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The Magnitude of Carbapenemase and ESBL Producing Enterobacteriaceae Isolates from Patients with Urinary Tract Infections at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1369:117-128. [PMID: 34914083 DOI: 10.1007/5584_2021_687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The emergence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), and carbapenemase-producing Enterobacteriaceae (CPE) is a public health concern. Therefore, this study aimed to determine the magnitude of carbapenemase and ESBL producing bacteria isolated from patients affected by Urinary Tract Infection (UTI). METHODS A cross-sectional study was conducted from December 2018 to March 2019 at Tikur Anbessa Specialized Hospital. A total of 120 Enterobacteriaceae isolates from UTI patients were collected and identified on species level using standard microbiological methods. Antimicrobial susceptibility test was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Detection of ESBL production was carried out by using ESBL ChromoSelect Agar medium and the combined disk diffusion. Production of carbapenemase was determined by using Hodge-test and modified carbapenem inactivation method as described in CLSI guidelines. RESULTS Out of the total 120 Enterobacteriaceae isolates, 74 (61.7%) were ESBL-producers, and 8 (6.7%) were carbapenemase producers. The most common ESBL producing isolate was E.coli 38 (51.4%) and the most common carbapenemase-producing isolate was K.pneumoniae five (62.5%). Most of the ESBL and carbapenemase-producing isolates were recovered from hospitalized patients 46 (62.2%) and 7 (87.5%) respectively. The rate of ESBL and CPE production was observed high among patients taking antibiotics 64.8% (59/91) and 7.7% (7/91) respectively, but no significant association was observed p > 0.05. Furthermore, about 1.7% (2/120) isolates were found both ESBL and carbapenemase producers. Significant resistances rates were observed in ESBL and CPE isolates. CONCLUSION Enterobacteriaceae isolates showed a significantly higher rate of ESBL production. A significant figure of carbapenemase production was observed among Enterobacteriaceae isolates causing UTI. The production of ESBL and CPE enhanced for an increased rate of MDR patterns. Efforts need to be made to introduce a system for tracking and detecting ESBL-PE and CPE-producing bacteria in hospitals, and monitoring dissemination of ESBL and CPE-producing Enterobacteriaceae is strongly recommended.
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Diriba K, Awulachew E, Gemede A, Anja A. The magnitude of extended-spectrum beta-lactamase- producing Enterobacteriaceae from clinical samples in Ethiopia: a systematic review and meta-analysis. Access Microbiol 2021; 3:000195. [PMID: 34151151 PMCID: PMC8209701 DOI: 10.1099/acmi.0.000195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The rapid spread of resistance among extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is a serious problem around the world. It results in serious clinical complications in humans and has become a global threat. Therefore, this systematic review and meta-analysis was aimed to estimate the pooled prevalence of ESBL-producing Enterobacteriaceae in different clinical samples in Ethiopia. METHODS A systematic search was conducted on PubMed, Web of Science, Embase, Google Scholar and the Cochrane Library. All identified observational studies reporting the prevalence of ESBL-producing Enterobacteriaceae from clinical samples in Ethiopia were included. Four authors independently extracted data and analysed using R software version 3.6.1 and STATA statistical software version 13. A random-effects model was computed to estimate the pooled prevalence of ESBL-producing Enterobacteriaceae in Ethiopia. RESULTS Of 142 articles reviewed, 14 studies that fulfilled the inclusion criteria were included in the meta-analysis. The pooled prevalence of ESBL-producing Enterobacteriaceae in the different clinical specimens in Ethiopia was 49 % (95 % CI: 39, 60). Klebsiella pneumoniae was the leading ESBL-producing Enterobacteriaceae followed by Escherichia coli and Acinetobacter baumannii with a prevalence of 74, 67 and 60 %, respectively. ESBL-producing isolates showed a high rate of resistance to cefotaxime, ceftriaxone, ceftazidime, Amoxicillin clavulanic acid (AMC), ampicillin and aztreonam. The better options for the treatment of ESBL-producing Enterobacteriaceae are amikacin and Imipenem. CONCLUSION The magnitude of ESBL-producing Enterobacteriaceae in different clinical samples in Ethiopia is alarmingly high and represents a threat to human health. Hence, a coordinated effort needs to be implemented for the prevention and control of these Enterobacteriaceae .
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Affiliation(s)
- Kuma Diriba
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Ephrem Awulachew
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Aschelew Gemede
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Asrat Anja
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
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Sharara SL, Amoah J, Pana ZD, Simner PJ, Cosgrove SE, Tamma PD. Is Piperacillin-Tazobactam Effective for the Treatment of Pyelonephritis Caused by Extended-Spectrum β-Lactamase-Producing Organisms? Clin Infect Dis 2020; 71:e331-e337. [PMID: 31859352 PMCID: PMC7643734 DOI: 10.1093/cid/ciz1205] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Limited data exist regarding the efficacy of piperacillin-tazobactam (TZP) for the management of nonbacteremic pyelonephritis caused by extended-spectrum β-lactamase (ESBL)-producing organisms. METHODS We conducted a multicenter observational study comparing clinical outcomes of adults hospitalized with ESBL-producing pyelonephritis who were receiving TZP versus carbapenems, using an inverse probability of treatment weighted propensity score analysis. Patients were eligible for inclusion if all of the following criteria were met: (1) urine cultures growing Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, or Proteus mirabilis at ≥50 000 colony-forming units/mL; (2) identification of an ESBL gene; (3) pyuria (≥10 white blood cells per high powered field in the urine); and (4) dysuria and fever plus at least 1 of the following symptoms: emesis, rigors, hypotension, or flank pain. RESULTS There were 186 patients included in the propensity score-weighted cohort; 45 (24%) received TZP and 141 (76%) received a carbapenem. Of these 186 patients, 27% were admitted to the intensive care unit, 48% were immunocompromised, and 45% had underlying urologic abnormalities. There were no differences between the 2 groups in the proportion of patients (20% vs 25%) with recurrent cystitis or pyelonephritis with the same ESBL-producing organism within 30 days (odds ratio, 0.75; 95% confidence interval, .31-1.81; P = .52). There were no differences in the resolution of clinical symptoms by Day 7 or in 30-day mortality. There was 1 (2%) patient in the TZP arm and 11 (8%) patients in the carbapenem arm who had incident carbapenem-resistant organisms isolated within 30 days (P = .09). CONCLUSIONS TZP may be a reasonable alternative to carbapenems for the management of ESBL-producing pyelonephritis and may mitigate the risk of emergence of carbapenem-resistant organisms, compared with carbapenem therapy.
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Affiliation(s)
- Sima L Sharara
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Joe Amoah
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland, USA
| | - Zoi D Pana
- European University of Cyprus, Department of Medicine, Nicosia, Cyprus
| | - Patricia J Simner
- The Johns Hopkins University School of Medicine, Department of Pathology, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- The Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, Maryland, USA
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Diriba K, Awulachew E, Tekele L, Ashuro Z. Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Among Apparently Health Food Handlers in Dilla University Student Cafeteria. Infect Drug Resist 2020; 13:3791-3800. [PMID: 33122924 PMCID: PMC7590998 DOI: 10.2147/idr.s269425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/07/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The rapid spread of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae among food handlers is a public health concern and has become a serious world threat. Klebsiella pneumoniae and Escherichia coli are the predominant ESBL-producing Enterobacteriaceae. This study aimed to assess the magnitude of ESBL producing K. pneumoniae and E. coli isolated from the stool of food handlers in the Dilla University Student Cafeteria. METHODS A cross-sectional study was conducted from November to September 2018/2019. A total of 220 stool samples were cultured on MacConkey agar and a series of biochemical tests were performed for the identification of bacterial species. Double-disk synergy method was used for the detection of ESBL-producing strains. RESULTS The rate of fecal carriage of E. coli and K. pneumoniae among the food handlers of the current study was 66.4%, of which 81.5% was E. coli, while 18.5% was K. pneumoniae. Of the total bacterial isolates, 25.3% were confirmed to be positive for ESBL production, of which 19.9% was E. coli, while 5.5% was K. pneumoniae. ESBL-producing fecal carriage showed high resistance to aztreonam, cefotaxime, ceftriaxone, cefuroxime, and ceftazidime, with resistance rates ranging from 88% to 100%, while the lowest resistance rate was observed against imipenem accounted <26.3%. In this study, 91.9% of ESBL-producers were co-resistant to β-lactams antibiotics plus at least one of the non-β-lactam antibiotics. ESBL carriers were more common among food handlers who used antibiotics repeatedly, drunk unpasteurized milk, and ate raw meat. CONCLUSION The magnitude of ESBL-producing E. coli and K. pneumoniae fecal carriage is alarmingly high and a threat to human health. MDR to third-generation cephalosporins and non-β-lactam antibiotics is more common among ESBL producers. Detecting ESBL-producing organisms has a remarkable importance in clinical decision-making. Hence, a coordinated effort should be implemented for the prevention and control of the disease.
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Affiliation(s)
- Kuma Diriba
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Ephrem Awulachew
- Department of Medical Laboratory Sciences, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Lami Tekele
- Department of Biochemistry, Health Science and Medical College, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Meije Y, Pigrau C, Fernández-Hidalgo N, Clemente M, Ortega L, Sanz X, Loureiro-Amigo J, Sierra M, Ayestarán A, Morales-Cartagena A, Ribera A, Duarte A, Abelenda G, Rodríguez-Baño J, Martínez-Montauti J. Non-intravenous carbapenem-sparing antibiotics for definitive treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamase (ESBL) or AmpC β-lactamase: A propensity score study. Int J Antimicrob Agents 2019; 54:189-196. [PMID: 31075401 DOI: 10.1016/j.ijantimicag.2019.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/09/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023]
Abstract
Carbapenems are considered the treatment of choice for extended-spectrum β-lactamase (ESBL)- or AmpC β-lactamase-producing Enterobacteriaceae bacteraemia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. This study compared the 30-day mortality and clinical failure associated with the use of carbapenems versus alternative non-intravenous antibiotics for the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia. This 12-year retrospective study (2004-2015) included all patients with bacteraemia due to ESBL/AmpC-producing Enterobacteriaceae at a Spanish hospital. Given the lack of randomisation of initial therapies, a propensity score for receiving carbapenems was calculated. There were 1115 patients with a first episode of bacteraemia due to Escherichia coli or Klebsiella pneumoniae, of which 123 (11.0%) were ESBL/AmpC-positive. There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (trimethoprim/sulfamethoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared with the carbapenem group, patients treated with an alternative regimen had a shorter hospital stay [median (IQR) 7 (5-10) days vs. 12 (9-18) days; P < 0.001]. Use of an alternative non-intravenous therapy did not increase mortality (OR = 0.27, 95% CI 0.05-1.61; P = 0.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95 (95% CI 0.94-26.01; P = 0.059). Alternative non-intravenous carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/AmpC-positive Enterobacteriaceae bacteraemia, allowing a reduction in carbapenem use. Use of trimethoprim/sulfamethoxazole in this series showed favourable results.
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Affiliation(s)
- Yolanda Meije
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain.
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Fernández-Hidalgo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercedes Clemente
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Lucía Ortega
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Xavier Sanz
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Jose Loureiro-Amigo
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Montserrat Sierra
- Microbiology Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Ana Ayestarán
- Pharmacy Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Barcelona, Spain
| | - Alejandra Morales-Cartagena
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Alba Ribera
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Alejandra Duarte
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Gabriela Abelenda
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Joaquim Martínez-Montauti
- Infectious Diseases Unit, Internal Medicine Department, Hospital de Barcelona, Societat Cooperativa d'Instal·lacions Assistencials Sanitàries (SCIAS), Diagonal 660, 08034 Barcelona, Spain
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Pharmacokinetics and Pharmacodynamics of Fosfomycin and Its Activity against Extended-Spectrum-β-Lactamase-, Plasmid-Mediated AmpC-, and Carbapenemase-Producing Escherichia coli in a Murine Urinary Tract Infection Model. Antimicrob Agents Chemother 2018; 62:AAC.02560-17. [PMID: 29581117 PMCID: PMC5971609 DOI: 10.1128/aac.02560-17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/17/2018] [Indexed: 01/16/2023] Open
Abstract
Fosfomycin has become an attractive treatment alternative for urinary tract infections (UTIs) due to increasing multidrug resistance (MDR) in Escherichia coli. In this study, we evaluated the pharmacokinetic (PK) and pharmacodynamic (PD) indices of fosfomycin and its in vivo activity in an experimental murine model of ascending UTI. Subcutaneous administration of fosfomycin showed that the mean peak plasma concentrations of fosfomycin were 36, 280, and 750 mg/liter following administration of a single dose of 0.75, 7.5, and 30 mg/mouse, respectively, with an elimination half-life of 28 min, and urine peak concentrations of 1,100, 33,400, and 70,000 mg/liter expected to be sustained above 1 mg/liter (MIC of the test strain, NU14) for 5, 8, and 9.5 h, respectively. The optimal PK/PD indices for reducing urine colony counts (number of CFU per milliliter) were determined to be the area under the concentration-time curve/MIC from 0 to 72 h and the maximum concentration/MIC on the basis of the dose-dependent bloodstream PK and the results of an evaluation of six dosing regimens. With a dosing regimen of 15 mg/mouse twice (every 36 h), fosfomycin significantly reduced the number of CFU per milliliter of all susceptible strains in urine, including clinical MDR strains, except for one clinical strain (P = 0.062). Variable degrees of reduction were observed in the bladder and kidneys. No significant reductions in the number of CFU per milliliter were observed with the resistant strains. In conclusion, fosfomycin shows concentration-dependent in vivo activity, and the results suggest that fosfomycin is an effective alternative to carbapenems in treating MDR E. coli in uncomplicated UTIs. The data on the effectiveness of fosfomycin against the MDR isolates along with the results of PK/PD modeling should facilitate the further development of improved recommendations for its clinical use.
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Seok H, Cha MK, Kang CI, Cho SY, Kim SH, Ha YE, Chung DR, Peck KR, Song JH. Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase. Infect Chemother 2018; 50:357-361. [PMID: 30600660 PMCID: PMC6312905 DOI: 10.3947/ic.2018.50.4.357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022] Open
Abstract
While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.
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Affiliation(s)
- Hyeri Seok
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyeong Cha
- Asia Pacific Foundation for Infectious Diseases, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sun Young Cho
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Hyun Kim
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Korea
| | - Young Eun Ha
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Asia Pacific Foundation for Infectious Diseases, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Song
- Division of Infectious Disease, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sbiti M, Lahmadi K, Louzi L. [Epidemiological profile of uropathogenic enterobacteria producing extended spectrum beta-lactamases]. Pan Afr Med J 2017; 28:29. [PMID: 29138665 PMCID: PMC5681015 DOI: 10.11604/pamj.2017.28.29.11402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/28/2017] [Indexed: 12/02/2022] Open
Abstract
Les infections urinaires à entérobactéries productrices de bêtalactamases à spectre élargi (E-BLSE) constituent un risque infectieux, un enjeu thérapeutique de taille et peuvent même conduire dans certains cas à des impasses du fait de leur multi-résistance aux antibiotiques. Le but de ce travail est de préciser le profil épidémiologique des (E-BLSE) uropathogènes et décrire leur niveau actuel de résistance aux antibiotiques pour une meilleure prise en charge des patients selon les données locales. Il s'agit d'une étude rétrospective sur une période de trois ans (du 1er janvier 2013 au 31 décembre 2015) concernant toutes les souches d'E-BLSE isolées de tous les ECBU traités au laboratoire de microbiologie de à l'Hôpital Militaire Moulay Ismail de Meknès. La culture a été faite selon les techniques usuelles, et l'antibiogramme a été réalisé par méthode de disque diffusion sous gélose Muller-Hinton selon les recommandations du Comité de l'antibiogramme de la Société française de microbiologie CA-SFM 2013/2014. Cette étude a permis de noter une importante prévalence globale d'isolement des E-BLSE (12.2%), particulièrement chez les patients hospitalisés (54.8%) dont la plus grande prévalence (72%) a été enregistrée dans le service d'urologie. Parmi ces E-BLSE Escherichia coli constitue la majorité (61%) des isolats, cependant au sein de la même espèce Klebsiella pneumoniae est le plus producteur de BLSE (25.8%). L'étude de l'antibioresistance des E-BLSE durant ces trois ans a mis en évidence des co-résistances à la ciprofloxacine (92.5%), au sulfametoxazole-trimethoprime (88,4%), à la gentamycine (67,2%). Globalement nos résultats sont en accord avec les données des autres pays méditerranéens exception faite pour l'amikacine dont la résistance est très basse (6.1%) dans notre étude. Cette étude a montré que la prévalence des E-BLSE en milieu hospitalier est importante et que sa diffusion en milieu communautaire est un fait préoccupant. Ces E-BLSE sont généralement résistantes aux antibiotiques, notamment des aux molécules utiles en urologie.
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Affiliation(s)
- Mohammed Sbiti
- Service de Microbiologie, Hôpital Militaire Moulay Ismail de Meknès, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohammed Ben Abdellah, Fès, Maroc
| | - Khalid Lahmadi
- Service de Microbiologie, Hôpital Militaire Moulay Ismail de Meknès, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohammed Ben Abdellah, Fès, Maroc
| | - Lhoussaine Louzi
- Pôle de Biologie Médicale, Hôpital Militaire Moulay Ismail Meknès, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohammed V, Souissi-Rabat, Maroc
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Lo CL, Lee CC, Li CW, Li MC, Hsueh PR, Lee NY, Ko WC. Fluoroquinolone therapy for bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:355-361. [DOI: 10.1016/j.jmii.2015.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 01/15/2023]
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Surgers L, Boyd A, Boelle PY, Lalande V, Jolivot PA, Girard PM, Arlet G, Cambier C, Homor A, Decre D, Meynard JL. Clinical and microbiological determinants of severe and fatal outcomes in patients infected with Enterobacteriaceae producing extended-spectrum β-lactamase. Eur J Clin Microbiol Infect Dis 2017; 36:1261-1268. [PMID: 28181033 DOI: 10.1007/s10096-017-2932-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/27/2017] [Indexed: 12/14/2022]
Abstract
Although extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become a worldwide public health concern, little is known regarding the clinical course of colonized or infected individuals. Our objective was to characterize the determinants of fatal outcomes related to ESBL-producing microorganisms at a large hospital in Paris, France. In 2012-2013, all consecutive patients with clinical samples testing positive for ESBL-producing Enterobacteriaceae at Saint-Antoine Hospital were identified. Patient clinical data were obtained at hospital entry, while information on intensive care unit (ICU) admissions and death were prospectively collected. Risk-factors for fatal 1-year outcomes were assessed using logistic regression. In total, 643/4684 (13%) ESBL-positive samples were observed, corresponding to 516 episodes (n = 206, 40% treated) among 330 patients. Most episodes were nosocomial-related (n = 347/516, 67%) involving Escherichia coli (n = 232/516, 45%) or Klebsiella pneumoniae (n = 164/516, 32%). Empirical antibiotic therapy was adequate in 89/206 (43%) infections, while the median length of hospital stay was 30 days [interquartile range (IQR) = 11-55] and 39/201 (19%) were admitted to the ICU. Overall, 104/241 patients (43%) with available data died within 1 year. In the multivariable analysis, 1-year death was associated with age >80 years (p = 0.01), concomitant comorbidity (p = 0.001), nosocomial-acquired infection (p = 0.002), and being infected rather than colonized (p < 0.001). In this series of patients with identified samples of ESBL-producing Enterobacteriaceae, hospital burden was large and 1-year mortality rates high. Understanding which patients in this setting would benefit from broad-spectrum empirical antibiotic therapy should be further examined.
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Affiliation(s)
- L Surgers
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France. .,INSERM U1135, CIMI, Team E13, Paris, France.
| | - A Boyd
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France
| | - P-Y Boelle
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France.,Département de Santé Publique, Hôpital Saint Antoine, APHP, Paris, France
| | - V Lalande
- Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - P-A Jolivot
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - P-M Girard
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, 75013, Paris, France.,INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, 75013, Paris, France
| | - G Arlet
- Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France.,INSERM U1135, CIMI, Team E13, Paris, France.,Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - C Cambier
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - A Homor
- Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - D Decre
- Sorbonne University, UPMC Univ Paris 06 CR7, Paris, France.,INSERM U1135, CIMI, Team E13, Paris, France.,Département de Bactériologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - J-L Meynard
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, APHP, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
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Malekolkottab M, Shojaei L, Khalili H, Doomanlou M. Clinical Response and Outcome in Patients with Multidrug Resistant Gram-negative Infections. J Res Pharm Pract 2017; 6:44-51. [PMID: 28331866 PMCID: PMC5348857 DOI: 10.4103/2279-042x.200990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: In this study, frequency and antimicrobial sensitivity pattern of multidrug resistant (MDR) microorganisms were evaluated in a referral teaching hospital in Iran. Methods: Patients with MDR Gram-negative pathogens were followed during the course of hospitalization. Demographic data, baseline diseases, type of biological sample, isolated microorganism, type of infection, antibiotic regimen before the availability of the culture result and change in the antibiotic regimen following receiving the antibiogram results, response to the treatment regimen, and duration of hospitalization and patient's outcome were considered variables for each recruited patient. Findings: In 71% of the patients, antibiotic regimens were changed according to the antibiogram results. A carbapenem alone or plus amikacin or ciprofloxacin were selected regimens for patients with extended-spectrum beta-lactamase (ESBL) infections. For patients with probable carbapenem-resistant Enterobacteriaceae infections, a carbapenem plus colistin was the most common antibiotic regimen. Clinical response was detected in 54.5% of the patients who were treated based on the antibiogram results. Clinical response was higher in the ESBL producers (ESBL-P) than the non-ESBL-P infections (75% vs. 52%). However, this difference was not significant (P = 0.09). Most nonresponders (80%) had sepsis due to Klebsiella species. Finally, 41.9% of the patients were discharged from the hospital and 58.2% died. Conclusion: Same as other countries, infections due MDR microorganisms is increasing in the recent years. This type of resistance caused poor clinical response and high rate mortality in the patients.
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Affiliation(s)
- Masoume Malekolkottab
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Doomanlou
- Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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12
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Sethaphanich N, Santanirand P, Rattanasiri S, Techasaensiri C, Chaisavaneeyakorn S, Apiwattanakul N. Pediatric extended spectrum β-lactamase infection: Community-acquired infection and treatment options. Pediatr Int 2016; 58:338-46. [PMID: 26513341 DOI: 10.1111/ped.12845] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/02/2015] [Accepted: 10/21/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection caused by extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in pediatric patients has been increasing and spreading to the community, compromising the options for effective antibiotics. This retrospective study was conducted to identify which antibiotics ESBL-producing Enterobacteriaceae remain susceptible to. In addition, the prevalence of community-acquired infection caused by these organisms, and the possibility of association between these organisms and septic shock, were explored. METHODS Antibiotic susceptibility of ESBL-producing and non-ESBL-producing Escherichia coli and Klebsiella pneumoniae strains isolated from pediatric patients were reviewed to determine the rates of susceptibility to various antibiotics. A chart review was performed to clarify the prevalence of community-acquired infection and the severity. RESULTS Of 849 strains analyzed, 40% were ESBL positive. Apart from cephalosporins, ESBL-producing strains were also less likely to be susceptible to other antibiotics, such as quinolones, gentamicin, netilmicin, and cotrimoxazole, more than 90% of which were still susceptible to amikacin, carbapenems, colistin, and tigecycline. Around 20% of community-acquired infections in the present study were caused by ESBL-producing strains. ESBL-producing strains found in the community were more likely to be susceptible to gentamicin, netilmicin, and cefepime than those found in hospital. Infection caused by ESBL-producing strains was not significantly associated with septic shock. CONCLUSION The increase in infection caused by ESBL-producing Enterobacteriaceae limits the availability of effective antibiotics. Given that carbapenems are necessary for treating serious infections, amikacin, cefepime, and piperacillin/tazobactam are possible options for consolidative therapy or for non-serious infection.
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Affiliation(s)
- Napapailin Sethaphanich
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pitak Santanirand
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chonnamet Techasaensiri
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sujittra Chaisavaneeyakorn
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nopporn Apiwattanakul
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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