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Chelaru EC, Muntean AA, Hogea MO, Muntean MM, Popa MI, Popa GL. The Importance of Carbapenemase-Producing Enterobacterales in African Countries: Evolution and Current Burden. Antibiotics (Basel) 2024; 13:295. [PMID: 38666971 PMCID: PMC11047529 DOI: 10.3390/antibiotics13040295] [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: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) is a worldwide healthcare problem. Multidrug-resistant organisms (MDROs) can spread quickly owing to their resistance mechanisms. Although colonized individuals are crucial for MDRO dissemination, colonizing microbes can lead to symptomatic infections in carriers. Carbapenemase-producing Enterobacterales (CPE) are among the most important MDROs involved in colonizations and infections with severe outcomes. This review aimed to track down the first reports of CPE in Africa, describe their dissemination throughout African countries and summarize the current status of CRE and CPE data, highlighting current knowledge and limitations of reported data. Two database queries were undertaken using Medical Subject Headings (MeSH), employing relevant keywords to identify articles that had as their topics beta-lactamases, carbapenemases and carbapenem resistance pertaining to Africa or African regions and countries. The first information on CPE could be traced back to the mid-2000s, but data for many African countries were established after 2015-2018. Information is presented chronologically for each country. Although no clear conclusions could be drawn for some countries, it was observed that CPE infections and colonizations are present in most African countries and that carbapenem-resistance levels are rising. The most common CPE involved are Klebsiella pneumoniae and Escherichia coli, and the most prevalent carbapenemases are NDM-type and OXA-48-type enzymes. Prophylactic measures, such as screening, are required to combat this phenomenon.
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Affiliation(s)
- Edgar-Costin Chelaru
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Andrei-Alexandru Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Mihai-Octav Hogea
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mădălina-Maria Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mircea-Ioan Popa
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Gabriela-Loredana Popa
- Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Pitout JDD, Peirano G, Matsumura Y, DeVinney R, Chen L. Escherichia coli sequence type 410 with carbapenemases: a paradigm shift within E. coli toward multidrug resistance. Antimicrob Agents Chemother 2024; 68:e0133923. [PMID: 38193668 PMCID: PMC10869336 DOI: 10.1128/aac.01339-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Escherichia coli sequence type ST410 is an emerging carbapenemase-producing multidrug-resistant (MDR) high-risk One-Health clone with the potential to significantly increase carbapenem resistance among E. coli. ST410 belongs to two clades (ST410-A and ST410-B) and three subclades (ST410-B1, ST410-B2, and ST410-B3). After a fimH switch between clades ST410-A and ST410-B1, ST410-B2 and ST410-B3 subclades showed a stepwise progression toward developing MDR. (i) ST410-B2 initially acquired fluoroquinolone resistance (via homologous recombination) in the 1980s. (ii) ST410-B2 then obtained CMY-2, CTX-M-15, and OXA-181 genes on different plasmid platforms during the 1990s. (iii) This was followed by the chromosomal integration of blaCMY-2, fstl YRIN insertion, and ompC/ompF mutations during the 2000s to create the ST410-B3 subclade. (iv) An IncF plasmid "replacement" scenario happened when ST410-B2 transformed into ST410-B3: F36:31:A4:B1 plasmids were replaced by F1:A1:B49 plasmids (both containing blaCTX-M-15) followed by blaNDM-5 incorporation during the 2010s. User-friendly cost-effective methods for the rapid identification of ST410 isolates and clades are needed because limited data are available about the frequencies and global distribution of ST410 clades. Basic mechanistic, evolutionary, surveillance, and clinical studies are urgently required to investigate the success of ST410 (including the ability to acquire successive MDR determinants). Such information will aid with management and prevention strategies to curb the spread of carbapenem-resistant E. coli. The medical community can ill afford to ignore the spread of a global E. coli clone with the potential to end the carbapenem era.
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Affiliation(s)
- Johann D. D. Pitout
- Cummings School of Medicine, Calcary, Alberta, Canada
- University of Calgary, Alberta Precision Laboratories, Calgary, Alberta, Canada
- University of Pretoria, Pretoria, Gauteng, South Africa
| | - Gisele Peirano
- Cummings School of Medicine, Calcary, Alberta, Canada
- University of Calgary, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Yasufumi Matsumura
- Kyoto University Graduate School of Medicine, Pretoria, Gauteng, South Africa
| | | | - Liang Chen
- Meridian Health Center for Discovery and Innovation, Kyoto, Japan
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, New Jersey, USA
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Venne DM, Hartley DM, Malchione MD, Koch M, Britto AY, Goodman JL. Review and analysis of the overlapping threats of carbapenem and polymyxin resistant E. coli and Klebsiella in Africa. Antimicrob Resist Infect Control 2023; 12:29. [PMID: 37013626 PMCID: PMC10071777 DOI: 10.1186/s13756-023-01220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/18/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales are among the most serious antimicrobial resistance (AMR) threats. Emerging resistance to polymyxins raises the specter of untreatable infections. These resistant organisms have spread globally but, as indicated in WHO reports, the surveillance needed to identify and track them is insufficient, particularly in less resourced countries. This study employs comprehensive search strategies with data extraction, meta-analysis and mapping to help address gaps in the understanding of the risks of carbapenem and polymyxin resistance in the nations of Africa. METHODS Three comprehensive Boolean searches were constructed and utilized to query scientific and medical databases as well as grey literature sources through the end of 2019. Search results were screened to exclude irrelevant results and remaining studies were examined for relevant information regarding carbapenem and/or polymyxin(s) susceptibility and/or resistance amongst E. coli and Klebsiella isolates from humans. Such data and study characteristics were extracted and coded, and the resulting data was analyzed and geographically mapped. RESULTS Our analysis yielded 1341 reports documenting carbapenem resistance in 40 of 54 nations. Resistance among E. coli was estimated as high (> 5%) in 3, moderate (1-5%) in 8 and low (< 1%) in 14 nations with at least 100 representative isolates from 2010 to 2019, while present in 9 others with insufficient isolates to support estimates. Carbapenem resistance was generally higher among Klebsiella: high in 10 nations, moderate in 6, low in 6, and present in 11 with insufficient isolates for estimates. While much less information was available concerning polymyxins, we found 341 reports from 33 of 54 nations, documenting resistance in 23. Resistance among E. coli was high in 2 nations, moderate in 1 and low in 6, while present in 10 with insufficient isolates for estimates. Among Klebsiella, resistance was low in 8 nations and present in 8 with insufficient isolates for estimates. The most widespread associated genotypes were, for carbapenems, blaOXA-48, blaNDM-1 and blaOXA-181 and, for polymyxins, mcr-1, mgrB, and phoPQ/pmrAB. Overlapping carbapenem and polymyxin resistance was documented in 23 nations. CONCLUSIONS While numerous data gaps remain, these data show that significant carbapenem resistance is widespread in Africa and polymyxin resistance is also widely distributed, indicating the need to support robust AMR surveillance, antimicrobial stewardship and infection control in a manner that also addresses broader animal and environmental health dimensions.
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Affiliation(s)
- Danielle M Venne
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - David M Hartley
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, 45229, USA
| | - Marissa D Malchione
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
- Sabin Vaccine Institute, Influenza Vaccine Innovation, 2175 K St NW, Washington, DC, 20037, USA
| | - Michala Koch
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Anjali Y Britto
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA
| | - Jesse L Goodman
- Center on Medical Product Access, Safety and Stewardship, Georgetown University, 3900 Reservoir Road, Washington, DC, 20057, USA.
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Duze ST, Thomas T, Pelego T, Jallow S, Perovic O, Duse A. Evaluation of Xpert Carba-R for detecting carbapenemase-producing organisms in South Africa. Afr J Lab Med 2023; 12:1898. [PMID: 36756217 PMCID: PMC9900380 DOI: 10.4102/ajlm.v12i1.1898] [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: 03/24/2022] [Accepted: 09/15/2022] [Indexed: 12/27/2022] Open
Abstract
This study evaluated the performance of the Xpert Carba-R assay for detecting the five common carbapenemases in carbapenemase-producing organisms in Johannesburg, South Africa between April 2021 and September 2021. The assay demonstrated 98% sensitivity and 97% specificity. It was also able to detect all the carbapenemases in double carbapenemase producers, as well as carbapenemases in non-fermenter organisms. The Xpert Carba-R assay, therefore, allows the rapid (< 1 h) and accurate identification of the common carbapenemases in pure bacterial cultures and rectal swabs. This assay can aid in the timeous institution of appropriate treatment and infection prevention and control measures.
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Affiliation(s)
- Sanelisiwe T. Duze
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Teena Thomas
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa,Infection Control Services Laboratory, National Health Laboratory Services, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Tshegofatso Pelego
- Infection Control Services Laboratory, National Health Laboratory Services, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
| | - Sabelle Jallow
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa,Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Olga Perovic
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa,Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Adriano Duse
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa,Infection Control Services Laboratory, National Health Laboratory Services, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
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Biedrzycka M, Izdebski R, Urbanowicz P, Polańska M, Hryniewicz W, Gniadkowski M, Literacka E. MDR carbapenemase-producing Klebsiella pneumoniae of the hypervirulence-associated ST23 clone in Poland, 2009-19. J Antimicrob Chemother 2022; 77:3367-3375. [PMID: 36177793 DOI: 10.1093/jac/dkac326] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/05/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To characterize carbapenemase-producing isolates of the Klebsiella pneumoniae hypervirulent (hvKp) clone ST23 in Poland. METHODS Fifteen K. pneumoniae ST23 isolates were identified by the Polish surveillance of carbapenemase-producing Enterobacterales. These comprised a cluster with KPC-2 + NDM-1 (n = 7), KPC-2 (n = 1) or NDM-1 (n = 1) enzymes from one hospital from 2018, and sporadic isolates with KPC-2 (n = 1), NDM-1 (n = 1), VIM-1 (n = 1) or OXA-48 (n = 3), recovered from 2009 to 2019 in different towns. The isolates were sequenced by Illumina MiSeq, followed by MinION for six representatives. Clonality, phylogeny, serotypes, virulomes, resistomes and plasmids of the isolates were analysed and compared with international ST23 strains, using various bioinformatic tools. RESULTS Only two diverse isolates with KPC-2 or VIM-1 were of typical hvKp ST23 serotypes K1 and O1v.2, and its predominant phylogenetic clade. These contained multiple chromosomal (ybt, clb) and pK2044/KpVP-1 plasmid (iuc, iro, rmpADC, rmpA2) virulence loci, whereas carbapenemase and other antimicrobial resistance (AMR) genes were on single additional plasmids. All remaining isolates were of K57 and O2v.2 serotypes, and a minor, distant clade of unclear phylogeny, including also ∼10 isolates from other European countries. These had fewer virulence loci (ybt, iuc, rmpADC, rmpA2) but abounded in plasmids, which with several chromosomal AMR mutations conferred more extensive MDR phenotypes than in K1 O1v.2. Lower clonal diversity than in K1, and numerous common characteristics of the isolates supported the hypothesis of the emerging character of the ST23 K57 clade. CONCLUSIONS A new MDR ST23 lineage has emerged in Europe, causing a potential threat to public health.
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Affiliation(s)
| | - R Izdebski
- National Medicines Institute, Warsaw, Poland
| | | | - M Polańska
- Faculty of Biology, Warsaw University, Warsaw, Poland
| | | | | | - E Literacka
- National Medicines Institute, Warsaw, Poland
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6
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1561-1569. [DOI: 10.1093/jac/dkac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
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Spaziante M, Venditti C, Butera O, Messina F, Di Caro A, Tonziello G, Lanini S, Cataldo MA, Puro V. Importance of Surveillance of New Delhi Metallo-Beta-Lactamase Klebsiella pneumoniae: Molecular Characterization and Clonality of Strains Isolated in the Lazio Region, Italy. Infect Drug Resist 2021; 14:3659-3665. [PMID: 34526785 PMCID: PMC8435879 DOI: 10.2147/idr.s318717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction New Delhi metallo-β-lactamase producing Klebsiella pneumoniae (NDM-Kpn) strains have been causing healthcare-associated infections worldwide. The aim of this study was to describe the molecular mechanisms of antimicrobial resistance and to analyze the clonality of NDM-Kpn isolates collected between January 2019 and June 2020 from patients admitted to hospitals from the Lazio region, Italy. Methods We performed a retrospective cohort study. Whole-genome sequencing (WGS) was performed on all NDM-Kpn strains; clonality and genetic relationships were further investigated. Results During the surveillance period, 17 NDM-Kpn isolates were obtained from 17 patients admitted to seven different hospitals. Eight different sequence types (STs) were detected: ST147 (n = 4), ST383 (n = 4), ST15 (n = 3), ST11 (n = 2), ST17 (n = 1), ST29 (n = 1), ST307 (n = 1) and the newly identified ST4853 (n = 1). Genetic relationships were further investigated by the WGS-based core genome MLST (cgMLST) scheme, and 5 cluster types (CTs) were identified. Whereas a substantial overall heterogeneity among isolates was detected (8 different STs were identified out of 17 isolates), the strains within each cluster showed a very high level of genome similarity. Discussion Our study highlights the key role of surveillance, which allowed taking a picture of a part of the NDM-Kpn strains circulating in Italy, adding further insight into their molecular features.
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Affiliation(s)
- Martina Spaziante
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Carolina Venditti
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Ornella Butera
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Francesco Messina
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Antonino Di Caro
- Laboratory of Microbiology, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Gilda Tonziello
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Simone Lanini
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Maria Adriana Cataldo
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Vincenzo Puro
- Emerging Infection Unit and Regional Service for Surveillance and Control of Infectious Diseases (SeRESMI), National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
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Wysocka M, Zamudio R, Oggioni MR, Gołębiewska J, Bronk M, Krawczyk B. Genetic Background and Antibiotic Resistance Profiles of K. pneumoniae NDM-1 Strains Isolated from UTI, ABU, and the GI Tract, from One Hospital in Poland, in Relation to Strains Nationally and Worldwide. Genes (Basel) 2021; 12:genes12081285. [PMID: 34440459 PMCID: PMC8394471 DOI: 10.3390/genes12081285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
In recent years, there has been an observed increase in infections caused by carbapenem-resistant Klebsiella pneumonia (Kp) strains. The aim of this study was the phenotypic and genotypic analysis of eight K. pneumoniae NDM (Kp NDM) isolates, recovered in Poland during the years 2016 and 2018 from seven patients with urinary tract infections (UTIs), asymptomatic bacteriuria (ABU), or colonization of the gut. PCR melting profile genotyping indicated a close relationship between the strains derived from 2018, which were not related to the strain isolated in 2016. WGS results were analyzed in relation to international Kp isolates. Clonal and phylogenetic analyses were performed based on multilocus sequence typing (MLST) and single nucleotide polymorphisms (SNPs) of the core genome. The metallo-β-lactamase was assigned to the NDM-1 type and the sequence was identified as ST11. Eleven antimicrobial resistance genes were detected, mostly from plasmid contigs. Unprecedented profiles of plasmid replicons were described with the IncFII/pKPX-1 dominant replicon. In terms of the KL24 and O2v1 capsular antigen profiles, these isolates corresponded to Greek strains. Strains isolated from UTI, ABU, and colonization GI tract patients were not carrying environment-specific virulence genes. Based on the assessment of strain relationships at the genome level and their direction of evolution, the international character of the sublines was demonstrated, with a documented epidemic potential in Poland and Greece. In conclusion, some groups of patients, e.g., renal transplant recipients or those with complicated UTIs, who are frequently hospitalized and undergoing antibiotic therapy, should be monitored not only for the risk of UTI, but also for colonization by Kp NDM strains.
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Affiliation(s)
- Magdalena Wysocka
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, ul. Narutowicza 11/12, 80-233 Gdańsk, Poland;
| | - Roxana Zamudio
- Department of Genetics and Genome Biology, University of Leicester, University Road, Leicester LE1 7RH, UK; (R.Z.); (M.R.O.)
| | - Marco R. Oggioni
- Department of Genetics and Genome Biology, University of Leicester, University Road, Leicester LE1 7RH, UK; (R.Z.); (M.R.O.)
| | - Justyna Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland;
| | - Marek Bronk
- Laboratory of Clinical Microbiology, University Centre for Laboratory Diagnostics, Medical University of Gdańsk Clinical Centre, ul. Dębinki 7, 80-952 Gdańsk, Poland;
| | - Beata Krawczyk
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, ul. Narutowicza 11/12, 80-233 Gdańsk, Poland;
- Correspondence:
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Emerging Antimicrobial-Resistant High-Risk Klebsiella pneumoniae Clones ST307 and ST147. Antimicrob Agents Chemother 2020; 64:AAC.01148-20. [PMID: 32747358 DOI: 10.1128/aac.01148-20] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There is an enormous global public health burden due to antimicrobial-resistant (AMR) Klebsiella pneumoniae high-risk clones. K. pneumoniae ST307 and ST147 are recent additions to the family of successful clones in the species. Both clones likely emerged in Europe during the early to mid-1990s and, in a relatively short time, became prominent global pathogens, spreading to all continents (with the exception of Antarctica). ST307 and ST147 consist of multiple clades/clusters and are associated with various carbapenemases (i.e., KPCs, NDMs, OXA-48-like, and VIMs). ST307 is endemic in Italy, Colombia, the United States (Texas), and South Africa, while ST147 is endemic in India, Italy, Greece, and certain North African countries. Both clones have been introduced into regions of nonendemicity, leading to worldwide nosocomial outbreaks. Genomic studies showed ST307 and ST147 contain identical gyrA and parC mutations and likely obtained plasmids with bla CTX-M-15 during the early to mid-2000s, which aided in their global distribution. ST307 and ST147 then acquired plasmids with various carbapenemases during the late 2000s, establishing themselves as important AMR pathogens in certain regions. Both clones are likely underreported due to restricted detection methodologies. ST307 and ST147 have the ability to become major threats to public health due to their worldwide distribution, ability to cause serious infections, and association with AMR, including panresistance. The medical community at large, especially those concerned with antimicrobial resistance, should be aware of the looming threat posed by emerging AMR high-risk clones such as K. pneumoniae ST307 and ST147.
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Baraniak A, Machulska M, Żabicka D, Literacka E, Izdebski R, Urbanowicz P, Bojarska K, Herda M, Kozińska A, Hryniewicz W, Gniadkowski M. Towards endemicity: large-scale expansion of the NDM-1-producing Klebsiella pneumoniae ST11 lineage in Poland, 2015-16. J Antimicrob Chemother 2020; 74:3199-3204. [PMID: 31406993 DOI: 10.1093/jac/dkz315] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/12/2019] [Accepted: 06/22/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES In 2015 and 2016 Poland recorded rapid proliferation of New Delhi MBL (NDM)-producing Enterobacterales, with at least 470 and 1780 cases, respectively. We addressed the roles of the Klebsiella pneumoniae ST11 NDM-1 outbreak genotype, already spreading in 2012-14, and of newly imported organisms in this increase. METHODS The study included 2136 NDM-positive isolates identified between April 2015 and December 2016, following transfer of patients with K. pneumoniae ST147 NDM-1 from Tunisia to Warsaw in March 2015. The isolates were screened by PCR mapping for variants of blaNDM-carrying Tn125-like elements. Selected isolates were typed by PFGE and MLST. NDM-encoding plasmids were analysed by nuclease S1/hybridization, transfer assays, PCR-based replicon typing and PCR mapping. RESULTS The organisms were mainly K. pneumoniae containing the Tn125A variant of the ST11 epidemic lineage (n = 2094; ∼98%). Their representatives were of the outbreak pulsotype and ST11, and produced NDM-1, encoded by specific IncFII (pKPX-1/pB-3002cz)-like plasmids. The isolates were recovered in 145 healthcare centres in 13/16 administrative regions, predominantly the Warsaw area. The 'Tunisian' genotype K. pneumoniae ST147 NDM-1 Tn125F comprised 18 isolates (0.8%) from eight institutions. The remaining 24 isolates, mostly K. pneumoniae and Escherichia coli of diverse STs, produced NDM-1 or NDM-5 specified by various Tn125 derivatives and plasmids. CONCLUSIONS The K. pneumoniae ST11 NDM-1 outbreak has dramatically expanded in Poland since 2012, which may bring about a countrywide endemic situation in the near future. In addition, the so-far limited K. pneumoniae ST147 NDM-1 outbreak plus multiple NDM imports from different countries were observed in 2015-16.
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Affiliation(s)
- A Baraniak
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - M Machulska
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - D Żabicka
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - E Literacka
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - R Izdebski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - P Urbanowicz
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
| | - K Bojarska
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - M Herda
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - A Kozińska
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - W Hryniewicz
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
| | - M Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland
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Hofmann F, Heudorf U, Steul K, Wichelhaus TA, Besier S, Hogardt M, Hack D, Steinmann E, Kempf VAJ, Reinheimer C. Anamnestic risk factor evaluation of patients carrying carbapenem-resistant Enterobacterales and/or Acinetobacter baumannii - impact on infection control management at a German University Hospital. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc05. [PMID: 32547905 PMCID: PMC7273331 DOI: 10.3205/dgkh000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Carbapenem-resistant Enterobacterales and Acinetobacterbaumannii are of major concern in terms of infection prevention and control. This study evaluated factors that may increase the frequency of Enterobacterales and A. baumannii with carbapenem resistance (CR) in patients admitted to a German University Hospital for implementation of optimized infection control management. Methods: A five-year-retrospective epidemiological cohort analysis was conducted on anamnestic risk factors for carrying Enterobacterales and/or A. baumannii with CR in patients who were first tested positive for these species at University Hospital Frankfurt (UHF) between January 2013 and June 2018. Results: 364 patients were tested positive for Enterobacterales and/or A. baumannii with CR, resulting in n=400 bacterial isolates in total, with Klebsiella pneumoniae being the most frequently detected species (n=146/400; 36.5%; 95% confidence interval: 31.8–41.4). In patients who were tested positive for Enterobacterales and/or A. baumannii with CR, any hospital stay within the previous 12 months was the most frequently reported common factor (n=275/364; 75.5%; 70.8–79.9). Conclusion: A hospital stay within the previous 12 months, including hospitals in Germany and abroad, is a frequent characteristic of patients who tested positive for Enterobacterales and/or A. baumannii with CR. Upon admission, any previous hospital stay of the given patient within the previous 12 months should be determined. Infection control strategies such as screening measures need to be adapted to these patient groups in hospital settings. In order to reflect the varying determinants in “nosocomial” cases in greater detail, the existing criteria used to characterize “nosocomial detection” of gram-negative bacteria with CR should be reviewed.
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Affiliation(s)
- Franziska Hofmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Katrin Steul
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Silke Besier
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Daniel Hack
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Elvira Steinmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
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12
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Mhaya A, Trabelsi R, M'Zali F, Bégu D, Tounsi S, Gdoura R, Arpin C. First description of NDM-1-positive Klebsiella pneumoniae in the Tunisian community. J Glob Antimicrob Resist 2020; 21:49-50. [PMID: 32169682 DOI: 10.1016/j.jgar.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Amel Mhaya
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France; Biotechnology Center of Sfax, Laboratory of Biopesticides, BP 1177 Sfax, 3018, Tunisia
| | - Rahma Trabelsi
- Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Fatima M'Zali
- University of Bordeaux, Aquitaine Microbiologie, Bordeaux, France
| | - Dominique Bégu
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France
| | - Slim Tounsi
- Biotechnology Center of Sfax, Laboratory of Biopesticides, BP 1177 Sfax, 3018, Tunisia
| | - Radhouane Gdoura
- Department of Life Sciences, Research Laboratory of Environmental Toxicology-Microbiology and Health (LR17ES06), Faculty of Sciences, University of Sfax, Sfax, Tunisia
| | - Corinne Arpin
- University of Bordeaux, UMR CNRS 5234, 146 rue Léo Saignat, Bordeaux Cedex, 33076, France
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13
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Bouattour H, Ghariani A, Essalah L, Mehiri E, Slim-Saidi L. Détection phénotypique et moléculaire des souches de Klebsiella pneumoniae productrices de carbapénémase. Med Mal Infect 2019; 49:225-226. [DOI: 10.1016/j.medmal.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 09/01/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022]
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14
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Izdebski R, Baraniak A, Zabicka D, Machulska M, Urbanowicz P, Fiett J, Literacka E, Bojarska K, Kozinska A, Zieniuk B, Hryniewicz W, Gniadkowski M. Enterobacteriaceae producing OXA-48-like carbapenemases in Poland, 2013-January 2017. J Antimicrob Chemother 2019; 73:620-625. [PMID: 29237086 DOI: 10.1093/jac/dkx457] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/06/2017] [Indexed: 11/14/2022] Open
Abstract
Objectives To analyse OXA-48 (OXA-48/181)-type carbapenemase-producing Enterobacteriaceae reported in Poland from 2013 until January 2017. Methods Bacterial isolates were typed by PFGE and MLST. Genes coding for OXA-48/181 types and other β-lactamases were amplified and sequenced. Mobile elements with blaOXA-48/181-like genes were PCR mapped. blaOXA-48/181-carrying plasmids were characterized by nuclease S1-hybridization profiling, transfer assays and PCR-based replicon typing, while the chromosomal location of the genes was confirmed by the I-CeuI analysis. Results Fifty-four isolates from 52 patients in 20 hospitals (14 cities) were included, in 14 cases having probable foreign origins indicated. The organisms were genetically diverse and represented numerous pandemic clones, including Klebsiella pneumoniae ST395 (n = 23), ST11, ST15 and ST101, Escherichia coli ST38, ST410 and ST648, and Enterobacter cloacae complex ST78. These produced OXA-48 (n = 49), OXA-181 (n = 4) or OXA-232 (n = 1). One of five K. pneumoniae ST395 pulsotypes caused a multicentre outbreak with 18 cases, which significantly contributed to the total number of patients. Depending on the variant, the blaOXA-48/181-like genes were parts of the Tn1999-, Tn2013- or Tn2016-like transposons, with blaOXA-48 found in an ISEcp1-associated module (Tn2016-like) for the first time. Three genotypes, including E. coli ST38, had chromosomal blaOXA-48 genes, while others carried transmissible IncL (∼60 kb; blaOXA-48; n = 30), IncM (∼80-95 kb; blaOXA-48; n = 4), IncX3 (∼50 kb; blaOXA-181; n = 4) or non-typeable (∼90-160 kb; blaOXA-48 or blaOXA-232) plasmids. Conclusions Even though OXA-48/181 producers seem to occur infrequently in Poland, their epidemiology has been marked by various phenomena, namely multiple imports, several limited transmissions plus one larger clonal outbreak, and possible plasmid transfers.
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Affiliation(s)
- R Izdebski
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
| | - A Baraniak
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
| | - D Zabicka
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - M Machulska
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
| | - P Urbanowicz
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
| | - J Fiett
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
| | - E Literacka
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - K Bojarska
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - A Kozinska
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - B Zieniuk
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - W Hryniewicz
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, 00-725 Warsaw, Poland
| | - M Gniadkowski
- Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland
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15
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Mansour W, Grami R, Jaidane N, Messaoudi A, Charfi K, Ben Romdhane L, Bel Haj Khalifa A, Khedher M, Boujaafar N, Bouallègue O, Mammeri H. Epidemiology and Whole-Genome Analysis of NDM-1-Producing Klebsiella pneumoniae KP3771 from Tunisia. Microb Drug Resist 2019; 25:644-651. [PMID: 30614778 DOI: 10.1089/mdr.2018.0204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: The whole-genome sequence (WGS) of Klebsiella pneumoniae KP3771 isolate was characterized. This strain was recovered from the urine sample of an 80-year-old man hospitalized in an intensive care unit of the University Hospital Tahar Sfar in Tunisia. Materials and Methods: WGS using a MiSeq platform was used. The assembled genome was subjected to several software analyses. Results: K. pneumoniae KP3771 was resistant to all antibiotics but colistin and tigecycline. WGS analysis found 18 transmissible genes encoding resistance markers, including blaNDM-1 and blaCTX-M-15 genes, which were carried by four plasmids belonging to the Inc Ib, IIk, and R groups. Three families of genes encoding virulence factors were detected, including adhesins (fimH, fimA, fimB, fimC, mrkD, Kpn, and ycfM), siderophores (enterobactin, aerobactin, and yersiniabactin siderophores), and protectin/invasin (traT). The strain was assigned to the sequence type 147. Conclusions: This study describes the genome of a carbapenemase-producing K. pneumoniae clinical isolate recovered in Tunisia. Bacteria WGS has become the reference technology to address epidemiological issues; this high level of information is particularly well suited to enrich epidemiological workflows' output.
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Affiliation(s)
- Wejdene Mansour
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,2 Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
| | - Raoudha Grami
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Nadia Jaidane
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Aziza Messaoudi
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Karama Charfi
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia
| | - Lotfi Ben Romdhane
- 3 Research Unit MARS (Modeling of Automated Reasoning Systems) University of Sousse, Sousse, Tunisia
| | - Anis Bel Haj Khalifa
- 4 Laboratory of Microbiology, University Hospital Tahar Sfar, Mahdia, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Mohamed Khedher
- 4 Laboratory of Microbiology, University Hospital Tahar Sfar, Mahdia, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Noureddine Boujaafar
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,5 Faculty of Pharmacy, Monastir, University of Monastir, Monastir, Tunisia
| | - Olfa Bouallègue
- 1 Research Unit Emergent Bacterial Resistance and Safety of Care UR12SP37, Laboratory of Microbiology, University Hospital Sahloul, Sousse, Tunisia.,2 Faculty of Medicine Ibn Al Jazzar, Sousse, University of Sousse, Tunisia
| | - Hedi Mammeri
- 6 INSERM, IAME, UMR 1137, Paris, France.,7 University Paris Diderot, IAME, UMR 1137, Sorbonne, Paris, France.,8 Service of Bacteriology, University Hospital Bichat, Paris, France
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16
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DZIRI O, ALONSO CA, DZIRI R, GHARSA H, MARAOUB A, TORRES C, CHOUCHANI C. Metallo-β-lactamases and class D carbapenemases in south-east Tunisia: Implication of mobile genetic elements in their dissemination. Int J Antimicrob Agents 2018; 52:871-877. [DOI: 10.1016/j.ijantimicag.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/14/2018] [Accepted: 06/02/2018] [Indexed: 10/28/2022]
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17
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Hamzaoui Z, Ocampo-Sosa A, Maamar E, Fernandez Martinez M, Ferjani S, Hammami S, Harbaoui S, Genel N, Arlet G, Saidani M, Slim A, Boutiba-Ben Boubaker I, Martinez-Martinez L. An Outbreak of NDM-1-ProducingKlebsiella pneumoniae, Associated with OmpK35 and OmpK36 Porin Loss in Tunisia. Microb Drug Resist 2018; 24:1137-1147. [DOI: 10.1089/mdr.2017.0165] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Zaineb Hamzaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Alain Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Elaa Maamar
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | | | - Sana Ferjani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Samia Hammami
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Sarra Harbaoui
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
| | - Nathalie Genel
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Guillaume Arlet
- Department of Bacteriology, Medical School, University Pierre et Marie Curie, Paris, France
| | - Mabrouka Saidani
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Amine Slim
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- Faculty of Medicine of Tunis—LR99ES09 Research Laboratory of Antimicrobial Resistance, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microbiology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Luis Martinez-Martinez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- Department of Molecular Biology, School of Medicine, University of Cantabria, Santander, Spain
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18
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Yousfi H, Hadjadj L, Dandachi I, Lalaoui R, Merah A, Amoura K, Dahi A, Dekhil M, Messalhi N, Diene SM, Baron S, Rolain JM. Colistin- and Carbapenem-Resistant Klebsiella pneumoniae Clinical_Isolates: Algeria. Microb Drug Resist 2018; 25:258-263. [PMID: 30256174 DOI: 10.1089/mdr.2018.0147] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study investigates the molecular mechanisms of colistin and carbapenem resistance in Klebsiella pneumoniae ST101 strains. The three K. pneumoniae carried blaCTX-M-15, blaTEM-183, and blaSHV-106 genes and two coharbored blaOXA-48. As for colistin resistance, the isolates had amino acid substitutions in PmrA/B and a truncated mgrB gene in one isolate.
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Affiliation(s)
- Hanane Yousfi
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Linda Hadjadj
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Iman Dandachi
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Rym Lalaoui
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Adil Merah
- 2 Microbiology Department, Annaba University Hospital , Annaba, Algeria
| | - Kamel Amoura
- 2 Microbiology Department, Annaba University Hospital , Annaba, Algeria .,3 Department of Infectious Diseases, Annaba University Hospital , Annaba, Algeria
| | - Ahlem Dahi
- 2 Microbiology Department, Annaba University Hospital , Annaba, Algeria .,3 Department of Infectious Diseases, Annaba University Hospital , Annaba, Algeria
| | - Mazouz Dekhil
- 2 Microbiology Department, Annaba University Hospital , Annaba, Algeria .,3 Department of Infectious Diseases, Annaba University Hospital , Annaba, Algeria
| | - Naima Messalhi
- 2 Microbiology Department, Annaba University Hospital , Annaba, Algeria .,3 Department of Infectious Diseases, Annaba University Hospital , Annaba, Algeria
| | - Seydina M Diene
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Sophie Baron
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
| | - Jean-Marc Rolain
- 1 Aix Marseille University , IRD, APHM, MEPHI, IHU-Mediterranean Infection, Marseille, France
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19
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Szymanek-Majchrzak K, Mlynarczyk A, Kuthan R, Sawicka-Grzelak A, Majchrzak K, Kawecki D, Kosieradzki M, Durlik M, Deborska-Materkowska D, Paczek L, Mlynarczyk G. Significance of Screening Tests and the Incidence of New Delhi Metallo-beta-lactamase-Producing Gram-negative Bacilli in the Surgery and Transplantation Wards of a Warsaw Medical Center During the Period From April 2014 to May 2017. Transplant Proc 2018; 50:2159-2163. [PMID: 30177130 DOI: 10.1016/j.transproceed.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/16/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The first New Delhi metallo-beta-lactamase (NDM)-producing bacteria were isolated in 2008 in the world, and in 2011 in Poland. Due to the high clonal diversity (17 types) of their blaNDM gene, encoded on (Tn125-like) mobile genetic elements, these strains usually exhibit resistance to nearly all available antibiotics, which is particularly dangerous for organ transplant recipients. PURPOSE To assess of the prevalence of Gram-negative NDM-positive bacilli in surgery/transplantation wards of a teaching hospital in Warsaw and to ascertain the significance of screening tests on the rates and nature of colonization. MATERIALS AND METHODS The evaluated strains were isolated from 30 patients (between April 2014 and May 2017). The species were identified with VITEK-MS, antibiotic susceptibility was determined with VITEK 2, disk-diffusion, and/or E-test methods, according to EUCAST guidelines. The presence of the blaNDM-1 gene was confirmed using the polymerase chain reaction technique. RESULTS AND CONCLUSIONS There were 77 blaNDM-1-positive Klebsiella pneumoniae strains isolated from 30 patients. Cultures from individual patients, mainly from rectal swabs (53.9%) and urine samples (39.8%), yielded 1-11 isolates. Fifteen patients were already colonized on admission, and the other 15 developed a symptomatic infection. In total, 24 (80%) patients were carriers, and their colonizations persisted for <1-20 months. Most isolates were susceptible only to colistin, gentamicin, amikacin, tigecycline, and/or sulfamethoxazole/trimethoprim. Gastrointestinal-tract-colonizing K pneumoniae are the main reservoir of the blaNDM-1 gene. Following the introduction of on-admission mandatory screening for carbapenem-resistant strains, the rates of NDM-producing K pneumoniae isolation increased (7.5-fold), while the rates of isolation from patients with symptomatic infections considerably decreased (2.8-fold).
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Affiliation(s)
- K Szymanek-Majchrzak
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland; Department of Medical Microbiology, The Infant Jesus Teaching Hospital, Warsaw, Poland.
| | - A Mlynarczyk
- Department of Medical Microbiology, The Infant Jesus Teaching Hospital, Warsaw, Poland
| | - R Kuthan
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Sawicka-Grzelak
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland; Department of Medical Microbiology, The Infant Jesus Teaching Hospital, Warsaw, Poland
| | - K Majchrzak
- Department of Prosthetic Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - D Kawecki
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - M Kosieradzki
- Department of General and Transplantation Surgery, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplant Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - D Deborska-Materkowska
- Department of Transplant Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Department of Immunology, Transplantology and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - G Mlynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland; Department of Medical Microbiology, The Infant Jesus Teaching Hospital, Warsaw, Poland
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20
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ElMahallawy HA, Zafer MM, Amin MA, Ragab MM, Al-Agamy MH. Spread of carbapenem resistant Enterobacteriaceae at tertiary care cancer hospital in Egypt. Infect Dis (Lond) 2018; 50:560-564. [PMID: 29373938 DOI: 10.1080/23744235.2018.1428824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Hadir A ElMahallawy
- a Department of Clinical Pathology , National Cancer Institute, Cairo University , Cairo , Egypt
| | - Mai M Zafer
- b Department of Microbiology and Immunology, Faculty of Pharmacy , Ahram Canadian University , 6th of October , Egypt
| | - Magdy A Amin
- c Department of Microbiology and Immunology, Faculty of Pharmacy , Cairo University , Cairo , Egypt
| | - Mai M Ragab
- c Department of Microbiology and Immunology, Faculty of Pharmacy , Cairo University , Cairo , Egypt
| | - Mohamed H Al-Agamy
- d Department of Pharmaceutics , College of Pharmacy,King Saud University , Riyadh , Saudi Arabia.,e Department of Microbiology and Immunology, Faculty of Pharmacy , Al-Azhar University , Cairo , Egypt
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21
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Ferstl PG, Filmann N, Brandt C, Zeuzem S, Hogardt M, Kempf VAJ, Müller M, Waidmann O, Reinheimer C. The impact of carbapenem resistance on clinical deterioration and mortality in patients with liver disease. Liver Int 2017; 37:1488-1496. [PMID: 28374901 DOI: 10.1111/liv.13438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Infections with multidrug-resistant gram-negative bacteria are significantly impairing the prognosis of patients with liver disease. In particular, carbapenem resistance further narrows therapeutic options. This study investigates the impact of carbapenem-resistant gram-negative bacteria on the outcome of patients with liver disease and cirrhosis. METHODS Between January 2011 and July 2015, 132 patients treated at the tertiary liver transplant centre at University Hospital Frankfurt, Germany, were tested positive for carbapenem-resistant gram-negative bacteria and retrospectively analysed in this study. Risk factors for fatal outcome were evaluated using multivariate regression analysis. Competing-risk analysis was performed on patients tested positive for Enterobacteriaceae or non-fermenting species, for example, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia. Subgroup analysis of cirrhotic patients was performed on a matched cohort of cirrhotic patients, comparable model for end-stage liver disease and tested negative for carbapenem-resistant gram-negative bacteria. RESULTS 97 (73.5%) and 35 (26.5%) patients were infected or colonised with carbapenem-resistant gram-negative bacteria respectively. Within the observation period, 61/132 (46.2%) patients died, with sepsis being the leading cause (38/61, 62.3%). Decompensated liver disease, sepsis and admission to intensive care unit were independent risk factors for fatal outcome. Lethal sepsis in patients positive for non-fermenting bacteria was significantly more frequent than in those positive for Enterobacteriaceae, independently from liver function. Subgroup analysis of cirrhotic patients showed that sepsis (54.9% vs 13%) and lethal sepsis were significantly more frequent after detection of carbapenem-resistant gram-negative bacteria, independently from localisation of pathogen detection. CONCLUSIONS Patients with advanced liver disease are prone to fatal infections caused by carbapenem-resistant gram-negative bacteria.
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Affiliation(s)
- Philip G Ferstl
- Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Brandt
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Hogardt
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mona Müller
- Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Oliver Waidmann
- Department for Internal Medicine I/Gastroenterology and Hepatology, University Hospital Frankfurt, Frankfurt am Main, Germany.,University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claudia Reinheimer
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, Frankfurt am Main, Germany.,Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt am Main, Germany
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22
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Carbapenem-Resistant Enterobacteriaceae: A Strategic Roadmap for Infection Control. Infect Control Hosp Epidemiol 2017; 38:580-594. [PMID: 28294079 DOI: 10.1017/ice.2017.42] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has increased worldwide with great regional variability. Infections caused by these organisms are associated with crude mortality rates of up to 70%. The spread of CRE in healthcare settings is both an important medical problem and a major global public health threat. All countries are at risk of falling victim to the emergence of CRE; therefore, a preparedness plan is required to avoid the catastrophic natural course of this epidemic. Proactive and adequate preventive measures locally, regionally, and nationally are required to contain the spread of these bacteria. The keys to success in preventing the establishment of CRE endemicity in a region are early detection through targeted laboratory protocols and containment of spread through comprehensive infection control measures. This guideline provides a strategic roadmap for infection control measures based on the best available evidence and expert opinion, to enable preparation of a multifaceted preparedness plan to abort epidemics of CRE. Infect Control Hosp Epidemiol 2017;38:580-594.
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23
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Reinheimer C, Keppler OT, Stephan C, Wichelhaus TA, Friedrichs I, Kempf VAJ. Elevated prevalence of multidrug-resistant gram-negative organisms in HIV positive men. BMC Infect Dis 2017; 17:206. [PMID: 28288577 PMCID: PMC5347171 DOI: 10.1186/s12879-017-2286-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/23/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Routes of transmission of multidrug-resistant gram-negative organisms (MDRGN) are not completely understood. Since sexual transmission of MDRGN might represent a potential mode that has not been noticed so far, this study evaluated transmission of MDRGN in HIV positive men. METHODS Between November 2014 and March 2016, we retrospectively investigated the MDRGN prevalence in rectal swabs of n = 109 males tested positive for HIV (HP). These findings were compared to the MDRGN prevalence in n = 109 rectal swabs in age-matched males tested negative for HIV (HN) within the same period. According to the infection control protocol of University Hospital Frankfurt, Germany (UHF), patients admitted to intensive/intermediate care units have to be screened for MDRGN on day of admittance. Patients without HIV testing or MDRGN screening were excluded. RESULTS MDRGN prevalence in rectal swabs was significantly higher (p = 0.002) in male HP (23.9%; 95% confidence interval 16.2-32.9%) than in age-matched male HN (8.3%; 3.8-15.1%). In total, 35 MDRGN species were detected. The most frequent MDRGN species was Escherichia coli with resistance due to ESBL expression and additional resistance to fluoroquinolones with n = 25/35 (71.4%; 53.7-85.4%). Thereof, n = 19/26 (73.1%; 52.2-88.4%) were detected in HP and n = 6/9 (66.7%; 29.9-92.5%) in HN, respectively. CONCLUSIONS Prevalence of MDRGN is significantly higher in male HIV positive than in male HIV negative individuals. This might indicate sexual transmission of MDRGN within the male HIV positive population. As treatment options in case of MRGN infections are limited, prevention of MDRGN transmission is strongly emphasized.
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Affiliation(s)
- Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany. .,University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.
| | - Oliver T Keppler
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Present address: Max von Pettenkofer-Institute for Hygiene and Clinical Microbiology, Virology, Ludwig Maximilians-University, Munich, Germany
| | - Christoph Stephan
- University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,Department for Internal Medicine II/Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Imke Friedrichs
- University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul-Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt am Main, Frankfurt am Main, Germany.,Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany
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24
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Reinheimer C, Kempf VAJ, Jozsa K, Wichelhaus TA, Hogardt M, O'Rourke F, Brandt C. Prevalence of multidrug-resistant organisms in refugee patients, medical tourists and domestic patients admitted to a German university hospital. BMC Infect Dis 2017; 17:17. [PMID: 28056820 PMCID: PMC5217604 DOI: 10.1186/s12879-016-2105-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures. METHODS From December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance. Data within these groups were compared and set in an epidemiological context. RESULTS 52.1% (95% confidence interval = 42.7-61.5) of REF and 41.6% (31.0-52.9) of ABROAD, were positive for at least one MDRGN, respectively. In contrast, 7.9% (5.6-10.6) of ICU were positive for MDRGN. Thereof, 0.9% (0.0-4.7) of REF, 15.5% (8.5-25.0) of ABROAD and 0% (0.0-0.7) of ICU were positive for at least one MDRGN with carbapenem resistance (CR). In total, 19 MDRGN with CR were detected in ABROAD, with the most frequent species with CR being A. baumannii with 42.1% (20.3-66.5). Regarding MRSA, 10.3% (5.4-17.2) of REF, 5.9% (1.9-13.3) of ABROAD and a significantly lower proportion 1.4% (0.6-2.9) of ICU, respectively, were tested positive. CONCLUSIONS Both REF and ABROAD pose a relevant hospital hygiene risk. High prevalence of MDRGN with CR in ABROAD was observed. Concise screening and infection control guidelines are needed in patient cohorts with increased risk for MDRO carriage.
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Affiliation(s)
- Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
| | - Katalin Jozsa
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - Thomas A Wichelhaus
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - Fiona O'Rourke
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
| | - Christian Brandt
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany
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25
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Messaoudi A, Haenni M, Mansour W, Saras E, Bel Haj Khalifa A, Chaouch C, Naija W, Boujâafar N, Bouallègue O, Madec JY. ST147 NDM-1-producing Klebsiella pneumoniae spread in two Tunisian hospitals. J Antimicrob Chemother 2016; 72:315-316. [PMID: 27659734 DOI: 10.1093/jac/dkw401] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aziza Messaoudi
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
| | - Marisa Haenni
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Wejdene Mansour
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Institut Supérieur des Sciences Appliquées et de Technologie de Mahdia, Université de Monastir, Monastir, Tunisia
| | - Estelle Saras
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Anis Bel Haj Khalifa
- Laboratoire de Microbiologie, Hopital Tahar Sfar, Mahdia, Tunisia
- Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisia
| | - Cherifa Chaouch
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Laboratoire de Microbiologie, Hopital Tahar Sfar, Mahdia, Tunisia
| | - Walid Naija
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia
| | - Noureddine Boujâafar
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisia
| | - Olfa Bouallègue
- Unité de Recherche: Résistances Bactériennes Émergentes et Sécurité des Soins 'UR12SP37', Laboratoire de Microbiologie, Hôpital Universitaire Sahloul, Sousse, Tunisia
- Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisia
| | - Jean-Yves Madec
- French Agency for Food, Environmental and Occupational Health Safety (ANSES), Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
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26
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Lee CR, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH. Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods. Front Microbiol 2016; 7:895. [PMID: 27379038 PMCID: PMC4904035 DOI: 10.3389/fmicb.2016.00895] [Citation(s) in RCA: 456] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/26/2016] [Indexed: 01/08/2023] Open
Abstract
The emergence of carbapenem-resistant Gram-negative pathogens poses a serious threat to public health worldwide. In particular, the increasing prevalence of carbapenem-resistant Klebsiella pneumoniae is a major source of concern. K. pneumoniae carbapenemases (KPCs) and carbapenemases of the oxacillinase-48 (OXA-48) type have been reported worldwide. New Delhi metallo-β-lactamase (NDM) carbapenemases were originally identified in Sweden in 2008 and have spread worldwide rapidly. In this review, we summarize the epidemiology of K. pneumoniae producing three carbapenemases (KPCs, NDMs, and OXA-48-like). Although the prevalence of each resistant strain varies geographically, K. pneumoniae producing KPCs, NDMs, and OXA-48-like carbapenemases have become rapidly disseminated. In addition, we used recently published molecular and genetic studies to analyze the mechanisms by which these three carbapenemases, and major K. pneumoniae clones, such as ST258 and ST11, have become globally prevalent. Because carbapenemase-producing K. pneumoniae are often resistant to most β-lactam antibiotics and many other non-β-lactam molecules, the therapeutic options available to treat infection with these strains are limited to colistin, polymyxin B, fosfomycin, tigecycline, and selected aminoglycosides. Although, combination therapy has been recommended for the treatment of severe carbapenemase-producing K. pneumoniae infections, the clinical evidence for this strategy is currently limited, and more accurate randomized controlled trials will be required to establish the most effective treatment regimen. Moreover, because rapid and accurate identification of the carbapenemase type found in K. pneumoniae may be difficult to achieve through phenotypic antibiotic susceptibility tests, novel molecular detection techniques are currently being developed.
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Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Young Bae Kim
- Division of STEM, North Shore Community College, Danvers MA, USA
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
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27
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Reinheimer C, Kempf VAJ, Göttig S, Hogardt M, Wichelhaus TA, O'Rourke F, Brandt C. Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015. ACTA ACUST UNITED AC 2016; 21:30110. [PMID: 26794850 DOI: 10.2807/1560-7917.es.2016.21.2.30110] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/14/2016] [Indexed: 11/20/2022]
Abstract
Multidrug-resistant Gram-negative bacteria (MDR GNB) were found to colonise 60.8% (95% confidence interval: 52.3-68.9) of 143 refugee patients mainly from Syria (47), Afghanistan (29), and Somalia (14) admitted to the University Hospital Frankfurt, Germany, between June and December 2015. This percentage exceeds the prevalence of MDR GNB in resident patients four-fold. Healthcare personnel should be aware of this and the need to implement or adapt adequate infection control measures.
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Affiliation(s)
- Claudia Reinheimer
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt am Main, Germany
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28
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Gamal D, Fernández-Martínez M, El-Defrawy I, Ocampo-Sosa AA, Martínez-Martínez L. First identification of NDM-5 associated with OXA-181 in Escherichia coli from Egypt. Emerg Microbes Infect 2016; 5:e30. [PMID: 27048740 PMCID: PMC4820674 DOI: 10.1038/emi.2016.24] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Doaa Gamal
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain.,Medical Microbiology Department, Theodor Bilharz Research Institute (TBRI), Cairo 12411, Egypt
| | - Marta Fernández-Martínez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Inas El-Defrawy
- Medical Microbiology Department, Theodor Bilharz Research Institute (TBRI), Cairo 12411, Egypt
| | - Alain A Ocampo-Sosa
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain
| | - Luis Martínez-Martínez
- Service of Microbiology, University Hospital Marqués de Valdecilla-IDIVAL, Santander 39008, Spain.,Department of Molecular Biology, School of Medicine, University of Cantabria, Santander 39008, Spain
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