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Bereanu AS, Bereanu R, Mohor C, Vintilă BI, Codru IR, Olteanu C, Sava M. Prevalence of Infections and Antimicrobial Resistance of ESKAPE Group Bacteria Isolated from Patients Admitted to the Intensive Care Unit of a County Emergency Hospital in Romania. Antibiotics (Basel) 2024; 13:400. [PMID: 38786129 PMCID: PMC11117271 DOI: 10.3390/antibiotics13050400] [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: 04/04/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
The ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella Pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) is a group of bacteria very difficult to treat due to their high ability to acquire resistance to antibiotics and are the main cause of nosocomial infections worldwide, posing a threat to global public health. Nosocomial infections with MDR bacteria are found mainly in Intensive Care Units, due to the multitude of maneuvers and invasive medical devices used, the prolonged antibiotic treatments, the serious general condition of these critical patients, and the prolonged duration of hospitalization. MATERIALS AND METHODS During a period of one year, from January 2023 to December 2023, this cross-sectional study was conducted on patients diagnosed with sepsis admitted to the Intensive Care Unit of the Sibiu County Emergency Clinical Hospital. Samples taken were tracheal aspirate, catheter tip, pharyngeal exudate, wound secretion, urine culture, blood culture, and peritoneal fluid. RESULTS The most common bacteria isolated from patients admitted to our Intensive Care Unit was Klebsiella pneumoniae, followed by Acinetobacter baumanii and Pseudomonas aeruginosa. Gram-positive cocci (Enterococcus faecium and Staphilococcus aureus) were rarely isolated. Most of the bacteria isolated were MDR bacteria. CONCLUSIONS The rise of antibiotic and antimicrobial resistance among strains in the nosocomial environment and especially in Intensive Care Units raises serious concerns about limited treatment options.
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Affiliation(s)
- Alina-Simona Bereanu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
| | - Rareș Bereanu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
| | - Cosmin Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
| | - Bogdan Ioan Vintilă
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
| | - Ioana Roxana Codru
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
| | - Ciprian Olteanu
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
| | - Mihai Sava
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (B.I.V.); (I.R.C.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu, nr. 2-4, 550245 Sibiu, Romania;
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Wang Z, Shao C, Shao J, Hao Y, Jin Y. Risk factors of Carbapenem-resistant Enterobacterales intestinal colonization for subsequent infections in hematological patients: a retrospective case-control study. Front Microbiol 2024; 15:1355069. [PMID: 38680915 PMCID: PMC11045900 DOI: 10.3389/fmicb.2024.1355069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Objective Infections caused by Carbapenem-resistant Enterobacterales (CRE) have high treatment costs, high mortality and few effective therapeutic agents. This study aimed to determine the risk factors for progression from intestinal colonization to infection in hematological patients and the risk factors for 30-day mortality in infected patients. Methods A retrospective case-control study was conducted in the Department of Hematology at Shandong Provincial Hospital affiliated to Shandong First Medical University from April 2018 to April 2022. Patients who developed subsequent infections were identified as the case group by electronic medical record query of patients with a positive rectal screen for CRE colonization, and patients who did not develop subsequent infections were identified as the control group by stratified random sampling. Univariate analysis and logistic regression analysis determined risk factors for developing CRE infection and risk factors for mortality in CRE-infected patients. Results Eleven hematological patients in the study developed subsequent infections. The overall 30-day mortality rate for the 44 hematological patients in the case-control study was 11.4% (5/44). Mortality was higher in the case group than in the control group (36.5 vs. 3.0%, P = 0.0026), and septic shock was an independent risk factor for death (P = 0.024). Univariate analysis showed that risk factors for developing infections were non-steroidal immunosuppressants, serum albumin levels, and days of hospitalization. In multivariable logistic regression analysis, immunosuppressants [odds ratio (OR), 19.132; 95% confidence interval (CI), 1.349-271.420; P = 0.029] and serum albumin levels (OR, 0.817; 95% CI, 0.668-0.999; P = 0.049) were independent risk factors for developing infections. Conclusion Our findings suggest that septic shock increases mortality in CRE-infected hematological patients. Hematological patients with CRE colonization using immunosuppressive agents and reduced serum albumin are more likely to progress to CRE infection. This study may help clinicians prevent the onset of infection early and take measures to reduce mortality rates.
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Affiliation(s)
| | | | | | | | - Yan Jin
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Bereanu AS, Vintilă BI, Bereanu R, Codru IR, Hașegan A, Olteanu C, Săceleanu V, Sava M. TiO 2 Nanocomposite Coatings and Inactivation of Carbapenemase-Producing Klebsiella Pneumoniae Biofilm-Opportunities and Challenges. Microorganisms 2024; 12:684. [PMID: 38674628 PMCID: PMC11051735 DOI: 10.3390/microorganisms12040684] [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: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
The worldwide increase of multidrug-resistant Gram-negative bacteria is a global threat. The emergence and global spread of Klebsiella pneumoniae carbapenemase- (KPC-) producing Klebsiella pneumoniae represent a particular concern. This pathogen has increased resistance and abilities to persist in human reservoirs, in hospital environments, on medical devices, and to generate biofilms. Mortality related to this microorganism is high among immunosuppressed oncological patients and those with multiple hospitalizations and an extended stay in intensive care. There is a severe threat posed by the ability of biofilms to grow and resist antibiotics. Various nanotechnology-based strategies have been studied and developed to prevent and combat serious health problems caused by biofilm infections. The aim of this review was to evaluate the implications of nanotechnology in eradicating biofilms with KPC-producing Klebsiella pneumoniae, one of the bacteria most frequently associated with nosocomial infections in intensive care units, including in our department, and to highlight studies presenting the potential applicability of TiO2 nanocomposite materials in hospital practice. We also described the frequency of the presence of bacterial biofilms on medical surfaces, devices, and equipment. TiO2 nanocomposite coatings are one of the best long-term options for antimicrobial efficacy due to their biocompatibility, stability, corrosion resistance, and low cost; they find their applicability in hospital practice due to their critical antimicrobial role for surfaces and orthopedic and dental implants. The International Agency for Research on Cancer has recently classified titanium dioxide nanoparticles (TiO2 NPs) as possibly carcinogenic. Currently, there is an interest in the ecological, non-toxic synthesis of TiO2 nanoparticles via biological methods. Biogenic, non-toxic nanoparticles have remarkable properties due to their biocompatibility, stability, and size. Few studies have mentioned the use of nanoparticle-coated surfaces as antibiofilm agents. A literature review was performed to identify publications related to KPC-producing Klebsiella pneumoniae biofilms and antimicrobial TiO2 photocatalytic nanocomposite coatings. There are few reviews on the antibacterial and antibiofilm applications of TiO2 photocatalytic nanocomposite coatings. TiO2 nanoparticles demonstrated marked antibiofilm activity, but being nano in size, these nanoparticles can penetrate cell membranes and may initiate cellular toxicity and genotoxicity. Biogenic TiO2 nanoparticles obtained via green, ecological technology have less applicability but are actively investigated.
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Affiliation(s)
- Alina-Simona Bereanu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Bogdan Ioan Vintilă
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Rareș Bereanu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
| | - Ioana Roxana Codru
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Adrian Hașegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Ciprian Olteanu
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Vicențiu Săceleanu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
| | - Mihai Sava
- Faculty of Medicine, Lucian Blaga University of Sibiu, Lucian Blaga Street 2A, 550169 Sibiu, Romania; (A.-S.B.); (R.B.); (A.H.); (V.S.); (M.S.)
- County Clinical Emergency Hospital, Bld. Corneliu Coposu nr. 2-4, 550245 Sibiu, Romania;
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Stordeur F, Si Larbi AG, Le Neindre K, Ory J, Faibis F, Lawrence C, Barbut F, Lecointe D, Farfour E. A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening. J Hosp Infect 2024; 148:20-29. [PMID: 38490490 DOI: 10.1016/j.jhin.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The duration of extensively drug-resistant bacteria (XDR) carriage depends on several factors for which the information can be difficult to recover. AIM To determine whether past screening and clinical results of patients can predict the results of subsequent screening. METHODS In total, 256 patients were retrospectively included from 10 healthcare centres in France from January 2014 to January 2022. We created a predictive clearance score, ranging from -5 to +7, that included the number of XDR species and the type of resistance detected in the sample, as well as the time from the last positive sample, the number of previous consecutive negative samples, and obtaining at least one negative PCR result in the collection. This score could be used for the upcoming rectal screening of a patient carrying an XDR as soon as the last screening sample was negative. FINDINGS The negative predictive value was >99% for score ≤0. The median time to achieve XDR clearance was significantly shorter for a score of 0 (443 days (259-705)) than that based on previously published criteria. CONCLUSION This predictive score shows high performance for the assessment of XDR clearance. Relative to previous guidelines, it could help to lift specific infection prevention and control measures earlier. Nevertheless, the decision should be made according to other factors, such as antimicrobial use and adherence to hand hygiene.
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Affiliation(s)
- F Stordeur
- Structure interne de gestion des risques, hygiène, qualité (SIGRHYQ), Centre Hospitalier Poissy-Saint-Germain en Laye, Poissy, France; Unité de prévention du risque infectieux (UPRI), AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Centre régional en Antibiothérapie (CRAtb) Ile-de-France, Paris, France.
| | - A-G Si Larbi
- Service d'hémovigilance, Hôpital Foch, Suresnes, France
| | - K Le Neindre
- Microbiologie de l'environnement, AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Service de Prévention & Contrôle de l'Infection, département des Agents Infectieux, CHU Caen Normandie, Caen, France
| | - J Ory
- Service de microbiologie et hygiène hospitalière, CHU Nîmes, Nîmes, France
| | - F Faibis
- Microbiologie, Grand Hôpital de l'est francilien (GHEF), site Jossigny, France
| | - C Lawrence
- Structure interne de gestion des risques, hygiène, qualité (SIGRHYQ), Centre Hospitalier Poissy-Saint-Germain en Laye, Poissy, France; Equipe opérationnelle d'hygiène, AP-HP Université Paris Saclay, site Raymond-Poincaré, Garches, France; Equipe de prévention des infections, Centre Hospitalier François Quesnay, Mantes-la-Jolie, France
| | - F Barbut
- Unité de prévention du risque infectieux (UPRI), AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Microbiologie de l'environnement, AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Centre National de Référence du Clostridioïdes difficile, Paris, France; INSERM, Faculté de Pharmacie de Paris, Université de Paris, Paris, France
| | - D Lecointe
- Service d'hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France
| | - E Farfour
- Service de Biologie Clinique, hôpital Foch, Suresnes, France
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Antimicrobial consumption and resistance in bacteria from humans and food-producing animals: Fourth joint inter-agency report on integrated analysis of antimicrobial agent consumption and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals in the EU/EEA JIACRA IV - 2019-2021. EFSA J 2024; 22:e8589. [PMID: 38405113 PMCID: PMC10885775 DOI: 10.2903/j.efsa.2024.8589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
The fourth joint inter-agency report on integrated analysis of antimicrobial consumption (AMC) and the occurrence of antimicrobial resistance (AMR) in bacteria from humans and food-producing animals (JIACRA) addressed data obtained by the Agencies' EU-wide surveillance networks for 2019-2021. The analysis also sought to identify whether significant trends in AMR and AMC were concomitant over 2014-2021. AMC in both human and animal sectors, expressed in mg/kg of estimated biomass, was compared at country and European level. In 2021, the total AMC was assessed at 125.0 mg/kg of biomass for humans (28 EU/EEA countries, range 44.3-160.1) and 92.6 mg/kg of biomass for food-producing animals (29 EU/EEA countries, range 2.5-296.5). Between 2014 and 2021, total AMC in food-producing animals decreased by 44%, while in humans, it remained relatively stable. Univariate and multivariate analyses were performed to study associations between AMC and AMR for selected combinations of bacteria and antimicrobials. Positive associations between consumption of certain antimicrobials and resistance to those substances in bacteria from both humans and food-producing animals were observed. For certain combinations of bacteria and antimicrobials, AMR in bacteria from humans was associated with AMR in bacteria from food-producing animals which, in turn, was related to AMC in animals. The relative strength of these associations differed markedly between antimicrobial class, microorganism and sector. For certain antimicrobials, statistically significant decreasing trends in AMC and AMR were concomitant for food-producing animals and humans in several countries over 2014-2021. Similarly, a proportion of countries that significantly reduced total AMC also registered increasing susceptibility to antimicrobials in indicator E. coli from food-producing animals and E. coli originating from human invasive infections (i.e., exhibited 'complete susceptibility' or 'zero resistance' to a harmonised set of antimicrobials). Overall, the findings suggest that measures implemented to reduce AMC in food-producing animals and in humans have been effective in many countries. Nevertheless, these measures need to be reinforced so that reductions in AMC are retained and further continued, where necessary. This also highlights the importance of measures that promote human and animal health, such as vaccination and better hygiene, thereby reducing the need for use of antimicrobials.
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Ning C, Ouyang H, Shen D, Sun Z, Liu B, Hong X, Lin C, Li J, Chen L, Li X, Huang G. Prediction of survival in patients with infected pancreatic necrosis: a prospective cohort study. Int J Surg 2024; 110:777-787. [PMID: 37851523 PMCID: PMC10871654 DOI: 10.1097/js9.0000000000000844] [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: 07/20/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Infected pancreatic necrosis (IPN) is a severe complication of acute pancreatitis, with mortality rates ranging from 15 to 35%. However, limited studies exist to predict the survival of IPN patients and nomogram has never been built. This study aimed to identify predictors of mortality, estimate conditional survival (CS), and develop a CS nomogram and logistic regression nomogram for real-time prediction of survival in IPN patients. METHODS A prospective cohort study was performed in 335 IPN patients consecutively enrolled at a large Chinese tertiary hospital from January 2011 to December 2022. The random survival forest method was first employed to identify the most significant predictors and capture clinically relevant nonlinear threshold effects. Instantaneous death risk and CS was first utilized to reveal the dynamic changes in the survival of IPN patients. A Cox model-based nomogram incorporating CS and a logistic regression-based nomogram were first developed and internally validated with a bootstrap method. RESULTS The random survival forest model identified seven foremost predictors of mortality, including the number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification. Duration of organ failure and time from onset to first intervention showed distinct thresholds and nonlinear relationships with mortality. Instantaneous death risk reduced progressively within the first 30 days, and CS analysis indicated gradual improvement in real-time survival since diagnosis, with 90-day survival rates gradually increasing from 0.778 to 0.838, 0.881, 0.974, and 0.992 after surviving 15, 30, 45, 60, and 75 days, respectively. After further variables selection using step regression, five predictors (age, number of organ failures, hemorrhage, time from onset to first intervention, and bloodstream infection) were utilized to construct both the CS nomogram and logistic regression nomogram, both of which demonstrated excellent performance with 1000 bootstrap. CONCLUSION Number of organ failures, duration of organ failure, age, time from onset to first intervention, hemorrhage, bloodstream infection, and severity classification were the most crucial predictors of mortality of IPN patients. The CS nomogram and logistic regression nomogram constructed by these predictors could help clinicians to predict real-time survival and optimize clinical decisions.
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Affiliation(s)
- Caihong Ning
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Hui Ouyang
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
| | - Dingcheng Shen
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Zefang Sun
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Baiqi Liu
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xiaoyue Hong
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Chiayen Lin
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jiarong Li
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Lu Chen
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xinying Li
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
| | - Gengwen Huang
- Department of General Surgery
- National Clinical Research Center for Geriatric Disorders
- Department of Pancreatic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
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Baek MS, Kim JH, Park JH, Kim TW, Jung HI, Kwon YS. Comparison of mortality rates in patients with carbapenem-resistant Enterobacterales bacteremia according to carbapenemase production: a multicenter propensity-score matched study. Sci Rep 2024; 14:597. [PMID: 38182719 PMCID: PMC10770160 DOI: 10.1038/s41598-023-51118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/30/2023] [Indexed: 01/07/2024] Open
Abstract
The spread of carbapenem-resistant Enterobacterales (CRE) poses a public health threat worldwide. We aimed to compare the mortality rates between the carbapenemase-producing (CP) and non-CP CRE bacteremia. We conducted a retrospective cohort study in patients with CRE bacteremia after propensity score (PS) matching. We performed a Kaplan-Meier curve analysis to identify the cumulative hazard for 30-day mortality. There were 318 patients with CRE between January 1, 2018, and December 31, 2022. There were 252 patients with CP-CRE and 66 with non-CP-RE, respectively. Before PS matching, the 30-day mortality rates were 40.9% in the non-CP-CRE group and 53.2% in the CP-CRE group (p = 0.097). In patients in the intensive care unit (ICU), the mortality rates were 49.0% in the non-CP-CRE group and 57.1% in the CP-CRE group (p = 0.340). After PS matching, the hazard ratio (HR) for mortality in the CP-CRE group was 1.49 (95% confidence interval [CI] 0.74-3.03), p = 0.266). In ICU patients, the HR of CP-CRE was 1.11 (95% CI 0.36-3.39, p = 0.860). The Kaplan-Meier curve for 30-day mortality showed no difference in cumulative hazard. After PS matching, there was no difference in 30-day mortality between patients with CP-CRE and non-CP-CRE bacteremia.
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Affiliation(s)
- Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jong Ho Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
- Institute of New Frontier Research Team, Hallym University, Chuncheon, Republic of Korea
| | - Joung Ha Park
- Division of Infectious Diseases, Department of Internal Medicine, Gwangmyeong Hospital, Chung-Ang University, Gwangmyeong, Republic of Korea
| | - Tae Wan Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hae In Jung
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Young Suk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea.
- Institute of New Frontier Research Team, Hallym University, Chuncheon, Republic of Korea.
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Wu YL, Hu XQ, Wu DQ, Li RJ, Wang XP, Zhang J, Liu Z, Chu WW, Zhu X, Zhang WH, Zhao X, Guan ZS, Jiang YL, Wu JF, Cui Z, Zhang J, Li J, Wang RM, Shen SH, Cai CY, Zhu HB, Jiang Q, Zhang J, Niu JL, Xiong XP, Tian Z, Zhang JS, Zhang JL, Tang LL, Liu AY, Wang CX, Ni MZ, Jiang JJ, Yang XY, Yang M, Zhou Q. Prevalence and risk factors for colonisation and infection with carbapenem-resistant Enterobacterales in intensive care units: A prospective multicentre study. Intensive Crit Care Nurs 2023; 79:103491. [PMID: 37480701 DOI: 10.1016/j.iccn.2023.103491] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This study aimed to investigate the prevalence and risk factors for carbapenem-resistant Enterobacterales colonisation/infection at admission and acquisition among patients admitted to the intensive care unit. RESEARCH METHODOLOGY/DESIGN A prospective and multicentre study. SETTING This study was conducted in 24 intensive care units in Anhui, China. MAIN OUTCOME MEASURES Demographic and clinical data were collected, and rectal carbapenem-resistant Enterobacterales colonisation was detected by active screening. Multivariate logistic regression models were used to analyse factors associated with colonisation/infection with carbapenem-resistant Enterobacterales at admission and acquisition during the intensive care unit stay. RESULTS There were 1133 intensive care unit patients included in this study. In total, 5.9% of patients with carbapenem-resistant Enterobacterales colonisation/infection at admission, and of which 56.7% were colonisations. Besides, 8.5% of patients acquired carbapenem-resistant Enterobacterales colonisation/infection during the intensive care stay, and of which 67.6% were colonisations. At admission, transfer from another hospital, admission to an intensive care unit within one year, colonisation/infection/epidemiological link with carbapenem-resistant Enterobacterales within one year, and exposure to any antibiotics within three months were risk factors for colonisation/infection with carbapenem-resistant Enterobacterales. During the intensive care stay, renal disease, an epidemiological link with carbapenem-resistant Enterobacterales, exposure to carbapenems and beta-lactams/beta-lactamase inhibitors, and intensive care stay of three weeks or longer were associated with acquisition. CONCLUSION The prevalence of colonisation/infection with carbapenem-resistant Enterobacterales in intensive care units is of great concern and should be monitored systematically. Particularly for the 8.5% prevalence of carbapenem-resistant Enterobacterales acquisition during the intensive care stay needs enhanced infection prevention and control measures in these setting. Surveillance of colonisation/infection with carbapenem-resistant Enterobacterales at admission and during the patient's stay represents an early identification tool to prevent further transmission of carbapenem-resistant Enterobacterales. IMPLICATIONS FOR CLINICAL PRACTICE Carbapenem-resistant Enterobacterales colonization screening at admission and during the patient's stay is an important tool to control carbapenem-resistant Enterobacterales spread in intensive care units.
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Affiliation(s)
- Yi-Le Wu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Qian Hu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - De-Quan Wu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruo-Jie Li
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xue-Ping Wang
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin Zhang
- The Second Department of Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhou Liu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Wen Chu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi Zhu
- Department of Pharmacology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Hui Zhang
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xue Zhao
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zi-Shu Guan
- Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Yun-Lan Jiang
- Department of Hospital Infection Prevention and Control, the First People's Hospital of Anqing, Anqing, Anhui, China
| | - Jin-Feng Wu
- Department of Hospital Infection Prevention and Control, Anqing Municipal Hospital, Anqing, Anhui, China
| | - Zhuo Cui
- Department of Hospital Infection Prevention and Control, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Ju Zhang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Bengbu, Bengbu, Anhui, China
| | - Jia Li
- Department of Hospital Infection Prevention and Control, The Third People's Hospital of Bengbu, Bengbu, Anhui, China
| | - Ru-Mei Wang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Chuzhou, Chuzhou, Anhui, China
| | - Shi-Hua Shen
- Department of Hospital Infection Prevention and Control, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Chao-Yang Cai
- Department of Hospital Infection Prevention and Control, The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Hai-Bin Zhu
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Huainan City, Huainan, Anhui, China
| | - Quan Jiang
- Department of Clinical Laboratory Medicine, Huainan Xinhua Medical Group, Huainan, Anhui, China
| | - Jing Zhang
- Department of Hospital Infection Prevention and Control, Huaibei People's Hospital, Huaibei, Anhui, China
| | - Jia-Lan Niu
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Huoqiu County, Huoqiu, Anhui, China
| | - Xian-Peng Xiong
- Department of Hospital Infection Prevention and Control, Lu'an People's Hospital, Lu'an, Anhui, China
| | - Zhen Tian
- Department of Hospital Infection Prevention and Control, Suzhou Municipal Hospital, Suzhou, Anhui, China
| | - Jian-She Zhang
- Department of Hospital Infection Prevention and Control, Taihe County People's Hospital, Taihe, Anhui, China
| | - Jun-Lin Zhang
- Department of Hospital Infection Prevention and Control, Tongling People's Hospital, Tongling, Anhui, China
| | - Li-Ling Tang
- Department of Hospital Infection Prevention and Control, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - An-Yun Liu
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Cheng-Xiang Wang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Wuhu, Wuhu, Anhui, China
| | - Ming-Zhu Ni
- Department of Hospital Infection Prevention and Control, The Second People's Hospital of Wuhu, Wuhu, Anhui, China
| | - Jing-Jing Jiang
- Department of Hospital Infection Prevention and Control, Xuancheng People's Hospital, Xuancheng, Anhui, China
| | - Xi-Yao Yang
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Min Yang
- The Second Department of Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Qiang Zhou
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Ferreira ICDS, Menezes RDP, Jesus TAD, Machado ICDB, Lopes MSM, Costa AD, Araújo LBD, Röder DVDDB. Impact of intestinal colonization by Gram-negative bacteria on the incidence of bloodstream infections and lethality in critically ill neonates. J Infect Public Health 2023; 16 Suppl 1:9-18. [PMID: 37951729 DOI: 10.1016/j.jiph.2023.10.040] [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: 07/26/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Early detection of antimicrobial-resistant microorganisms is crucial to prevent subsequent invasive infections and contain their spread in the Neonatal Intensive Care Unit (NICU). This study aims to investigate the association between intestinal colonization (IC) by Gram-negative bacteria and the risk of bloodstream infection (BSI) in critically ill neonates. METHODS Data from the electronic medical records of 678 newborns admitted to a NICU Brazilian between 2018 and 2022 were retrospectively analyzed. Participants were monitored by the National Health Security Network. RESULTS Among neonates, 6.9 % had IC (56.9 % attributed to Acinetobacter baumannii); of these, 19.1 % developed BSI (66.7 % by Staphylococcus spp.). Within the A. baumannii colonization, 34.5 % occurred during an outbreak in September 2021. Colonized individuals had a longer mean length of stay (49.3 ± 26.4 days) and higher mortality rate (12.8 %) compared to non-colonized individuals (22.2 ± 16.9 days; 6.7 %, respectively). Previous use of antimicrobials and invasive devices significantly increased the risk of colonization. Colonization by drug-resistant microorganisms, along with the occurrence of BSI, was associated with increased mortality and reduced survival time. CONCLUSIONS IC contributed to the incidence of BSI, leading to more extended hospital stays and higher mortality rates. Its early detection proved to be essential to identify an outbreak and control the spread of resistant microorganisms within the NICU.
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Affiliation(s)
| | - Ralciane de Paula Menezes
- Technical Course in Clinical Analysis, Technical School of Health, Federal University of Uberlândia, Minas Gerais, Brazil.
| | - Thiago Alves de Jesus
- Undergraduate Course in Biomedicine, Institute of Biomedical Sciences, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Izabella Clara de Brito Machado
- Undergraduate Course in Biomedicine, Institute of Biomedical Sciences, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Mallu Santos Mendonça Lopes
- Undergraduate Course in Biomedicine, Institute of Biomedical Sciences, Federal University of Uberlândia, Minas Gerais, Brazil
| | - Aline Diulia Costa
- Undergraduate Course in Biomedicine, Institute of Biomedical Sciences, Federal University of Uberlândia, Minas Gerais, Brazil
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Nakayama A, Yamaguchi I, Okamoto K, Maesaki S. Targeted Infection Control Practices in Japanese Hospitals for Multidrug-Resistant Organisms: Guidance From the Public Health Center. Cureus 2023; 15:e50680. [PMID: 38229815 PMCID: PMC10791020 DOI: 10.7759/cureus.50680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction The study conducted by the Kawaguchi City Public Health Center (PHC) in 2023 on hospital infection control (IC) programs revealed that hospitals can improve their IC programs if the PHC provides training sessions (TSs) that have numerical effects. In this study, we expected that we could help hospitals develop their IC practices by providing targeted guidance. This study aimed to clarify targeted guidance on IC practices and TS programs to develop hospitals'hospitals' IC programs on multidrug-resistant organisms (MDROs) by examining hospitals'hospitals' IC programs in reference to the study conducted in 2023 and other case reports. Methods In June 2022, the Kawaguchi City PHC conducted TSs for 19 hospitals and eight affiliated (AFs) clinics with beds, providing guidelines and practices on infection control (IC) for MDROs. After the TSs, we sent a questionnaire to these hospitals and affiliated clinics. The questionnaire inquired about current and planned IC policies, hand hygiene compliance programs (HHCPs), the usefulness of the TSs conducted by the PHC, and IC programs that the facilities intended to implement or develop in the future. This study examined the relationship between the perceived usefulness of the information provided and the IC programs planned for development, referencing a study conducted in 2023 and other case reports. Results Seventeen hospitals and six AFs with beds responded to the survey, yielding an 85.2% response rate. IC policies for methicillin-resistant Staphylococcus aureus (MRSA) were prepared by 21 hospitals (91.3%), whereas only five hospitals (21.7%) had prepared IC policies for carbapenem-resistant Enterobacteriaceae. Regarding HHCPs, an increase in the availability of alcohol-based hand sanitizer was identified by 17 hospitals (73.9%), while 13 hospitals (56.5%) reported using posters or symbols, 12 hospitals (52.2%) reported using TS and hand sanitizers, and nine hospitals (39.1%) assessed HH compliance and provided feedback. Furthermore, nine hospitals (39.1%) identified HHCPs and Environmental Cleaning (EC) for carbapenemase-producing Enterobacteriaceae (CPE) as useful information. There was a statistically significant association between TSs on HHCPs and the development of new HHCPs (p = 0.027). Additionally, information on EC for CPE was significantly associated with the development of staff cohorting strategies (p = 0.007). However, TS programs were not significantly connected to EC, nor were TSs to be developed. Conclusion The PHC should advise hospitals to assess if their HHCPs effectively contribute to improving HH compliance. It is essential for the PHC to furnish hospitals with resources and information that aid in the development of EC training. Additionally, the PHC should support the creation of specific and effective TS programs focused on EC or TS development. Conducting surveys to identify barriers to implementing staff cohorting strategies is also recommended. We propose that TS programs should include quantifiable data on HHCPs and EC, such as.
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Affiliation(s)
- Ayako Nakayama
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Ichiro Yamaguchi
- Department of Environmental Health, National Institute of Public Health, Saitama, JPN
| | - Koji Okamoto
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, JPN
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11
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Vock I, Aguilar-Bultet L, Goldenberger D, Ragozzino S, Kuster S, Tschudin-Sutter S. Epidemiology of patients harboring carbapenemase-producing bacteria and comparison with patients with detection of extended-spectrum beta-lactamase-producing Enterobacterales-A retrospective cohort study. Infect Control Hosp Epidemiol 2023; 44:1959-1965. [PMID: 37424228 PMCID: PMC10755146 DOI: 10.1017/ice.2023.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE We evaluated the epidemiology of carbapenemase-producing bacteria (CPB) in Switzerland by comparing risk factors between patients colonized with CPB and patients colonized with extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE). METHODS This retrospective cohort study was conducted at the University Hospital Basel in Switzerland. Hospitalized patients with CPB in any sample between January 2008 and July 2019 were included. The ESBL-PE group consisted of hospitalized patients with detection of ESBL-PE from any sample between January 2016 and December 2018. Comparisons of risk factors for acquisition of CPB and ESBL-PE were performed by logistic regression. RESULTS Inclusion criteria were met for 50 patients in the CPB group and 572 in the ESBL-PE group. In the CPB group, 62% had a travel history and 60% had been hospitalized abroad. When comparing the CPB group to the ESBL-PE group, hospitalization abroad (odds ratio [OR], 25.33; 95% confidence interval [CI], 11.07-57.98) and prior antibiotic therapy (OR, 4.76; 95% CI, 2.15-10.55) remained independently associated with CPB colonization. Hospitalization abroad (P < .001) and prior antibiotic therapy (P < .001) predicted CPB in the comparison of CPB with ESBL Escherichia coli, whereas hospitalization abroad was associated with CPB in comparison to ESBL Klebsiella pneumoniae. CONCLUSIONS Although CPB still seem to be mainly imported from areas of higher endemicity, local acquisition of CPB is emerging, especially in patients with close and/or frequent contact with healthcare services. This trend resembles the epidemiology of ESBL K. pneumoniae, supporting mainly healthcare-associated transmission. Frequent evaluation of CPB epidemiology is required to improve detection of patients at risk of CPB carriage.
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Affiliation(s)
- Isabelle Vock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Daniel Goldenberger
- Division of Bacteriology and Mycology, University Hospital Basel, University Basel, Switzerland
| | - Silvio Ragozzino
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Sabine Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Switzerland
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12
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Pan F, Chen P, Duan Y, Yu F, Weng W, Zhang H. Prevalence of intestinal colonization and nosocomial infection with carbapenem-resistant Enterobacteriales in children: a retrospective study. Front Public Health 2023; 11:1251609. [PMID: 38074706 PMCID: PMC10702246 DOI: 10.3389/fpubh.2023.1251609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
Objective We investigated the epidemiological surveillance of the intestinal colonization and nosocomial infection of carbapenem-resistant Enterobacteriales (CRE) isolates from inpatients, which can provide the basis for developing effective prevention. Methods A total of 96 CRE strains were collected from 1,487 fecal samples of hospitalized children between January 2016 and June 2017, which were defined as the "CRE colonization" group. In total, 70 CRE clinical isolates were also randomly selected for the comparison analysis and defined as the "CRE infection" group. The antimicrobial susceptibility of all strains was determined by the microdilution broth method. Polymerase chain reaction (PCR) was used to analyze carbapenemase genes, plasmid typing, and integrons. Multilocus sequence typing was further used to determine clonal relatedness. Results In the "CRE colonization" group, Klebsiella pneumoniae was mostly detected with a rate of 42.7% (41/96), followed by Escherichia coli (34.4%, 33/96) and Enterobacter cloacae (15.6%, 15/96). The ST11 KPC-2 producer, ST8 NDM-5 producer, and ST45 NDM-1 producer were commonly present in carbapenem-resistant K. pneumoniae (CRKPN), carbapenem-resistant E. coli (CRECO), and carbapenem-resistant E. cloacae (CRECL) isolates, respectively. In the "CRE infection" group, 70% (49/70) of strains were K. pneumoniae, with 21.4% E. cloacae (15/70) and 5.7% E. coli (4/70). The ST15 OXA-232 producer and ST48 NDM-5 producer were frequently observed in CRKPN isolates, while the majority of NDM-1-producing CRECL isolates were assigned as ST45. Phylogenetic analysis showed that partial CRE isolates from intestinal colonization and nosocomial infection were closely related, especially for ST11 KPC-2-producing CRKPN and ST45 NDM-1-producing CRECL. Furthermore, plasmid typing demonstrated that IncF and IncFIB were the most prevalent plasmids in KPC-2 producers, while IncX3/IncX2 and ColE were widely spread in NDM producer and OXA-232 producer, respectively. Then, class 1 integron intergrase intI1 was positive in 74.0% (71/96) of the "CRE colonization" group and 52.9% (37/70) of the "CRE infection" group. Conclusion This study revealed that CRE strains from intestinal colonization and nosocomial infection showed a partial correlation in the prevalence of CRE, especially for ST11 KPC-2-producing CRKPN and ST45 NDM-1-producing CRECL. Therefore, before admission, long-term active screening of rectal colonization of CRE isolates should be emphasized.
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Affiliation(s)
- Fen Pan
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Yuxin Duan
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fangyuan Yu
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhao Weng
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Zhang
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Lee KH, Kim D, Hong JS, Park SY, Cho NH, Kim MN, Lee YJ, Wi Y, Lee EH, Han SH, Jeong SH, Song YG. Prevalence of carbapenemase producing Enterobacterales colonization and risk factor of clinical infection. J Infect Public Health 2023; 16:1860-1869. [PMID: 37837922 DOI: 10.1016/j.jiph.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) are global concerns in infection control, and the number of CPE outbreaks in hospitals is increasing despite the strengthening of contact precautions. This study aimed to confirm the prevalence and transition rate of CPE infection from stool surveillance culture and to identify the acquisition pathway of CPE. METHODS This is a longitudinal review of patients with stool surveillance cultures at a tertiary center in Seoul, South Korea, from July 2018 to June 2020. Pulsed-field gel electrophoresis, multi-locus sequence typing, and whole genome sequencing were performed for carbapenemase-producing Klebsiella pneumoniae and Escherichia coli strains. RESULTS Among 1620 patients who had undergone stool CPE surveillance cultures, only 7.1% of active surveillance at the Emergency Room (ER) and 4.4% of universal surveillance in the Intensive Care Unit (ICU) were stool CPE positive. The transition rates from stool carriers to clinical CPE infections were 29.4% in the ER and 31.3% in the ICU. However, it was significantly high (55.0%) in the initial stool CPE-negative ICU patients. Among the initial stool CPE-positive patients, hypertension (61% vs. 92.3%, P = 0.004), malignancy (28.8% vs. 53.8%, P = 0.027), and mechanical ventilation (25.4% vs. 53.8%, P = 0.011) were significant risk factors for clinical CPE infection. Molecular typing revealed that sequence type (ST) 307 and ST 395 were dominant in K. pneumoniae, and ST 410 was dominant in E. coli isolates. CONCLUSIONS Active surveillance showed a higher detection rate than universal stool CPE screening, and one-third of positive stool CPE specimens ultimately developed subsquent clinical CPE infection. According to the molecular typing of the identified CPE strains, in-hospital spread prevailed over external inflow, and the transition rate to clinical CPE was particularly high in the ICU. Therefore, in order to control CPE propagation, not only active surveillance to block inflow from outside, but also continuous ICU monitoring within the hospital is necessary.
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Affiliation(s)
- Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dokyun Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Sung Hong
- Department of Companion Animal Health and Science, Silla University, Busan, Republic of Korea
| | - Soon Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Mi Na Kim
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yun Jung Lee
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yeonji Wi
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Eun Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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14
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Dai Y, Zhang L, Pan T, Shen Z, Meng T, Wu J, Gu F, Wang X, Tan R, Qu H. The ICU-CARB score: a novel clinical scoring system to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission. Antimicrob Resist Infect Control 2023; 12:118. [PMID: 37898771 PMCID: PMC10613373 DOI: 10.1186/s13756-023-01326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With the widespread spread of carbapenem-resistant gram-negative bacteria (CR-GNB) in medical facilities, the carriage of CR-GNB among critically ill patients has become a significant concern in intensive care units (ICU). This study aimed to develop a scoring system to identify CR-GNB carriers upon ICU admission. METHODS Consecutive critically ill patients admitted to the ICU of Shanghai Ruijin Hospital between January 2017 and December 2020 were included. The patients were then divided into training and testing datasets at a 7:3 ratio. Parameters associated with CR-GNB carriage were identified using least absolute shrinkage and selection operator regression analysis. Each parameter was assigned a numerical score ranging from 0 to 100 using logistic regression analysis. Subsequently, a four-tier risk-level system was developed based on the cumulative scores, and assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of the 1736 patients included in this study, the prevalence of CR-GNB carriage was 10.60%. The clinical scoring system including seven variables (neurological disease, high-risk department history, length of stay ≥ 14 days, ICU history, invasive mechanical ventilation, gastrointestinal tube placement, and carbapenem usage) exhibited promising predictive capabilities. Patients were then stratified using the scoring system, resulting in CR-GNB carriage rates of 2.4%, 12.0%, 36.1%, and 57.9% at the respective risk levels (P < 0.001). Furthermore, the AUC of the developed model in the training set was calculated to be 0.82 (95% CI, 0.78-0.86), while internal validation yielded an AUC of 0.83 (95% CI, 0.77-0.89). CONCLUSIONS The ICU-CARB Score serves as a straightforward and precise tool that enables prompt evaluation of the risk of CR-GNB carriage at the time of ICU admission, thereby facilitating the timely implementation of targeted pre-emptive isolation.
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Affiliation(s)
- Yunqi Dai
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianjiao Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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15
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Wei X, Li Q, He Y, Li L, Li S, Li T. Molecular characteristics and antimicrobial resistance profiles of Carbapenem-Resistant Klebsiella pneumoniae isolates at a tertiary hospital in Nanning, China. BMC Microbiol 2023; 23:318. [PMID: 37898766 PMCID: PMC10612196 DOI: 10.1186/s12866-023-03038-x] [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: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE Carbapenem resistant Klebsiella pneumoniae is associated with nosocomial infections and can cause high mortality, which poses great threat to human health. This study was aimed at investigating the molecular epidemiology and antimicrobial resistance profiles of carbapenem resistant Klebsiella pneumoniae isolates and providing clues for management and control of carbapenem resistant Klebsiella pneumoniae infections. METHODS A total of 2324 Klebsiella pneumoniae strains were isolated from the First Affiliated Hospital of Guangxi Medical University from June 2018 to October 2020, and 103 carbapenem resistant Klebsiella pneumoniae strains from inpatients were collected, and the specimens mainly came from the sputum, urine, secretions, and blood. The antimicrobial susceptibility tests were performed using the VITEK 2 Compact system or the Kirby-Bauer disk-diffusion method. The resistance genes were detected by polymerase chain reaction and sequencing. The homology analysis of carbapenem resistant Klebsiella pneumoniae strains was performed by multilocus sequence typing. RESULTS Antimicrobial susceptibility results showed that the 103 carbapenem resistant Klebsiella pneumoniae strains were resistant to most common antibiotics. Resistance genes detection showed that the carbapenem resistant Klebsiella pneumoniae isolates mainly carried metallo-beta-lactamase, and the predominant gene was NDM-1. The homology analysis found that the major ST type were ST11, follow by ST15 and ST17. CONCLUSION The carbapenem resistant Klebsiella pneumoniae isolates in our study shown resistance to most common antibiotics. Of the 103 carbapenem resistant Klebsiella pneumoniae strains, 91 strains (88.35%) carried carbapenemases genes, and NDM was the predominant carbapenemase gene detected. ST11 was the major ST typing of carbapenem resistant Klebsiella pneumoniae in our hospital. Our finding may play a role in control and management of the carbapenem resistant Klebsiella pneumoniae infections and guiding clinical antibiotic therapy. In addition, metallo-beta-lactamase should be served as a key target to be monitored in carbapenem resistant Klebsiella pneumoniae infection.
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Affiliation(s)
- Xianzhen Wei
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qiuxiang Li
- Department of Clinical Laboratory, Joint Logistics Support Force of the Chinese People's Liberation Army, 923 Hospital, Nanning, China
| | - Yu He
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Linlin Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shan Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Taijie Li
- Department of Clinical Laboratory, Wuming Hospital of Guangxi Medical University, Nanning, China.
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Agodi A, Montineri A, Manuele R, Noto P, Carpinteri G, Castiglione G, Grassi P, Lazzara A, Mattaliano AR, Granvillano G, La Mastra C, La Rosa MC, Maugeri A, Barchitta M. Molecular Typing and Resistance Profile of Acinetobacter baumannii Isolates during the COVID-19 Pandemic: Findings from the "EPIRADIOCLINF" Project. Antibiotics (Basel) 2023; 12:1551. [PMID: 37887252 PMCID: PMC10603994 DOI: 10.3390/antibiotics12101551] [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: 09/01/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Due to the COVID-19 pandemic, there has been a shift in focus towards controlling the spread of SARS-CoV-2, which has resulted in the neglect of traditional programs aimed at preventing healthcare-associated infections and combating antimicrobial resistance. The present work aims to characterize the colonization or infection with Acinetobacter baumannii of COVID-19 patients and to identify any clonality between different isolates. Specifically, data and resistance profiles of A. baumannii isolates were prospectively collected from patients recruited by the EPIRADIOCLINF project. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used for molecular typing. Overall, we analyzed 64 isolates of A. baumannii from 48 COVID-19 patients. According to our analysis, we have identified the spread of a clonally related isolate, referred to as B. The PFGE pattern B includes four subtypes: B1 (consisting of 37 strains), B2 (11), B3 (5), and B4 (2). Furthermore, in the isolates that were examined using MLST, the most observed sequence type was ST/281. In terms of resistance profiles, 59 out of the total isolates (92.2%) were found to be resistant to gentamicin, carbapenems, ciprofloxacin, and tobramycin. The isolation and identification of A. baumannii from COVID-19 patients, along with the high levels of transmission observed within the hospital setting, highlight the urgent need for the implementation of effective prevention and containment strategies.
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Affiliation(s)
- Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Arturo Montineri
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Rosa Manuele
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Paola Noto
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giuseppe Carpinteri
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giacomo Castiglione
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Patrizia Grassi
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Antonio Lazzara
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Anna Rita Mattaliano
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Giuseppa Granvillano
- Azienda Ospedaliero-Universitaria Policlinico AOUP “G. Rodolico-San Marco”, 95123 Catania, Italy; (A.M.); (R.M.); (G.C.); (A.L.); (A.R.M.)
| | - Claudia La Mastra
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Maria Clara La Rosa
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95123 Catania, Italy; (C.L.M.); (M.C.L.R.); (A.M.); (M.B.)
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Del Rio A, Puci M, Muresu N, Sechi I, Saderi L, Cugia L, Sotgiu G, Piana A. Comparison of genotypic and phenotypic antimicrobial profile in carbapenemases producing Klebsiella pneumoniae. ACTA BIO-MEDICA : ATENEI PARMENSIS 2023; 94:e2023201. [PMID: 37850773 PMCID: PMC10644917 DOI: 10.23750/abm.v94i5.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND AIM Prompt administration of appropriate antibiotic therapy is crucial in improving outcomes, particularly in cases sustained by multi-drug resistant strains. Although phenotypic antimicrobial susceptibility testing (AST) represents the gold standard to address antibiotics treatment, the long time required to obtained affordable results could negatively affect the prognosis. In contrast, rapid genotypic AST provide essential information for treatment and surveillance program. In order to evaluate the potential adoption of rapid AST in clinical routine, we compared the genotypic and phenotypic antimicrobial profiles of different K.pneumoniae strains, characterized by different expression of carbapenemases-encoding genes. METHODS A set of 109 strains of Cr-Kp were tested for the antimicrobial drugs by the automatized Vitek II system and, in parallel, to the new combination of β-lactams/β-lactamases inhibitors (BL/BLI) by Etest. An antimicrobial resistance index (ARI) was calculated for each strain, assigning each 1 or 0 points based on observed resistance/susceptibility, and dividing the total by the number of antibiotics tested. Kruskal-Wallis test, followed by Dunn's post hoc test (Bonferroni correction), were used to compare quantitative variables among resistance gene subgroups. RESULTS We observed a higher ARI score in KPC/OXA-48 strains, similar profile in KPC alone and KPC/CTX-M groups and a significant lower resistance in no-carbapenemases-producing group. Same trend was observed in AST for BL/BLI. CONCLUSIONS These preliminary results showed a close link between genotypic and phenotypic AST, supporting the adoption of rapid AST in cases of severe infections, ensuring to saving time and providing, the surveillance of MDR strains and improving stewardship programs.
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Taylor SL, Papanicolas LE, Flynn E, Boyd MA, Wesselingh SL, Rogers GB. Preventing empirical antibiotic treatment failure in migrant populations: screening by infection risk, not ethnic background. Int J Infect Dis 2023; 134:168-171. [PMID: 37343782 DOI: 10.1016/j.ijid.2023.06.014] [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: 02/13/2023] [Revised: 05/14/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023] Open
Abstract
Multidrug-resistant organisms (MDROs) are a major international health threat. In many low and middle-income countries poorly regulated antibiotic use, limited surveillance, and inadequate sanitation give rise to high rates of antibiotic resistance. A resulting reliance on last-line antibiotic options further contributes to the emergence of MDROs. The potential for these pathogens to spread across international borders is a matter of considerable concern. However, this problem is commonly framed as primarily a threat to the health security of countries where resistance is not yet endemic. In fact, it is little acknowledged that those at greatest risk from antibiotic treatment failure are individuals who move from regions of high MDRO prevalence to settings where standard empirical treatment options remain largely effective. In this perspective, we highlight the poor treatment outcomes for disseminated bacterial infections in individuals who have moved from settings in which MDROs are common to those where MDROs are currently less common. We discuss MDRO screening strategies that could avoid stigmatizing vulnerable populations by focusing on future risk of disseminated infection, rather than past risk of acquisition. In practical terms, this means screening individuals before childbirth, immunosuppressive treatments, major surgery, or other events associated with disseminated infection risk, rather than prioritizing screening for individuals from regions with high carriage rates. We argue that such measures would reduce antibiotic treatment failure and improve outcomes while protecting migrant populations from the divisive consequences of targeted screening programs.
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Affiliation(s)
- Steven L Taylor
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Lito E Papanicolas
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Erin Flynn
- South Australian Health and Medical Research Institute, Adelaide, Australia; National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australia
| | - Mark A Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Geraint B Rogers
- South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Rohatgi A, Gupta P. Benzoic acid derivatives as potent antibiofilm agents against Klebsiella pneumoniae biofilm. J Biosci Bioeng 2023; 136:190-197. [PMID: 37479559 DOI: 10.1016/j.jbiosc.2023.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023]
Abstract
Klebsiella pneumoniae is responsible for a significant proportion of human urinary tract infections, and its biofilm is a major virulence. One potential approach to controlling biofilm-associated infections is targeting the adhesin MrkD1P to disrupt biofilm formation. We employed Schrodinger's Maestro tool with the OPLS 2005 force field to dock compounds with the target protein. Two benzoic acid derivatives, 3-hydroxy benzoic acid and 2,5-dihydroxybenzoic acid, had strong binding free energies (-55.57 and -18.68 kcal/mol) and were the most potent compounds. The in-vitro experiments were conducted to validate the in-silico results. The results showed that both compounds effectively inhibited biofilm formation at low concentrations (4 and 8 mg/mL, respectively) and had antibiofilm activity, restricting cell attachment. Both compounds demonstrated a strong biofilm inhibitory effect, with 97% and 89% reduction in biofilm by 3-hydroxy benzoic acid and 2,5-dihydroxybenzoic acid, respectively. These findings suggest that natural compounds can be a potential source of new drugs to combat biofilm-associated infections. The study highlights the potential of targeting adhesin MrkD1P as an effective approach to controlling biofilm-associated infections caused by K. pneumoniae. The results may have implications for the development of new therapies for biofilm-associated infections and pave the way for future research in this area.
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Affiliation(s)
- Anuj Rohatgi
- Department of Biotechnology, National Institute of Technology, Raipur 492010, India
| | - Pratima Gupta
- Department of Biotechnology, National Institute of Technology, Raipur 492010, India.
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Lemonnier D, Machuel M, Obin O, Outurquin G, Adjidé C, Mullié C. Trends in Antibiotic-Resistant Bacteria Isolated from Screening Clinical Samples in a Tertiary Care Hospital over the 2018-2022 Period. Antibiotics (Basel) 2023; 12:1314. [PMID: 37627734 PMCID: PMC10451239 DOI: 10.3390/antibiotics12081314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
To assess the putative impact of the COVID-19 pandemic on multidrug-resistant (MDR) bacteria recovered from routine screening samples and, more globally, the trends in time to first positive screening sample and carriage duration of those bacteria in patients admitted to a tertiary hospital, data from laboratory results were retrospectively mined over the 2018-2022 period. No significant differences could be found in the number of positive patients or MDR isolates per year, time to positive screening, or carriage duration. Extended-spectrum beta-lactamase producers were dominant throughout the studied period but their relative proportion decreased over time as well as that of meticillin-resistant Staphylococcus aureus. Meanwhile, carbapenemase-producing enterobacteria (CPE) proportion increased. Among the 212 CPE isolates, Klebsiella pneumoniae and Escherichia coli were the more frequent species but, beginning in 2020, a significant rise in Enterobacter cloacae complex and Citrobacter freundii occurred. OXA48 was identified as the leading carbapenemase and, in 2020, a peak in VIM-producing enterobacteria linked to an outbreak of E. cloacae complex during the COVID-19 pandemic was singled out. Finally, a worrisome rise in isolates producing multiple carbapenemases (NDM/VIM and mostly NDM/OXA48) was highlighted, especially in 2022, which could lead to therapeutic dead-ends if their dissemination is not controlled.
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Affiliation(s)
- Delphine Lemonnier
- Unité de Prévention du Risque Infectieux, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France;
| | - Marine Machuel
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France (C.A.)
| | - Odile Obin
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France (C.A.)
| | - Gaëtan Outurquin
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France (C.A.)
| | - Crespin Adjidé
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France (C.A.)
| | - Catherine Mullié
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, 80054 Amiens, France (C.A.)
- Laboratoire AGIR UR UPJV 4294, UFR de Pharmacie, Université de Picardie Jules Verne, 80037 Amiens, France
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21
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Lee SH, Kim CH, Lee HY, Park KH, Han SH. Epidemiology of Carbapenem-Resistant Enterobacteriaceae Bacteremia in Gyeonggi Province, Republic of Korea, between 2018 and 2021. Antibiotics (Basel) 2023; 12:1286. [PMID: 37627706 PMCID: PMC10451680 DOI: 10.3390/antibiotics12081286] [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: 06/29/2023] [Revised: 07/28/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing since 2008, with Gyeonggi Province in South Korea being particularly vulnerable due to its large number of healthcare facilities. This study examines the trends of CRE occurrence in Gyeonggi Province over the past four years and the epidemiological characteristics of the infected patients. Patients with positive CRE blood cultures admitted to healthcare facilities in Gyeonggi Province from January 2018 to December 2021 were evaluated in this study. Risk factors for CRE-related death were analyzed using data from patients who died within 30 days of the last blood sampling. Older adults aged 70 years and above constituted the majority of patients with CRE bacteremia. Antibiotic use did not significantly affect mortality risk. Non-survivors were more common in tertiary hospitals and intensive care units and included patients with hypertension, malignant tumors, and multiple underlying diseases. Klebsiella pneumoniae was the most common CRE strain, with Klebsiella pneumoniae carbapenemase being the predominant carbapenemase. Our study suggests the endemicity of CRE in Gyeonggi Province and highlights the increasing isolation of CRE strains in South Korean long-term care hospitals within the province. Further, infection control measures and government support specific to each healthcare facility type are crucial.
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Affiliation(s)
- Seung Hye Lee
- Gyeonggi Infectious Disease Control Center, Health Bureau, Gyeonggi Provincial Government, Suwon-si 16508, Gyeonggi-do, Republic of Korea; (S.H.L.)
| | - Chan Hee Kim
- Gyeonggi Infectious Disease Control Center, Health Bureau, Gyeonggi Provincial Government, Suwon-si 16508, Gyeonggi-do, Republic of Korea; (S.H.L.)
| | - Hee Young Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam-si 13620, Gyeonggi-do, Republic of Korea;
| | - Kun Hee Park
- Pyeongchang County Health and Medical Center, Pyeongchang-gun 25374, Gangwon-do, Republic of Korea;
| | - Su Ha Han
- Department of Nursing, College of Medicine, SoonChunHyang University, Cheonan-si 31151, Chungcheongnam-do, Republic of Korea
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22
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Park SH, Yi Y, Suh W, Ji SK, Han E, Shin S. The impact of enhanced screening for carbapenemase-producing Enterobacterales in an acute care hospital in South Korea. Antimicrob Resist Infect Control 2023; 12:62. [PMID: 37400884 DOI: 10.1186/s13756-023-01270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) poses a significant challenge to infection control in healthcare settings. Active screening is recommended to prevent intra-hospital CPE transmission. METHODS CPE screening was initiated at a 660-bed hospital in South Korea in September 2018, targeting patients previously colonized/infected or admitted to outside healthcare facilities (HCFs) within 1 month. Universal intensive care unit (ICU) screening was performed at the time of admission. After a hospital-wide CPE outbreak in July-September 2019, the screening program was enhanced by extending the indications (admission to any HCF within 6 months, receipt of hemodialysis) with weekly screening of ICU patients. The initial screening method was changed from screening cultures to the Xpert Carba-R assay. The impact was assessed by comparing the CPE incidence per 1000 admissions before (phase 1, September 2018-August 2019) and after instituting the enhanced screening program (phase 2, September 2019-December 2020). RESULTS A total of 13,962 (2,149 and 11,813 in each phase) were screened as indicated, among 49,490 inpatients, and monthly screening compliance increased from 18.3 to 93.5%. Compared to phase 1, the incidence of screening positive patients increased from 1.2 to 2.3 per 1,000 admissions (P = 0.005) during phase 2. The incidence of newly detected CPE patients was similar (3.1 vs. 3.4, P = 0.613) between two phases, but the incidence of hospital-onset CPE patients decreased (1.9 vs. 1.1, P = 0.018). A significant decrease was observed (0.5 to 0.1, P = 0.014) in the incidence of patients who first confirmed CPE positive through clinical cultures without a preceding positive screening. Compared to phase 1, the median exposure duration and number of CPE contacts were also markedly reduced in phase 2: 10.8 days vs. 1 day (P < 0.001) and 11 contacts vs. 1 contact (P < 0.001), respectively. During phase 2, 42 additional patients were identified by extending the admission screening indications (n = 30) and weekly in-ICU screening (n = 12). CONCLUSIONS The enhanced screening program enabled us to identify previously unrecognized CPE patients in a rapid manner and curtailed a hospital-wide CPE outbreak. As CPE prevalence increases, risk factors for CPE colonization can broaden, and hospital prevention strategies should be tailored to the changing local CPE epidemiology.
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Affiliation(s)
- Sun Hee Park
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- The Catholic University of Korea, Eunpyeong St. Mary's Hospital, 93-19 Jingwan-dong, Eunpyeong-gu, Seoul, Republic of Korea.
| | - Yunmi Yi
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woosuck Suh
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seul Ki Ji
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Eunhee Han
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soyoung Shin
- Infection Prevention and Control Unit, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Karampatakis T, Tsergouli K, Roilides E. Infection control measures against multidrug-resistant Gram-negative bacteria in children and neonates. Future Microbiol 2023; 18:751-765. [PMID: 37584552 DOI: 10.2217/fmb-2023-0072] [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] [Indexed: 08/17/2023] Open
Abstract
The increase in infections caused by multidrug-resistant (MDR) Gram-negative bacteria in neonatal and pediatric intensive care units over recent years is alarming. MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii have constituted the main causes of the MDR Gram-negative bacteria problem. The implementation of infection control measures such as hand hygiene, cohorting of patients, contact precautions, active surveillance and environmental cleaning could diminish their spread. Recently, water safety has been identified as a major component of infection control policies. The aim of the current review is to highlight the effectiveness of these infection control measures in managing outbreaks caused by MDR Gram-negative bacteria in neonatal and pediatric intensive care units and highlight future perspectives on the topic.
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Affiliation(s)
| | - Katerina Tsergouli
- Microbiology Department, Agios Pavlos General Hospital, Thessaloniki, 551 34, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Health Sciences, Hippokration General Hospital, Thessaloniki, 546 42, Greece
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Zhou S, Mi S, Rao X, Zhang Q, Wei S, Xiao M, Peng Z, Wang J. Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units. Sci Rep 2023; 13:9527. [PMID: 37308521 DOI: 10.1038/s41598-023-36321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/01/2023] [Indexed: 06/14/2023] Open
Abstract
Carbapenem antibiotics are widely used in ICU, and the prevalence of carbapenem-resistant microorganisms (CRO) has increased. This study aimed to assess the role of individualized active surveillance using Xpert Carba-R of carbapenem resistance genes on CRO risk. A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022. The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance using Xpert Carba-R was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI] 0.62-0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95% CI 0.62-0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95% CI 0.40-0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95% CI 0.47-0.90; P = 0.008). Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in ICU. Further prospective studies should be performed to verify these conclusions and guide further management of patients in ICU.
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Affiliation(s)
- Shuliang Zhou
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China
| | - Sulin Mi
- Department of Cardiovascular Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Xin Rao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China
| | - Qi Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China
| | - Shiwen Wei
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China
| | - Meng Xiao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China.
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China.
| | - Jing Wang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China.
- Clinical Research Center of Hubei Critical Care Medicine, Donghu Road 169, Wuhan, 430071, Hubei, China.
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Shibabaw A, Sahle Z, Metaferia Y, Atlaw A, Adenew B, Gedefie A, Tilahun M, Ebrahim E, Kassa Y, Debash H, Wang SH. Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia. IJID REGIONS 2023; 7:77-83. [PMID: 37009574 PMCID: PMC10050477 DOI: 10.1016/j.ijregi.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are usually healthcare associated. The aim of this study was to investigate the epidemiology of hospital-acquired CRE and multi-drug-resistant infections, and identify associated risk factors in hospitalized patients in Northeast Ethiopia. METHODS This cross-sectional study was conducted in patients admitted with sepsis between January and June 2021. Demographic and clinical data were collected using questionnaires. In total, 384 samples were collected and cultured based on source of infection. Bacterial species identification was performed using biochemical tests, and drug susceptibility testing was done using the Kirby-Bauer disk diffusion method. The modified carbapenem inactivation method was employed for carbapenemase detection. Data were analysed using Statistical Package for the Social Sciences. RESULTS The overall rate of CP-CRE infection was 14.6%. Bloodstream infections and urinary tract infections were the predominant hospital-acquired infections (HAIs). The majority of CP-CRE were Escherichia coli and Klebsiella pneumoniae, and accounted for 4.9%. Chronic underlying disease (adjusted odds ratio (AOR): 7.9, 95% confidence interval (CI): 1.9-31.5), number of beds per room (AOR: 11, 95% CI: 1.7-75) and eating raw vegetables (AOR: 11, 95% CI: 3.4-40) were significantly associated with hospital-acquired CRE infection. CONCLUSIONS The rate of CP-CRE infection found in this study is concerning. There is a need for further evaluation of risk factors and measures to decrease HAI. Hand hygiene, increased laboratory capacity, improved infection prevention measures, and antimicrobial stewardship programmes are needed in healthcare settings to halt the transmission of CP-CRE.
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Affiliation(s)
- Agumas Shibabaw
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zenawork Sahle
- Department of Medical Laboratory Sciences, Debre Berhan Health Science College, Debre Berhan, Ethiopia
| | - Yeshi Metaferia
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asgdew Atlaw
- Department of Medical Laboratory Sciences, Debre Berhan Health Science College, Debre Berhan, Ethiopia
| | - Behailu Adenew
- Department of Medical Laboratory Sciences, Debre Berhan Comprehensive Specialized Hospital, Debre Berhan, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yeshimebet Kassa
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shu-Hua Wang
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, and Global One Health initiative, The Ohio State University, Columbus, OH, USA
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Arzilli G, Forni S, Righi L, Barnini S, Petricci P, Parisio EM, Pistello M, Vivani P, Gemignani G, Baggiani A, Bellandi T, Privitera G, Gemmi F, Tavoschi L, Porretta A. Trends in hospital acquired NDM-producing Enterobacterales in Tuscany (Italy) from 2019 to 2021: impact of the COVID-19 pandemic. J Hosp Infect 2023:S0195-6701(23)00142-1. [PMID: 37160231 DOI: 10.1016/j.jhin.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES In Tuscany, Italy, New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) in hospitalised patients has increasingly been observed since 2018, leading in 2019 to the implementation of enhanced control measures successfully reducing transmission. We describe the NDM-CRE epidemiology during the COVID-19 pandemic in Tuscany. METHODS Data on NDM-CRE patients hospitalised in five Tuscan hospitals were collected from 01/2019 to 12/2021. Weekly rates of NDM-CRE cases on hospital days in medical and critical-care wards were calculated. In March-December 2020, NDM-CRE rates were stratified by COVID-19 diagnosis. Multivariate regression analysis was performed to assess outcomes' differences among two periods analysed and between COVID-19 populations. RESULTS Since March 2020 an increase in NDM-CRE cases was observed, associated with COVID-19 admissions. COVID-19 patients differed significantly from non-COVID-19 ones by several variables, including patient features (age, Charlson index) and clinical history and outcomes (NDM-CRE infection/colonisation, ICU stay, length of stay, mortality). During the pandemic, we observed a higher rate of NDM-CRE cases per hospital days in both non-COVID-19 patients (273/100,000) and COVID-19 patients (370/100,00) when compared with pre-pandemic period cases (187/100,00). CONCLUSIONS Our data suggest a resurgence in NDM-CRE spread among hospitalised patients in Tuscany during the COVID-19 pandemic, as well as a change in patients' case-mix. The observed increase in hospital transmission of NDM-CRE could be related to changes in infection prevention and control procedures, aimed mainly at COVID-19 management, leading to new challenges in hospital preparedness and crisis management planning.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Silvia Forni
- Regional Health Agency of Tuscany, Florence, Italy
| | - Lorenzo Righi
- Quality of care and Clinical networks, Tuscany Region, Florence, Italy
| | - Simona Barnini
- Microbiology Unit, University Hospital of Pisa, Pisa, Italy
| | | | | | - Mauro Pistello
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Virology Unit, University Hospital of Pisa, Pisa, Italy
| | - Paola Vivani
- Massa Carrara Hospital, Toscana Northwest Health Authority, Massa Carrara, Italy
| | | | - Angelo Baggiani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
| | - Tommaso Bellandi
- Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
| | | | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Andrea Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; University Hospital of Pisa, Pisa, Italy
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Gajic I, Jovicevic M, Popadic V, Trudic A, Kabic J, Kekic D, Ilic A, Klasnja S, Hadnadjev M, Popadic DJ, Andrijevic A, Prokic A, Tomasevic R, Ranin L, Todorovic Z, Zdravkovic M, Opavski N. The emergence of multidrug-resistant bacteria causing healthcare-associated infections in COVID-19 patients - a retrospective multi-centre study. J Hosp Infect 2023; 137:1-7. [PMID: 37121488 PMCID: PMC10140260 DOI: 10.1016/j.jhin.2023.04.013] [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: 03/14/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
INTRODUCTION We evaluated the prevalence, aetiologies and antibiotic resistance patterns of bacterial infections in hospitalized patients with laboratory-confirmed SARS-CoV-2. We also investigated comorbidities, risk factors, and the mortality rate in COVID-19 patients with bacterial infections. METHODS This retrospective observational study evaluated medical records of 7249 randomly selected patients with COVID-19 admitted to three clinical centres between January 1 2021 and February 16, 2022. A total of 6478 COVID-19 patients met the eligibility criteria for analysis. RESULTS The mean age of the patients with SARS-CoV-2 and bacterial infections was 68.6 ± 15.5 years (range: 24 to 94 years). The majority of patients (68.7%) were older than 65 years. The prevalence of bacterial infections among hospitalized COVID-19 patients was 12.9%, most of them being hospital-acquired (11.5%). Bloodstream (37.7%) and respiratory tract infections (25.6%) were the most common bacterial infections. Klebsiella pneumoniae and Acinetobacter baumannii caused 25.2% and 23.6% of all bacterial infections, respectively. Carbapenem-resistance in Enterobacterales, A. baumannii, and Pseudomonas aeruginosa were 72.6%, 93.7%, and 69.1%. Age >60 years and infections caused by ≥3 pathogens were significantly more prevalent among deceased patients compared to survivors (p<0.05). Furthermore, 95% of patients who were intubated developed ventilator-associated pneumonia. The overall in-hospital mortality rate of patients with SARS-CoV-2 and bacterial infections was 51.6%, while 91.7% of patients who required invasive mechanical ventilation died. CONCLUSIONS Our results reveal a striking association between healthcare-associated bacterial infections as an important complication of COVID-19 and fatal outcomes.
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Affiliation(s)
- I Gajic
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia.
| | - M Jovicevic
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - V Popadic
- University Medical Hospital Centre "Bežanijska kosa", Dr Žorža Matea bb, 11070 Belgrade, Serbia
| | - A Trudic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Institutski put 4, 21204 Sremska Kamenica, Serbia
| | - J Kabic
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - D Kekic
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - A Ilic
- Clinical Hospital Centre Zemun, Vukova 9, 11000 Belgrade, Serbia
| | - S Klasnja
- University Medical Hospital Centre "Bežanijska kosa", Dr Žorža Matea bb, 11070 Belgrade, Serbia
| | - M Hadnadjev
- Institute for Pulmonary Diseases of Vojvodina, Institutski put 4, 21204 Sremska Kamenica, Serbia
| | - D J Popadic
- Clinical Hospital Centre Zemun, Vukova 9, 11000 Belgrade, Serbia
| | - A Andrijevic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; Institute for Pulmonary Diseases of Vojvodina, Institutski put 4, 21204 Sremska Kamenica, Serbia
| | - A Prokic
- Clinical Hospital Centre Zemun, Vukova 9, 11000 Belgrade, Serbia
| | - R Tomasevic
- Clinical Hospital Centre Zemun, Vukova 9, 11000 Belgrade, Serbia
| | - L Ranin
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - Z Todorovic
- University Medical Hospital Centre "Bežanijska kosa", Dr Žorža Matea bb, 11070 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - M Zdravkovic
- University Medical Hospital Centre "Bežanijska kosa", Dr Žorža Matea bb, 11070 Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
| | - N Opavski
- Faculty of Medicine, University of Belgrade, Dr Subotića starijeg 1, 11000 Belgrade, Serbia
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Baek MS, Kim S, Kim WY, Kweon MN, Huh JW. Gut microbiota alterations in critically Ill patients with carbapenem-resistant Enterobacteriaceae colonization: A clinical analysis. Front Microbiol 2023; 14:1140402. [PMID: 37082174 PMCID: PMC10110853 DOI: 10.3389/fmicb.2023.1140402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundCarbapenem-resistant Enterobacteriaceae (CRE) are an emerging concern for global health and are associated with high morbidity and mortality in critically ill patients. Risk factors for CRE acquisition include broad-spectrum antibiotic use and microbiota dysbiosis in critically ill patients. Therefore, we evaluated the alteration of the intestinal microbiota associated with CRE colonization in critically ill patients.MethodsFecal samples of 41 patients who were diagnosed with septic shock or respiratory failure were collected after their admission to the intensive care unit (ICU). The gut microbiota profile determined using 16S rRNA gene sequencing and quantitative measurement of fecal short-chain fatty acids were evaluated in CRE-positive (n = 9) and CRE negative (n = 32) patients. The analysis of bacterial metabolic abundance to identify an association between CRE acquisition and metabolic pathway was performed.ResultsCRE carriers showed a significantly increased proportion of the phyla Proteobacteria and decreased numbers of the phyla Bacteroidetes as compared to the CRE non-carriers. Linear discriminant analysis (LDA) with linear discriminant effect size showed that the genera Erwinia, Citrobacter, Klebsiella, Cronobacter, Kluyvera, Dysgomonas, Pantoea, and Alistipes had an upper 2 LDA score in CRE carriers. The alpha-diversity indices were significantly decreased in CRE carriers, and beta-diversity analysis demonstrated that the two groups were clustered significantly apart. Among short-chain fatty acids, the levels of isobutyric acid and valeric acid were significantly decreased in CRE carriers. Furthermore, the PICRUSt-predicted metabolic pathways revealed significant differences in five features, including ATP-binding cassette transporters, phosphotransferase systems, sphingolipid metabolism, other glycan degradation, and microbial metabolism, in diverse environments between the two groups.ConclusionCritically ill patients with CRE have a distinctive gut microbiota composition and community structure, altered short-chain fatty acid production and changes in the metabolic pathways. Further studies are needed to determine whether amino acids supplementation improves microbiota dysbiosis in patients with CRE.
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Affiliation(s)
- Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seungil Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kweon
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Correspondence: Jin Won Huh,
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Tian F, Li Y, Wang Y, Yu B, Song J, Ning Q, Jian C, Ni M. Risk factors and molecular epidemiology of fecal carriage of carbapenem resistant Enterobacteriaceae in patients with liver disease. Ann Clin Microbiol Antimicrob 2023; 22:10. [PMID: 36710337 PMCID: PMC9884424 DOI: 10.1186/s12941-023-00560-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Carbapenem resistant Enterobacteriaceae (CRE) colonization is a risk factor for CRE infection. CRE infection results in an increase in mortality in patients with cirrhosis. However, minimal data regarding the prevalence and the risk factors of CRE colonization in patients with liver disease yet without liver transplantation are available. The present study aimed to investigate the prevalence, risk factors and molecular epidemiology characteristics of CRE fecal carriage among patients with liver disease. METHODS Stool specimens from 574 adult inpatients with liver disease were collected from December 2020 to April 2021. CRE were screened using selective chromogenic agar medium and identified by the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined using the broth microdilution method. Carbapenemase genes were characterized by polymerase chain reaction (PCR) and DNA sequencing. Multilocus sequence typing (MLST) was performed for Carbapenem Resistant Klebsiella pneumoniae (CR-KPN) isolates and Carbapenem Resistant Escherichia Coli (CR-ECO) isolates. RESULTS The total number of stool specimens (732) were collected from 574 patients with liver disease. 43 non-duplicated CRE strains were isolated from 39 patients with a carriage rate of 6.79% (39/574). The carriage rate was 15.60% (17/109) in patients with acute-on-chronic liver failure (ACLF). Multivariate analysis indicated that ACLF (P = 0.018), the history of pulmonary infection within past 3 months (P = 0.001) and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months (P = 0.000) were independent risk factors of CRE colonization in patients with liver disease. Klebsiella Pnuemoniae (KPN) (51.28%) and Escherichia coli (ECO) (30.77%) were main strains in these patients. All CRE strains showed high resistance to most antimicrobials except for polymyxin B and tigecycline. Most (83.72%, 36/43) of the CRE carried carbapenemase genes. blaKPC-2 was the major carbapenemase gene. The molecular epidemiology of KPN were dominated by ST11, while the STs of ECO were scattered. CONCLUSIONS The present study revealed that CRE fecal carriage rates were higher in patients with ACLF than in patients without liver failure. ACLF, the history of pulmonary infection within past 3 months and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months were independent risk factors of CRE colonization in patients with liver disease. Regular CRE screening for hospitalized patients with liver disease should be conducted to limit the spread of CRE strain.
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Affiliation(s)
- Fangbing Tian
- grid.412793.a0000 0004 1799 5032Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yin Li
- grid.412793.a0000 0004 1799 5032Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Wang
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bing Yu
- grid.33199.310000 0004 0368 7223Department of Pathogen Biology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianxin Song
- grid.412793.a0000 0004 1799 5032Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Ning
- grid.412793.a0000 0004 1799 5032Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cui Jian
- grid.412793.a0000 0004 1799 5032Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Ni
- grid.412793.a0000 0004 1799 5032Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Timler M, Timler W, Bednarz A, Zakonnik Ł, Kozłowski R, Timler D, Marczak M. Identification and Preliminary Hierarchisation of Selected Risk Factors for Carbapenemase-Producing Enterobacteriaceae (CPE) Colonisation: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1960. [PMID: 36767330 PMCID: PMC9915316 DOI: 10.3390/ijerph20031960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Drug-resistant bacteria are one of the main reasons of deaths worldwide. One of the significant groups of these bacteria are carbapenemase-producing Enterobacteriaceae (CPE). The goal of this cross-sectional study was the identification and hierarchisation of selected risk factors of CPE colonisation. To achieve that goal, we examined 236 patients for the presence of CPE using the standard method of anal swabs. The patients were divided into three groups: hospitalised patients; those chronically dialysed; those requiring home care. A very thorough medical interview was conducted for comorbidities. A statistical analysis relationship between comorbidities and locations of the patient's stay with the positive result of the culture was investigated. A significant relationship was demonstrated between the positive result of the culture and confirmed dementia, heart failure, connective tissue diseases, and established irregularities in the level of leukocytes. No significant relationship was demonstrated with the remaining comorbidities considered in the study. Afterwards these factors were compared for importance for the assessment of risk of a positive swab result-the biggest importance was found in establishing connective tissue disease. Next were dementia, abnormal values of leukocytes, heart failure, and at the end, stay at the orthopaedics ward. Conclusions: The study identified asymptomatic carriers of CPE, which demonstrates the need for further studies in order to identify infection risk factors. The connective tissue diseases are the most important variable which enable the prediction of CPE colonisation-the next ones are dementia, abnormal values of leukocytes, heart failure, and stay at the orthopaedics ward.
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Affiliation(s)
- Małgorzata Timler
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Wojciech Timler
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Ariadna Bednarz
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
| | - Łukasz Zakonnik
- Faculty of Economics and Sociology, University of Lodz, 90-214 Lodz, Poland
| | - Remigiusz Kozłowski
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 92-212 Lodz, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, 92-212 Lodz, Poland
| | - Michał Marczak
- Department of Management and Logistics in Healthcare, Medical University of Lodz, 90-419 Lodz, Poland
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Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All. Pathogens 2023; 12:pathogens12010144. [PMID: 36678492 PMCID: PMC9866331 DOI: 10.3390/pathogens12010144] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients' being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.
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Regional outbreak of multidrug-resistant Klebsiella pneumoniae carbapenemase-producing Pseudomonas Aeruginosa. Infect Control Hosp Epidemiol 2023; 44:96-98. [PMID: 34593069 PMCID: PMC8971143 DOI: 10.1017/ice.2021.394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Klebsiella pneumoniae carbapenemase-producing P. aeruginosa (KPC-CRPA) are rare in the United States. An outbreak of KPC-CRPA was investigated in Texas using molecular and epidemiologic methods and 17 cases of KPC-CRPA were identified. The isolates were genetically related and harbored the emerging P. aeruginosa multilocus sequence type 235, the first in the United States.
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Efficacy of Vaporized Hydrogen Peroxide Combined with Silver Ions against Multidrug-Resistant Gram-Negative and Gram-Positive Clinical Isolates. Int J Mol Sci 2022; 23:ijms232415826. [PMID: 36555465 PMCID: PMC9779286 DOI: 10.3390/ijms232415826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/19/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious public health problem that results in high morbidity and mortality rates. In particular, multidrug-resistant (MDR) strains circulating in hospital settings pose a major threat as they are associated with serious nosocomial infections. Therefore, regular cleaning and disinfection procedures, usually using chemical disinfectants, must be implemented in these facilities. Hydrogen peroxide (HP)-based disinfectants have proven high microbicidal activity and several comparative advantages over conventional disinfectants. We assessed the in vitro biocidal activity of an 8% HP solution combined with 30 mg/L silver ions (HP + Ag) against MDR clinical isolates of Klebsiella pneumoniae (MDRKp) and Pseudomonas aeruginosa (MDRPa), and methicillin-resistant Staphylococcus aureus (MRSA). Accordingly, the in vitro antibacterial activity was determined using the macrodilution method, and the efficacy was determined for 30 min in terms of (1) activity on bacteria in suspension and (2) activity on surfaces using vaporized HP + Ag on a 20 cm2 stainless steel surface. A strong bactericidal effect of HP + Ag was observed against MDRKp, MDRPa, and MRSA strains, with minimum inhibitory concentrations and minimum bactericidal concentrations between 362.5 and 5800 mg/L. A strong effect was observed during the 30 min of HP + Ag exposure to the resistant clinical isolates, with over 4-Log10 reduction in CFUs. Regarding the efficacy of the disinfectant on surfaces, bacterial load reductions of >99% were observed. These results suggest that HP + Ag is potentially useful as an effective disinfectant for decontaminating surfaces in hospital settings suspected of contamination with MDR bacteria.
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van Dijk MD, Voor In 't Holt AF, Alp E, Hell M, Petrosillo N, Presterl E, Tsakris A, Severin JA, Vos MC. Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study. Antimicrob Resist Infect Control 2022; 11:152. [PMID: 36474304 PMCID: PMC9727845 DOI: 10.1186/s13756-022-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are differences in infection prevention and control (IPC) policies to prevent transmission of highly resistant microorganisms (HRMO). The aim of this study is to give an overview of the IPC policy of six European hospitals and their HRMO prevalence, to compare the IPC policies of these hospitals with international guidelines, and to investigate the hospitals' adherence to their own IPC policy. METHODS The participating hospitals were located in Salzburg (Austria), Vienna (Austria), Kayseri (Turkey), Piraeus (Greece), Rome (Italy) and Rotterdam (The Netherlands). Data were collected via an online survey. Questions were aimed at prevalence rates in the years 2014, 2015, 2016 of carbapenemase-producing Klebsiella pneumoniae (CPK), carbapenemase-producing Pseudomonas aeruginosa (CPPA), vancomycin-resistant Enterococcus faecium (VRE) and hospitals' IPC policies of 2017. Implemented IPC measures (i.e. with a self-reported adherence of > 90%) were counted (26 points maximal). RESULTS The self-reported prevalence of CPK per year was low in the Austrian and Dutch hospitals and high in the Turkish and Greek hospitals. CPPA was highly prevalent in the Turkish hospital only, while the prevalence of VRE in four hospitals, except the Austrian hospitals which reported lower prevalence numbers, was more evenly distributed. The Dutch hospital had implemented the most IPC measures (n = 21), the Turkish and Greek hospitals the least (n = 14 and 7, respectively). CONCLUSION Hospitals with the highest self-reported prevalence of CPK and CPPA reported the least implemented IPC measures. Also, hospitals with a higher prevalence often reported a lower adherence to own IPC policy.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Markus Hell
- Department of Clinical Microbiology and Infection Control, MEDILAB-Academic Teaching Laboratories, Paracelsus Medical University, Salzburg, Austria
- Teaching Hospital, Kardinal Schwarzenberg Klinikum, Paracelsus Medical University, Schwarzach, Austria
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
- Department of Infection Control, University Hospital Campus Bio-Medico, Rome, Italy
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Effects of screening strategies to detect carbapenem-resistant gram-negative bacteria: A systematic review. Am J Infect Control 2022; 50:1381-1388. [PMID: 35227794 DOI: 10.1016/j.ajic.2022.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This systematic review aims to summarize the evidence on the effects of screening strategies to detect carbapenem-resistant gram-negative bacteria (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa). METHODS Eligible studies were randomized trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. We conducted searches in CENTRAL, PUBMED, Embase, Epistemonikos, and in multiple databases available in the Virtual Health Library (LILACS, Scielo, WHO IBECS, and PAHO IBECS). All the searches covered the period until 4 June 2021. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned standardized form. When possible, we intended to conduct meta-analyses using a random-effect model. We assessed the certainty of the evidence (CoE) and summarized the results using the GRADE approach. RESULTS Our search strategy yielded 57,451 references. No randomized trials were identified. Sixteen studies (one controlled before-after study and 15 interrupted time series) met our inclusion criteria and were included in the review. Most studies were conducted in tertiary care general hospitals from the United States, Europe, and Asia. Eleven studies included adult patients hospitalized in general wards and intensive care units, one was carried out in a neonatal intensive care unit, two in hematology or oncology units, and one in a solid organ transplantation department. Eleven studies were conducted in the setting of an outbreak. Regarding the detection strategy used, all studies included screening strategies for high-risk patients at the moment of admission and 7 studies reported a contact surveillance strategy. Most studies were conducted in settings where infection prevention and control measures were concomitantly installed or reinforced. Data were not suitable for meta-analysis, so the results were presented as a narrative synthesis. Most studies showed a decline in the prevalence of both infection and colonization rates after the implementation of a policy of active surveillance, but the CoE is low. Screening strategies may result in little to no difference in the risk of all-cause mortality and the length of hospital stay. CONCLUSIONS Existing evidence may favor the use of surveillance culture to carbapenem-resistant gram-negative bacteria, but its quality is poor, so solid conclusions cannot be drawn. Well-conducted randomized trials or high-quality quasi-experimental studies are needed to improve the certainty of the existing evidence. These studies should assess the effect of the addition of screening strategies as a single intervention and measure clinically important outcomes such as infection, length of hospital stay, and mortality.
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Zeng G, Pang Y, Zheng J, Zhuo C, Guo Y, Liang J, Li X, Lei Z, Zhu J, Xu L, Gao Z, Zhuo C, Liu J. Colonization with Carbapenem-Resistant Enterobacteriaceae Contributes to Unfavorable Outcomes in End-Stage Liver Disease Patients. Antibiotics (Basel) 2022; 11:1667. [PMID: 36421311 PMCID: PMC9686982 DOI: 10.3390/antibiotics11111667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 12/25/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are the highest priority pathogens of the World Health Organization, and their prevalence in end-stage liver disease (ESLD) patients is increasing. CRE colonization is an independent risk factor for CRE infections. We aimed to assess risk factors and explore the relationship between CRE colonization, infection, and prognosis in patients with ESLD. A total of 311 patients with ESLD were screened for CRE colonization by fecal swabs from October 2020 to January 2022. Antimicrobial susceptibility was tested using the broth microdilution method. Carbapenem resistance genes, multilocus sequence type, and capsular serotype were analyzed by polymerase chain reaction (PCR). Seventeen CRE strains were detected, among which the most common was Klebsiella pneumoniae. The CRE colonization rate was 5.5%. Artificial liver support was an independent risk factor for CRE colonization. Compared to the non-CRE colonization group, the colonization group had a higher incidence of CRE infection and a worse prognosis. Furthermore, these strains were not closely related, and all were sensitive to polymyxin and tigecycline. There was a high colonization rate in ESLD patients, and colonization strains were highly diverse. CRE colonization deserves attention in these patients, especially when treated with artificial liver support.
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Affiliation(s)
- Guofen Zeng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Department of Infectious Diseases, The Affiliated Kashi Hospital, Sun Yat-sen University, Kashi 844000, China
| | - Yihua Pang
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Jiaxin Zheng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Chuyue Zhuo
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510030, China
| | - Yingyi Guo
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510030, China
| | - Jiayin Liang
- Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xiaojie Li
- Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Ziying Lei
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Jianyun Zhu
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Lejia Xu
- Department of Pharmacy, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zhiliang Gao
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Chao Zhuo
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510030, China
| | - Jing Liu
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Allander L, Vickberg K, Lagerbäck P, Sandegren L, Tängdén T. Evaluation of In Vitro Activity of Double-Carbapenem Combinations against KPC-2-, OXA-48- and NDM-Producing Escherichia coli and Klebsiella pneumoniae. Antibiotics (Basel) 2022; 11:1646. [PMID: 36421290 PMCID: PMC9686504 DOI: 10.3390/antibiotics11111646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/28/2022] [Accepted: 11/10/2022] [Indexed: 09/08/2023] Open
Abstract
Double-carbapenem combinations have shown synergistic potential against carbapenemase-producing Enterobacterales, but data remain inconclusive. This study evaluated the activity of double-carbapenem combinations against 51 clinical KPC-2-, OXA-48-, NDM-1, and NDM-5-producing Escherichia coli and Klebsiella pneumoniae and against constructed E. coli strains harboring genes encoding KPC-2, OXA-48, or NDM-1 in an otherwise isogenic background. Two-drug combinations of ertapenem, meropenem, and doripenem were evaluated in 24 h time-lapse microscopy experiments with a subsequent spot assay and in static time-kill experiments. An enhanced effect in time-lapse microscopy experiments at 24 h and synergy in the spot assay was detected with one or more combinations against 4/14 KPC-2-, 17/17 OXA-48-, 2/17 NDM-, and 1/3 NDM-1+OXA-48-producing clinical isolates. Synergy rates were higher against meropenem- and doripenem-susceptible isolates and against OXA-48 producers. NDM production was associated with significantly lower synergy rates in E. coli. In time-kill experiments with constructed KPC-2-, OXA-48- and NDM-1-producing E. coli, 24 h synergy was not observed; however, synergy at earlier time points was found against the KPC-2- and OXA-48-producing constructs. Our findings indicate that the benefit of double-carbapenem combinations against carbapenemase-producing E. coli and K. pneumoniae is limited, especially against isolates that are resistant to the constituent antibiotics and produce NDM.
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Affiliation(s)
- Lisa Allander
- Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
| | - Karin Vickberg
- Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
| | - Pernilla Lagerbäck
- Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
| | - Linus Sandegren
- Department of Medical Biochemistry and Microbiology, Uppsala University, 751 23 Uppsala, Sweden
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden
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Dealing with Hidden Threats: The Antimicrobial Effect of the Embalming Process. Microorganisms 2022; 10:microorganisms10112180. [PMID: 36363772 PMCID: PMC9693414 DOI: 10.3390/microorganisms10112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Individuals naturally carry bacteria and other microbes as part of their natural flora, with some being opportunistic pathogens. Approximately 30% of the population is known to carry Staphylococcus aureus in their nasal cavity, an organism that causes infections ranging from soft tissue abscesses to toxic shock syndrome. This problem is compounded by the presence of antibiotic-resistant strains such as Methicillin-Resistant Staphylococcus aureus (MRSA). Commensal bacteria present on cadavers pose a risk to those who handle the body. As a Medical School Anatomy laboratory that performs hands-on cadaveric dissection, we wanted to know whether the embalming process is sufficient to kill all commensal bacteria that pose a risk to staff and students. Even if these strains do not cause disease in these individuals, secondary transmission could occur to friends and family, who may be at higher risk of acquiring an infection. Embalming is assumed to eliminate all microbial contamination on the body. However, there are limited studies to confirm this. This study characterises the incidence of antibiotic sensitive and resistant bacteria in cadavers donated for medical teaching and research. We have screened for Methicillin-Resistant Organisms (MRO) and Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria. In this study group of cadavers, approximately 46% (16/35) carry an MRO, while 51% (18/35) carry an ESBL positive organism prior to embalming. By determining the organisms’ presence pre- and post-embalming, we can evaluate the embalming procedure’s effectiveness. Our results show embalming eliminates detectable microbes in about 51% (18/35) of the cadavers. MRO dropped by 75% (16 to 4 positive cadavers), while ESBL organisms went down by almost 95% (from 18 to 1 positive cadaver). There was a further decrease in the number of positive cadavers after storage at 4 °C to 6% (2/32). Thus, although the embalming process does not immediately sterilise all the cadavers, prolonged storage at 4 °C can further reduce the number of viable bacteria.
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Lomont A, Sevin T, Assouvie L, Dalix A, Assoukpa J, Lecuru M, Lecointe D. Carbapenemase-producing Enterobacterales and vancomycin-resistant Enterococcus faecium carriage in patients who have traveled in foreign countries: A single center 5-year prospective study. Am J Infect Control 2022; 50:1234-1239. [PMID: 35167899 DOI: 10.1016/j.ajic.2022.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Numerous patients carrying carbapenemase-producing Enterobacterales (CPE) and/or vancomycin-resistant Enterococcus faecium (VRE) in France have previously travelled abroad. The risk of spreading CPE/VRE by patients who have stayed abroad without hospitalization is underexplored. This prompted us to screen and isolate all patients who travelled abroad in the previous 12 months upon admission to our hospital. Our aim was to evaluate the efficiency of this CPE/VRE-related risk policy. METHODS From 2014 to 2018, patients who had travelled abroad in the previous year before their admission underwent microbiological screening and were pre-emptively isolated. Contact precautions were verified and CPE/VRE cross-transmission events investigated. RESULTS Among 1,780 screened patients, 59 (3.3%) were colonized with CPE and/or VRE, of whom 17 (29.3%) were not hospitalized abroad. Nine generated 18 readmissions. No episodes of CPE/VRE cross-transmission were related to patients with a stay abroad without hospitalization, whereas 2 patients hospitalized abroad generated one episode each, despite implementation of contact precautions reaching values from 73.6% to 87.5%. DISCUSSION Throughout 17 admissions and 18 readmissions, patients who stayed abroad without hospitalization represented a true risk of spreading CPE/VRE, without generating cross-transmission. CONCLUSIONS Our strategy of CPE/VRE-related risk policy is successful.
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Affiliation(s)
- A Lomont
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - T Sevin
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - L Assouvie
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - A Dalix
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - J Assoukpa
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - M Lecuru
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - D Lecointe
- Service d'Hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France.
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Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures. Porto Biomed J 2022; 7:e186. [PMID: 37152080 PMCID: PMC10158887 DOI: 10.1097/j.pbj.0000000000000186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal. Methods A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records. Results Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection. Conclusions Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.
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Kardaś-Słoma L, Fournier S, Dupont JC, Rochaix L, Birgand G, Zahar JR, Lescure FX, Kernéis S, Durand-Zaleski I, Lucet JC. Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study. Antimicrob Resist Infect Control 2022; 11:117. [PMID: 36117231 PMCID: PMC9484055 DOI: 10.1186/s13756-022-01149-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Spread of resistant bacteria causes severe morbidity and mortality. Stringent control measures can be expensive and disrupt hospital organization. In the present study, we assessed the effectiveness and cost-effectiveness of control strategies to prevent the spread of Carbapenemase-producing Enterobacterales (CPE) in a general hospital ward (GW). Methods A dynamic, stochastic model simulated the transmission of CPE by the hands of healthcare workers (HCWs) and the environment in a hypothetical 25-bed GW. Input parameters were based on published data; we assumed the prevalence at admission of 0.1%. 12 strategies were compared to the baseline (no control) and combined different prevention and control interventions: targeted or universal screening at admission (TS or US), contact precautions (CP), isolation in a single room, dedicated nursing staff (DNS) for carriers and weekly screening of contact patients (WSC). Time horizon was one year. Outcomes were the number of CPE acquisitions, costs, and incremental cost-effectiveness ratios (ICER). A hospital perspective was adopted to estimate costs, which included laboratory costs, single room, contact precautions, staff time, i.e. infection control nurse and/or dedicated nursing staff, and lost bed-days due to prolonged hospital stay of identified carriers. The model was calibrated on actual datasets. Sensitivity analyses were performed. Results The baseline scenario resulted in 0.93 CPE acquisitions/1000 admissions and costs 32,050 €/1000 admissions. All control strategies increased costs and improved the outcome. The efficiency frontier was represented by: (1) TS with DNS at a 17,407 €/avoided CPE case, (2) TS + DNS + WSC at a 30,700 €/avoided CPE case and (3) US + DNS + WSC at 181,472 €/avoided CPE case. Other strategies were dominated. Sensitivity analyses showed that TS + CP might be cost-effective if CPE carriers are identified upon admission or if the cases have a short hospital stay. However, CP were effective only when high level of compliance with hand hygiene was obtained. Conclusions Targeted screening at admission combined with DNS for identified CPE carriers with or without weekly screening were the most cost-effective options to limit the spread of CPE. These results support current recommendations from several high-income countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01149-0.
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Guo B, Guo Z, Zhang H, Shi C, Qin B, Wang S, Chang Y, Chen J, Chen P, Guo L, Guo W, Han H, Han L, Hu Y, Jin X, Li Y, Liu H, Lou P, Lu Y, Ma P, Shan Y, Sun Y, Zhang W, Zheng X, Shao H. Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: A multi-center cross-sectional study. Front Microbiol 2022; 13:894341. [PMID: 36187994 PMCID: PMC9521644 DOI: 10.3389/fmicb.2022.894341] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveIn intensive care units (ICUs), carbapenem-resistant Enterobacterales (CRE) pose a significant threat. We aimed to examine the distribution, epidemiological characteristics, and risk factors for CRE positivity in ICUs.Materials and methodsThis cross-sectional study was conducted in 96 ICUs of 78 hospitals in Henan Province, China. The clinical and microbiological data were collected. A multivariable logistic regression model was used to analyze the risk factors for CRE positivity.ResultsA total of 1,009 patients were enrolled. There was a significant difference in CRE positive rate between pharyngeal and anal swabs (15.16 vs. 19.13%, P < 0.001). A total of 297 carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 22 carbapenem-resistant Escherichia coli (CR-ECO), 6 carbapenem-resistant Enterobacter cloacae (CR-ECL), 19 CR-KPN/CR-ECO, and 2 CR-KPN/CR-ECL were detected. Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), and a combination of KPC and NDM were detected in 150, 9, and 11 swab samples, respectively. Multivariable logistic regression analysis determined length of ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotics exposure as independent risk factors for CRE positivity. Age and cardiovascular diseases were independent risk factors for mixed infections of CRE. The occurrence of CRE in secondary and tertiary hospitals was 15.06 and 25.62%, respectively (P < 0.05). Patients from tertiary hospitals had different clinical features compared with those from secondary hospitals, including longer hospital stays, a higher rate of patients transferred from other hospitals, receiving renal replacement therapy, exposure to immunosuppressive drugs, use of antibiotics, and a higher rate of the previous infection.ConclusionIn ICUs in Henan Province, CRE positive rate was very high, mostly KPC-type CR-KPN. Patients with prolonged ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotic exposure are prone to CRE. Age and cardiovascular diseases are susceptibility factors for mixed infections of CRE. The CRE positive rate in tertiary hospitals was higher than that in secondary hospitals, which may be related to the source of patients, antibiotic exposure, disease severity, and previous infection.
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Affiliation(s)
- Bo Guo
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Ziqi Guo
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Huifeng Zhang
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Chuanchuan Shi
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
| | - Bingyu Qin
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
- Bingyu Qin,
| | - Shanmei Wang
- Department of Microbiology Laboratory, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yinjiang Chang
- Department of Critical Care Medicine, Puyang People’s Hospital, Puyang, China
| | - Jian Chen
- Department of Critical Care Medicine, Xuchang Central Hospital, Xuchang, China
| | - Peili Chen
- Department of Critical Care Medicine, Shangqiu People’s Hospital, Shangqiu, China
| | - Limin Guo
- Department of Critical Care Medicine, Jiyuan People’s Hospital, Jiyuan, China
| | - Weidong Guo
- Department of Critical Care Medicine, Xinxiang Central Hospital, Xinxiang, China
- Department of Critical Care Medicine, The Fourth Clinical College of Xinxiang Medical College, Xinxiang, China
| | - Huaibin Han
- Department of Critical Care Medicine, Zhoukou Central Hospital, Zhoukou, China
| | - Lihong Han
- Department of Critical Care Medicine, Luoyang Central Hospital, Luoyang, China
| | - Yandong Hu
- Department of Critical Care Medicine, Sanmenxia Central Hospital, Sanmenxia, China
| | - Xiaoye Jin
- Department of Critical Care Medicine, Kaifeng People’s Hospital, Kaifeng, China
| | - Yening Li
- Department of Critical Care Medicine, Luohe Central Hospital, Luohe, China
| | - Hong Liu
- Department of Critical Care Medicine, Pingdingshan First People’s Hospital, Pingdingshan, China
| | - Ping Lou
- Department of Critical Care Medicine, Zhengzhou First People’s Hospital, Zhengzhou, China
| | - Yibing Lu
- Department of Critical Care Medicine, Xinyang Central Hospital, Xinyang, China
| | - Panfeng Ma
- Department of Critical Care Medicine, Anyang People’s Hospital, Anyang, China
| | - Yanhua Shan
- Department of Critical Care Medicine, Zhumadian Central Hospital, Zhumadian, China
| | - Yiyi Sun
- Department of Critical Care Medicine, Hebi People’s Hospital, Hebi, China
| | - Wukui Zhang
- Department of Critical Care Medicine, Jiaozuo People’s Hospital, Jiaozuo, China
| | - Xisheng Zheng
- Department of Critical Care Medicine, Nanyang Central Hospital, Nanyang, China
| | - Huanzhang Shao
- Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
- Department of Critical Care Medicine, Henan University People’s Hospital, Zhengzhou, China
- Henan Key Laboratory for Critical Care Medicine, Zhengzhou, China
- Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Zhengzhou, China
- *Correspondence: Huanzhang Shao,
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Zhu R, Xu X, Lian S, Cai M, Zhang H, Chen X, Cao Y. Intestinal Colonization with Carbapenem-Resistant Enterobacteriaceae in Acute Leukemia Patients: Risk Factors and Molecular Characteristics. Infect Drug Resist 2022; 15:4275-4283. [PMID: 35965853 PMCID: PMC9365016 DOI: 10.2147/idr.s376413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Carbapenem-resistant Enterobacteriaceae (CRE) colonization is associated with bacterial translocation, which can result in subsequent endogenous CRE infection. In the present study, we aim to investigate the colonization-related risk factors and molecular epidemiological characteristics of CRE in patients with acute leukemia. Methods From January 2021 to December 2021, acute leukemia patients were screened for CRE by fecal/perianal swabs. We identified the species, carbapenemase-encoding genes, and virulence genes of the colonizing strains and performed antimicrobial susceptibility tests and ERIC-PCR typing. Risk factors for CRE colonization were identified by univariate and multivariate analysis. Results We collected a total of 21 colonizing strains from 320 patients. All strains were resistant to meropenem. Klebsiella pneumoniae was the most abundant species, and ERIC-PCR typing showed low diversity. Univariate analysis showed that age, cephalosporins, penicillins, tigecyclines, and hematopoietic stem cell transplantation status were risk factors for CRE colonization; simultaneously discovered CRE strains played a dominant role in invasive infection of colonized patients. Logistic multivariate regression analysis showed that age, cephalosporins, and tigecyclines were independent risk factors for CRE intestinal colonization. Conclusion CRE colonization can increase the incidence of CRE infection in patients with acute leukemia. Early detection of CRE colonization through CRE screening is an important measure to control the spread of CRE.
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Affiliation(s)
- Rongping Zhu
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China
| | - Xiaohong Xu
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China
| | - Siyan Lian
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China
| | - Meili Cai
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China
| | - Hui Zhang
- Fujian Medical University, Fuzhou, 350001, People’s Republic of China
| | - Xin Chen
- Fujian Medical University, Fuzhou, 350001, People’s Republic of China
| | - Yingping Cao
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China
- Correspondence: Yingping Cao, Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, 350001, People’s Republic of China, Tel +86 13365910806, Email
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Is It Possible to Eradicate Carbapenem-Resistant Acinetobacter baumannii (CRAB) from Endemic Hospitals? Antibiotics (Basel) 2022; 11:antibiotics11081015. [PMID: 36009885 PMCID: PMC9405503 DOI: 10.3390/antibiotics11081015] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Despite the global efforts to antagonize carbapenem-resistant Acinetobacter baumannii (CRAB) spreading, it remains an emerging threat with a related mortality exceeding 40% among critically ill patients. The purpose of this review is to provide evidence concerning the best infection prevention and control (IPC) strategies to fight CRAB spreading in endemic hospitals. Methods: The study was a critical review of the literature aiming to evaluate all available studies reporting IPC measures to control CRAB in ICU and outside ICU in both epidemic and endemic settings in the past 10 years. Results: Among the 12 included studies, the majority consisted of research reports of outbreaks mostly occurred in ICUs. The reported mortality reached 50%. Wide variability was observed related to the frequency of application of recommended CRAB IPC measures among the studies: environmental disinfection (100%); contact precautions (83%); cohorting staff and patients (75%); genotyping (66%); daily chlorhexidine baths (58%); active rectal screening (50%); closing or stopping admissions to the ward (33%). Conclusions: Despite effective control of CRAB spreading during the outbreaks, the IPC measures reported were heterogeneous and highly dependent on the different setting as well as on the structural characteristics of the wards. Reinforced ‘search and destroy’ strategies both on the environment and on the patient, proved to be the most effective measures for permanently eliminating CRAB spreading.
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Arieti F, Savoldi A, Rejendran NB, Sibani M, Tebon M, Pezzani MD, Gorska A, Wozniak TM, Tacconelli E. The antimicrobial resistance travel tool, an interactive evidence-based educational tool to limit antimicrobial resistance spread. J Travel Med 2022; 29:6554586. [PMID: 35348740 PMCID: PMC9282094 DOI: 10.1093/jtm/taac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND International travel has been recognized as a risk factor contributing to the spread of antimicrobial resistance (AMR). However, tools focused on AMR in the context of international travel and designed to guide decision-making are limited. We aimed at developing an evidence-based educational tool targeting both healthcare professionals (HCPs) and international travellers to help prevent the spread of AMR. METHODS A literature review on 12 antimicrobial-resistant bacteria (ARB) listed as critical and high tiers in the WHO Pathogen Priority List covering four key areas was carried out: AMR surveillance data; epidemiological studies reporting ARB prevalence data on carriage in returning travellers; guidance documents reporting indications on screening for ARB in returning travellers and recommendations for ARB prevention for the public. The evidence, catalogued at country-level, provided the content for a series of visualizations that allow assessment of the risk of AMR acquisition through travel. RESULTS Up to January 2021, the database includes data on: (i) AMR surveillance for 2.018.241 isolates from 86 countries; (ii) ARB prevalence of carriage from 11.679 international travellers and (iii) 15 guidance documents published by major public health agencies. The evidence allowed the development of a consultation scheme for the evaluation of risk factors, prevalence of carriage, proportion and recommendations for screening of AMR. For the public, pre-travel practical measures to minimize the risk of transmission were framed. CONCLUSIONS This easy-to-use, annually updated, freely accessible AMR travel tool (https://epi-net.eu/travel-tool/overview/), is the first of its kind to be developed. For HCPs, it can provide a valuable resource for teaching and a repository that facilitates a stepwise assessment of the risk of AMR spread and strengthen implementation of optimized infection control measures. Similarly, for travellers, the tool has the potential to raise awareness of AMR and outlines preventive measures that reduce the risk of AMR acquisition and spread.
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Affiliation(s)
- Fabiana Arieti
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Alessia Savoldi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Nithya Babu Rejendran
- Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen 72074, Germany.,German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen 72074, Germany
| | - Marcella Sibani
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Maela Tebon
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Maria Diletta Pezzani
- Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona 37134, Italy
| | - Anna Gorska
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Teresa M Wozniak
- Menzies School of Health Research, Charles Darwin University, Darwin 8100, Northern Territory, Australia.,Australian e-Health Research Centre CSIRO, Brisbane 4000, Qeensland Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy.,Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research, University of Tübingen, Tübingen 72074, Germany.,German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen 72074, Germany
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Ngougni Pokem P, Wittebole X, Collienne C, Rodriguez-Villalobos H, Tulkens PM, Elens L, Van Bambeke F, Laterre PF. Population Pharmacokinetics of Temocillin Administered by Continuous Infusion in Patients with Septic Shock Associated with Intra-Abdominal Infection and Ascitic Fluid Effusion. Antibiotics (Basel) 2022; 11:antibiotics11070898. [PMID: 35884152 PMCID: PMC9311849 DOI: 10.3390/antibiotics11070898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Temocillin is active against Gram-negative bacteria, including many extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. We studied its pharmacokinetics in plasma and ascitic fluid after intravenous administration of a loading dose of 2 g over 30 min, followed by continuous infusion of 6 g/24 h, to 19 critically-ill patients with septic shock associated with complicated intra-abdominal infection. We established a pharmacokinetic model describing unbound temocillin concentrations in plasma and ascitic fluid and performed Monte-Carlo simulations to evaluate the probability of target attainment (PTA) of unbound concentrations (100% fT > MIC, i.e., unbound concentrations remaining above the MIC during 100% of the time) for the applied and hypothetical dosing regimens. The temocillin AUC in ascitic fluid was 46% of the plasma AUC. Plasma unbound concentrations were best described by a two-compartment model, and an additional compartment was added to describe unbound concentration in ascitic fluid, with renal clearance as a covariate. Dosing simulations showed that 90% PTA was achieved in the plasma with the current dosing regimen for MIC ≤ 16 mg/L (EUCAST susceptibility breakpoint) but not in the ascitic fluid if renal clearance was ≥40 mL/min. Hypothetical dosing with a higher (a) loading dose or (b) infused dose allowed to reach target concentrations in ascitic fluid (a) more rapidly or (b) sustainably, but these simulations need to be evaluated in the clinics for safety and efficacy.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Xavier Wittebole
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
| | - Christine Collienne
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
| | | | - Paul M. Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
- Correspondence: ; Tel.: +32-2-764-73-78
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
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Santos-Marques C, Ferreira H, Gonçalves Pereira S. Infection prevention and control strategies against carbapenem resistant Enterobacteriaceae - a systematic review. J Infect Prev 2022; 23:167-185. [PMID: 37256160 PMCID: PMC10226056 DOI: 10.1177/17571774211066762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/17/2021] [Indexed: 09/20/2023] Open
Abstract
Background Antimicrobial resistance is exponentially worsening, and the spread of prevalent carbapenem resistant Enterobacteriaceae (CRE) is a major contributor to this global concern. Infection prevention and control strategies are increasingly consolidated key tools to control this worldwide problem. Aim To identify, collect and analyse available evidence regarding the impact of infection prevention and control strategies on prevalent CRE dissemination. Methods Pubmed®, Scopus® and Web of Science® were searched systematically for articles published between 1th January 2017 and 30th June 2020, guided by the research question 'What are the most effective and efficient strategies to prevent and control infection/colonisation caused by Carbapenem resistant Escherichia coli and Carbapenem resistant Klebsiella pneumoniae?'. Findings Eleven thousand six hundred and thirty-five publications were found, but after applying the inclusion and exclusion criteria, only 30 were selected. The majority of reviewed studies (n = 24) were performed in outbreak situations, 26 studies occurred in acute care units and of those, 17 in intensive care units . From the set of implemented infection prevention and control measures, in 29 studies surveillance cultures were applied, in 23 studies patients were isolated or cohorted and, in general, all described the implementation of standard and contact precaution measures. Conclusion This systematic review underlines the importance of infection prevention and control strategies in CRE dissemination, standing out the need of further studies outside outbreak and intensive care units contexts. Investment increments and training and educating of all involved are also important contributors to shift this problem, but still with relevant gaps in their implementation, in all types of care units, that need to be addressed.
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Affiliation(s)
- Catarina Santos-Marques
- Center for Innovative Care and
Health Technology – ciTechCare, Polytechnic of Leiria, Portugal
- Microbiology Laboratory, Biological
Sciences Department, Faculty of Pharmacy of University of Porto, Portugal
- Research Unit on Applied Molecular
Biosciences – UCIBIO, Portugal
| | - Helena Ferreira
- Microbiology Laboratory, Biological
Sciences Department, Faculty of Pharmacy of University of Porto, Portugal
- Research Unit on Applied Molecular
Biosciences – UCIBIO, Portugal
| | - Sónia Gonçalves Pereira
- Center for Innovative Care and
Health Technology – ciTechCare, Polytechnic of Leiria, Portugal
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Tălăpan D, Rafila A. Five-Year Survey of Asymptomatic Colonization with Multidrug-Resistant Organisms in a Romanian Tertiary Care Hospital. Infect Drug Resist 2022; 15:2959-2967. [PMID: 35706926 PMCID: PMC9191195 DOI: 10.2147/idr.s360048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine the rate of carriage of multidrug-resistant organisms (MDROs) between 2015 and 2019 among patients admitted to the National Institute of Infectious Diseases “Prof. Dr. Matei Balș,” from Bucharest, Romania. Methods Nasal, throat, and rectal/perirectal screening swabs were collected either immediately or during the first 24 hours of admission and sent to the microbiology laboratory where the following MDROs were identified: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant/carbapenemase-producing Enterobacterales (CRE/CPE), multidrug-resistant/extended drug-resistant Acinetobacter baumannii (MDR/XDR-AB), and multidrug-resistant/extended drug-resistant Pseudomonas aeruginosa (MDR/XDR-PA). Results A total of 5083 unique patients were screened for MRSA and 5008 for VRE, ESBL/CRE/CPE, MDR/XDR-AB, and MDR/XDR-PA. MRSA was detected in 8.24% of patients, VRE in 17.67%, ESBL Enterobacterales in 25.85%, and CPE in 6.13%. MDR/XDR-AB was found in 1.59% and MDR/XDR-PA in 1.91% of patients. The rates of carriage increased between 2015 and 2019 for MRSA (7.23–7.6%), VRE (9–16.68%), CPE (1.15–6.77%), MDR/XDR-PA (1.15–1.91%), and MDR/XDR-AB (1.15–2.04%). OXA-48-type carbapenemase was predominant in Klebsiella pneumoniae (68.62%) and Escherichia coli (89.47%). CPE bacteria other than Klebsiella pneumoniae and Escherichia coli identified in our study carried mostly metallo-beta-lactamase (n = 28, 84.85%). Conclusion In this study, 37% of the unique patients screened over five years were found to be MDRO carriers. The proportion of VRE and CPE rectal carriers increased significantly between 2015 and 2019. The most frequently isolated carbapenemase was the OXA-48 type.
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Affiliation(s)
- Daniela Tălăpan
- Microbiology Laboratory, National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania.,Department of Microbiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Alexandru Rafila
- Microbiology Laboratory, National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania.,Department of Microbiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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Gray NA, Toy L, Dalla-Bona K, Broom J, Gray M. The lived experience of haemodialysis patients managed with transmission-based precautions for MDRO colonisation: A qualitative study. Infect Dis Health 2022; 27:211-218. [PMID: 35690584 DOI: 10.1016/j.idh.2022.05.003] [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: 02/15/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients undergoing haemodialysis colonised with multi-drug resistant organisms (MDROs) are commonly managed with transmission-based precautions (TBP) to prevent nosocomial transmission. TBP have been linked to mixed effects on patient psychological well-being and clinical care. This study was designed to report the lived experience of dialysis patients managed with TBP. METHODS A qualitative study of 15 patients undergoing haemodialysis managed with TBP was performed. Participants took part in individual semi-structured interviews. Data was analysed utilising an interpretive phenomenological approach. RESULTS Four themes were identified. 1. Communication of what MDRO screening meant, the results, and implications of MDRO positivity was perceived by many patients as insufficient and inconsistent. 2. Experiences of care in isolation were described, with both positive (privacy) and negative (reduced interaction) experiences identified. 3. Psychosocial and emotional responses including concern about health implications and stigma were reported, but also screening was described by some as increasing their perception of being cared for by health care workers, as they felt all health risks were being managed. 4. Confusion around perceived inconsistencies of management, particularly across different environments (eg hospital vs home) and staff. CONCLUSION TBP have complex positive and negative impacts on patients which should be considered when developing MDRO management policy and communication around such policy. Strategies to improve communication, patient and staff education, and remove (or explain) perceived inconsistencies of practice may reduce the negative consequences of TBP leading to improved delivery of quality, person-centred care.
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Affiliation(s)
- Nicholas A Gray
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; University of the Sunshine Coast, Sippy Downs, Queensland, Australia; Sunshine Coast Health Institute, Birtinya, Queensland, Australia.
| | - Lisa Toy
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Kim Dalla-Bona
- Department of Nephrology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Jennifer Broom
- Infectious Diseases Research Network, Sunshine Coast University Hospital, Birtinya, Queensland, Australia; The University of Queensland, Herston, Queensland, Australia. https://twitter.com/jenniferkbroom
| | - Marion Gray
- University of Southern Queensland, Ipswich, Queensland, Australia
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Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127005. [PMID: 35742254 PMCID: PMC9223098 DOI: 10.3390/ijerph19127005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 01/25/2023]
Abstract
Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions.
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