1
|
Collar GDS, Moreira NK, Becker J, Barth AL, Caierão J. Determination of aztreonam/ceftazidime-avibactam synergism and proposal of a new methodology for the evaluation of susceptibility in vitro. Diagn Microbiol Infect Dis 2024; 109:116236. [PMID: 38537506 DOI: 10.1016/j.diagmicrobio.2024.116236] [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: 11/10/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 04/30/2024]
Abstract
We proposed a new methodology, the microelution ATM/CZA (mATM/CZA), based on the antibiotic disc elution and the use of resazurin, for rapid (<4h) determination of in vitro susceptibility to aztreonam combined with ceftazidime-avibactam among Enterobacterales. The mATM/CZA presented excellent accuracy with 1.9 %, 98.1 % and 100 % of major error, specificity and sensitivity, respectively. Furthermore, we assessed synergism between aztreonam and ceftazidime-avibactam in Enterobacterales and Pseudomonas aeruginosa, which was observed in 37/55 Enterobacterales and 31/56 P. aeruginosa. As reference methodologies (checkerboard, time-kill curve) are not compatible with the routine of the clinical microbiology laboratories, mATM/CZA is an important alternative to evaluate susceptibility of the combination in a scenario where its clinical use is increasingly important.
Collapse
Affiliation(s)
- Gabriela da Silva Collar
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
| | - Natália Kehl Moreira
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Julia Becker
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Afonso Luís Barth
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Laboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil
| | - Juliana Caierão
- Laboratório de Pesquisa em Bacteriologia Clínica (LaBaC), Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| |
Collapse
|
2
|
Sellera FP, Lincopan N, Fuentes-Castillo D, Stehling EG, Furlan JPR. Rapid evolution of pan-β-lactam resistance in Enterobacterales co-producing KPC and NDM: insights from global genomic analysis after the COVID-19 pandemic. THE LANCET. MICROBE 2024; 5:e412-e413. [PMID: 38367635 DOI: 10.1016/s2666-5247(24)00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Fábio Parra Sellera
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; School of Veterinary Medicine, Metropolitan University of Santos, Santos, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Instituto de Ciências Biomédicas, University of São Paulo, São Paulo, Brazil; Department of Clinical Analysis, Faculty of Pharmacy, University of São Paulo, São Paulo, Brazil
| | - Danny Fuentes-Castillo
- Departamento de Patología y Medicina Preventiva, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - Eliana Guedes Stehling
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, S/N, Monte Alegre, Ribeirão Preto 14040-903, Brazil
| | - João Pedro Rueda Furlan
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, S/N, Monte Alegre, Ribeirão Preto 14040-903, Brazil.
| |
Collapse
|
3
|
Oh S, Sung YS, Jang M, Kim YJ, Park HW, Nho D, Lee DG, Yim HW, Cho SY. Impact of the coronavirus disease 2019 pandemic on the incidence of other infectious diseases in the hematology hospital in Korea. Korean J Intern Med 2024; 39:513-523. [PMID: 38649159 PMCID: PMC11076895 DOI: 10.3904/kjim.2023.508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/10/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND/AIMS Since the coronavirus disease 2019 (COVID-19) outbreak, hospitals have implemented infection control measures to minimize the spread of the virus within facilities. This study aimed to investigate the impact of COVID-19 on the incidence of healthcare-associated infections (HCAIs) and common respiratory virus (cRV) infections in hematology units. METHODS This retrospective study included all patients hospitalized in Catholic Hematology Hospital between 2019 and 2020. Patients infected with vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacterales (CPE), Clostridium difficile infection (CDI), and cRV were analyzed. The incidence rate ratio (IRR) methods and interrupted time series analyses were performed to compare the incidence rates before and after the pandemic. RESULTS The incidence rates of CPE and VRE did not differ between the two periods. However, the incidence of CDI increased significantly (IRR: 1.41 [p = 0.002]) after the COVID-19 pandemic. The incidence of cRV infection decreased by 76% after the COVID-19 outbreak (IRR: 0.240 [p < 0.001]). The incidence of adenovirus, parainfluenza virus, and rhinovirus infection significantly decreased in the COVID-19 period (IRRs: 0.087 [p = 0.003], 0.031 [p < 0.001], and 0.149 [p < 0.001], respectively). CONCLUSION The implementation of COVID-19 infection control measures reduced the incidence of cRV infection. However, CDI increased significantly and incidence rates of CPE and VRE remained unchanged in hematological patients after the pandemic. Infection control measures suitable for each type of HCAI, such as stringent hand washing for CDI and enough isolation capacities, should be implemented and maintained in future pandemics, especially in immunocompromised patients.
Collapse
Affiliation(s)
- Seohee Oh
- Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yu-Sun Sung
- Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Mihee Jang
- Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yong-Jin Kim
- Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyun-Wook Park
- Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| |
Collapse
|
4
|
Furlan JPR, da Silva Rosa R, Ramos MS, Dos Santos LDR, Savazzi EA, Stehling EG. Emergence of carbapenem-resistant Klebsiella pneumoniae species complex from agrifood systems: detection of ST6326 co-producing KPC-2 and NDM-1. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2024. [PMID: 38651793 DOI: 10.1002/jsfa.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Klebsiella pneumoniae species complex (KpSC) is an important disseminator of carbapenemase-encoding genes, mainly blaKPC-2 and blaNDM-1, from hospitals to the environment. Consequently, carbapenem-resistant strains can be spread through the agrifood system, raising concerns about food safety. This study therefore aimed to isolate carbapenem-resistant KpSC strains from the agricultural and environmental sectors and characterize them using phenotypic, molecular, and genomic analyses. RESULTS Klebsiella pneumoniae and Klebsiella quasipneumoniae strains isolated from soils used for lemon, guava, and fig cultivation, and from surface waters, displayed an extensive drug-resistance profile and carried blaKPC-2, blaNDM-1, or both. In addition to carbapenemase-encoding genes, KpSC strains harbor a broad resistome (antimicrobial resistance and metal tolerance) and present putative hypervirulence. Soil-derived K. pneumoniae strains were assigned as high-risk clones (ST11 and ST307) and harbored the blaKPC-2 gene associated with Tn4401b and Tn3-like elements on IncN-pST15 and IncX5 plasmids. In surface waters, the coexistence of blaKPC-2 and blaNDM-1 genes was identified in K. pneumoniae ST6326, a new carbapenem-resistant regional Brazilian clone. In this case, blaKPC-2 with Tn4401a isoform and blaNDM-1 associated with a Tn125-like transposon were located on different plasmids. Klebsiella quasipneumoniae ST526 also presented the blaNDM-1 gene associated with a Tn3000 transposon on an IncX3 plasmid. CONCLUSION These findings provide a warning regarding the transmission of carbapenemase-positive KpSC across the agricultural and environmental sectors, raising critical food safety and environmental issues. © 2024 Society of Chemical Industry.
Collapse
Affiliation(s)
- João Pedro Rueda Furlan
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Rafael da Silva Rosa
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Micaela Santana Ramos
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Lucas David Rodrigues Dos Santos
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Eliana Guedes Stehling
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
5
|
Wang JL, Lai CC, Tsai YW, Ko WC, Hsueh PR. High ceftazidime-avibactam resistance among carbapenem-resistant Enterobacter species: Data from the Antimicrobial Testing Leadership and Surveillance (ATLAS) programme, 2014-2021. Int J Antimicrob Agents 2024; 63:107105. [PMID: 38325719 DOI: 10.1016/j.ijantimicag.2024.107105] [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: 09/21/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Trends in the susceptibility to ceftazidime-avibactam (CZA) and tigecycline (TGC) among Enterobacter species from different geographic areas are unknown.This study aimed to analyse the trends in CZA and TGC susceptibility changes across different continents from 2014 to 2021 utilizing Antimicrobial Testing Leadership and Surveillance (ATLAS) data. METHODS A total of 23 669 isolates of Enterobacter species were collected over an 8-y period. RESULTS The overall non-susceptibility rate of Enterobacter isolates to both CZA and TGC was 3.2%. India (16.5%), Guatemala (15.4%), and the Philippines (13.1%) exhibited the highest resistance to CZA. The increase in CZA resistance rates was particularly evident in Asia, with an increase from 4.0% to 8.3%, and in Latin America, from 1.5% to 5%. The non-susceptibility rate for TGC mildly increased in Africa/Middle East but decreased in other continents during the study period. The overall rate of carbapenem resistance increased from 2.9% in 2014-2017 to 4.3% in 2018-2021. Among carbapenem-resistant Enterobacter isolates, the CZA resistance rate was highest in Asia (87.4%), followed by Europe (69.2%) and Africa/Middle East (60.8%). Among the 380 Enterobacter isolates resistant to CZA and carbapenem, the most common genotype of carbapenemase genes was blaNDM (59.2%), followed by blaVIM (24.2%), blaOXA (4.2%), blaIMP (1.1%), and blaKPC (1.1%). The susceptibility of carbapenem-resistant Enterobacter to TGC remained high, with an overall susceptibility rate of 90%. CONCLUSIONS The heterogeneous distribution of CZA resistance rates among different geographical regions highlights the divergent therapeutic options for drug-resistant Enterobacter species.
Collapse
Affiliation(s)
- Jiun-Ling Wang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Ya-Wen Tsai
- Center of Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Ren Hsueh
- Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan; PhD Program for Ageing, School of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
6
|
Büchler AC, Haddad Galas M, Buetti N, Alp E, Apisarnthanarak A, Dziekan G, Fabre V, Gottwalt S, Jindai K, Ndoye B, Márquez Villareal H, Otaiza F, Pittet D, Schellack N, Gardiol C, Harbarth S. Challenges and success stories of the implementation of infection control and antimicrobial stewardship strategies: proceedings of the 5th Global Ministerial Summit on Patient Safety, 2023. Antimicrob Resist Infect Control 2024; 13:16. [PMID: 38331974 PMCID: PMC10854024 DOI: 10.1186/s13756-023-01344-7] [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: 08/31/2023] [Accepted: 11/25/2023] [Indexed: 02/10/2024] Open
Abstract
The 5th edition of the Global Ministerial Summit on Patient Safety was held in Montreux, Switzerland, in February 2023, delayed by three years due to the COVID-19 pandemic. The overarching theme of the summit was "Less Harm, Better Care - from Resolution to Implementation", focusing on the challenges of implementation of infection prevention and control (IPC) strategies as well as antimicrobial stewardship programs (ASP) around the world. IPC strategies and ASP are of increasing importance due to the substantial burden of healthcare-associated infections and antimicrobial resistance threatening patient safety. Here, we summarize countries' and regional experiences and activities related to the implementation of IPC strategies and ASP shared at the meeting. Full implementation of effective programs remains a major challenge in all settings due to limited support by political and healthcare leaders, and human and financial constraints. In addition, the COVID-19 pandemic challenged already well-established programs. By enforcing sustained implementation by dedicated, cross-disciplinary healthcare personnel with a broad skill set, a reduction in healthcare-associated infections and multidrug-resistant pathogens can be achieved, leading ultimately to improved patient safety.
Collapse
Affiliation(s)
- Andrea C Büchler
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Murielle Haddad Galas
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Niccolò Buetti
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Gerald Dziekan
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Simon Gottwalt
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Kazuaki Jindai
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Kyoto, Japan
| | - Babacar Ndoye
- Infection Control and Patient Safety, WHO Afro Consultant, Brazzaville, Congo Republic
| | - Hilda Márquez Villareal
- Department of Public Health. University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Fernando Otaiza
- Department of Quality of Healthcare and Patient Safety, National Infection Control Program, Ministry of Health of Chile, Santiago, Chile
| | - Didier Pittet
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Natalie Schellack
- Departement of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Céline Gardiol
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland.
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Vilella P, Maldonado JP, Fernández P, Flores MF, De Bernardi C, Vilte Velazquez KY, Hernández D, De La Fuente JL, Saad EJ. [Clinical and microbiological characteristics of urinary tract infections in the first year after renal transplantation]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2023; 80:476-498. [PMID: 38150202 PMCID: PMC10851398 DOI: 10.31053/1853.0605.v80.n4.41244] [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: 05/26/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction Urinary tract infections (UTI) are the most frequent infection in kidney transplant (KT) patients. The main objective was to determine the clinical and microbiological characteristics of UTIs that occur during the first year after KT. Methods Retrospective cohort study that included patients over 18 years of age who received KT between 2009-2020 in two hospitals in Córdoba city, Argentina. Patients were followed up during the first year after the transplant by recording them in the medical records, and those who presented at least one episode of UTI were analyzed. Results During the study period, 568 KTs were performed, of which 207 (36.4%) had at least one episode of UTI. In total, there were 419 UTI episodes, 6 (1.4%) polymicrobial UTI episodes, so a total of 426 microorganisms were identified in the urine cultures. Of the total number of episodes, 206 (49.2%) occurred between 31 and 180 days post-transplant. The main etiological agent was E. coli with 225 isolates (52.8%) followed by Klebsiella sp. with 94 (22.1%). 52.1% of all episodes were caused by multi-resistant microorganisms (MRM). Among the E. coli isolates, 94 (41.8%) were MRM. In the multivariate analysis, the risk factors associated with UTI due to MRM were a history of recurrent UTI (Odds ratio 2.43; 95% CI: 1.37-4.30) and induction with basiliximab (Odds ratio 1.53; 95% CI: 1.029-2.29). Main conclusion UTIs occurred in more than a third of kidney transplant patients, being slightly more than half caused by MOR.
Collapse
|
9
|
Romina PE, Lucía A, Leticia C, Federica F, Pablo Á, Verónica S, Antonio G, Inés B, Rafael V. In vitro effectiveness of ceftazidime-avibactam in combination with aztreonam on carbapenemase-producing Enterobacterales. J Glob Antimicrob Resist 2023; 35:62-66. [PMID: 37611893 DOI: 10.1016/j.jgar.2023.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE This work aimed to describe the in vitro performance of the combined activity of ceftazidime-avibactam (CZA) plus aztreonam (ATM) against carbapenemase-producing Enterobacterales (CPE). METHODS We studied 44 CPE clinical isolates: NDM-1 (31), KPC-2 (5), KPC-3 (3), VIM-2 (2), NDM-1+KPC-2 (2), and OXA-48 (1). The efficacy of CZA in combination with were determined by two methods: (i) Kirby-Bauer's double disk synergy test and; (ii) Determination of the minimum inhibitory concentration to CZA by E-test, in either Mueller-Hinton agar alone or, supplemented with ATM 4 mg/L. Additionally, the Fractional inhibitory concentration index (FICI) was determined; values of ≤ 0.5 were interpreted as synergistic, while FICI > 0.5 were considered indifferent. RESULTS All isolates were carbapenem-resistant, 14 were resistant to CZA and ATM, 15 were only CZA resistant, 12 were only ATM resistant, and three were susceptible to both. 34/44 isolates presented positive double disk synergy tests between CZA and ATM regardless of their susceptibility profile, the isolates with negative synergy tests were susceptible to at least one of the agents. On the other hand, the 21 isolates selected to compare the MIC to CZA alone and CZA plus 4 mg/L ATM of exhibited FICI values between 0.016 and 0.125, indicating a synergistic effect. CONCLUSIONS This method is available to clinical laboratories and would provide valuable information to guide the treatment of infections with CZA and ATM. In this sense, the use of CZA together with ATM is a potentially suitable combination for the treatment of carbapenemase-producing microorganisms.
Collapse
Affiliation(s)
- Papa-Ezdra Romina
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Araújo Lucía
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Caiata Leticia
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ferreira Federica
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ávila Pablo
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Seija Verónica
- Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Galiana Antonio
- Laboratorio de Microbiología, Hospital Maciel, Montevideo, Uruguay
| | - Bado Inés
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Vignoli Rafael
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
| |
Collapse
|
10
|
De La Cadena E, Pallares CJ, García-Betancur JC, Porras JA, Villegas MV. Update of antimicrobial resistance in level III and IV health institutions in Colombia between January 2018 and December 2021. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:457-473. [PMID: 38109138 PMCID: PMC10826464 DOI: 10.7705/biomedica.7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Abstract
Introduction Antimicrobial resistance surveillance is a fundamental tool for the development, improvement, and adjustment of antimicrobial stewardship programs, therapeutic guidelines, and universal precautions to limit the cross-transmission of resistant bacteria between patients. Since the beginning of 2020, the SARS-CoV-2 pandemic profoundly challenged the health system and, according to some reports, increased the rates of antimicrobial resistance. Objective To describe the behavior of antimicrobial resistance of the most frequent bacterial pathogens in twenty Colombian hospitals from January 2018 to December 2021. Materials and methods We conducted a descriptive study based on the microbiological information recorded from January 2018 to December 2021 in twenty levels III and IV health institutions in twelve Colombian cities. We identified the species of the ten most frequent bacteria along with their resistance profile to the antibiotic markers after analyzing the data through WHONET. Results We found no statistically significant changes in most pathogens’ resistance profiles from January 2018 to December 2021. Only Pseudomonas aeruginosa had a statistically significant increase in its resistance profile, particularly to piperacillin/tazobactam and carbapenems. Conclusions The changes in antimicrobial resistance in these four years were not statistically significant except for P. aeruginosa to piperacillin/tazobactam and carbapenems.
Collapse
Affiliation(s)
- Elsa De La Cadena
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia.
| | - Christian José Pallares
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia; Comité de Infecciones y Vigilancia Epidemiológica, Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia.
| | - Juan Carlos García-Betancur
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C..
| | - Jessica A Porras
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C..
| | - María Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia; Comité de Infecciones y Vigilancia Epidemiológica, Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia.
| |
Collapse
|
11
|
Muteeb G. Network meta-analysis of antibiotic resistance patterns in gram-negative bacterial infections: a comparative study of carbapenems, fluoroquinolones, and aminoglycosides. Front Microbiol 2023; 14:1304011. [PMID: 38098660 PMCID: PMC10720636 DOI: 10.3389/fmicb.2023.1304011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Antimicrobial resistance poses a grave global threat, particularly with the emergence of multidrug-resistant gram-negative bacterial infections, which severely limit treatment options. The increasing global threat of antimicrobial resistance demands rigorous investigation, particularly concerning multidrug-resistant gram-negative bacterial infections that present limited therapeutic options. This study employed a network meta-analysis, a powerful tool for comparative effectiveness assessment of diverse antibiotics. The primary aim of this study was to comprehensively evaluate and compare resistance patterns among widely used antibiotic classes, namely carbapenems, fluoroquinolones, and aminoglycosides, for combating gram-negative pathogens. Methods We searched PubMed, Web of Sciences, Scopus, Scholarly, Medline, Embase, and Cochrane databases up to August 27, 2023. Studies showing antibiotic resistance in clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii exposed to carbapenems, fluoroquinolones, and aminoglycosides were included. This study determined treatment-specific resistance percentages and ranked these treatments based on resistance using a random-effects network meta-analysis technique. To investigate the impact of the study and pathogen features, subgroup and meta-regression analyses were performed. Risk ratios and 95% confidence intervals (CIs) were calculated using a network meta-analysis (NMA) incorporating both direct and indirect evidence. Clinical improvement, cure, microbiological eradication, and death from any cause were the primary outcomes. Nephrotoxicity was a secondary result. Results The analysis included 202 publications and 365,782 gram-negative isolates. The NMA included data from 20 studies and 4,835 patients. Carbapenems had the lowest resistance rates throughout the pathogen spectrum, with resistance percentages of 17.1, 22.4, and 33.5% for Enterobacteriaceae, P. aeruginosa, and A. baumannii, respectively. For the same infections, aminoglycosides showed resistance rates of 28.2, 39.1, and 50.2%, respectively. Fluoroquinolones had the highest resistance rates at 43.1, 57.3, and 65.7%, respectively. Unexpectedly, resistance to all three antibiotic classes has increased over time, with multidrug resistance being the most prevalent. Conclusion This extensive network meta-analysis provides an overview of the patterns of resistance throughout the world and how they are changing. The most effective choice is still carbapenems, but the increasing resistance highlights the critical need for multimodal therapies to protect antibiotic effectiveness against these powerful gram-negative infections.
Collapse
Affiliation(s)
- Ghazala Muteeb
- Department of Nursing, College of Applied Medical Science, King Faisal University, Al-Ahsa, Saudi Arabia
| |
Collapse
|
12
|
Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, Quirós R. Systematic Review and Meta-analysis of Deaths Attributable to Antimicrobial Resistance, Latin America. Emerg Infect Dis 2023; 29:2335-2344. [PMID: 37877573 PMCID: PMC10617342 DOI: 10.3201/eid2911.230753] [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: 10/26/2023] Open
Abstract
Antimicrobial resistance is a pressing global health concern, leading to 4.95 million deaths in 2019. We conducted a systematic review and meta-analysis to assess the lethality attributed to infections caused by multidrug-resistant organisms (MDROs) in Latin America and the Caribbean. A comprehensive search of major databases retrieved relevant studies from 2000-2022. We included 54 observational studies, primarily from Brazil, Argentina, and Colombia. The most commonly studied organism was methicillin-resistant Staphylococcus aureus. The overall unadjusted case fatality rate related to MDROs was 45.0%; higher adjusted lethality was observed in persons infected with MDROs than in those infected with other pathogens (adjusted odds ratio 1.93, 95% CI 1.58-2.37). A higher lethality rate was seen in patients who did not receive appropriate empirical treatment (odds ratio 2.27, 95% CI 1.44-3.56). These findings underscore the increased lethality associated with antimicrobial resistance in Latin America and the Caribbean.
Collapse
|
13
|
Díaz-Madriz JP, Zavaleta-Monestel E, Villalobos-Madriz JA, Rojas-Chinchilla C, Castrillo-Portillo P, Meléndez-Alfaro A, Vásquez-Mendoza AF, Muñoz-Gutiérrez G, Arguedas-Chacón S. Impact of the Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Selection of Surgical Prophylaxis in a Hospital without Antibiotic Prescription Restrictions in Costa Rica: A Retrospective Study. Antibiotics (Basel) 2023; 12:1572. [PMID: 37998774 PMCID: PMC10668641 DOI: 10.3390/antibiotics12111572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
This study aims to characterize the impact of the implementation of an antimicrobial stewardship program (AMS) on the optimal selection of surgical antibiotic prophylaxis in adult patients. This is a retrospective quasi-experimental study that compared the selection and duration of antibiotics for all surgical prophylaxis prescriptions over six months, both before (pre-AMS) and after a five-year intervention of AMS (post-AMS). In addition, data related to the consumption of antibiotics, adverse drug reactions, and surgical site infections throughout the years of the intervention were analyzed. The rate of appropriate selection of antibiotic prophylaxis in surgical procedures improved to 80% during the post-AMS period. The percentage of optimal duration increased from 69.1% (N = 1598) in the pre-AMS period to 78.0% (N = 841) in the post-AMS period (p < 0.001). The consumption of ceftriaxone significantly decreased, while the use of cefazolin increased more than nine times. No severe adverse reactions or increases in surgical site infections were detected after the intervention. The implementation of an AMS in the surgical ward demonstrated a trend towards a positive overall impact on the selection and duration of prophylactic antibiotics for surgery, with positive results also observed in other variables associated with the prescription of these antibiotics.
Collapse
Affiliation(s)
- José Pablo Díaz-Madriz
- Pharmacy Department, Hospital Clínica Bíblica, San José 10104, Costa Rica; (J.P.D.-M.); (J.A.V.-M.); (C.R.-C.); (S.A.-C.)
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José 10108, Costa Rica; (P.C.-P.); (A.M.-A.)
- Antimicrobial Stewardship Program, Hospital Clínica Bíblica, San José 10104, Costa Rica; (A.F.V.-M.); (G.M.-G.)
| | - Esteban Zavaleta-Monestel
- Pharmacy Department, Hospital Clínica Bíblica, San José 10104, Costa Rica; (J.P.D.-M.); (J.A.V.-M.); (C.R.-C.); (S.A.-C.)
| | - Jorge Arturo Villalobos-Madriz
- Pharmacy Department, Hospital Clínica Bíblica, San José 10104, Costa Rica; (J.P.D.-M.); (J.A.V.-M.); (C.R.-C.); (S.A.-C.)
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José 10108, Costa Rica; (P.C.-P.); (A.M.-A.)
| | - Carolina Rojas-Chinchilla
- Pharmacy Department, Hospital Clínica Bíblica, San José 10104, Costa Rica; (J.P.D.-M.); (J.A.V.-M.); (C.R.-C.); (S.A.-C.)
- Antimicrobial Stewardship Program, Hospital Clínica Bíblica, San José 10104, Costa Rica; (A.F.V.-M.); (G.M.-G.)
| | | | - Alison Meléndez-Alfaro
- Faculty of Pharmacy, Universidad de Ciencias Médicas, San José 10108, Costa Rica; (P.C.-P.); (A.M.-A.)
| | | | - Gabriel Muñoz-Gutiérrez
- Antimicrobial Stewardship Program, Hospital Clínica Bíblica, San José 10104, Costa Rica; (A.F.V.-M.); (G.M.-G.)
| | - Sebastián Arguedas-Chacón
- Pharmacy Department, Hospital Clínica Bíblica, San José 10104, Costa Rica; (J.P.D.-M.); (J.A.V.-M.); (C.R.-C.); (S.A.-C.)
- Antimicrobial Stewardship Program, Hospital Clínica Bíblica, San José 10104, Costa Rica; (A.F.V.-M.); (G.M.-G.)
| |
Collapse
|
14
|
Galas M. Antimicrobial Resistance: A global, multisectoral concern that requires a coordinated response. Rev Argent Microbiol 2023; 55:291-293. [PMID: 38142109 DOI: 10.1016/j.ram.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Affiliation(s)
- Marcelo Galas
- Antimicrobial Resistance Surveillance, Pan American Health Organization, Argentina
| |
Collapse
|
15
|
Cornistein W, Santonato D, Novau PA, Fabbro LG, Jorge MF, Malvicini MA, Vilches V, Iudica FM. Synergy between infection control and antimicrobial stewardship programs to control carbapenem-resistant Enterobacterales. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e162. [PMID: 37771737 PMCID: PMC10523542 DOI: 10.1017/ash.2023.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 09/30/2023]
Abstract
Objective Argentina is the third country in the world with the higher levels of CRE. The primary objective is to achieve an optimal result in the CRE infection rate after the implementation of an IPC program and antimicrobial stewardship programs (ASP) in a large teaching hospital in Argentina. Methods Retrospective, observational study from January 2018 to December 2021, in a 220-bed tertiary care teaching hospital in Buenos Aires province. Actions aimed at CRE control and prevention included CRE and healthcare-associated infection (HAI) surveillance; compliance with hand hygiene, hospital hygiene, contact isolation precautions, and care bundles for the prevention of device-associated infections; optimization of antimicrobial treatments, antimicrobial consumption, education, and feedback. Results Synergy between an ICP and ASP achieved controlled rate of CRE infections reaching the lowest levels during 2020 (0.08 episodes/1000 patient days). Colonization rate remained stable throughout the study period. Ventilator-associated pneumonia (VAP) rate showed a trend toward lower rates. Compliance with care bundles showed rates >85%. Antimicrobial consumption increased slightly during the study period (15%). Among high-impact antimicrobials, only colistin consumption increased. Conclusion Our study demonstrates the sustained and beneficial impact of an IPC Program and an ASP to control CRE infection.
Collapse
Affiliation(s)
- Wanda Cornistein
- Infection Prevention and Control Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Daniela Santonato
- Infection Prevention and Control Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Paula Andrea Novau
- Infection Prevention and Control Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Leonardo Guillermo Fabbro
- Infection Prevention and Control Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Melisa Fernanda Jorge
- Infection Prevention and Control Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | | | - Viviana Vilches
- Microbiology Laboratory, Hospital Universitario Austral, Buenos Aires, Argentina
| | | |
Collapse
|
16
|
Catalano A, Iacopetta D, Ceramella J, Pellegrino M, Giuzio F, Marra M, Rosano C, Saturnino C, Sinicropi MS, Aquaro S. Antibiotic-Resistant ESKAPE Pathogens and COVID-19: The Pandemic beyond the Pandemic. Viruses 2023; 15:1843. [PMID: 37766250 PMCID: PMC10537211 DOI: 10.3390/v15091843] [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: 07/05/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Antibacterial resistance is a renewed public health plague in modern times, and the COVID-19 pandemic has rekindled this problem. Changes in antibiotic prescribing behavior, misinformation, financial hardship, environmental impact, and governance gaps have generally enhanced the misuse and improper access to antibiotics during the COVID-19 pandemic. These determinants, intersected with antibacterial resistance in the current pandemic, may amplify the potential for a future antibacterial resistance pandemic. The occurrence of infections with multidrug-resistant (MDR), extensively drug-resistant (XDR), difficult-to-treat drug-resistant (DTR), carbapenem-resistant (CR), and pan-drug-resistant (PDR) bacteria is still increasing. The aim of this review is to highlight the state of the art of antibacterial resistance worldwide, focusing on the most important pathogens, namely Enterobacterales, Acinetobacter baumannii, and Klebsiella pneumoniae, and their resistance to the most common antibiotics.
Collapse
Affiliation(s)
- Alessia Catalano
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Via Orabona 4, 70126 Bari, Italy
| | - Domenico Iacopetta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| | - Jessica Ceramella
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| | - Michele Pellegrino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| | - Federica Giuzio
- Department of Science, University of Basilicata, 85100 Potenza, Italy; (F.G.); (C.S.)
| | - Maria Marra
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| | - Camillo Rosano
- Proteomics and Mass Spectrometry Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy;
| | - Carmela Saturnino
- Department of Science, University of Basilicata, 85100 Potenza, Italy; (F.G.); (C.S.)
| | - Maria Stefania Sinicropi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy; (D.I.); (J.C.); (M.P.); (M.M.); (M.S.S.); (S.A.)
| |
Collapse
|
17
|
Furlan JPR, da Silva Rosa R, Ramos MS, Dos Santos LDR, Lopes R, Savazzi EA, Stehling EG. Genetic plurality of bla KPC-2-harboring plasmids in high-risk clones of Klebsiella pneumoniae of environmental origin. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 881:163322. [PMID: 37068681 DOI: 10.1016/j.scitotenv.2023.163322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 06/01/2023]
Abstract
International high-risk clones of Klebsiella pneumoniae are important human pathogens that are spreading to the environment. In the COVID-19 pandemic scenario, the frequency of carbapenemase-producing strains increased, which can contribute to the contamination of the environment, impacting the surrounding and associated ecosystems. In this regard, KPC-producing strains were recovered from aquatic ecosystems located in commercial, industrial, or agricultural areas and were submitted to whole-genome characterization. K. pneumoniae and Klebsiella quasipneumoniae subsp. quasipneumoniae strains were assigned to high-risk clones (ST11, ST340, ST307) and the new ST6325. Virulome analysis showed genes related to putative hypervirulence. Strains were resistant to almost all antimicrobials tested, being classified as extensively drug-resistant or multidrug-resistant. In this context, a broad resistome (clinically important antimicrobials and hazardous metal) was detected. Single replicon (IncX5, IncN-pST15, IncU) and multireplicon [IncFII(K1)/IncFIB(pQil), IncFIA(HI1)/IncR] plasmids were identified carrying the blaKPC-2 gene with Tn4401 and non-Tn4401 elements. An unusual association of blaKPC-2 and qnrVC1 and the coexistence of blaKPC-2 and mer operon (mercury tolerance) was found. Comparative analysis revealed that blaKPC-2-bearing plasmids were most similar to plasmids from Enterobacterales of Brazil, China, and the United States, evidencing the long persistence of plasmids at the human-animal-environmental interface. Furthermore, the presence of uncommon plasmids, displaying the interspecies, intraspecies, and clonal transmission, was highlighted. These findings alert for the spread of high-risk clones producing blaKPC-2 in the environmental sector and call attention to rapid dispersion in a post-pandemic world.
Collapse
Affiliation(s)
- João Pedro Rueda Furlan
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Rafael da Silva Rosa
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Micaela Santana Ramos
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Lucas David Rodrigues Dos Santos
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Ralf Lopes
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | | | - Eliana Guedes Stehling
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil.
| |
Collapse
|
18
|
Ramay BM, Castillo C, Grajeda L, Santos LF, Romero JC, Lopez MR, Gomez A, Caudell M, Smith RM, Styczynski A, Herzig CTA, Bollinger S, Ning MF, Horton J, Omulo S, Palmer GH, Cordon-Rosales C, Call DR. Colonization With Antibiotic-Resistant Bacteria in a Hospital and Associated Communities in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S82-S88. [PMID: 37406049 PMCID: PMC10321699 DOI: 10.1093/cid/ciad222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND We estimated the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) from a hospital and associated communities in western Guatemala. METHODS Randomly selected infants, children, and adults (<1, 1-17, and ≥18 years, respectively) were enrolled from the hospital (n = 641) during the coronavirus disease 2019 (COVID-19) pandemic, March to September 2021. Community participants were enrolled using a 3-stage cluster design between November 2019 and March 2020 (phase 1, n = 381) and between July 2020 and May 2021 (phase 2, with COVID-19 pandemic restrictions, n = 538). Stool samples were streaked onto selective chromogenic agar, and a Vitek 2 instrument was used to verify ESCrE or CRE classification. Prevalence estimates were weighted to account for sampling design. RESULTS The prevalence of colonization with ESCrE and CRE was higher among hospital patients compared to community participants (ESCrE: 67% vs 46%, P < .01; CRE: 37% vs 1%, P < .01). Hospital ESCrE colonization was higher for adults (72%) compared with children (65%) and infants (60%) (P < .05). Colonization was higher for adults (50%) than children (40%) in the community (P < .05). There was no difference in ESCrE colonization between phase 1 and 2 (45% and 47%, respectively, P > .05), although reported use of antibiotics among households declined (23% and 7%, respectively, P < .001). CONCLUSIONS While hospitals remain foci for ESCrE and CRE colonization, consistent with the need for infection control programs, community prevalence of ESCrE in this study was high, potentially adding to colonization pressure and transmission in healthcare settings. Better understanding of transmission dynamics and age-related factors is needed.
Collapse
Affiliation(s)
- Brooke M Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Carmen Castillo
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Laura Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Lucas F Santos
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Juan Carlos Romero
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Andrea Gomez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Mark Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Styczynski
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn T A Herzig
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mariangeli Freitas Ning
- Central America Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Jennifer Horton
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health–Kenya, Nairobi, Nairobi County, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Celia Cordon-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| |
Collapse
|
19
|
Styczynski A, Herzig C, Luvsansharav UO, McDonald LC, Smith RM. Using Colonization to Understand the Burden of Antimicrobial Resistance Across Low- and Middle-Income Countries. Clin Infect Dis 2023; 77:S70-S74. [PMID: 37406047 PMCID: PMC10851945 DOI: 10.1093/cid/ciad224] [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: 07/07/2023] Open
Abstract
Understanding the burden of antibiotic resistance globally is hindered by incomplete surveillance, particularly across low-resource settings. The Antibiotic Resistance in Communities and Hospitals (ARCH) consortium encompasses sites across 6 resource-limited settings and is intended to address these gaps. Supported by the Centers for Disease Control and Prevention, the ARCH studies seek to characterize the burden of antibiotic resistance by examining colonization prevalence at the community and hospital level and to evaluate for risk factors that are associated with colonization. In this supplement, 7 articles present results from these initial studies. Though future studies identifying and evaluating prevention strategies will be critical to mitigate spreading resistance and its impact on populations, the findings from these studies address important questions surrounding the epidemiology of antibiotic resistance.
Collapse
Affiliation(s)
- Ashley Styczynski
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn Herzig
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ulzii-Orshikh Luvsansharav
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
20
|
Patel TS, McGovern OL, Mahon G, Osuka H, Boszczowski I, Munita JM, Garzon MI, Salomao MC, Marssola G, Tavares BM, Francisco DB, Gurgel APA, Arantes T, Bori A, Nogueira C, Peters A, Spencer M, Orellana C, Barbe M, Lopez C, Stender S, Lessa FC. Trends in Inpatient Antibiotic Use Among Adults Hospitalized During the Coronavirus Disease 2019 Pandemic in Argentina, Brazil, and Chile, 2018-2021. Clin Infect Dis 2023; 77:S4-S11. [PMID: 37406043 DOI: 10.1093/cid/ciad261] [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: 02/01/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND High rates of antibiotic use (AU) among inpatients with coronavirus disease 2019 (COVID-19) despite low rates of bacterial coinfection and secondary infection have been reported. We evaluated the impact of the COVID-19 pandemic on AU in healthcare facilities (HCFs) in South America. METHODS We conducted an ecologic evaluation of AU in inpatient adult acute care wards in 2 HCFs each in Argentina, Brazil, and Chile. The AU rates for intravenous antibiotics were calculated as the defined daily dose per 1000 patient-days, using pharmacy dispensing records and hospitalization data from March 2018-February 2020 (prepandemic) and March 2020-February 2021 (pandemic). Differences in median AU were compared between the prepandemic and pandemic periods, using the Wilcoxon rank sum test to determine significance. Interrupted time series analysis was used to analyze changes in AU during the COVID-19 pandemic. RESULTS Compared with the prepandemic period, the median difference in AU rates for all antibiotics combined increased in 4 of 6 HCFs (percentage change, 6.7%-35.1%; P < .05). In the interrupted time series models, 5 of 6 HCFs had significant increases in use of all antibiotics combined immediately at the onset of the pandemic (immediate effect estimate range, 15.4-268), but only 1 of these 5 HCFs experienced a sustained increase over time (change in slope, +8.13; P < .01). The effect of the pandemic onset varied by antibiotic group and HCF. CONCLUSIONS Substantial increases in AU were observed at the beginning of the COVID-19 pandemic, suggesting the need to maintain or strengthen antibiotic stewardship activities as part of pandemic or emergency HCF responses.
Collapse
Affiliation(s)
- Twisha S Patel
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Olivia L McGovern
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Garrett Mahon
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- CACI International, Reston, Virginia, USA
| | - Hanako Osuka
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Chenega Enterprise Systems and Solutions Chesapeake, Virginia, USA
| | - Icaro Boszczowski
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jose M Munita
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Isabel Garzon
- Servicio de Infectología, Hospital Privado de Córdoba, Cordoba, Argentina
- Hospital Español, Córdoba, Argentina
| | - Matias C Salomao
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Bruno M Tavares
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Tiago Arantes
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | - Andrea Bori
- Department of Infection Control of Hospital das Clínicas, Faculdade de Medicina, Universidade de Sao Paulo, Sau Paulo, Brazil
| | | | - Anne Peters
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maria Spencer
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Millennium Initiative for Collaborative Research on Bacterial Resistance, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicine, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Cristian Orellana
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Mario Barbe
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | | | | | - Fernanda C Lessa
- International Infection Control Program, Division of Healthcare Quality Promotion, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
21
|
Allel K, Peters A, Conejeros J, Martínez JRW, Spencer-Sandino M, Riquelme-Neira R, Rivas L, Rojas P, Orellana Chea C, García P, Araos R, McGovern O, Patel TS, Arias CA, Lessa FC, Undurraga EA, Munita JM. Antibiotic Consumption During the Coronavirus Disease 2019 Pandemic and Emergence of Carbapenemase-Producing Klebsiella pneumoniae Lineages Among Inpatients in a Chilean Hospital: A Time-Series Study and Phylogenomic Analysis. Clin Infect Dis 2023; 77:S20-S28. [PMID: 37406053 DOI: 10.1093/cid/ciad151] [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] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The impact of coronavirus disease 2019 (COVID-19) on antimicrobial use (AU) and resistance has not been well evaluated in South America. These data are critical to inform national policies and clinical care. METHODS At a tertiary hospital in Santiago, Chile, between 2018 and 2022, subdivided into pre- (3/2018-2/2020) and post-COVID-19 onset (3/2020-2/2022), we evaluated intravenous AU and frequency of carbapenem-resistant Enterobacterales (CRE). We grouped monthly AU (defined daily doses [DDD]/1000 patient-days) into broad-spectrum β-lactams, carbapenems, and colistin and used interrupted time-series analysis to compare AU during pre- and post-pandemic onset. We studied the frequency of carbapenemase-producing (CP) CRE and performed whole-genome sequencing analyses of all carbapenem-resistant (CR) Klebsiella pneumoniae (CRKpn) isolates collected during the study period. RESULTS Compared with pre-pandemic, AU (DDD/1000 patient-days) significantly increased after the pandemic onset, from 78.1 to 142.5 (P < .001), 50.9 to 110.1 (P < .001), and 4.1 to 13.3 (P < .001) for broad-spectrum β-lactams, carbapenems, and colistin, respectively. The frequency of CP-CRE increased from 12.8% pre-COVID-19 to 51.9% after pandemic onset (P < .001). The most frequent CRE species in both periods was CRKpn (79.5% and 76.5%, respectively). The expansion of CP-CRE harboring blaNDM was particularly noticeable, increasing from 40% (n = 4/10) before to 73.6% (n = 39/53) after pandemic onset (P < .001). Our phylogenomic analyses revealed the emergence of two distinct genomic lineages of CP-CRKpn: ST45, harboring blaNDM, and ST1161, which carried blaKPC. CONCLUSIONS AU and the frequency of CP-CRE increased after COVID-19 onset. The increase in CP-CRKpn was driven by the emergence of novel genomic lineages. Our observations highlight the need to strengthen infection prevention and control and antimicrobial stewardship efforts.
Collapse
Affiliation(s)
- Kasim Allel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Institute for Global Health, University College London, London, United Kingdom
| | - Anne Peters
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - José Conejeros
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
| | - José R W Martínez
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Maria Spencer-Sandino
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Roberto Riquelme-Neira
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Facultad de Medicina Veterinaria y Agronomía, Universidad de las Américas, Santiago, Chile
| | - Lina Rivas
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | | | | | - Patricia García
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Rafael Araos
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
| | - Olivia McGovern
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Twisha S Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cesar A Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Texas, USA
| | - Fernanda C Lessa
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eduardo A Undurraga
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Escuela de Gobierno, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Investigación para la Gestión Integrada del Riesgo de Desastres (CIGIDEN), Chile
- Canadian Institute for Advanced Research (CIFAR) Azrieli Global Scholars Program, CIFAR, Toronto, Canada
| | - José M Munita
- Multidisciplinary Initiative for Collaborative Research On Bacterial Resistance (MICROB-R), Santiago, Chile
- Genomics and Resistant Microbes (GeRM), Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile
- Hospital Padre Hurtado, Santiago, Chile
| |
Collapse
|
22
|
Kiffer CRV, Rezende TFT, Costa-Nobre DT, Marinonio ASS, Shiguenaga LH, Kulek DNO, Arend LNVS, Santos ICDO, Sued-Karam BR, Rocha-de-Souza CM, Kraft L, Abreu A, Peral RTDS, Carvalho-Assef APD, Pillonetto M. A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence. Clin Infect Dis 2023; 77:S29-S37. [PMID: 37406041 DOI: 10.1093/cid/ciad260] [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] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. METHODS Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais-Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015-2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ2 test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). RESULTS 83 282 blaKPC and 86 038 blaNDM were tested for all microorganisms. Enterobacterales DR for blaKPC and blaNDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for blaNDM was 2.5% (313/12 528). An annual percent increase for blaNDM of 41.1% was observed, and a decrease for blaKPC of -4.0% in Enterobacterales, and an annual increase for blaNDM of 71.6% and for blaKPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. CONCLUSIONS This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with blaNDM rising over the years.
Collapse
Affiliation(s)
- Carlos R V Kiffer
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Infectious Diseases Discipline, Laboratório Especial de Microbiologia Clínica-LEMC/ALERTA, EPM, UNIFESP, São Paulo, Brazil
| | - Thais F T Rezende
- Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
- Infectious Diseases Discipline, Laboratório Especial de Microbiologia Clínica-LEMC/ALERTA, EPM, UNIFESP, São Paulo, Brazil
| | | | | | | | - Debora Nicole Oliveira Kulek
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
| | - Lavinia Nery Villa Stangler Arend
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
| | - Ivson Cassiano de Oliveira Santos
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Bruna Ribeiro Sued-Karam
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Claudio Marcos Rocha-de-Souza
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Leticia Kraft
- Coordenação Geral de Laboratórios de Saúde Publica, Departamento de Articulação Estratégica de Vigilância em Saúde e Ambiente, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
| | - Andre Abreu
- Núcleo de Epidemiologia e Vigilância em Saúde, Instituto Oswaldo Cruz-FIOCRUZ, Brasilia, Distrito Federal, Brazil
| | - Renata Tigulini de Souza Peral
- Coordenação Geral de Laboratórios de Saúde Publica, Departamento de Articulação Estratégica de Vigilância em Saúde e Ambiente, Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasilia, Distrito Federal, Brazil
| | - Ana Paula D'Alincourt Carvalho-Assef
- Instituto Oswaldo Cruz (IOC)-Fundação Instituto Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar-LAPIH, Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcelo Pillonetto
- Laboratorio Central do Paraná - LACENPR, Secretaria de Estado da Saúde, Curitiba, Parana, Brazil
- Escola de Medicina e Ciencias da Vida - EMCV, Pontifícia Universidade Católica do Paraná-PUCPR, Curitiba, Parana, Brazil
| |
Collapse
|
23
|
Furlan JPR, Sellera FP, Stehling EG. Strengthening genomic surveillance of carbapenemases in soils: a call for global attention. THE LANCET. MICROBE 2023; 4:e386-e387. [PMID: 36966797 DOI: 10.1016/s2666-5247(23)00093-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 06/05/2023]
Affiliation(s)
- João Pedro Rueda Furlan
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fábio P Sellera
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil; School of Veterinary Medicine, Metropolitan University of Santos, Santos, Brazil
| | - Eliana Guedes Stehling
- Department of Clinical Analyses, Toxicology and Food Science, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
24
|
Reyes LF, Rodriguez A, Fuentes YV, Duque S, García-Gallo E, Bastidas A, Serrano-Mayorga CC, Ibáñez-Prada ED, Moreno G, Ramirez-Valbuena PC, Ospina-Tascon G, Hernandez G, Silva E, Díaz AM, Jibaja M, Vera-Alarcon M, Díaz E, Bodí M, Solé-Violán J, Ferrer R, Albaya-Moreno A, Socias L, Figueroa W, Lozano-Villanueva JL, Varón-Vega F, Estella Á, Loza-Vazquez A, Jorge-García R, Sancho I, Shankar-Hari M, Martin-Loeches I. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study. Sci Rep 2023; 13:6553. [PMID: 37085552 PMCID: PMC10119842 DOI: 10.1038/s41598-023-32265-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/24/2023] [Indexed: 04/23/2023] Open
Abstract
Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
Collapse
Affiliation(s)
- Luis Felipe Reyes
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia.
- Clinica Universidad de La Sabana, Chía, Colombia.
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
| | - Alejandro Rodriguez
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Yuli V Fuentes
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Clinica Universidad de La Sabana, Chía, Colombia
| | - Sara Duque
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Esteban García-Gallo
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Alirio Bastidas
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Cristian C Serrano-Mayorga
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
- Clinica Universidad de La Sabana, Chía, Colombia
| | - Elsa D Ibáñez-Prada
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | - Gerard Moreno
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Glenn Hernandez
- Critical Care Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Ana Maria Díaz
- Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
| | - Manuel Jibaja
- Eugenio Espejo Hospital of Specialties, Quito, Pichincha, Ecuador
| | | | - Emili Díaz
- Critical Care Department, Hospital Universitari Parc Taulí, Universitat Autonoma Barcelona, Sabadell, Spain
| | - María Bodí
- Critical Care Department, URV/IISPV/CIBERES, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Jordi Solé-Violán
- Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain
- Universidad Fernando Pessoa, Canarias, Spain
| | - Ricard Ferrer
- Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Lorenzo Socias
- Son Llatzer University Hospital, Palma de Mallorca, Spain
| | - William Figueroa
- Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia
| | | | | | - Ángel Estella
- Jerez University Hospital, Jerez de la Frontera, Spain
| | - Ana Loza-Vazquez
- Critical Care Department, Hospital Universitario Virgen del Valme, Sevilla, Spain
| | | | - Isabel Sancho
- Critical Care Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Manu Shankar-Hari
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, UK
| |
Collapse
|
25
|
Celis Y, Esparza G, Zachariah R, Pérez F. Operational research to strengthen evidence-based interventions to tackle antimicrobial resistance in the Region of the Americas. Rev Panam Salud Publica 2023; 47:e78. [PMID: 37089784 PMCID: PMC10115187 DOI: 10.26633/rpsp.2023.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Yamile Celis
- Pan American Health OrganizationBogotaColombiaPan American Health Organization, Bogota, Colombia
| | - German Esparza
- Pan American Health OrganizationBogotaColombiaPan American Health Organization, Bogota, Colombia
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Diseases-World Health OrganizationGenevaSwitzerlandSpecial Programme for Research and Training in Tropical Diseases-World Health Organization, Geneva, Switzerland
| | - Freddy Pérez
- Pan American Health OrganizationWashington, DCUnited States of AmericaPan American Health Organization, Washington, DC, United States of America.
- Federal University of Health Sciences of Porto AlegrePorto AlegreBrazilFederal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
26
|
Faccone D, Gomez SA, de Mendieta JM, Sanz MB, Echegorry M, Albornoz E, Lucero C, Ceriana P, Menocal A, Martino F, De Belder D, Corso A, Pasterán F. Emergence of Hyper-Epidemic Clones of Enterobacterales Clinical Isolates Co-Producing KPC and Metallo-Beta-Lactamases during the COVID-19 Pandemic. Pathogens 2023; 12:pathogens12030479. [PMID: 36986401 PMCID: PMC10052147 DOI: 10.3390/pathogens12030479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The global spread of carbapenemase-producing Enterobacterales has become an epidemiological risk for healthcare systems by limiting available antimicrobial treatments. The COVID-19 pandemic worsened this scenario, prompting the emergence of extremely resistant microorganisms. METHODS Between March 2020 and September 2021, the NRL confirmed 82 clinical Enterobacterales isolates harboring a combination of blaKPC and MBL genes. Molecular typing was analyzed by PFGE and MLST. Modified double-disk synergy (MDDS) tests were used for phenotypic studies. RESULTS Isolates were submitted from 28 hospitals located in seven provinces and Buenos Aires City, including 77 K. pneumoniae, 2 K. oxytoca, 2 C. freundii, and 1 E. coli. Almost half of K. pneumoniae isolates (n = 38; 49.4%), detected in 15 hospitals, belong to the CC307 clone. CC11 was the second clone, including 29 (37.7%) isolates (22, ST11 and 7, ST258) from five cities and 12 hospitals. Three isolates belonging to CC45 were also detected. The carbapenemase combinations observed were as follows: 55% blaKPC-2 plus blaNDM-5; 32.5% blaKPC-2 plus blaNDM-1; 5% blaKPC-3 plus blaNDM-1; 5% blaKPC-2 plus blaIMP-8; and 2.5% strain with blaKPC-2 plus blaNDM-5 plus blaOXA-163. Aztreonam/avibactam and aztreonam/relebactam were the most active combinations (100% and 91% susceptible, respectively), followed by fosfomycin (89%) and tigecycline (84%). CONCLUSIONS The MDDS tests using ceftazidime-avibactam/EDTA and aztreonam/boronic acid disks improved phenotypic classification as dual producers. The successful high-risk clones of K. pneumoniae, such as hyper-epidemic CC307 and CC11 clones, drove the dissemination of double carbapenemase-producing isolates during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Diego Faccone
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Sonia A Gomez
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Juan Manuel de Mendieta
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - María Belén Sanz
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Mariano Echegorry
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Ezequiel Albornoz
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Celeste Lucero
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Paola Ceriana
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Alejandra Menocal
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Florencia Martino
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina
| | - Denise De Belder
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Alejandra Corso
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| | - Fernando Pasterán
- Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina
| |
Collapse
|
27
|
Herrera F, Torres D, Laborde A, Berruezo L, Jordán R, Rossi IR, Valledor A, Costantini P, Dictar M, Nenna A, Pereyra ML, Lambert S, Benso J, Poletta F, Gonzalez Ibañez ML, Baldoni N, Eusebio MJ, Lovano F, Barcán L, Luck M, Racioppi A, Tula L, Pasterán F, Corso A, Rapoport M, Nicola F, García Damiano MC, Carbone R, Monge R, Reynaldi M, Greco G, Bronzi M, Valle S, Chaves ML, Vilches V, Blanco M, Carena AÁ. Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation. Antibiotics (Basel) 2023; 12:antibiotics12020226. [PMID: 36830136 PMCID: PMC9952392 DOI: 10.3390/antibiotics12020226] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88-8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29-9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74-93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80-0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia.
Collapse
Affiliation(s)
- Fabián Herrera
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
- Correspondence: ; Tel.: +54-911-58628323
| | - Diego Torres
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | | | | | - Rosana Jordán
- Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina
| | | | | | | | - Miguel Dictar
- Instituto Alexander Fleming, Buenos Aires C1426, Argentina
| | - Andrea Nenna
- Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina
| | | | | | - José Benso
- Hospital Italiano de San Justo, Buenos Aires C1198, Argentina
| | - Fernando Poletta
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | | | - Nadia Baldoni
- Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina
| | | | | | - Laura Barcán
- Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Martín Luck
- Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina
| | | | - Lucas Tula
- Hospital El Cruce, Buenos Aires B1888, Argentina
| | - Fernando Pasterán
- Servicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, Argentina
| | - Alejandra Corso
- Servicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, Argentina
| | - Melina Rapoport
- Servicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, Argentina
| | - Federico Nicola
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| | | | - Ruth Carbone
- Hospital HIGA Rodolfo Rossi, La Plata B1902, Argentina
| | - Renata Monge
- Hospital Británico de Buenos Aires, Buenos Aires C1280, Argentina
| | | | - Graciela Greco
- Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
- Hospital Italiano de San Justo, Buenos Aires C1198, Argentina
| | - Marcelo Bronzi
- Instituto de Oncología Angel H. Roffo, Buenos Aires C1417, Argentina
| | - Sandra Valle
- Instituto Alexander Fleming, Buenos Aires C1426, Argentina
| | - María Laura Chaves
- Hospital Municipal de Oncología Marie Curie, Buenos Aires C1405, Argentina
| | - Viviana Vilches
- Hospital Universitario Austral, Buenos Aires B1629, Argentina
| | | | - Alberto Ángel Carena
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina
| |
Collapse
|
28
|
Vaccination against Community-Acquired Pneumonia in Spanish Adults: Practical Recommendations by the NeumoExperts Prevention Group. Antibiotics (Basel) 2023; 12:antibiotics12010138. [PMID: 36671339 PMCID: PMC9854614 DOI: 10.3390/antibiotics12010138] [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: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.
Collapse
|
29
|
Celis Y, Esparza G, Zachariah R, Pérez F. Investigación operativa para fortalecer las intervenciones basadas en la evidencia para abordar la resistencia a los antimicrobianos en la Región de las Américas *. Rev Panam Salud Publica 2023; 47:e85. [PMID: 37143508 PMCID: PMC10153579 DOI: 10.26633/rpsp.2023.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- Yamile Celis
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá, Colombia.
| | - German Esparza
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá, Colombia.
| | - Rony Zachariah
- Programa Especial en Investigación y Capacitación en Enfermedades Tropicales-Organización Mundial de la SaludGinebraSuizaPrograma Especial en Investigación y Capacitación en Enfermedades Tropicales-Organización Mundial de la Salud, Ginebra, Suiza.
| | - Freddy Pérez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
- Universidade Federal de Ciências da Saúde de Porto AlegreBrasilUniversidade Federal de Ciências da Saúde de Porto Alegre, Brasil.
- Freddy Pérez, .
| |
Collapse
|
30
|
Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana. Antibiotics (Basel) 2022; 12:antibiotics12010058. [PMID: 36671259 PMCID: PMC9855120 DOI: 10.3390/antibiotics12010058] [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: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42-4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02-0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.
Collapse
|
31
|
Antimicrobial resistance in Escherichia coli and Pseudomonas aeruginosa before and after the coronavirus disease 2019 (COVID-19) pandemic in the Dominican Republic. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e191. [PMID: 36505946 PMCID: PMC9726630 DOI: 10.1017/ash.2022.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
Objective To describe antimicrobial resistance before and after the COVID-19 pandemic in the Dominican Republic. Design Retrospective study. Setting The study included 49 outpatient laboratory sites located in 13 cities nationwide. Participants Patients seeking ambulatory microbiology testing for urine and bodily fluids. Methods We reviewed antimicrobial susceptibility reports for Escherichia coli isolates from urine and Pseudomonas aeruginosa (PSAR) from bodily fluids between January 1, 2018, to December 31, 2021, from deidentified susceptibility data extracted from final culture results. Results In total, 27,718 urine cultures with E. coli and 2,111 bodily fluid cultures with PSAR were included in the analysis. On average, resistance to ceftriaxone was present in 25.19% of E. coli isolated from urine each year. The carbapenem resistance rates were 0.15% for E. coli and 3.08% for PSAR annually. The average rates of E. coli with phenotypic resistance consistent with possible extended-spectrum β-lactamase (ESBL) in urine were 25.63% and 24.75%, respectively, before and after the COVID-19 pandemic. The carbapenem resistance rates in urine were 0.11% and 0.20%, respectively, a 200% increase. The average rates of PSAR with carbapenem resistance in bodily fluid were 2.33% and 3.84% before and after the COVID-19 pandemic, respectively, a 130% percent increase. Conclusions Resistance to carbapenems in PSAR and E. coli after the COVID-19 pandemic is rising. These resistance patterns suggest that ESBL is common in the Dominican Republic. Carbapenem resistance was uncommon but increased after the COVID-19 pandemic.
Collapse
|