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Mauritz MD, Claus B, Forster J, Petzold M, Schneitler S, Halfmann A, Hauswaldt S, Nurjadi D, Toepfner N. The EC-COMPASS: Long-term, multi-centre surveillance of Enterobacter cloacae complex - a clinical perspective. J Hosp Infect 2024; 148:11-19. [PMID: 38554809 DOI: 10.1016/j.jhin.2024.03.010] [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: 01/08/2024] [Revised: 03/02/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Enterobacter cloacae complex (ECCO) comprises closely related Enterobacterales, causing a variety of infections ranging from mild urinary tract infections to severe bloodstream infections. ECCO has emerged as a significant cause of healthcare-associated infections, particularly in neonatal and adult intensive care. AIM The Enterobacter Cloacae COMplex PASsive Surveillance (EC-COMPASS) aims to provide a detailed multi-centre overview of ECCO epidemiology and resistance patterns detected in routine microbiological diagnostics in four German tertiary-care hospitals. METHODS In a sentinel cluster of four German tertiary-care hospitals, all culture-positive ECCO results between 1st January 2020 and 31st December 2022, were analysed based on Hybase® laboratory data. FINDINGS Analysis of 31,193 ECCO datasets from 14,311 patients revealed a higher incidence in male patients (P<0.05), although no significant differences were observed in ECCO infection phenotypes. The most common sources of ECCO were swabs (42.7%), urine (17.5%), respiratory secretions (16.1%), blood cultures (8.9%) and tissue samples (5.6%). The annual bacteraemia rate remained steady at approximately 33 cases per hospital. Invasive ECCO infections were predominantly found in oncology and intensive care units. Incidences of nosocomial outbreaks were infrequent and limited in scope. Notably, resistance to carbapenems was consistently low. CONCLUSION EC-COMPASS offers a profound clinical perspective on ECCO infections in German tertiary-healthcare settings, highlighting elderly men in oncology and intensive care units as especially vulnerable to ECCO infections. Early detection strategies targeting at-risk patients could improve ECCO infection management.
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Affiliation(s)
- M D Mauritz
- Department of General Pediatrics and Adolescent Medicine, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.
| | - B Claus
- Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany; PedScience Research Institute, Datteln, Germany
| | - J Forster
- Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - M Petzold
- Institute for Medical Microbiology and Virology, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany
| | - S Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - A Halfmann
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - S Hauswaldt
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Germany
| | - D Nurjadi
- Department of Infectious Diseases and Microbiology, University of Luebeck, Luebeck, Germany
| | - N Toepfner
- Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Mbaga DS, Kenmoe S, Esemu SN, Bowo-Ngandji A, Keneh NK, Tatah Kihla Akoachere JF, Gonsu HK, Ndip Ndip R, Ebogo-Belobo JT, Kengne-Ndé C, Tendongfor N, Assam Assam JP, Ndip LM, Njiki Bikoï J, Riwom Essama SH. Epidemiology of carbapenem-resistant Acinetobacter baumannii colonization in neonatal intensive care units: A systematic review and meta-analysis. World J Meta-Anal 2024; 12:90229. [DOI: 10.13105/wjma.v12.i1.90229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The rising prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) in neonatal intensive care units (NICUs) represents an escalating challenge in healthcare settings, particularly in managing hospital-acquired infections (HAIs). Studies across various World Health Organization regions have documented a significant incidence of CRAB-related HAIs, with rates as high as 41.7 cases per 1000 patients in ICUs, accounting for 13.6% of all HAIs. These infections pose a doubled mortality risk compared to infections with carbapenem-susceptible Acinetobacter baumannii. A particularly concerning aspect of CRAB colonization is its asymptomatic nature, enabling its transmission through healthcare workers (HCWs) or the NICU environment to vulnerable neonates with developing immune systems.
AIM To explore the prevalence of CRAB colonization in NICUs, focusing on neonates, healthcare workers, and the environmental samples, to enhance epidemiological understanding and inform targeted interventions.
METHODS We conducted according to PRISMA 2020 checklist guidelines, a comprehensive literature search across multiple databases including MEDLINE (Ovid), EMBASE (Ovid), Global Health (Ovid), Web of Science, and Global Index Medicus. Studies were selected based on predetermined criteria, primarily involving neonates, HCWs, and environmental swabs, using culture or molecular methods to detect CRAB colonization. We excluded studies that did not specifically focus on NICUs, were duplicates, or lacked necessary data. The study selection and quality assessment were conducted independently by two reviewers. Data extraction involved collecting comprehensive details about each study. Our statistical analysis used a random-effects model to calculate the pooled prevalence and confidence intervals, stratifying results by regional location. We assessed study heterogeneity using Cochran's Q statistic and I² statistic, with regression tests employed to evaluate potential publication bias.
RESULTS We analyzed 737 records from five databases, ultimately including 13 studies from ten countries. For neonates, the pooled prevalence was 4.8% (95%CI: 1.1% to 10.5%) with the highest rates observed in South-East Asia (10.5%; 95%CI: 2.4% to 23.3%). Among HCWs, a single Indian study reported a 3.3% prevalence. Environmental samples showed a prevalence of 2.3% (95%CI: 0% to 9.3%), with the highest rates in South-East Asia (10%; 95%CI: 4.2% to 17.7%). Significant heterogeneity was found across studies, and no publication bias was detected.
CONCLUSION This systematic review highlights a significant prevalence of CRAB colonization in neonates across various regions, particularly in South-East Asia, contrasting with lower rates in high-income countries. The study reveals a gap in research on HCWs colonization, with only a single study from India reporting moderate prevalence. Environmental samples indicate moderate levels of CRAB contamination, again higher in South-East Asia. These findings underscore the need for more extensive and focused research on CRAB colonization in NICUs, including exploring the roles of HCWs and the environment in transmission, understanding antimicrobial resistance patterns, and developing effective prevention measures.
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Affiliation(s)
- Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Nene Kaah Keneh
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | - Hortense Kamga Gonsu
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Roland Ndip Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala 00237, Cameroon
| | - Nicholas Tendongfor
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | - Lucy Mande Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Jacky Njiki Bikoï
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
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Styczynski A, Amin MB, Hoque KI, Parveen S, Md Pervez AF, Zeba D, Akhter A, Pitchik H, Islam MA, Hossain MI, Saha SR, Gurley ES, Luby S. Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant Gram-negative bacteria: a hospital-based cohort study. Antimicrob Resist Infect Control 2024; 13:13. [PMID: 38281974 PMCID: PMC10823664 DOI: 10.1186/s13756-024-01366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery. METHODS We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization. RESULTS We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10-1.40; CRB 2.46, 95% CI 1.39-4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08-1.59; newborn ESBL-PB 1.34, 95% CI 1.09-1.64; newborn CRB 1.73, 95% CI 1.20-2.47). CONCLUSIONS In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.
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Affiliation(s)
- Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA.
| | - Mohammed Badrul Amin
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Kazi Injamamul Hoque
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahana Parveen
- Programme on Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Abu Faisal Md Pervez
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Dilruba Zeba
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Akhi Akhter
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Helen Pitchik
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Muhammed Iqbal Hossain
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sumita Rani Saha
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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Morhart P, Gerlach RG, Kunz C, Held J, Valenza G, Wölfle J, Reutter H, Hanslik GJ, Fahlbusch FB. Application of Next-Generation Sequencing to Enterobacter Hormaechei Subspecies Analysis during a Neonatal Intensive Care Unit Outbreak. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1696. [PMID: 37892359 PMCID: PMC10605273 DOI: 10.3390/children10101696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION The Enterobacter cloacae complex (ECC) species are potential neonatal pathogens, and ECC strains are among the most commonly encountered Enterobacter spp. associated with nosocomial bloodstream infections. Outbreaks caused by ECC can lead to significant morbidity and mortality in susceptible neonates. At the molecular level, ECC exhibits genomic heterogeneity, with six closely related species and subspecies. Genetic variability poses a challenge in accurately identifying outbreaks by determining the clonality of ECC isolates. This difficulty is further compounded by the limitations of the commonly used molecular typing methods, such as pulsed field gel electrophoresis, which do not provide reliable accuracy in distinguishing between ECC strains and can lead to incorrect conclusions. Next-generation sequencing (NGS) offers superior resolution in determining strain relatedness. Therefore, we investigated the clinical pertinence of incorporating NGS into existing bundle measures to enhance patient management during an outbreak of ECC in a level-3 neonatal intensive care unit (NICU) in Germany. METHODS As the standard of care, all neonates on the NICU received weekly microbiological swabs (nasopharyngeal and rectal) and analysis of endotracheal secretion, where feasible. During the 2.5-month outbreak, colonisation with ECC was detected in n = 10 neonates. The phylogenetic relationship and potential antimicrobial resistance genes as well as mobile genetic elements were identified via bacterial whole-genome sequencing (WGS) using Illumina MiSeq followed by in silico data analysis. RESULTS Although all ECC isolates exhibited almost identical antimicrobial susceptibility patterns, the WGS data revealed the involvement of four different ECC clones. The isolates could be characterised as Enterobacter hormaechei subspecies steigerwaltii (n = 6, clonal), subsp. hoffmannii (n = 3, two clones) and subsp. oharae (n = 1). Despite the collection of environmental samples, no source of this diffuse outbreak could be identified. A new standardised operating procedure was implemented to enhance the management of neonates colonised with MRGN. This collaborative approach involved both parents and medical professionals and successfully prevented further transmission of ECC. CONCLUSIONS Initially, it was believed that the NICU outbreak was caused by a single ECC clone due to the similarity in antibiotic resistance. However, our findings show that antibiotic susceptibility patterns can be misleading in investigating outbreaks of multi-drug-resistant ECC. In contrast, bacterial WGS accurately identified ECC at the clonal level, which significantly helped to delineate the nature of the observed outbreak.
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Affiliation(s)
- Patrick Morhart
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Roman G. Gerlach
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Caroline Kunz
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Jürgen Held
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Giuseppe Valenza
- Institute of Microbiology—Clinical Microbiology, Immunology and Hygiene, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany (C.K.); (J.H.); (G.V.)
| | - Joachim Wölfle
- Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Heiko Reutter
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Gregor J. Hanslik
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics and Adolescent Medicine, Friedrich-Alexander-University of Erlangen-Nürnberg, 91054 Erlangen, Germany; (P.M.); (H.R.); (G.J.H.)
| | - Fabian B. Fahlbusch
- Neonatology and Pediatric Intensive Care, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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Liang R, Chen Z, Yang S, Yang J, Wang Z, Lin X, Xu F. A diagnostic model based on routine blood examination for serious bacterial infections in neonates-a cross-sectional study. Epidemiol Infect 2023; 151:e137. [PMID: 37519228 PMCID: PMC10540195 DOI: 10.1017/s0950268823001231] [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: 04/20/2022] [Revised: 06/26/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023] Open
Abstract
Routine blood examination is an easy way to examine infectious diseases. This study is aimed to develop a model to diagnose serious bacterial infections (SBI) in ICU neonates based on routine blood parameters. This was a cross-sectional study, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). SBI was defined as suffering from one of the following: pyelonephritis, bacteraemia, bacterial meningitis, sepsis, pneumonia, cellulitis, and osteomyelitis. Variables with statistical significance in the univariate logistic regression analysis and log systemic immune-inflammatory index (SII) were used to develop the model. The area under the curve (AUC) was calculated to assess the performance of the model. A total of 1,880 participants were finally included for analysis. Weight, haemoglobin, mean corpuscular volume, white blood cell, monocyte, premature delivery, and log SII were selected to develop the model. The developed model showed a good performance to diagnose SBI for ICU neonates, with an AUC of 0.812 (95% confidence interval (CI): 0.737-0.888). A nomogram was developed to make this model visualise. In conclusion, our model based on routine blood parameters performed well in the diagnosis of neonatal SBI, which may be helpful for clinicians to improve treatment recommendations.
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Affiliation(s)
- Runqiang Liang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Ziyu Chen
- Department of Respiratory Medicine, Foshan Sanshui District People’s Hospital, Foshan, China
| | - Shumei Yang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Jie Yang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Zhu Wang
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
| | - Xin Lin
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Fang Xu
- National Key Clinical Specialty Construction Project/Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou, China
- Guangdong Neonatal ICU Medical Quality Control Center, Guangzhou, China
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Evaluating the Use of Neonatal Colonization Screening for Empiric Antibiotic Therapy of Sepsis and Pneumonia. Antibiotics (Basel) 2023; 12:antibiotics12020189. [PMID: 36830099 PMCID: PMC9952289 DOI: 10.3390/antibiotics12020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
(1) Background: Since 2013, weekly screening for multidrug-resistant Gram-negative (MDRGN) bacteria has been performed in German neonatal intensive care units (NICU). National guidelines recommend considering these colonization analyses for antibiotic treatment regimens. Our retrospective single center study provides insight into the clinical dichotomy of bacterial colonization and infection rates in neonates. (2) Methods: We analyzed microbiological data of neonates admitted to our tertiary level NICU over nine years. Colonization with MDRGN/Serratia marcescens (SERMA) was compared to microbiological findings in sepsis and pneumonia. (3) Results: We analyzed 917 blood and 1799 tracheal aspirate samples. After applying criteria from the Nosocomial Infection Surveillance for Neonates (NEO-KISS), we included 52 and 55 cases of sepsis and pneumonia, respectively; 19.2% of sepsis patients and 34.5% of pneumonia patients had a prior colonization with MDRGN bacteria or SERMA. In these patients, sepsis was not attributable to MDRGN bacteria yet one SERMA, while in pneumonias, ten MDRGN bacteria and one SERMA were identified. We identified late-onset pneumonia and cesarean section as risk factors for MDRGN/SERMA acquisition. (4) Conclusions: Colonization screening is a useful tool for hygiene surveillance. However, our data suggest that consideration of colonization with MDRGN/SERMA might promote extensive use of last resort antibiotics in neonates.
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Yuan W, Xu J, Guo L, Chen Y, Gu J, Zhang H, Yang C, Yang Q, Deng S, Zhang L, Deng Q, Wang Z, Ling B, Deng D. Clinical Risk Factors and Microbiological and Intestinal Characteristics of Carbapenemase-Producing Enterobacteriaceae Colonization and Subsequent Infection. Microbiol Spectr 2022; 10:e0190621. [PMID: 36445086 PMCID: PMC9769896 DOI: 10.1128/spectrum.01906-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
Gastrointestinal colonization with carbapenem-resistant Enterobacteriaceae (CRE) is always a prerequisite for the development of translocated infections. Here, we sought to screen for fecal carriage of CRE and identify the risk factors for CRE colonization as well as subsequent translocated pneumonia in critically ill patients admitted to the intensive care unit (ICU) of a university hospital in China. We further focused on the intestinal flora composition and fecal metabolic profiles in CRE rectal colonization and translocated infection patients. Animal models of gastrointestinal colonization with a carbapenemase-producing Klebsiella pneumoniae (carbapenem-resistant K. pneumoniae [CRKP]) clinical isolate expressing green fluorescent protein (GFP) were established, and systemic infection was subsequently traced using an in vivo imaging system (IVIS). The intestinal barrier, inflammatory factors, and infiltrating immune cells were further investigated. In this study, we screened 54 patients hospitalized in the ICU with CRE rectal colonization, and 50% of the colonized patients developed CRE-associated pneumonia, in line with the significantly high mortality rate. Upon multivariate analysis, risk factors associated with subsequent pneumonia caused by CRE in patients with fecal colonization included enteral feeding and carbapenem exposure. Furthermore, CRKP colonization and translocated infection influenced the diversity and community composition of the intestinal microbiome. Downregulated propionate and butyrate probably play important and multiangle roles in regulating immune cell infiltration, inflammatory factor expression, and mucus and intestinal epithelial barrier integrity. Although the risk factors and intestinal biomarkers for subsequent infections among CRE-colonized patients were explored, further work is needed to elucidate the complicated mechanisms. IMPORTANCE Carbapenem-resistant Enterobacteriaceae have emerged as a major threat to modern medicine, and the spread of carbapenem-resistant Enterobacteriaceae is a clinical and public health problem. Gastrointestinal colonization by potential pathogens is always a prerequisite for the development of translocated infections, and there is a growing need to assess clinical risk factors and microbiological and intestinal characteristics to prevent the development of clinical infection by carbapenem-resistant Enterobacteriaceae.
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Affiliation(s)
- Wenli Yuan
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Jiali Xu
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Dali University, Dali, Yunnan Province, China
| | - Lin Guo
- Intensive Care Union, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Yonghong Chen
- State Key Laboratory for Conservation and Utilization of Bio-Resources, Key Laboratory for Microbial Resources of the Ministry of Education, School of Life Sciences, Yunnan University, Kunming, Yunnan Province, China
| | - Jinyi Gu
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Huan Zhang
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Chenghang Yang
- Intensive Care Union, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Qiuping Yang
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Shuwen Deng
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Longlong Zhang
- State Key Laboratory for Conservation and Utilization of Bio-Resources, Key Laboratory for Microbial Resources of the Ministry of Education, School of Life Sciences, Yunnan University, Kunming, Yunnan Province, China
| | - Qiongfang Deng
- Intensive Care Union, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Zi Wang
- Department of Clinical Pharmacy, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Bin Ling
- Intensive Care Union, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
| | - Deyao Deng
- Department of Clinical Laboratory, The Affiliated Hospital of Yunnan University (The Second Hospital of Yunnan Province), Kunming, Yunnan Province, China
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Bubser C, Liese J, Serna-Higuita LM, Müller A, Vochem M, Arand J, Karck U, Gross M, Poets CF, Härtel C, Zemlin M, Gille C, Köstlin-Gille N. Impact of early antibiotic exposure on the risk of colonization with potential pathogens in very preterm infants: a retrospective cohort analysis. Antimicrob Resist Infect Control 2022; 11:72. [PMID: 35590392 PMCID: PMC9118610 DOI: 10.1186/s13756-022-01110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sepsis is one of the most important complications in preterm infants. For this reason, most preterm infants receive antibiotics during their first postnatal week. Since 2013, a weekly colonization screening has been installed in German neonatal intensive care units (NICUs), including multi-drug resistant organisms (MDRO) and pathogens with increased epidemic potential. We here investigated the impact of early antibiotic exposure on the colonization with these pathogens.
Methods
Data from 1407 preterm infants with gestational age < 32 + 0 weeks and born in three NICUs in Germany between January 2014 and December 2019 were analysed.
Results
Antibiotics were administered to 911/1407 (64.7%) participating infants during their first postnatal week. Screening-targeted pathogens were detected in 547/1407 (38.9%). Early antibiotic exposure did not increase the risk of colonization with screening-targeted pathogens. The only independent risk factor for colonisation with potential pathogens was the admitting hospital. Interestingly, longer antibiotic therapy (> 7 days) decreased the risk for acquiring pathogens with increased epidemic potential.
Conclusion
Early antibiotic exposure did not impact the risk for colonization with MDRO or highly epidemic pathogens in preterm infants. Further studies are needed to identify risk factors for the acquisition of MDRO and highly epidemic pathogens and potential associations with long-term outcome.
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Böhne C, Knegendorf L, Schwab F, Ebadi E, Bange FC, Vital M, Schlüter D, Hansen G, Pirr S, Peter C, Bohnhorst B, Baier C. Epidemiology and infection control of Methicillin-resistant Staphylococcus aureus in a German tertiary neonatal intensive and intermediate care unit: A retrospective study (2013-2020). PLoS One 2022; 17:e0275087. [PMID: 36129948 PMCID: PMC9491611 DOI: 10.1371/journal.pone.0275087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/10/2022] [Indexed: 11/25/2022] Open
Abstract
In preterm and term infants who require intermediate or intensive care Methicillin-resistant Staphylococcus aureus (MRSA) infection can lead to significant morbidity. In this study MRSA colonization and infection were assessed in a mixed tertiary neonatal intensive and intermediate care unit in Germany over an 8-year period (2013-2020). We investigated patient-related factors, associated with nosocomial MRSA acquisition, and we discuss our infection control concept for MRSA. Of 3488 patients treated during the study period, 24 were MRSA positive patients, corresponding to 26 patient hospital stays. The incidence was 0.7 MRSA patients per 100 patients. The incidence density was 0.4 MRSA patient hospital stays per 1000 patient days. Twelve patients (50%) acquired MRSA in the hospital. One patient developed a hospital acquired MRSA bloodstream infection 9 days after birth (i.e., 0.03% of all patients on the ward during the study period). A total of 122 patients had to be screened to detect one MRSA positive patient. In a logistic regression model, the use of 3rd generation intravenous cephalosporin (cefotaxim) was associated with nosocomial MRSA acquisition compared with matched control patients who did not acquire MRSA. In sum, the burden of MRSA colonization and infection in the ward was low during the study period. A comprehensive infection control concept that included microbiologic colonization screening, prospective infection surveillance together with isolation and emphasis on basic hygiene measures is essential to handle MRSA in this specialized setting.
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Affiliation(s)
- Carolin Böhne
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Leonard Knegendorf
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine, Berlin, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Franz-Christoph Bange
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Marius Vital
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Dirk Schlüter
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Gesine Hansen
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Sabine Pirr
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Corinna Peter
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Bettina Bohnhorst
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
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10
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Alriyami A, Kiger JR, Hooven TA. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit. Neoreviews 2022; 23:e448-e461. [PMID: 35773508 DOI: 10.1542/neo.23-7-e448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
See Bonus NeoBriefs videos and downloadable teaching slides Intubated infants in the NICU are at risk of developing ventilator-associated pneumonia (VAP), a common type of health care-associated infection. The Centers for Disease Control and Prevention developed guidelines for diagnosing VAP in patients younger than 1 year, which include worsening gas exchange, radiographic findings, and at least 3 defined clinical signs of pneumonia. VAP in infants is treated with empiric antibiotics selected based on local resistance patterns and individualized patient data. Many NICUs have implemented prevention bundles in an effort to decrease VAP by ensuring the cleanest environment for intubated neonates (hand hygiene, sterile handling of equipment), positioning of infants to prevent gastric reflux, and constantly reevaluating for extubation readiness. Although these prevention bundle elements are intuitive and generally low risk, none are based on strong research support. This article reviews the epidemiology, pathogenesis, diagnosis, treatment, and prevention of VAP in NICU patients, focusing on recent evidence, highlighting areas of emerging research, and identifying persistent knowledge gaps.
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Affiliation(s)
- Ayesha Alriyami
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - James R Kiger
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas A Hooven
- Division of Newborn Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Richard King Mellon Institute for Pediatric Research, Pittsburgh, PA
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11
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Baier-Grabner S, Equiluz-Bruck S, Endress D, Blaschitz M, Schubert S, Indra A, Fudel M, Frischer T, Götzinger F. A Yersiniabactin-producing Klebsiella aerogenes Strain Causing an Outbreak in an Austrian Neonatal Intensive Care Unit. Pediatr Infect Dis J 2022; 41:593-599. [PMID: 35421055 DOI: 10.1097/inf.0000000000003553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Yersiniabactin, a siderophore with a high affinity to iron, has been described as a potential virulence factor in Enterobacteriaceae. Klebsiella aerogenes is a Gram-negative rod known to cause invasive infection in very low birth weight infants but is an unusual pathogen to cause outbreaks in neonatal intensive care units (NICU). METHODS We performed a retrospective analysis of all patients colonized with K. aerogenes in our NICU from September to December 2018. Each infant with an occurrence of K. aerogenes in any microbiological culture was defined as a case. Clinical data were taken from medical charts. K. aerogenes isolates were genotyped using whole-genome sequencing combined with core genome multilocus sequencing type analysis. Yersiniabactin production was evaluated by luciferase assay. RESULTS In total 16 patients were colonized with K. aerogenes over the 3-month period and 13 patients remained asymptomatic or developed late-onset neonatal sepsis from another pathogen. Three patients developed necrotizing enterocolitis, 2 complicated by sepsis and 1 of them died. All symptomatic patients were premature infants with low birth weight. Genetic sequencing confirmed an outbreak with the same strain, all samples expressed the high-pathogenicity island, necessary for the production of yersiniabactin. Six exemplary cases were proven to produce yersiniabactin in vitro. CONCLUSION This is the first report of an outbreak of a yersiniabactin-producing K. aerogenes strain causing invasive infection in preterm infants. We hypothesize that, due to improved iron uptake, this strain was associated with higher virulence than non-yersiniabactin-producing strains. Extended search for virulence factors and genetic sequencing could be pivotal in the management of NICU outbreaks in the future.
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Affiliation(s)
| | | | - David Endress
- From the Department of Pediatrics and Adolescent Medicine
| | | | - Sören Schubert
- Max von Pettenkofer-Institute, Faculty of Medicine, LMU Munich, Germany
| | - Alexander Indra
- Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Marta Fudel
- Department of Hospital Hygiene, Klinik Ottakring, Vienna, Austria
| | - Thomas Frischer
- Sigmund Freud Private University, Sigmund Freud Platz 3, Vienna, Austria
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12
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Pereira AL, de Oliveira PM, Faria-Junior C, Alves EG, de Castro E Caldo Lima GR, da Costa Lamounier TA, Haddad R, de Araújo WN. Environmental spreading of clinically relevant carbapenem-resistant gram-negative bacilli: the occurrence of bla KPC-or-NDM strains relates to local hospital activities. BMC Microbiol 2022; 22:6. [PMID: 34979901 PMCID: PMC8725513 DOI: 10.1186/s12866-021-02400-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022] Open
Abstract
Background Aquatic matrices impacted by sewage may shelter carbapenem-resistant (CR) Gram-negative bacilli (GNB) harboring resistance genes of public health concern. In this study, sewage treatment plants (STPs) servicing well-defined catchment areas were surveyed for the presence of CR-GNB bearing carbapenemase genes (blaKPC or blaNDM). Results A total of 325 CR-GNB were recovered from raw (RS) and treated (TS) sewage samples as well as from water body spots upstream (UW) and downstream (DW) from STPs. Klebsiella-Enterobacter (KE) group amounted to 116 isolates (35.7%). CR-KE isolates were recovered from TS, DW (35.7%) and RS samples (44.2%) (p = 0.001); but not from UW samples. KE isolates represented 65.8% of all blaKPC or blaNDM positive strains. The frequency of blaKPC-or-NDM strains was positively associated with the occurrence of district hospitals located near STPs, as well as with the number of hospitalizations and of sewer connections serviced by the STPs. blaKPC-or-NDM strains were recovered from ST samples in 7 out of 14 STPs, including four tertiary-level STPs; and from 6 out of 13 DW spots whose RS samples also had blaKPC-or-NDM strains. Conclusions Clinically relevant GNB bearing blaKPC-or-NDM resist sewage treatments and spread into environmental aquatic matrices mainly from STPs impacted by hospital activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02400-1.
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Affiliation(s)
- Alex Leite Pereira
- Campus of Ceilândia, University of Brasília. Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília, DF, CEP: 72220-275, Brazil.
| | - Pâmela Maria de Oliveira
- Campus of Ceilândia, University of Brasília. Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília, DF, CEP: 72220-275, Brazil
| | - Célio Faria-Junior
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília, DF, CEP: 70830-010, Brazil
| | - Everton Giovanni Alves
- Central Laboratory for Public Health (LACEN-DF), SGAN 601, Asa Norte, Brasília, DF, CEP: 70830-010, Brazil
| | | | - Thaís Alves da Costa Lamounier
- Campus of Ceilândia, University of Brasília. Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília, DF, CEP: 72220-275, Brazil
| | - Rodrigo Haddad
- Campus of Ceilândia, University of Brasília. Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília, DF, CEP: 72220-275, Brazil
| | - Wildo Navegantes de Araújo
- Campus of Ceilândia, University of Brasília. Centro Metropolitano, Conjunto A, Ceilândia Sul, Brasília, DF, CEP: 72220-275, Brazil
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13
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Greimel TM, Stampfer L, Leitner E, Kienesberger S, Zechner EL, Bozic M, Wagner GE, Unterhauser K, Kitsera M, Hauer AC, Gorkiewicz G, Wurm P, Valitutti F, Högenauer C, Hoffmann KM. Toxin-Producing Klebsiella oxytoca in Healthy Infants: Commensal or Pathobiont? J Pediatr Gastroenterol Nutr 2022; 74:e1-e7. [PMID: 34520403 DOI: 10.1097/mpg.0000000000003299] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Klebsiella oxytoca is a gastrointestinal pathobiont with the potential to produce the toxins tilivalline and tilimycin, which cause antibiotic-associated hemorrhagic colitis. Overgrowth of toxigenic K oxytoca has recently been implicated in necrotizing enterocolitis. K oxytoca colonizes 2-9% of healthy adults, however, there is no systematic data on colonization in healthy children. We investigated K oxytoca colonization and its toxigenic properties in healthy infants. METHODS We sampled stool of healthy infants and determined K oxytoca colonization using stool culture and PCR (pehX). Toxin in stool was measured with HPLC/high-resolution mass spectrometry. K oxytoca isolates were typed using multi-locus sequence typing (MLST) and K oxytoca toxin PCR (npsA/B). Cytotoxin production of isolates was analyzed by MTT assay. RESULTS K oxytoca was detected in 30 of 61 infants (49%) using stool culture and in 45 of 61 (73%) using PCR (pehX). Toxin marker PCR (npsA/B) was positive in 66% of stool samples positive for K oxytoca PCR. Stool toxin levels were too low for quantitation but traces of tilivalline were detected. Contrarily, 49% of K oxytoca isolates demonstrated toxicity in the MTT assay. MLST revealed 36 distinct sequence types affiliated with all known K oxytoca sequence type clusters (A, B1 and B2). CONCLUSIONS More than 70% of healthy infants were colonized with K oxytoca. Toxin quantities in stool of colonized healthy infants were below detection level, yet half of the isolates produced toxin in vitro demonstrating their pathobiont potential. The high occurrence of toxigenic K oxytoca in healthy infants has to be considered for future disease association studies.
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Affiliation(s)
- Theresa M Greimel
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine
| | - Laura Stampfer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine
| | - Eva Leitner
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz
| | - Sabine Kienesberger
- Institute of Molecular Biosciences, University of Graz
- BioTechMed-Graz
- Field of Excellence BioHealth - University of Graz, Graz
| | - Ellen L Zechner
- Institute of Molecular Biosciences, University of Graz
- BioTechMed-Graz
- Field of Excellence BioHealth - University of Graz, Graz
| | - Michael Bozic
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz
| | - Gabriel E Wagner
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz
| | | | | | - Almuthe C Hauer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine
| | - Gregor Gorkiewicz
- Institute of Pathology, Medical University of Graz, Austria
- BioTechMed-Graz
| | - Philipp Wurm
- Institute of Pathology, Medical University of Graz, Austria
| | | | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz
- BioTechMed-Graz
| | - Karl Martin Hoffmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine
- Kinderärzte Zentrum Graz-Raaba, Raaba-Grambach, Austria
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14
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Milic M, Siljic M, Cirkovic V, Jovicevic M, Perovic V, Markovic M, Martic J, Stanojevic M, Mijac V. Colonization with Multidrug-Resistant Bacteria in the First Week of Life among Hospitalized Preterm Neonates in Serbia: Risk Factors and Outcomes. Microorganisms 2021; 9:microorganisms9122613. [PMID: 34946217 PMCID: PMC8709168 DOI: 10.3390/microorganisms9122613] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this prospective cohort study was to determine the prevalence of gut colonization with multidrug-resistant (MDR) bacteria, risk factors for colonization, infection risk, and outcomes among preterm neonates hospitalized at a tertiary-care center in Serbia. During the period from December 2017 to April 2018, 103 neonates were screened for rectal carriage at admission and on the seventh day of life. Characterization of MDR strains was done by conventional microbiology and molecular methods. Out of 61 (59.2%) colonized neonates, 12 (11.6%) were found colonized at admission, while 49 (47.6%) became colonized at the study site. Among a total of 72 MDR isolates, extended-spectrum beta-lactamase (ESBL)-producing enterobacteria prevailed (56/72, 77%), followed by Acinetobacter baumannii (14/72, 19%). The majority of ESBL-producing strains carried multiple genes (blaTEM/blaCTX-M-15 or blaTEM/blaSHV). Longer previous hospitalization and delivery by cesarean section were associated with MDR colonization, while mechanical ventilation was a risk factor for colonization at the study site. Infections due to MDR bacteria were more frequent among colonized than non-colonized neonates, but not significantly, and mortality was low (1%) in the studied neonates. These results indicate that hospitalized preterm neonates in Serbia are rapidly colonized with a diversity of MDR species and resistance phenotypes/genotypes.
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Affiliation(s)
- Marija Milic
- Department of Neonatal Intensive Care, Institute of Neonatology, Kralja Milutina 50, 11000 Belgrade, Serbia;
| | - Marina Siljic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
| | - Valentina Cirkovic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
| | - Milos Jovicevic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
| | - Vladimir Perovic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
| | - Milos Markovic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
- Correspondence: (M.M.); (V.M.)
| | - Jelena Martic
- Department of Neonatology, Institute for Mother and Child Health Care of Serbia “Dr Vukan Cupic”, Faculty of Medicine, University of Belgrade, Radoja Dakica 6, 11070 Belgrade, Serbia;
| | - Maja Stanojevic
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
| | - Vera Mijac
- Department of Bacteriology, Virology and Immunology, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia; (M.S.); (V.C.); (M.J.); (V.P.); (M.S.)
- Correspondence: (M.M.); (V.M.)
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Klebsiella oxytoca Complex: Update on Taxonomy, Antimicrobial Resistance, and Virulence. Clin Microbiol Rev 2021; 35:e0000621. [PMID: 34851134 DOI: 10.1128/cmr.00006-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Klebsiella oxytoca is actually a complex of nine species-Klebsiella grimontii, Klebsiella huaxiensis, Klebsiella michiganensis, K. oxytoca, Klebsiella pasteurii, Klebsiella spallanzanii, and three unnamed novel species. Phenotypic tests can assign isolates to the complex, but precise species identification requires genome-based analysis. The K. oxytoca complex is a human commensal but also an opportunistic pathogen causing various infections, such as antibiotic-associated hemorrhagic colitis (AAHC), urinary tract infection, and bacteremia, and has caused outbreaks. Production of the cytotoxins tilivalline and tilimycin lead to AAHC, while many virulence factors seen in Klebsiella pneumoniae, such as capsular polysaccharides and fimbriae, have been found in the complex; however, their association with pathogenicity remains unclear. Among the 5,724 K. oxytoca clinical isolates in the SENTRY surveillance system, the rates of nonsusceptibility to carbapenems, ceftriaxone, ciprofloxacin, colistin, and tigecycline were 1.8%, 12.5%, 7.1%, 0.8%, and 0.1%, respectively. Resistance to carbapenems is increasing alarmingly. In addition to the intrinsic blaOXY, many genes encoding β-lactamases with varying spectra of hydrolysis, including extended-spectrum β-lactamases, such as a few CTX-M variants and several TEM and SHV variants, have been found. blaKPC-2 is the most common carbapenemase gene found in the complex and is mainly seen on IncN or IncF plasmids. Due to the ability to acquire antimicrobial resistance and the carriage of multiple virulence genes, the K. oxytoca complex has the potential to become a major threat to human health.
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Brinkwirth S, Ayobami O, Eckmanns T, Markwart R. Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020. Euro Surveill 2021; 26:2001628. [PMID: 34763754 PMCID: PMC8646982 DOI: 10.2807/1560-7917.es.2021.26.45.2001628] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/17/2021] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcusspp. (VRE), are of rising concern.AimWe summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region.MethodsWe searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates.ResultsWe included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7-13.4; range: 6.1-17.5) and 1.1% (95% CI: 0.21-2.7; range: 0.39-2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76-19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3-13.5; range: 0.39-36.0) and 2.6 (95% CI: 0.53-5.8; range: 0-9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5-16.3; range: 2.6-11.5). In ICU, this proportion was 11.5% (95% CI: 4.7-20.1; range: 0-40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7-28.9; range: 14.3-32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0-57.3; range: 14.3-41.3).ConclusionsInfections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.
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Affiliation(s)
- Simon Brinkwirth
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Olaniyi Ayobami
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
| | - Robby Markwart
- Unit 37: Nosocomial Infections, Surveillance of Antimicrobial Resistance and Consumption, Robert Koch Institute, Berlin, Germany
- Jena University Hospital, Institute of General Practice and Family Medicine, Jena, Germany
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Sofijanova A, Bojadzieva S, Naunova- Timovska S, Mandzukovska H, Shuperliska E, Jordanova O. Relationship of serum procalcitonin levels and c-reactive protein levels in newborns with sepsis in different types of respiratory support in intensive care unit. Arch Public Health 2021. [DOI: 10.3889/aph.2021.5995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia and proven sepsis, p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.
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18
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Matok LA, Azrad M, Leshem T, Abuzahya A, Khamaisi T, Smolkin T, Peretz A. Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study. Microorganisms 2021; 9:microorganisms9061245. [PMID: 34201210 PMCID: PMC8229721 DOI: 10.3390/microorganisms9061245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023] Open
Abstract
We evaluated carriage rates of extended spectrum β-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants' medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates' antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.
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Affiliation(s)
| | - Maya Azrad
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel;
- Correspondence: (M.A.); (A.P.); Tel.: +972-4-665-2322 (M.A.)
| | - Tamar Leshem
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel;
| | - Anan Abuzahya
- Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel; (A.A.); (T.K.)
| | - Thanaa Khamaisi
- Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel; (A.A.); (T.K.)
| | - Tatiana Smolkin
- Department of Neonatology and Neonatal Intensive Care Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1311502, Israel;
| | - Avi Peretz
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel;
- Correspondence: (M.A.); (A.P.); Tel.: +972-4-665-2322 (M.A.)
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Schöndorf D, Simon A, Wagenpfeil G, Gärtner B, Geipel M, Zemlin M, Schöndorf M, Meyer S. Colonization Screening Targeting Multidrug-Resistant Gram-Negative Pathogens Does Not Increase the Use of Carbapenems in Very Low Birth Weight Infants. Front Pediatr 2020; 8:427. [PMID: 32850541 PMCID: PMC7423965 DOI: 10.3389/fped.2020.00427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/19/2020] [Indexed: 01/17/2023] Open
Abstract
Since 2012, a colonization screening (CoS) for multidrug-resistant Gram-negative bacteria (MRGN) in very low birth weight infants (VLWBI) was implemented in order to provide a basis for an effective empiric therapy of subsequent nosocomial infections (NI). According to antibiotic stewardship, carbapenems should be reserved for NI caused by MRGN or severe NI. We examined whether the CoS increased the first-line use of carbapenems. In this retrospective cohort analysis, we enrolled all VLBWI before (2009-2011) and after (2012-2014) the introduction of CoS (2012) at a tertiary university neonatal intensive care and neonatal intermediate care unit (NIMC) in Germany. Rectal swabs were used to detect MRGN colonization (on admission and weekly until discharge from the NIMC). The use of carbapenems was measured by days of therapy (DoT). To exclude the replacement of carbapenems by other antibiotics, antibiotic therapy for late-onset sepsis (LOS) was assessed by DoT and length of therapy (LoT). In 55/201 (27.4%) VLBWI, CoS detected MRGN colonization. Compared to the cohort prior to the introduction of CoS (n = 191), a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) was seen (n = 201). This was due to a significant decrease in LoT (p < 0.001) and total DoT (p < 0.001) in the birth weight category of 1,000-1,499 g. In these infants, DoT for carbapenems (p = 0.009) was significantly lower, possibly caused by a significant decline of LOS (25 episodes vs. 39 episodes, p = 0.025). Conversely, no significant differences in LoT and total DoT were seen in infants with a birth weight <500 g (p = 1.000; p = 0.758) and in infants weighing 500-999 g (p = 0.754; p = 0.794). DoT for carbapenems was not significantly different in the total cohort after the introduction of CoS (p = 0.341). Prolonged exposure to carbapenems (in terms of DoT) significantly postponed the first detection of MRGN colonization (p = 0.023). The introduction of CoS did not result in an increased use of carbapenems. Concomitant carbapenem treatment may reduce the sensitivity of CoS relying on rectal swabs.
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Affiliation(s)
- Dominik Schöndorf
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Hospital of Saarland, Homburg, Germany
| | - Gudrun Wagenpfeil
- Theoretical Medicine, Institute for Medical Biometrics, Epidemiology and Medical Computer Sciences, University Hospital of Saarland, Homburg, Germany
| | - Barbara Gärtner
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, University Hospital of Saarland, Homburg, Germany
| | - Martina Geipel
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Michael Zemlin
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Marika Schöndorf
- Pediatric Oncology and Hematology, University Hospital of Saarland, Homburg, Germany
| | - Sascha Meyer
- General Pediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
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