilmoja ML, Metsvaht T, Lutsar I. Molecular epidemiology ofStaphylococcus epidermidisin neonatal intensive care units. APMIS 2016; 125:63-73. [DOI: 10.1111/apm.12637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/26/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hiie Soeorg
- Department of Microbiology; University of Tartu; Tartu Estonia
| | - Kristi Huik
- Department of Microbiology; University of Tartu; Tartu Estonia
| | - Ülle Parm
- Department of Microbiology; University of Tartu; Tartu Estonia
| | - Mari-Liis Ilmoja
- Department of Microbiology; University of Tartu; Tartu Estonia
- Pediatric Intensive Care Unit; Tallinn Children's Hospital; Tallinn Estonia
| | - Tuuli Metsvaht
- Department of Microbiology; University of Tartu; Tartu Estonia
- Pediatric Intensive Care Unit; Tartu University Hospital; Tartu Estonia
| | - Irja Lutsar
- Department of Microbiology; University of Tartu; Tartu Estonia
| |
Collapse
|
49
|
Molecular Epidemiology of a Vancomycin-Intermediate Heteroresistant Staphylococcus epidermidis Outbreak in a Neonatal Intensive Care Unit. Antimicrob Agents Chemother 2016; 60:5673-81. [PMID: 27401579 DOI: 10.1128/aac.00726-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023] Open
Abstract
Coagulase-negative staphylococci (CoNS) have become the leading cause of bloodstream infections (BSIs) in intensive care units (ICUs), particularly in premature neonates. Vancomycin-intermediate heteroresistant CoNS (hVICoNS) have been identified as sources of BSIs worldwide, and their potential to emerge as significant pathogens in the neonatal ICU (NICU) remains uncertain. This study describes the molecular epidemiology of an outbreak of vancomycin-heteroresistant (hV) Staphylococcus epidermidis central-line-associated BSI (CLABSI) in a single tertiary care NICU and compares it to a second tertiary care NICU that had not been associated with an outbreak. Between November 2009 and April 2014, 119 S. epidermidis CLABSIs were identified in two tertiary care NICUs in Quebec, Canada. Decreased vancomycin susceptibility was identified in about 88% of all collected strains using Etest methods. However, discrepancies were found according to the Etest and population analysis profiling-area under the concentration-time curve (PAP-AUC) methods used. All strains were susceptible to linezolid, and a few isolates were nonsusceptible to daptomycin. Great genetic diversity was observed within the collection, with 31 pulsed-field gel electrophoresis (PFGE) patterns identified. The outbreak strains were all determined to be heteroresistant to vancomycin and were polyclonal. The study identified two major clones, PFGE patterns E and G, which were found in both NICUs across the 5-year study period. This suggests the persistence of highly successful clones that are well adapted to the hospital environment. hV S. epidermidis seems more common than currently realized in the NICU, and certain hV S. epidermidis clones can become endemic to the NICU. The reservoirs for these clones remain unknown at this time, and identification of the reservoirs is needed to better understand the impact of hV S. epidermidis in the NICU and to inform infection prevention strategies. In addition, there is a need to investigate and validate hV determination protocols for different species of CoNS.
Collapse
|
50
|
First Report of cfr-Carrying Plasmids in the Pandemic Sequence Type 22 Methicillin-Resistant Staphylococcus aureus Staphylococcal Cassette Chromosome mec Type IV Clone. Antimicrob Agents Chemother 2016; 60:3007-15. [PMID: 26953212 PMCID: PMC4862533 DOI: 10.1128/aac.02949-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022] Open
Abstract
Linezolid is often the drug of last resort for serious methicillin-resistant Staphylococcus aureus (MRSA) infections. Linezolid resistance is mediated by mutations in 23S rRNA and genes for ribosomal proteins; cfr, encoding phenicol, lincosamide, oxazolidinone, pleuromutilin, and streptogramin A (PhLOPSA) resistance; its homologue cfr(B); or optrA, conferring oxazolidinone and phenicol resistance. Linezolid resistance is rare in S. aureus, and cfr is even rarer. This study investigated the clonality and linezolid resistance mechanisms of two MRSA isolates from patients in separate Irish hospitals. Isolates were subjected to cfr PCR, PhLOPSA susceptibility testing, 23S rRNA PCR and sequencing, DNA microarray profiling, spa typing, pulsed-field gel electrophoresis (PFGE), plasmid curing, and conjugative transfer. Whole-genome sequencing was used for single-nucleotide variant (SNV) analysis, multilocus sequence typing, L protein mutation identification, cfr plasmid sequence analysis, and optrA and cfr(B) detection. Isolates M12/0145 and M13/0401 exhibited linezolid MICs of 64 and 16 mg/liter, respectively, and harbored identical 23S rRNA and L22 mutations, but M12/0145 exhibited the mutation in 2/6 23S rRNA alleles, compared to 1/5 in M13/0401. Both isolates were sequence type 22 MRSA staphylococcal cassette chromosome mec type IV (ST22-MRSA-IV)/spa type t032 isolates, harbored cfr, exhibited the PhLOPSA phenotype, and lacked optrA and cfr(B). They differed by five PFGE bands and 603 SNVs. Isolate M12/0145 harbored cfr and fexA on a 41-kb conjugative pSCFS3-type plasmid, whereas M13/0401 harbored cfr and lsa(B) on a novel 27-kb plasmid. This is the first report of cfr in the pandemic ST22-MRSA-IV clone. Different cfr plasmids and mutations associated with linezolid resistance in genotypically distinct ST22-MRSA-IV isolates highlight that prudent management of linezolid use is essential.
Collapse
|