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Guel-Gomez M, Angulo-Zamudio UA, Leon-Sicairos N, Flores-Villaseñor H, Mendívil-Zavala E, Plata-Guzmán A, Martinez-Garcia JJ, Angulo-Rocha J, Ochoa-Espinoza R, Crespo-Palazuelos P, Bracamontes-Murillo J, León-Ramírez A, Rodriguez-Ceceña JC, Canizalez-Roman A. Outbreak of Serratia marcescens in the Neonatal Intensive Care Unit of a Tertiary Care Hospital in Mexico. Adv Med 2023; 2023:3281910. [PMID: 37780054 PMCID: PMC10539092 DOI: 10.1155/2023/3281910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction We describe an outbreak of Serratia marcescens (S. marcescens) infection in the neonatal intensive care unit at Women's Hospital in Sinaloa, Mexico. Methods In April 2021, an outbreak of S. marcescens infection was identified. A case was identified as any patient who tested positive for S. marcescens and showed signs of an infectious process. Results S. marcescens was isolated from the blood cultures of 15 neonates with clinical signs of neonatal sepsis. Statistical analysis showed that all neonates had an invasive medical device. The problem was controlled after hospital hygiene and sanitation measures were strengthened. Conclusion The study provides evidence of an outbreak of nosocomial bacteremia due to the cross-transmission of S. marcescens. The findings highlight the need for hospitals to implement strict hygiene measures, especially regarding hand washing, to prevent future outbreaks.
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Affiliation(s)
- Martha Guel-Gomez
- The Women's Hospital, Secretariat of Health, Culiacan Sinaloa 80020, Mexico
| | | | - Nidia Leon-Sicairos
- School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80019, Mexico
- Pediatric Hospital of Sinaloa, Culiacan Sinaloa 80200, Mexico
| | - Hector Flores-Villaseñor
- School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80019, Mexico
- The Sinaloa State Public Health Laboratory, Secretariat of Health, Culiacan Sinaloa 80020, Mexico
| | | | | | - Jesus J. Martinez-Garcia
- School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80019, Mexico
- Pediatric Hospital of Sinaloa, Culiacan Sinaloa 80200, Mexico
| | - Jorge Angulo-Rocha
- The Women's Hospital, Secretariat of Health, Culiacan Sinaloa 80020, Mexico
| | | | | | | | - Angel León-Ramírez
- The Women's Hospital, Secretariat of Health, Culiacan Sinaloa 80020, Mexico
| | | | - Adrian Canizalez-Roman
- The Women's Hospital, Secretariat of Health, Culiacan Sinaloa 80020, Mexico
- School of Medicine, Autonomous University of Sinaloa, Culiacan Sinaloa 80019, Mexico
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2
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Rauti R, Navok S, Biran D, Tadmor K, Leichtmann-Bardoogo Y, Ron EZ, Maoz BM. Insight on Bacterial Newborn Meningitis Using a Neurovascular-Unit-on-a-Chip. Microbiol Spectr 2023; 11:e0123323. [PMID: 37222614 PMCID: PMC10269748 DOI: 10.1128/spectrum.01233-23] [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: 03/22/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
Understanding the pathogenesis of bacterial infections is critical for combatting them. For some infections, animal models are inadequate and functional genomic studies are not possible. One example is bacterial meningitis, a life-threatening infection with high mortality and morbidity. Here, we used the newly developed, physiologically relevant, organ-on-a-chip platform integrating the endothelium with neurons, closely mimicking in vivo conditions. Using high-magnification microscopy, permeability measurements, electrophysiological recordings, and immunofluorescence staining, we studied the dynamic by which the pathogens cross the blood-brain barrier and damage the neurons. Our work opens up possibilities for performing large-scale screens with bacterial mutant libraries for identifying the virulence genes involved in meningitis and determining the role of these genes, including various capsule types, in the infection process. These data are essential for understanding and therapy of bacterial meningitis. Moreover, our system offers possibilities for the study of additional infections-bacterial, fungal, and viral. IMPORTANCE The interactions of newborn meningitis (NBM) with the neurovascular unit are very complex and are hard to study. This work presents a new platform to study NBM in a system that enables monitoring of multicellular interactions and identifies processes that were not observed before.
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Affiliation(s)
- Rossana Rauti
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Sharon Navok
- The Shmunis School of Biomedicine and Cancer Research, Tel Aviv University, Tel Aviv, Israel
| | - Dvora Biran
- The Shmunis School of Biomedicine and Cancer Research, Tel Aviv University, Tel Aviv, Israel
| | - Keshet Tadmor
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | - Eliora Z. Ron
- The Shmunis School of Biomedicine and Cancer Research, Tel Aviv University, Tel Aviv, Israel
| | - Ben M. Maoz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- The Center for Nanoscience and Nanotechnology, Tel Aviv University, Tel Aviv, Israel
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3
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Duggan HL, Chow SSW, Austin NC, Shah PS, Lui K, Tan K. Early-onset sepsis in very preterm neonates in Australia and New Zealand, 2007-2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:31-37. [PMID: 35705325 DOI: 10.1136/archdischild-2021-323243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the epidemiology and population trends of early-onset sepsis in very preterm neonates admitted to neonatal intensive care units (NICU) in Australia and New Zealand. DESIGN Retrospective observational cohort study using a dual-nation registry database. SETTING 29 NICUs that have contributed to the Australian and New Zealand Neonatal Network. PARTICIPANTS Neonates born at <32 weeks' gestation born between 2007 and 2018 and then admitted to a NICU. MAIN OUTCOME MEASURES Microorganism profiles, incidence, mortality and morbidity. RESULTS Over the 12-year period, 614 early-onset sepsis cases from 43 178 very preterm admissions (14.2/1000 admissions) were identified. The trends of early-onset sepsis incidence remained stable, varying between 9.8 and 19.4/1000 admissions (linear trend, p=0.56). The leading causative organisms were Escherichia coli (E. coli) (33.7%) followed by group B Streptococcus (GBS) (16.1%). The incidence of E. coli increased between 2007 (3.2/1000 admissions) and 2018 (8.3/1000 admissions; p=0.02). Neonates with E. coli had higher odds of mortality compared with those with GBS (OR=2.8, 95% CI 1.2 to 6.1). Mortality due to GBS decreased over the same period (2007: 0.6/1000 admissions, 2018: 0.0/1000 admissions; p=0.01). Early-onset sepsis tripled the odds of mortality (OR=3.0, 95% CI 2.4 to 3.7) and halved the odds of survival without morbidity (OR=0.5, 95% CI 0.4 to 0.6). CONCLUSION Early-onset sepsis remains an important condition among very preterm populations. Furthermore, E. coli is a dominant microorganism of very preterm early-onset sepsis in Australia and New Zealand. Rates of E. coli have been increasing in recent years, while GBS-associated mortality has decreased.
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Affiliation(s)
- Husharn L Duggan
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Sharon S W Chow
- Australia and New Zealand Neonatal Network, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola C Austin
- Department of Paediatrics, Christchurch Women's Hospital, Christchurch, New Zealand
| | | | - Kei Lui
- Australia and New Zealand Neonatal Network, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Newborn Care, The Royal Hospital for Women, Newborn Intensive Care Unit, Randwick, New South Wales, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia .,Monash Newborn, Monash Health, Clayton, Victoria, Australia
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4
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Flannery DD, Puopolo KM, Hansen NI, Sánchez PJ, Stoll BJ. Neonatal infections: Insights from a multicenter longitudinal research collaborative. Semin Perinatol 2022; 46:151637. [PMID: 35864010 PMCID: PMC10959576 DOI: 10.1016/j.semperi.2022.151637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
For more than 30 years, the Neonatal Research Network (NRN) has conducted studies addressing the epidemiology of neonatal infections, including incidence, microbiology, maternal and neonatal risk factors, associated clinical findings, and outcomes. These studies have provided clinicians and policymakers critical data needed to inform national guidance for infection risk assessment and support daily practice. Further, NRN studies have prompted research into optimal approaches to infection diagnosis, treatment, and antimicrobial stewardship. In this article, we summarize the key findings of NRN infection-related studies, with an emphasis on those published in 2000 or later.
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Affiliation(s)
- Dustin D Flannery
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Karen M Puopolo
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nellie I Hansen
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Pablo J Sánchez
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Barbara J Stoll
- Department of Pediatrics, Emory University, Atlanta, GA, USA
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5
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Abstract
Early-onset sepsis (EOS) is a significant cause of morbidity and mortality among newborn infants, particularly among those born premature. The epidemiology of EOS is changing over time. Here, we highlight the most contemporary data informing the epidemiology of neonatal EOS, including incidence, microbiology, risk factors, and associated outcomes, with a focus on infants born in high-income countries during their birth hospitalization. We discuss approaches to risk assessment for EOS, summarizing national guidelines and comparing key differences between approaches for term and preterm infants. Lastly, we analyze contemporary antibiotic resistance data for EOS pathogens to inform optimal empiric treatment for EOS.
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Affiliation(s)
- Dustin D Flannery
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Karen M Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA
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6
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Meena PR, Priyanka P, Rana A, Raj D, Singh AP. Alarming level of single or multidrug resistance in poultry environments-associated extraintestinal pathogenic Escherichia coli pathotypes with potential to affect the One Health. ENVIRONMENTAL MICROBIOLOGY REPORTS 2022; 14:400-411. [PMID: 35261153 DOI: 10.1111/1758-2229.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Prem Raj Meena
- Department of Microbiology, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Priyanka Priyanka
- Department of Microbiology, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - Anuj Rana
- Department of Microbiology, College of Basic Sciences & Humanities, Chaudhary Charan Singh Haryana Agricultural University, Hisar, Haryana, India
| | - Dharma Raj
- Department of Biostatistics and Bioinformatics, ICMR-National Institute for Research in Environmental Health (NIREH), Bhopal, Madhya Pradesh, India
| | - Arvind Pratap Singh
- Department of Microbiology, School of Life Sciences, Central University of Rajasthan, Ajmer, Rajasthan, India
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7
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Flannery DD, Puopolo KM, Hansen NI, Gerber JS, Sánchez PJ, Stoll BJ. Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens. Pediatr Infect Dis J 2022; 41:263-271. [PMID: 34862339 PMCID: PMC8831448 DOI: 10.1097/inf.0000000000003380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens. METHODS Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks' gestation and cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptible was defined as intermediate or resistant on final result. RESULTS We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 Gram-positive isolates with ampicillin and gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 72/94 (76.6%) isolates were nonsusceptible to ampicillin, 8/94 (8.5%) were nonsusceptible to gentamicin, and 7/96 (7.3%) isolates were nonsusceptible to both. Five percent or less of tested Gram-negative isolates were nonsusceptible to each of third or fourth generation cephalosporins, piperacillin-tazobactam, and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates nonsusceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants. CONCLUSIONS The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of 1 single antimicrobial agent is likely to provide adequate empiric therapy in all cases.
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Affiliation(s)
- Dustin D. Flannery
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Nellie I. Hansen
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - Jeffrey S. Gerber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Pablo J. Sánchez
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Barbara J. Stoll
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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8
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Chambers CA, Dadelahi AS, Moley CR, Olson RM, Logue CM, Skyberg JA. Nucleotide receptors mediate protection against neonatal sepsis and meningitis caused by alpha-hemolysin expressing Escherichia coli K1. FASEB J 2022; 36:e22197. [PMID: 35147989 DOI: 10.1096/fj.202101485r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 01/15/2023]
Abstract
Neonatal meningitis-associated Escherichia coli (NMEC) is among the leading causes of bacterial meningitis and sepsis in newborn infants. Several virulence factors have been identified as common among NMEC, and have been shown to play an important role in the development of bacteremia and/or meningitis. However, there is significant variability in virulence factor expression between NMEC isolates, and relatively little research has been done to assess the impact of variable virulence factor expression on immune cell activation and the outcome of infection. Here, we investigated the role of NMEC strain-dependent P2X receptor (P2XR) signaling on the outcome of infection in neonatal mice. We found that alpha-hemolysin (HlyA)-expressing NMEC (HlyA+ ) induced robust P2XR-dependent macrophage cell death in vitro, while HlyA- NMEC did not. P2XR-dependent cell death was inflammasome independent, suggesting an uncoupling of P2XR and inflammasome activation in the context of NMEC infection. In vivo inhibition of P2XRs was associated with increased mortality in neonatal mice infected with HlyA+ NMEC, but had no effect on the survival of neonatal mice infected with HlyA- NMEC. Furthermore, we found that P2XR-dependent protection against HlyA+ NMEC in vivo required macrophages, but not neutrophils or NLRP3. Taken together, these data suggest that HlyA+ NMEC activates P2XRs which in turn confers macrophage-dependent protection against infection in neonates. In addition, our findings indicate that strain-dependent virulence factor expression should be taken into account when studying the immune response to NMEC.
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Affiliation(s)
- Catherine A Chambers
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Alexis S Dadelahi
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Charles R Moley
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Rachel M Olson
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
| | - Catherine M Logue
- Department of Population Heath, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| | - Jerod A Skyberg
- Department of Veterinary Pathobiology, University of Missouri, Columbia, Missouri, USA
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9
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Sacher-Pirklbauer A, Klein-Jöbstl D, Sofka D, Blanc-Potard AB, Hilbert F. Phylogenetic Groups and Antimicrobial Resistance Genes in Escherichia coli from Different Meat Species. Antibiotics (Basel) 2021; 10:antibiotics10121543. [PMID: 34943755 PMCID: PMC8698590 DOI: 10.3390/antibiotics10121543] [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: 10/31/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
Escherichia coli isolated from meat of different animal species may harbour antimicrobial resistance genes and may thus be a threat to human health. The objectives of this study were to define antimicrobial resistance genes in E. coli isolates from pork, beef, chicken- and turkey meat and analyse whether their resistance genotypes associated with phylogenetic groups or meat species. A total number of 313 E. coli samples were isolated using standard cultural techniques. In 98% of resistant isolates, a dedicated resistance gene could be identified by PCR. Resistance genes detected were tet(A) and tet(B) for tetracycline resistance, strA and aadA1 for streptomycin resistance, sulI and sulII for resistance against sulphonamides, dfr and aphA for kanamycin resistance and blaTEM for ampicillin resistance. One stx1 harbouring E. coli isolated from pork harboured the tet(A) gene and belonged to phylogenetic group B2, whilst another stx1 positive isolate from beef was multi-resistant and tested positive for blaTEM,aphA, strA–B, sulII, and tet(A) and belonged to phylogenetic group A. In conclusion, the distribution of resistance elements was almost identical and statistically indifferent in isolates of different meat species. Phylogenetic groups did not associate with the distribution of resistance genes and a rather low number of diverse resistance genes were detected. Most E. coli populations with different resistance genes against one drug often revealed statistically significant different MIC values.
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Affiliation(s)
- Angelika Sacher-Pirklbauer
- Institute of Food Safety, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine, 1210 Vienna, Austria; (A.S.-P.); (D.S.)
| | - Daniela Klein-Jöbstl
- Section of Herd Management, Clinic for Ruminats, University of Veterinary Medicine, 1210 Vienna, Austria;
| | - Dmitrij Sofka
- Institute of Food Safety, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine, 1210 Vienna, Austria; (A.S.-P.); (D.S.)
| | - Anne-Béatrice Blanc-Potard
- Laboratory of Pathogen-Host Interactions (LPHI), Université Montpellier, 34095 Montpellier, France;
- CNRS, UMR 5235, 34095 Montpellier, France
| | - Friederike Hilbert
- Institute of Food Safety, Department for Farm Animals and Veterinary Public Health, University of Veterinary Medicine, 1210 Vienna, Austria; (A.S.-P.); (D.S.)
- Correspondence: ; Tel.: +43-125-0773-316
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10
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Williams M, Jones AB, Maxedon AL, Tabakh JE, McCloskey CB, Bard DE, Heruth DP, Chavez-Bueno S. Whole-genome sequencing-based phylogeny, antibiotic resistance, and invasive phenotype of Escherichia coli strains colonizing the cervix of women in preterm labor. BMC Microbiol 2021; 21:330. [PMID: 34861816 PMCID: PMC8641181 DOI: 10.1186/s12866-021-02389-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/10/2021] [Indexed: 01/12/2023] Open
Abstract
Background Escherichia coli is a major neonatal pathogen and the leading cause of early-onset sepsis in preterm newborns. Maternal E. coli strains are transmitted to the newborn causing invasive neonatal disease. However, there is a lack of data regarding the phenotypic and genotypic characterization of E. coli strains colonizing pregnant women during labor. Methods This prospective study performed at the University of Oklahoma Medical Center (OUHSC) from March 2014 to December 2015, aimed to investigate the colonization rate, and the phylogeny, antibiotic resistance traits, and invasive properties of E. coli strains colonizing the cervix of fifty pregnant women diagnosed with preterm labor (PTL). Molecular analyses including bacterial whole-genome sequencing (WGS), were performed to examine phylogenetic relationships among the colonizing strains and compare them with WGS data of representative invasive neonatal E. coli isolates. Phenotypic and genotypic antibiotic resistance traits were investigated. The bacteria’s ability to invade epithelial cells in vitro was determined. Results We recruited fifty women in PTL. Cervical samples yielded E. coli in 12 % (n=6). The mean gestational age was 32.5 (SD±3.19) weeks. None delivered an infant with E. coli disease. Phenotypic and genotypic antibiotic resistance testing did not overall demonstrate extensive drug resistance traits among the cervical E. coli isolates, however, one isolate was multi-drug resistant. The isolates belonged to five different phylogroups, and WGS analyses assigned each to individual multi-locus sequence types. Single nucleotide polymorphism-based comparisons of cervical E. coli strains with six representative neonatal E. coli bacteremia isolates demonstrated that only half of the cervical E. coli isolates were phylogenetically related to these neonatal invasive strains. Moreover, WGS comparisons showed that each cervical E. coli isolate had distinct genomic regions that were not shared with neonatal E. coli isolates. Cervical and neonatal E. coli isolates that were most closely related at the phylogenetic level had similar invasion capacity into intestinal epithelial cells. In contrast, phylogenetically dissimilar cervical E. coli strains were the least invasive among all isolates. Conclusions
This pilot study showed that a minority of women in PTL were colonized in the cervix with E. coli, and colonizing strains were not phylogenetically uniformly representative of E. coli strains that commonly cause invasive disease in newborns. Larger studies are needed to determine the molecular characteristics of E. coli strains colonizing pregnant women associated with an increased risk of neonatal septicemia. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02389-7.
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Affiliation(s)
- Marvin Williams
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, OK, 73117, Oklahoma City, USA
| | - Alyssa B Jones
- University of Missouri Kansas City, 2411 Holmes Street, MO, 64108, Kansas City, USA
| | - Amanda L Maxedon
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, OK, 73117, Oklahoma City, USA
| | - Jennifer E Tabakh
- Division of Infectious Diseases, Children's Mercy Hospital Kansas City, UMKC School of Medicine, 2401 Gillham Road, 1st floor Annex, 1501.13, MO, 64108, Kansas City, USA
| | - Cindy B McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, MO, 73117, Kansas City, USA
| | - David E Bard
- Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, MO, 64108, Oklahoma City, USA
| | - Daniel P Heruth
- University of Missouri Kansas City, 2411 Holmes Street, MO, 64108, Kansas City, USA.,The Children's Mercy Research Institute, Children's Mercy Kansas City, MO, 64108, Kansas City, USA
| | - Susana Chavez-Bueno
- University of Missouri Kansas City, 2411 Holmes Street, MO, 64108, Kansas City, USA. .,Division of Infectious Diseases, Children's Mercy Hospital Kansas City, UMKC School of Medicine, 2401 Gillham Road, 1st floor Annex, 1501.13, MO, 64108, Kansas City, USA.
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11
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K1 Antigen Is Associated with Different AST Profile in Escherichia coli: A One-Month-Long Pilot Study. Microorganisms 2021; 9:microorganisms9091884. [PMID: 34576781 PMCID: PMC8469396 DOI: 10.3390/microorganisms9091884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Escherichia coli is responsible for diseases of varying severity. The “K” antigen designates the capsular polysaccharides on the bacterial surface, which are mostly similar to those of highly pathogenic bacteria. The K1 antigen is often found in pathogenic E. coli. Aim: While the published studies on the AST profile of K1-positive E. coli have focused on pregnant women or newborns, this study aimed to characterize the AST profile of K1-positive E. coli independently of the clinical sample of isolation. Over a 4-week-long period, all patients hospitalized/consulting at the Poitiers University Hospital presenting a determined AST on E. coli were prospectively included to define their K1-status (Pastorex Meningitis) and to collect the clinical (age/sex) or biological metadata (AST/MIC). Among the 296 included samples, no differential representation was observed between K1 results regarding sample nature. K1-negative results were associated with multiple antibiotic-resistance (12.3% vs. 33.0%; p < 0.01). AST phenotypes differed between these groups, with a higher proportion of K1-negativity among resistant strains, especially on β-lactams (ureidopenicillin, 25.8% vs. 14.9%; and ampicillin/inhibitor, 50.0% vs. 26.8%; p < 0.05) or quinolone (19.8% vs. 7.0%) and sulfamethoxazole-trimethoprim (30.2% vs. 12.3%) (p < 0.01). This study analyzed E. coli ASTs in clinical samples of all types, regarding their K1-antigen status.
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12
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Chambers CA, Lacey CA, Brown DC, Skyberg JA. Nitric oxide inhibits interleukin-1-mediated protection against Escherichia coli K1-induced sepsis and meningitis in a neonatal murine model. Immunol Cell Biol 2021; 99:596-610. [PMID: 33550610 DOI: 10.1111/imcb.12445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 01/03/2023]
Abstract
Neonatal meningitis-associated Escherichia coli (NMEC) is a leading cause of sepsis and meningitis in newborn infants. Neonates are known to have impaired inflammasome activation and interleukin (IL)-1 production. However, it is unknown what role this plays in the context of NMEC infection. Here we investigated the role of IL-1 signaling in the pathogenesis of NMEC infection. We found both IL-1β and IL-1α were secreted from macrophages and microglial cells in response to NMEC in a Toll-like receptor 4- and NLR family pyrin domain containing 3 (NPLR3)-dependent manner. Intracerebral infection of adult mice indicated a protective role of IL-1 signaling during NMEC infection. However, IL-1 receptor blockade in wild-type neonatal mice did not significantly alter bacterial loads in the blood or brain, and we, therefore, investigated whether protection conferred by IL-1 was age dependent. Neonates are known to have increased nitric oxide (NO) levels compared with adults, and we found NO inhibited the secretion of IL-1 by macrophages in response to NMEC. In contrast to our results in wild-type neonates, blockade of IL-1 receptor in neonates lacking inducible nitric oxide synthase (iNOS) led to significantly increased bacterial loads in the blood and brain. These data indicate IL-1 signaling is protective during NMEC infection in neonates only when iNOS is absent. Collectively, our findings suggest that increased NO production by neonates inhibits IL-1 production, and that this suppresses the protective role of IL-1 signaling in response to NMEC infection. This may indicate a general mechanism for increased susceptibility of neonates to infection and could lead to new therapeutic strategies in the future.
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Affiliation(s)
- Catherine A Chambers
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
| | - Carolyn A Lacey
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA.,Department of Immunology, Duke University Medical Center, Durham, NC, USA
| | - Dana C Brown
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
| | - Jerod A Skyberg
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO, USA
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Buccini DF, Cardoso MH, Franco OL. Antimicrobial Peptides and Cell-Penetrating Peptides for Treating Intracellular Bacterial Infections. Front Cell Infect Microbiol 2021; 10:612931. [PMID: 33614528 PMCID: PMC7892433 DOI: 10.3389/fcimb.2020.612931] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022] Open
Abstract
Bacterial infections caused by intracellular pathogens are difficult to control. Conventional antibiotic therapies are often ineffective, as high doses are needed to increase the number of antibiotics that will cross the host cell membrane to act on the intracellular bacterium. Moreover, higher doses of antibiotics may lead to elevated severe toxic effects against host cells. In this context, antimicrobial peptides (AMPs) and cell-penetrating peptides (CPPs) have shown great potential to treat such infections by acting directly on the intracellular pathogenic bacterium or performing the delivery of cargos with antibacterial activities. Therefore, in this mini-review, we cover the main AMPs and CPPs described to date, aiming at intracellular bacterial infection treatment. Moreover, we discuss some of the proposed mechanisms of action for these peptide classes and their conjugation with other antimicrobials.
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Affiliation(s)
- Danieli F Buccini
- S-inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil
| | - Marlon H Cardoso
- S-inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil
| | - Octavio L Franco
- S-inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande, Brazil.,Centro de Análises Proteômicas e Bioquímicas, Pós-Graduação em Ciências Genômicas e Biotecnologia, Universidade Católica de Brasília, Brasília, Brazil
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14
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Flannery DD, Akinboyo IC, Mukhopadhyay S, Tribble AC, Song L, Chen F, Li Y, Gerber JS, Puopolo KM. Antibiotic Susceptibility of Escherichia coli Among Infants Admitted to Neonatal Intensive Care Units Across the US From 2009 to 2017. JAMA Pediatr 2021; 175:168-175. [PMID: 33165599 PMCID: PMC7653538 DOI: 10.1001/jamapediatrics.2020.4719] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Escherichia coli is a leading cause of serious infection among term and preterm newborn infants. Surveillance of antibiotic susceptibility patterns of E coli among infants admitted to neonatal intensive care units should inform empirical antibiotic administration. OBJECTIVE To assess the epidemiologic characteristics and antibiotic susceptibility patterns of E coli in infants admitted to neonatal intensive care units in the US over time. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used the Premier Health Database, a comprehensive administrative database of inpatient encounters from academic and community hospitals across the US. Participants included newborn infants admitted to centers contributing microbiology data from January 1, 2009, to December 31, 2017, with E coli isolated from blood, cerebrospinal fluid, or urine cultures. Data were collected and analyzed from December 1, 2018, to November 30, 2019. MAIN OUTCOMES AND MEASURES Changes in annual antibiotic susceptibility of E coli during the study period. The proportion of infants with nonsusceptible organisms (resistant or intermediate susceptibility) in antibiotic categories by year, birth weight, infection source, and timing of infection and patient and center characteristics associated with neonatal E coli infection and antibiotic susceptibility were assessed. RESULTS A total of 721 infants (434 male [60.2%]; median age at E coli infection, 14 days [interquartile range, 1-33 days]) from 69 centers had at least 1 episode of E coli infection and available susceptibility results. No significant changes were observed over time in the overall annual proportions of antibiotic nonsusceptibility to ampicillin (mean [SD], 66.8% [1.5%]; range, 63.3% to 68.6%; estimated yearly change, -0.28% [95% CI, -1.75% to 1.18%]), nonsusceptibility to aminoglycosides (mean [SD], 16.8% [4.5%]; range, 10.7% to 23.2%; estimated yearly change, -0.85% [95% CI, -1.93% to 0.23%]), or extended-spectrum β-lactamase phenotype (mean [SD], 5.0% [3.7%]; range, 0% to 11.1%; estimated yearly change, 0.46% [95% CI, -0.18% to 1.11%]). No isolates with nonsusceptibility to carbapenems were identified. Among 218 infants with early-onset infection, 22 (10.1%) had isolates with nonsusceptibility to both ampicillin and gentamicin, the antibiotics most commonly administered to newborns as empirical therapy. CONCLUSIONS AND RELEVANCE In this cohort study, nonsusceptibility to commonly administered antibiotics was found in substantial proportions of neonatal E coli isolates, with no significant change from 2009 to 2017. These findings may inform empirical antibiotic choices for newborn infants.
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Affiliation(s)
- Dustin D. Flannery
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Neonatology, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Ibukunoluwa C. Akinboyo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Sagori Mukhopadhyay
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Neonatology, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alison C. Tribble
- Division of Pediatric Infectious Diseases, Department of Pediatrics, C. S. Mott Children’s Hospital/University of Michigan, Ann Arbor
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Healthcare Analytics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Feiyan Chen
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Healthcare Analytics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yun Li
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia,Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia,Division of Pediatric Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen M. Puopolo
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Division of Neonatology, Children’s Hospital of Philadelphia Newborn Care at Pennsylvania Hospital, Philadelphia,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia
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15
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Koizumi A, Maruyama K, Ohki Y, Nakayama A, Yamada Y, Kurosawa H, Tsukagoshi H, Fujiu T, Takahashi M, Kimura T, Saruki N, Murakami M, Arakawa H. Prevalence and Risk Factor for Antibiotic-resistant Escherichia coli Colonization at Birth in Premature Infants: A Prospective Cohort Study. Pediatr Infect Dis J 2020; 39:546-552. [PMID: 32118857 DOI: 10.1097/inf.0000000000002623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Escherichia coli causes neonatal early-onset sepsis (EOS) that is associated with high mortality and increasing antibiotic resistance. Thus, we estimated the prevalence, antibiotic susceptibility and risk factors for colonization of E. coli in premature infants at birth and characterized the pathogenicity of the isolates. METHODS A prospective surveillance study was conducted at three Japanese perinatal centers between August 2014 and February 2017. Infants weighing <2 kg and/or at gestational age <35 weeks at birth were enrolled. We screened the mothers and neonates for E. coli colonization. Pulsed-field gel electrophoresis was used to analyze the relatedness between the maternal and neonatal isolates. Virulence factors for the isolates were determined using polymerase chain reaction. RESULTS We enrolled 421 premature infants born to 382 mothers. The rate of colonization in mothers was 47.6%, comprising 5.9% extended-spectrum beta-lactamase-producing E. coli (ESBL-E) and 20.0% ampicillin-resistant strains. Ten (2.4%) infants exhibited colonization; ESBL-E and ampicillin-resistant strains colonized three and four infants, respectively. Three antibiotic-resistant, strain-positive infants developed EOS. Pulsed-field gel electrophoresis revealed vertical transmission of bacteria in four infants. Multivariate logistic regression analysis revealed that ESBL-E-positive mothers [odds ratio (OR), 19.2; 95% confidence interval (CI), 2.5-145.7)] and vaginal delivery (OR, 9.4; 95% CI, 1.7-50.7) were risk factors for neonatal colonization. The infant isolates possessed numerous virulence factors. CONCLUSIONS Although the prevalence of E. coli-colonized premature infants at birth was low, the rate of antibiotic resistance and the attack rate for EOS were high. Infants with ESBL-E positive mothers should be closely monitored for EOS.
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Affiliation(s)
- Aya Koizumi
- From the Department of Neonatology, Gunma Children's Medical Center, Shibukawa.,Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine
| | - Kenichi Maruyama
- From the Department of Neonatology, Gunma Children's Medical Center, Shibukawa
| | - Yasushi Ohki
- Department of Pediatrics, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan
| | - Akifumi Nakayama
- Department of Medical Technology, School of Health Sciences, Gifu University of Medical Science, Seki, Gifu, Japan
| | - Yoshiyuki Yamada
- Department of Allergy and Immunology, Gunma Children's Medical Center, Shibukawa
| | - Hajime Kurosawa
- Gunma Prefectural Institute of Public Health and Environmental Science
| | | | - Toru Fujiu
- Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine
| | | | - Takao Kimura
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Nobuhiro Saruki
- Gunma Prefectural Institute of Public Health and Environmental Science
| | - Masami Murakami
- Department of Clinical Laboratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hirokazu Arakawa
- Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine
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16
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Genovese C, La Fauci V, D'Amato S, Squeri A, Anzalone C, Costa GB, Fedele F, Squeri R. Molecular epidemiology of antimicrobial resistant microorganisms in the 21th century: a review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:256-273. [PMID: 32420962 PMCID: PMC7569612 DOI: 10.23750/abm.v91i2.9176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/10/2020] [Indexed: 12/26/2022]
Abstract
Healthcare-associated infections (HAIs) are the most frequent and severe complication acquired in healthcare settings with high impact in terms of morbidity, mortality and costs. Many bacteria could be implicated in these infections, but, expecially multidrug resistance bacteria could play an important role. Many microbial typing technologies have been developed until to the the bacterial whole-genome sequencing and the choice of a molecular typing method therefore will depend on the skill level and resources of the laboratory and the aim and scale of the investigation. In several studies the molecular investigation of pathogens involved in HAIs was performed with many microorganisms identified as causative agents such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Clostridium difficile, Acinetobacter spp., Enterobacter spp., Enterococcus spp., Staphylococcus aureus and several more minor species. Here, we will describe the most and least frequently reported clonal complex, sequence types and ribotypes with their worldwide geographic distribution for the most important species involved in HAIs.
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Affiliation(s)
- Cristina Genovese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Vincenza La Fauci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Smeralda D'Amato
- Postgraduate Medical School in Hygiene and Preventive Medicine, University of Messina, Italy.
| | - Andrea Squeri
- Department of Human Pathology of the adult and developmental age Gaetano Barresi, University of Messina, Messina, Italy.
| | - Carmelina Anzalone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Gaetano Bruno Costa
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Francesco Fedele
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
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17
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Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Youngster I, Marom R, Lavie K, Smolkin T, Troitzky M, Stein M, Stein M, Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Eventov‐Fiedman S, Keller N, Kriger O, Somekh E, Tasher D, Gottesman G, Guri A, Ashkenazi‐Hoffnung L, Ben‐Zvi H, Youngster I, Herzlich J, Schindler Y, Marom R, Rubinstein U, Midlij E, Miron D, Damouni R, Kassis I, Nimri‐Atrash N, Freiman S, Lavie K, Smolkin T, Melamed R, Troitzky M, Sayag A. Nationwide epidemiology of early-onset sepsis in Israel 2010-2015, time to re-evaluate empiric treatment. Acta Paediatr 2019; 108:2192-2198. [PMID: 31168848 DOI: 10.1111/apa.14889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/25/2023]
Abstract
AIM Early-onset neonatal sepsis (EOS) may lead to significant morbidity and mortality, yet the recommended antimicrobials have not changed for many years. We aimed to optimise EOS treatment by examining EOS pathogens, resistance rates and resistance risk factors. METHODS A retrospective, nationwide cohort study analysing 2010-2015 EOS data in Israel. RESULTS The 21 participating centres constitute 92% of the total birth cohort (around 180 000 live births/year). Of 549 EOS neonates (0.57/1000 live births), 306 (56%) and 243 (44%) were full-term and preterm, respectively (0.35 vs. 2.94 per/1000 live births). Gram-negative pathogens predominated, especially in preterms. Escherichia coli and Streptococcus agalactiae were most common pathogens (0.2 and 0.19 per 1000 live births, respectively). In 277 Gram-negatives, 16%, 14%, 8% and 3% were gentamicin-resistant, extended-spectrum beta-lactamase (ESBL)-positive, gentamicin-resistant and ESBL-positive, and amikacin-resistant, respectively; preterms had higher resistance rates. No risk factors for antimicrobial resistance were identified. Mortality was reported in 21% of Gram-negative EOS versus 7% of Gram-positive EOS [OR 3.4 (95% CI 1.8-6.2), p < 0.01]. CONCLUSION In this nationwide study, EOS was caused predominantly by Gram-negatives, with high gentamicin resistance and ESBL phenotype rates, without identifiable resistance risk factors. As EOS is life-threatening, modification of empiric therapy for amikacin-based regimens should be considered, mainly in preterms.
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Affiliation(s)
- Daniel Glikman
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Nitzan Curiel
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Aharona Glatman‐Freedman
- Israel Centre for Disease Control Tel Hashomer Ramat Gan Israel
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
| | - Orli Megged
- Paediatrics Shaare Zedek Medical Center Jerusalem Israel
- The School of Medicine The Hebrew University and Hadassah Medical Centre Jerusalem Israel
| | - Ilan Youngster
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Paediatrics, Centre for Microbiome Research Assaf Harofeh Medical Centre Zerifin Israel
| | - Ronella Marom
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Neonatology Tel Aviv Medical Centre Tel Aviv Israel
| | - Karen Lavie
- Neonatology Carmel Medical Centre Haifa Israel
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
| | - Tatiana Smolkin
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Neonatology Baruch Padeh Medical Centre Poria Israel
| | - Mara Troitzky
- Neonatology Barzilai Medical Centre Ashkelon Israel
- Ben‐Gurion University of the Negev Be'er Sheva Israel
| | - Michal Stein
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Infectious disease and infection control unit Hillel Yaffe Medical Centre Hadera Israel
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18
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Zhu M, Jin Y, Duan Y, He M, Lin Z, Lin J. Multi-Drug Resistant Escherichia coli Causing Early-Onset Neonatal Sepsis - a Single Center Experience from China. Infect Drug Resist 2019; 12:3695-3702. [PMID: 31819551 PMCID: PMC6885540 DOI: 10.2147/idr.s229799] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background and objective Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) have raised public-health concerns and are becoming a global health challenge. This study aimed to investigate changes in antimicrobial resistance of E. coli responsible for early-onset sepsis (EOS) in a perinatal center in eastern China. Methods Two periods, 2002 to 2008 and 2012 to 2018, were investigated. EOS was defined as the presence of a single potentially pathogenic bacterium grown from blood or cerebrospinal fluid in cultures drawn in any newborn infant within 72 hrs of birth. The changes in antimicrobial resistance of E. coli were analyzed. Results A total of 163 cases of EOS were identified, and E. coli continued to be the leading pathogen in our neonatal intensive care unit (NICU). Overall resistance of E. coli to third-generation cephalosporins increased from 14.3% in 2002–2008 to 46.7% in 2012–2018 (p<0.05). This resistance pattern closely parallels ESBL production. Compared to that from term infants, E. coli isolated from preterm infants had a significantly higher rate of resistance to ampicillin (93.3% vs 48.4%, p<0.01) and gentamicin (60.0% vs 9.4%, p<0.01), as well as a higher rate of ESBL production (66.7% vs 15.6%, p<0.01). Conclusion We conclude that ESBL-producing multi-drug resistant E. coli has emerged as the major pathogen responsible for early-onset neonatal sepsis, particularly in preterm infants. Clinicians should consider this trend and attempt to select proper effective antibiotics as the empirical treatment for early-onset neonatal sepsis.
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Affiliation(s)
- Minli Zhu
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Yuting Jin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Yue Duan
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Minzhi He
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Zhenlang Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China
| | - Jing Lin
- Department of Neonatology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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19
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Cole BK, Ilikj M, McCloskey CB, Chavez-Bueno S. Antibiotic resistance and molecular characterization of bacteremia Escherichia coli isolates from newborns in the United States. PLoS One 2019; 14:e0219352. [PMID: 31276562 PMCID: PMC6611611 DOI: 10.1371/journal.pone.0219352] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/14/2019] [Indexed: 02/01/2023] Open
Abstract
Background Escherichia coli is a major cause of neonatal sepsis. Contemporary antibiotic resistance data and molecular characterization of neonatal E. coli bacteremia isolates in the US are limited. Methods E. coli blood isolates, antibiotic susceptibility data, and clinical characteristics were obtained from prospectively identified newborns from 2006 to 2016. The E. coli isolates were classified using an updated phylogrouping method and multi-locus sequence typing. The presence of several virulence traits was also determined. Results Forty-three newborns with E. coli bacteremia were identified. Mean gestational age was 32.3 (SD±5.4) weeks. Median age was 7 days (interquartile range 0–10). Mortality (28%) occurred exclusively in preterm newborns. Resistance to ampicillin was 67%, to gentamicin was 14%, and to ceftriaxone was 2%; one isolate produced extended-spectrum beta lactamases. Phylogroup B2 predominated. Sequence type (ST) 95 and ST131 prevailed; ST1193 emerged recently. All isolates carried fimH, nlpI, and ompA, and 46% carried the K1 capsule. E. coli from newborns with bacteremia diagnosed at <72 hours old had more virulence genes compared to E. coli from newborns ≥ 72 hours old. The hek/hra gene was more frequent in isolates from newborns who died than in isolates from survivors. Conclusion Antibiotic resistance in E. coli was prevalent in this large collection of bacteremia isolates from US newborns. Most strains belonged to distinctive extra-intestinal pathogenic E. coil phylogroups and STs. Further characterization of virulence genes in neonatal E. coli bacteremia strains is needed in larger numbers and in more geographically diverse areas.
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Affiliation(s)
- Bryan K. Cole
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Marko Ilikj
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Cindy B. McCloskey
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Susana Chavez-Bueno
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
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20
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Long J, Xu Y, Ou L, Yang H, Xi Y, Chen S, Duan G. Polymorphism of Type I-F CRISPR/Cas system in Escherichia coli of phylogenetic group B2 and its application in genotyping. INFECTION GENETICS AND EVOLUTION 2019; 74:103916. [PMID: 31195154 DOI: 10.1016/j.meegid.2019.103916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 12/26/2022]
Abstract
E. coli of phylogenetic group B2 is responsible for many extraintestinal infections, posing a great threat to health. The relatively polymorphic nature of CRISPR in phylogenetically related E. coli strains makes them potential markers for bacterial typing and evolutionary studies. In the current work, we investigated the occurrence and diversity of CRISPR/Cas system and explored its potential for genotyping. Type I-F CRISPR/Cas systems were found in 413 of 1190 strains of E. coli and exhibited the clustering within certain CCs and STs. And CRISPR spacer contents correlated well with MLST types. The divergence analysis of CRISPR showed stronger discriminatory power than MLST, and CRISPR polymorphism was instrumental for differentiating highly closely related strains. The timeline of spacer acquisition and deletion provided important information for inferring the evolution model between distinct serotypes. Identical spacer sequences were shared by strains with the same H-antigen type but not strains with the same O-antigen type. The homology between spacers and antibiotic-resistant plasmids demonstrated the role of Type I-F system in limiting the acquisition of antimicrobial resistance. Collectively, our data presents the dynamic nature of Type I-F CRISPR in E. coli of phylogenetic group B2 and provides new insights into the application of CRISPR-based typing in the species.
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Affiliation(s)
- Jinzhao Long
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yake Xu
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China; School Hospital, Henan University of Science and Technology, Luoyang, Henan, China
| | - Liuyang Ou
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Haiyan Yang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuanlin Xi
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Shuaiyin Chen
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Guangcai Duan
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China; Henan Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan, China.
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21
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Abstract
Extraintestinal pathogenic Escherichia coli (ExPEC) strains are responsible for a majority of human extraintestinal infections globally, resulting in enormous direct medical and social costs. ExPEC strains are comprised of many lineages, but only a subset is responsible for the vast majority of infections. Few systematic surveillance systems exist for ExPEC. To address this gap, we systematically reviewed and meta-analyzed 217 studies (1995 to 2018) that performed multilocus sequence typing or whole-genome sequencing to genotype E. coli recovered from extraintestinal infections or the gut. Twenty major ExPEC sequence types (STs) accounted for 85% of E. coli isolates from the included studies. ST131 was the most common ST from 2000 onwards, covering all geographic regions. Antimicrobial resistance-based isolate study inclusion criteria likely led to an overestimation and underestimation of some lineages. European and North American studies showed similar distributions of ExPEC STs, but Asian and African studies diverged. Epidemiology and population dynamics of ExPEC are complex; summary proportion for some STs varied over time (e.g., ST95), while other STs were constant (e.g., ST10). Persistence, adaptation, and predominance in the intestinal reservoir may drive ExPEC success. Systematic, unbiased tracking of predominant ExPEC lineages will direct research toward better treatment and prevention strategies for extraintestinal infections.
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22
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ESBL-producing Escherichia coli
and Its Rapid Rise among Healthy People. Food Saf (Tokyo) 2017; 5:122-150. [PMID: 32231938 DOI: 10.14252/foodsafetyfscj.2017011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023] Open
Abstract
Since around the 2000s, Escherichia coli (E. coli) resistant to both oxyimino-cephalosporins and fluoroquinolones has remarkably increased worldwide in clinical settings. The kind of E. coli is also identified in patients suffering from community-onset infectious diseases such as urinary tract infections. Moreover, recoveries of multi-drug resistant E. coli from the feces of healthy people have been increasingly documented in recent years, although the actual state remains uncertain. These E. coli isolates usually produce extended-spectrum β-lactamase (ESBL), as well as acquisition of amino acid substitutions in the quinolone-resistance determining regions (QRDRs) of GyrA and/or ParC, together with plasmid-mediated quinolone resistance determinants such as Qnr, AAC(6')-Ib-cr, and QepA. The actual state of ESBL-producing E. coli in hospitalized patients has been carefully investigated in many countries, while that in healthy people still remains uncertain, although high fecal carriage rates of ESBL producers in healthy people have been reported especially in Asian and South American countries. The issues regarding the ESBL producers have become very complicated and chaotic due to rapid increase of both ESBL variants and plasmids mediating ESBL genes, together with the emergence of various "epidemic strains" or "international clones" of E. coli and Klebsiella pneumoniae harboring transferable-plasmids carrying multiple antimicrobial resistance genes. Thus, the current state of ESBL producers outside hospital settings was overviewed together with the relation among those recovered from livestock, foods, pets, environments and wildlife from the viewpoint of molecular epidemiology. This mini review may contribute to better understanding about ESBL producers among people who are not familiar with the antimicrobial resistance (AMR) threatening rising globally.
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23
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Escherichia coli early-onset sepsis: trends over two decades. Eur J Pediatr 2017; 176:1227-1234. [PMID: 28770413 DOI: 10.1007/s00431-017-2975-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/12/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Escherichia coli early-onset sepsis (EOS) is an important cause of mortality and morbidity in neonates, especially in preterm and very low birth weight (VLBW) newborns. The aim of our study was to evaluate potential changes in the clinical and microbiological characteristics of E. coli EOS in our setting. Epidemiological, clinical, and microbiological data from all neonates with proven E. coli EOS from January 1994 to December 2014 were retrospectively collected in a single tertiary care hospital in Barcelona (Spain). Seventy-eight E. coli EOS cases were analyzed. A slight increase in the incidence of E. coli EOS was observed during the study period. VLBW newborns remained the group with higher incidence (10.4 cases per 1000 live births) and mortality (35.3%). Systematic use of PCR increased E. coli EOS diagnosis, mainly in the term newborn group. There was an increase in resistant E. coli strains causing EOS, with especially high resistance to ampicillin and gentamicin (92.8 and 28.6%, respectively). Nonetheless, resistant strains were not associated with poorer clinical outcomes. CONCLUSIONS There is an urgent need to reconsider the empirical therapy used in neonatal EOS, particularly in VLBW newborns. What is Known: • E. coli early-onset sepsis (EOS) and E. coli resistant strains have been described as overall stable but increasing in VLBW neonates (< 1.500 g) in previous studies. What is New: • Our study shows an increasing incidence of E. coli EOS in all age groups, overruling group B Streptoccocus for the last 10 years. E. coli resistant strains also increased equally in all age groups, with high resistance rates to our first line antibiotics (ampicillin and gentamicin). • Empiric antibiotic therapy of EOS, mainly in VLBW newborns, should be adapted to this new scenario.
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24
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Garinis AC, Kemph A, Tharpe AM, Weitkamp JH, McEvoy C, Steyger PS. Monitoring neonates for ototoxicity. Int J Audiol 2017; 57:S41-S48. [PMID: 28949262 DOI: 10.1080/14992027.2017.1339130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Neonates admitted to the neonatal intensive care unit (NICU) are at greater risk of permanent hearing loss compared to infants in well mother and baby units. Several factors have been associated with this increased prevalence of hearing loss, including congenital infections (e.g. cytomegalovirus or syphilis), ototoxic drugs (such as aminoglycoside or glycopeptide antibiotics), low birth weight, hypoxia and length of stay. The aetiology of this increased prevalence of hearing loss remains poorly understood. DESIGN Here we review current practice and discuss the feasibility of designing improved ototoxicity screening and monitoring protocols to better identify acquired, drug-induced hearing loss in NICU neonates. STUDY SAMPLE A review of published literature. CONCLUSIONS We conclude that current audiological screening or monitoring protocols for neonates are not designed to adequately detect early onset of ototoxicity. This paper offers a detailed review of evidence-based research, and offers recommendations for developing and implementing an ototoxicity monitoring protocol for young infants, before and after discharge from the hospital.
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Affiliation(s)
- Angela C Garinis
- a Oregon Hearing Research Center, Otolaryngology , Oregon Health & Science University , Portland , OR , USA.,b National Center for Rehabilitative Auditory Research , VA Portland Health Care System , Portland , OR , USA
| | - Alison Kemph
- c Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Anne Marie Tharpe
- c Hearing and Speech Sciences , Vanderbilt University School of Medicine , Nashville , TN , USA
| | | | - Cynthia McEvoy
- e Neonatology, Pediatrics , Oregon Health & Science University , Portland , OR , USA
| | - Peter S Steyger
- a Oregon Hearing Research Center, Otolaryngology , Oregon Health & Science University , Portland , OR , USA.,b National Center for Rehabilitative Auditory Research , VA Portland Health Care System , Portland , OR , USA
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25
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Bacterium-Derived Cell-Penetrating Peptides Deliver Gentamicin To Kill Intracellular Pathogens. Antimicrob Agents Chemother 2017; 61:AAC.02545-16. [PMID: 28096156 DOI: 10.1128/aac.02545-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/07/2017] [Indexed: 12/20/2022] Open
Abstract
Commonly used antimicrobials show poor cellular uptake and often have limited access to intracellular targets, resulting in low antimicrobial activity against intracellular pathogens. An efficient delivery system to transport these drugs to the intracellular site of action is needed. Cell-penetrating peptides (CPPs) mediate the internalization of biologically active molecules into the cytoplasm. Here, we characterized two CPPs, α1H and α2H, derived from the Yersinia enterocolitica YopM effector protein. These CPPs, as well as Tat (trans-activator of transcription) from HIV-1, were used to deliver the antibiotic gentamicin to target intracellular bacteria. The YopM-derived CPPs penetrated different endothelial and epithelial cells to the same extent as Tat. CPPs were covalently conjugated to gentamicin, and CPP-gentamicin conjugates were used to target infected cells to kill multiple intracellular Gram-negative pathogenic bacteria, including Escherichia coli K1, Salmonella enterica serovar Typhimurium, and Shigella flexneri Taken together, CPPs show great potential as delivery vehicles for antimicrobial agents and may contribute to the generation of new therapeutic tools to treat infectious diseases caused by intracellular pathogens.
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26
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Cools P. The role of Escherichia coli in reproductive health: state of the art. Res Microbiol 2017; 168:892-901. [PMID: 28242352 DOI: 10.1016/j.resmic.2017.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/09/2017] [Accepted: 02/13/2017] [Indexed: 01/27/2023]
Abstract
Escherichia coli is a well-known commensal of the normal intestinal microbiome that can also colonize the vaginal microbiome, usually without symptoms. However, E. coli can also be a highly virulent and frequently deadly pathogen. In this review, I will discuss the role E. coli has in reproductive health and disease.
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Affiliation(s)
- Piet Cools
- Laboratory Bacteriology Research, Department of Clinical Chemistry, Microbiology and Immunology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
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27
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Schrag SJ, Farley MM, Petit S, Reingold A, Weston EJ, Pondo T, Hudson Jain J, Lynfield R. Epidemiology of Invasive Early-Onset Neonatal Sepsis, 2005 to 2014. Pediatrics 2016; 138:peds.2016-2013. [PMID: 27940705 DOI: 10.1542/peds.2016-2013] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) and Escherichia coli have historically dominated as causes of early-onset neonatal sepsis. Widespread use of intrapartum prophylaxis for GBS disease led to concerns about the potential adverse impact on E coli incidence. METHODS Active, laboratory, and population-based surveillance for culture-positive (blood or cerebrospinal fluid) bacterial infections among infants 0 to 2 days of age was conducted statewide in Minnesota and Connecticut and in selected counties of California and Georgia during 2005 to 2014. Demographic and clinical information were collected and hospital live birth denominators were used to calculate incidence rates (per 1000 live births). We used the Cochran-Amitage test to assess trends. RESULTS Surveillance identified 1484 cases. GBS was most common (532) followed by E coli (368) and viridans streptococci (280). Eleven percent of cases died and 6.3% of survivors had sequelae at discharge. All-cause (2005: 0.79; 2014: 0.77; P = .05) and E coli (2005: 0.21; 2014: 0.18; P = .25) sepsis incidence were stable. GBS incidence decreased (2005: 0.27; 2014: 0.22; P = .02). Among infants <1500 g, incidence was an order of magnitude higher for both pathogens and stable. The odds of death among infants <1500 g were similar for both pathogens but among infants ≥1500 g, the odds of death were greater for E coli cases (odds ratio: 7.0; 95% confidence interval: 2.7-18.2). CONCLUSIONS GBS prevention efforts have not led to an increasing burden of early-onset E coli infections. However, the stable burden of E coli sepsis and associated mortality underscore the need for interventions.
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Affiliation(s)
- Stephanie J Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Monica M Farley
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Arthur Reingold
- Division of Epidemiolgy, School of Public Health, University of California, Berkley, Berkley, California; and
| | - Emily J Weston
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hudson Jain
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neontal Research Network (NRN) was established in 1986 in response to the need for rigorous studies to guide care and management of sick and premature newborns. The network is comprise of clinical centers that perform clinical protocols to investigate the safety and efficay of treatment and management strategies for newborn infants as well as a data cordinating center. Infrastructure is set up for observational and interventional studies as well as neurodevelopmental follow-up of patients. The network has conducted trials and observational studies on major neonatal problems including pulmonary disease, neuroprotection, sepsis and infection, necrotizing enterocolitis, vaccine administration to preterm infants, retinopathy of prematurity, cardiovascular issues including blood pressure, human milk, growth and nutrition, hematologic issues, resuscitation, pulmonary hypertension, and neurodevelopmental outcome. This mechanism of clinical research for newborns has led to changes in care practices leading to improved outcomes for high-risk infants.
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Affiliation(s)
- Rosemary D. Higgins
- Pregnancy and Perinatology Branch, National Health (NIH), Institute
of Child Health and Human Development (NICHD), National Institues of 6710B Rockledge Drive, Room 2233 Mail Stop Code 7002 Bethesda, MD 20892,Corresponding author.
(R.D. Higgins)
| | - Seetha Shankaran
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics,
Wayne State University School of Medicine, Detroit, MI
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29
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Krishnan S, Chang AC, Stoltz BM, Prasadarao NV. Escherichia coli K1 Modulates Peroxisome Proliferator-Activated Receptor γ and Glucose Transporter 1 at the Blood-Brain Barrier in Neonatal Meningitis. J Infect Dis 2016; 214:1092-104. [PMID: 27456707 DOI: 10.1093/infdis/jiw306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/13/2016] [Indexed: 12/14/2022] Open
Abstract
Escherichia coli K1 meningitis continues to be a major threat to neonatal health. Previous studies demonstrated that outer membrane protein A (OmpA) of E. coli K1 interacts with endothelial cell glycoprotein 96 (Ecgp96) in the blood-brain barrier to enter the central nervous system. Here we show that the interaction between OmpA and Ecgp96 downregulates peroxisome proliferator-activated receptor γ (PPAR-γ) and glucose transporter 1 (GLUT-1) levels in human brain microvascular endothelial cells, causing disruption of barrier integrity and inhibition of glucose uptake. The suppression of PPAR-γ and GLUT-1 by the bacteria in the brain microvessels of newborn mice causes extensive pathophysiology owing to interleukin 6 production. Pretreatment with partial or selective PPAR-γ agonists ameliorate the pathological outcomes of infection by suppressing interleukin 6 production in the brain. Thus, inhibition of PPAR-γ and GLUT-1 by E. coli K1 is a novel pathogenic mechanism in meningitis, and pharmacological upregulation of PPAR-γ and GLUT-1 levels may provide novel therapeutic avenues.
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Affiliation(s)
- Subramanian Krishnan
- Division of Infectious Diseases, Department of Pediatrics Department of Surgery, Children's Hospital Los Angeles
| | - Alexander C Chang
- Division of Infectious Diseases, Department of Pediatrics Department of Surgery, Children's Hospital Los Angeles
| | - Brian M Stoltz
- Department of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena
| | - Nemani V Prasadarao
- Division of Infectious Diseases, Department of Pediatrics Department of Surgery, Children's Hospital Los Angeles Keck School of Medicine, University of Southern California, Los Angeles
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