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Hafez HM, El Deeb S, Mahmoud Swaif M, Ismail Ibrahim R, Ali Kamil R, Salman Abdelwahed A, Ehab Ibrahim A. Micellar Organic-solvent Free HPLC Design of Experiment for the Determination of Ertapenem and Meropenem; Assessment using GAPI, AGREE and Analytical Eco-scale models. Microchem J 2022. [DOI: 10.1016/j.microc.2022.108262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Wendt S, Lübbert C, Karlas T. Klebsiellen-Leberabszess. ZEITSCHRIFT FÜR GASTROENTEROLOGIE 2022. [DOI: 10.1055/a-1801-3748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Balushi MA, Kumar R, Al-Rashdi A, Ratna A, Al-Jabri A, Al-Shekaili N, Rani R, Sumri SA, Al-Ghabshi L, Al-Abri S, Al-Jardani A. Genomic analysis of the emerging carbapenem-resistant Klebsiella pneumoniae sequence type 11 harbouring Klebsiella pneumoniae carbapenemase (KPC) in Oman. J Infect Public Health 2022; 15:1089-1096. [PMID: 36116408 DOI: 10.1016/j.jiph.2022.08.014] [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: 07/20/2022] [Revised: 08/14/2022] [Accepted: 08/23/2022] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The presence of carbapenemase enzymes among Enterobacterales is the main mechanism to reduce susceptibility to a wide range of antibiotics. Carbapenemase enzymes such as the Klebsiella pneumoniae carbapenemase (KPC) hydrolyse beta-lactam antibiotics group, which includes carbapenem, leads to fewer treatment options. We aim to describe the first report of carbapenem-resistant K. pneumoniae (CRKP) sequence type (ST) 11 harbouring KPC in Oman. MATERIAL AND METHODS Five confirmed CRKP isolates were isolated from clinical samples during the period of January 2019 till December 2019. Strains were genotyped by pulse field gel electrophoresis (PFGE) for genetic relatedness. Whole genome sequencing (WGS) was performed to observe relationships with global strains using multilocus sequence typing (MLST). Antimicrobial genes, capsular loci-K-types, plasmids types and virulence genes were also identified using whole genome sequence data. RESULTS All five CRKP were determined to have blaKPC-2 with or without blaOX-A48 and blaNDM-2. The molecular genotyping by PFGE showed 100% similarity among the five isolates. The MLST allelic profile analysis clonally clustered our strains with SL-258, CG-11 and ST11 mainly reported from South Asia. Further molecular characterization of the capsular K-locus and O-locus genes, revealed the strains to belong to KL-47 type and OL101 type respectively. The core genome typing suggests that our strains were clonally related to Chinese strains with less than five chromosomal nucleotides differences. CONCLUSION Epidemiological and molecular analyses confirmed that these KPC-producing K. pneumoniae strains are from a single clone that caused multiple nosocomial infections in one health institution. This finding highlights the importance to sustain the surveillance and infection prevention efforts and to step up active screening to prevent the spread of nosocomial infection.
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Affiliation(s)
- Mohammed Al Balushi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Rajesh Kumar
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Azza Al-Rashdi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Amin Ratna
- Infection Prevention and Control, Sultan Qaboos Hospital,Ministry of Health, Oman
| | - Ahood Al-Jabri
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Neima Al-Shekaili
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Ramasandhya Rani
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Sara Al Sumri
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Laila Al-Ghabshi
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Oman
| | - Amina Al-Jardani
- Central Public Health Laboratories, Ministry of Health, Al Mujamma Street, Bait Al Falaj, Darsait, P.O Box 393, Postal Code 100, Muscat, Oman.
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Zhang H, Zhang G, Yang Y, Zhang J, Li D, Duan S, Yang Q, Xu Y. Antimicrobial resistance comparison of Klebsiella pneumoniae pathogens isolated from intra-abdominal and urinary tract infections in different organs, hospital departments and regions of China between 2014 and 2017. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:639-648. [DOI: 10.1016/j.jmii.2020.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/27/2022]
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Roode GJ, Bütow KW, Naidoo S. Microbial contamination profile change over a 4-year period in nonoperated cleft soft palate. J Appl Microbiol 2021; 132:665-674. [PMID: 34180558 DOI: 10.1111/jam.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/16/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS Surgical site infection is a major concern in cleft soft palate. Knowledge of the type, number and antimicrobial resistance of pathogens present preoperatively contribute to treatment success. The aim of this study is to determine whether or not the microbial contamination (diversity) preoperatively has changed since 2015. METHODS AND RESULTS Swabs were taken from the surgical site in 103 consecutive patients who presented for primary repair of the soft palate cleft. These were sent for microscopy, culture and sensitivity testing. Swabs were taken before disinfecting the site. Results were tabled and compared with two previous studies from the same facility. Out of 103 patients, 100 patients showed positive cultures with 42 different pathogenic micro-organisms identified. Most dominant pathogen was Klebsiella pneumoniae, 45.6%, increased by 28% from the previous two studies, with 93.6% of these pathogens resistant to one or more antimicrobials. Most of the other identified pathogens showed an alarming increase in occurrence, with a wide resistance to antimicrobials. CONCLUSIONS The increase in number and diversity of microbial contamination as well as their resistance to antimicrobials is a real concern. Ways of preventing postoperative infection in a natural way need to be explored. SIGNIFICANCE Surgeons need to be aware of constant changes in micro-organisms.
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Affiliation(s)
| | - Kurt-Wilhelm Bütow
- Maxillo-Facial and Oral Surgical Practice, Life-Wilgers Hospital, Lynnwood Ridge, South Africa
| | - Sharan Naidoo
- Maxillo-Facial and Oral Surgical Practice, Mediclinic Midstream Hospital, Lyttelton, South Africa.,Department of Maxillofacial and Oral surgery, Facial Deformity Clinic, University of Pretoria, Pretoria, South Africa
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Roode GJ, Bütow KW. A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery. Clin Med Res 2018; 16:9-15. [PMID: 29724746 PMCID: PMC6108510 DOI: 10.3121/cmr.2018.1385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/20/2018] [Accepted: 03/23/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. DESIGN A descriptive observational study. SETTINGS A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon. PARTICIPANTS All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. INCLUSION CRITERIA written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. EXCLUSION CRITERIA patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study. METHODS Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other. RESULTS Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. CONCLUSIONS This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.
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Affiliation(s)
- Gieljam Johannes Roode
- Senior lecturer, Department of Anatomy, University of Pretoria, P/Bag x 323, Arcadia, 0007, South Africa,
| | - Kurt-Wilhelm Bütow
- Consultant Professor, Department of Maxillo-Facial and Oral Surgery, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa;
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Kaiser T, Finstermeier K, Häntzsch M, Faucheux S, Kaase M, Eckmanns T, Bercker S, Kaisers UX, Lippmann N, Rodloff AC, Thiery J, Lübbert C. Stalking a lethal superbug by whole-genome sequencing and phylogenetics: Influence on unraveling a major hospital outbreak of carbapenem-resistant Klebsiella pneumoniae. Am J Infect Control 2018; 46:54-59. [PMID: 28935481 DOI: 10.1016/j.ajic.2017.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS). METHODS One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads. RESULTS A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P <.001) after implementation of systematic screening for KPC-2-Kp (33,623 screening investigations within 11 months). Using descriptive epidemiology, systematic screening showed no significant effect (7 out of 66 [10.6%] vs 4 out of 23 [17.4%] patients; P = .465). The phylogenetic analysis supported the assumption that a contaminated positioning pillow served as a reservoir for the persistence of KPC-2-Kp. CONCLUSIONS Effective phylogenetic identification of transmissions requires systematic microbiologic screening. Extensive screening and phylogenetic analysis based on WGS should be started as soon as possible in a bacterial outbreak situation.
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Findings from an outbreak of carbapenem-resistant Klebsiella pneumoniae emphasize the role of antibiotic treatment for cross transmission. Infection 2017; 46:103-112. [PMID: 29177610 DOI: 10.1007/s15010-017-1103-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition. METHODS In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient's age, gender, and Barthel index on colonization was elucidated. RESULTS Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP. CONCLUSIONS In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla OXA-48 positive CKP.
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Maechler F, Peña Diaz LA, Schröder C, Geffers C, Behnke M, Gastmeier P. Prevalence of carbapenem-resistant organisms and other Gram-negative MDRO in German ICUs: first results from the national nosocomial infection surveillance system (KISS). Infection 2014; 43:163-8. [PMID: 25395161 DOI: 10.1007/s15010-014-0701-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/01/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Standardized prevalence and incidence data on carbapenem-resistant organisms (CRO) and, as a relevant subgroup, carbapenem-resistant Enterobacteriaceae (CRE) are scarce. CRO-surveillance within the German nosocomial infection surveillance system (KISS) aims to provide epidemiological surveillance data on CRO colonizations and infections. METHODS CRO-surveillance is part of a KISS-module for the surveillance of multidrug-resistant organisms (MDRO). MDRO-KISS methods require surveillance of all patients admitted to the ward and standardized documentation of imported and ICU-acquired cases. Data on all MDRO-carriers including colonization and infection with MDRO are collected. All presented data were routine data collected from January 1st 2013 until December 1st 2013 in accordance with the German Protection against Infection Act (IfSG). RESULTS 341 ICUs submitted data on MDRO during the first year. In total, 5,171 cases of multidrug-resistant Gram-negative bacteria (MRGN) were identified. 848 were CRO (16%). 325 CRO-cases were acquired within the ICU (38%), and 373 CRO-patients had an infection (44%). CRO-prevalence was 0.29 per 100 patients. Acquisition rate of MRGN was 1.32 per 1,000 patient days. This rate is more than doubled the acquisition rates of other MDRO under surveillance within MDRO-KISS (0.57 MRSA, 0.49 VRE). CRO-acquisition rate was 0.3 per 1,000 patient days. Incidence density of MRGN infections bacteria was 0.58 per 1,000 patient days (CRO 0.15/1,000 patient days). CONCLUSIONS To date, CRO are common in German ICUs and the relatively large proportions of ICU-acquired CRO and infections emphasize their potential to cause outbreaks. High MRGN infection rates and high ESBL prevalence data from clinical studies suggest a lack of MRGN identification in asymptomatic carriers.
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Affiliation(s)
- F Maechler
- Institut für Hygiene und Umweltmedizin, Charité Berlin, Hindenburgdamm 27, 12203, Berlin, Germany,
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Li J, Liu F, Wang Q, Ge P, Woo PCY, Yan J, Zhao Y, Gao GF, Liu CH, Liu C. Genomic and transcriptomic analysis of NDM-1 Klebsiella pneumoniae in spaceflight reveal mechanisms underlying environmental adaptability. Sci Rep 2014; 4:6216. [PMID: 25163721 PMCID: PMC4147364 DOI: 10.1038/srep06216] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 01/10/2023] Open
Abstract
The emergence and rapid spread of New Delhi Metallo-beta-lactamase-1 (NDM-1)-producing Klebsiella pneumoniae strains has caused a great concern worldwide. To better understand the mechanisms underlying environmental adaptation of those highly drug-resistant K. pneumoniae strains, we took advantage of the China's Shenzhou 10 spacecraft mission to conduct comparative genomic and transcriptomic analysis of a NDM-1 K. pneumoniae strain (ATCC BAA-2146) being cultivated under different conditions. The samples were recovered from semisolid medium placed on the ground (D strain), in simulated space condition (M strain), or in Shenzhou 10 spacecraft (T strain) for analysis. Our data revealed multiple variations underlying pathogen adaptation into different environments in terms of changes in morphology, H2O2 tolerance and biofilm formation ability, genomic stability and regulation of metabolic pathways. Additionally, we found a few non-coding RNAs to be differentially regulated. The results are helpful for better understanding the adaptive mechanisms of drug-resistant bacterial pathogens.
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Affiliation(s)
- Jia Li
- 1] Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China [2] School of medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin 300071, China
| | - Fei Liu
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Qi Wang
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Pupu Ge
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Patrick C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, University Pathology Building, Compound Pokfulam Road, Hong Kong, China
| | - Jinghua Yan
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbei Road, Changping District, Beijing 102206, China
| | - George F Gao
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Cui Hua Liu
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Changting Liu
- Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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