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Zhuo J, Liang B, Zhang H, Chi Y, Cai Y. An overview of gram-negative bacteria with difficult-to-treat resistance: definition, prevalence, and treatment options. Expert Rev Anti Infect Ther 2023; 21:1203-1212. [PMID: 37811630 DOI: 10.1080/14787210.2023.2267765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Difficult-to-treat resistance (DTR) is a newly proposed resistance phenotype characterized by resistance to all first-line drugs. The emergence of DTR as a new resistance phenotype has significant implications for clinical practice. This new concept has the potential to be widely used instead of traditional phenotypes. AREAS COVERED This study carried out a detailed analysis about the definition, application, and evolution of various resistance phenotypes. We collected all the research articles on Gram-negative bacteria with difficult-to-treat resistance (GNB-DTR), analyzed the DTR in each region and each bacterial species. The advantages and doubts of DTR, the dilemma of GNB-DTR infections and the potential therapeutic strategies are summarized in the review. EXPERT OPINION Available studies show that the prevalence of GNB-DTR is not optimistic. Unlike traditional resistance phenotypes, DTR is more closely aligned with the clinical treatment perspective and can help with the prompt selection of an appropriate treatment plan. Currently, potential treatment options for GNB-DTR include a number of second-line drugs and novel antibiotics. However, the definition of first-line drugs is inherently dynamic. Therefore, the DTR concept based on first-line drugs needs to be continuously updated and refined, considering the emergence of new antibiotics, resistance characteristics, and pathogen prevalence in different regions.
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Affiliation(s)
- Jiaju Zhuo
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Beibei Liang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Huan Zhang
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Yulong Chi
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
| | - Yun Cai
- Center of Medicine Clinical Research, Department of Pharmacy, Medical Supplies Center of PLA General Hospital, Beijing, China
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Mouanga-Ndzime Y, Onanga R, Longo-Pendy NM, Bignoumba M, Bisseye C. Epidemiology of community origin of major multidrug-resistant ESKAPE uropathogens in a paediatric population in South-East Gabon. Antimicrob Resist Infect Control 2023; 12:47. [PMID: 37173760 PMCID: PMC10176853 DOI: 10.1186/s13756-023-01250-y] [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: 11/23/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) in children are very common. They are often associated with a high risk of sepsis and death. In recent years, antibiotic-resistant uropathogens ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae) are increasingly encountered in UTIs. These bacteria, usually multidrug-resistance (MDR), extensive drug-resistance (XDR), pandrug-resistance (PDR), Extended-spectrum cephalosporin-resistance (ESC), Usual Drug Resistance (UDR), Difficult-to-Treat Resistance (DTR) and Carbapenem-resistance Enterobacteriales (CRE), represent a global threat for the management of paediatric UTIs. The aim of this study was to determine the epidemiology of community origin and antibiotic sensitivity of major ESKAPE uropathogens in paediatric UTIs in South-East Gabon. METHODS The study involved 508 children aged 0-17 years. Identification of bacterial isolates was carried out using Vitek-2 compact automated system and the antibiogram with the disk diffusion and microdilution methods according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Logistic regression analysis was used to assess the impact of patients' socio-clinical characteristics on uropathogens phenotype in both univariate and multivariate analysis. RESULTS The prevalence of UTIs was 59%. E. coli (35%) and K. pneumoniae (34%) were the main ESKAPE involved in UTIs followed by Enterococcus spp. (8%) and S. aureus (6%). Among major ESKAPE, DTR-E. coli (p = 0.01), CRE-E. coli (p = 0.02) and XDR-E. coli (p = 0.03), Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) were associated with abdomino-pelvic pain. While MDR-E. coli (p < 0.001), UDR-E. coli (p = 0.02), ESC-E. coli (p < 0.001), MDR- Enterococcus (p = 0.04), UDR- Enterococcus (p = 0.02), bacteria resistant to Ampicillin (p < 0.01), Cefotaxime (p = 0.04), Ciprofloxacin (p < 0.001), Benzylpenicillin (p = 0.03) and Amikacin (p = 0.04) were more frequent among male children. MDR-Enterococcus (p < 0.01), bacteria resistant to Amoxicillin-clavulanic acid (p = 0.03), Cefalotin (p = 0.01), Ampicillin (p = 0.02) and Gentamicin (p = 0.03) were associated with treatment failure. In addition, Trimethoprim-sulfamethoxazole-resistant bacteria (p = 0.03) was associated with recurrent UTIs while those resistant to Ciprofloxacin was associated with pollakiuria (p = 0.01) and urinary burning (p = 0.04). Furthermore, UDR-K. pneumoniae (p = 0.02) was more frequent in neonates and infants. CONCLUSION This study determined the epidemiology of ESKAPE uropathogens in paediatric UTIs. It found a high prevalence of paediatric UTIs associated with children's socio-clinical characteristics and diverse bacterial antibiotic resistance phenotypes.
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Affiliation(s)
- Yann Mouanga-Ndzime
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, BP 769, Franceville, Gabon.
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, BP 943, Franceville, Gabon.
| | - Richard Onanga
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - Neil-Michel Longo-Pendy
- Unité de Recherche en Ecologie de La Santé (URES), Centre Interdisciplinaire de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - Michelle Bignoumba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, BP 769, Franceville, Gabon
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, BP 943, Franceville, Gabon
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Behera DU, Ratnajothy K, Dey S, Gaur M, Sahoo RK, Sahoo S, Rautaraya B, Rout MK, Subudhi E. In vitro synergistic interaction of colistin and other antimicrobials against intrinsic colistin-resistant Morganella morganii isolates. 3 Biotech 2023; 13:127. [PMID: 37064006 PMCID: PMC10097849 DOI: 10.1007/s13205-023-03551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
Morganella morganii, a non-negligent opportunistic pathogen of the family Enterobacteriaceae, enlisted recently in the global priority pathogens by WHO for its swift propensity to acquire drug-resistant genes, engendering enhanced death rates. A combination of diverse antimicrobials could be recycled to overcome the ongoing acquisition of resistance mechanisms by M. morganii. Herein, we investigated the in vitro synergistic effect of colistin with meropenem, rifampicin, minocycline and linezolid against three intrinsic colistin-resistant M. morganii strains collected from critical departments of tertiary care hospitals. The strains were identified and tested for antimicrobial susceptibility by VITEK 2 automated system. The 16S rRNA sequencing was used to reconfirm the species identification. Minimum inhibitory concentrations (MICs) of colistin, meropenem, rifampicin, minocycline and linezolid were determined by the broth microdilution method. Synergistic interactions were studied by checkerboard and time-kill assay. The VITEK 2 identification and 16S rRNA sequencing confirmed that the strains were M. morganii. The automated antimicrobial susceptibility test revealed that all three isolates were multi-drug resistant. The checkerboard analysis demonstrated the synergy of all four combinations with FICI values ranging from 0.06 to 0.31 in all three isolates. These results suggest a potential role of meropenem as an adjuvant for treating M. morganii infections. The current work presented the first evidence of synergy between colistin and other antibiotics against M. morganii infection, which needs validation through in vitro and in vivo studies using a larger number of isolates. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-023-03551-w.
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Affiliation(s)
- Dibyajyoti Uttameswar Behera
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
| | - Keerthanan Ratnajothy
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
| | - Suchanda Dey
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
| | - Mahendra Gaur
- Drug Development and Analysis Laboratory, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha 751003 India
| | - Rajesh Kumar Sahoo
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
| | - Saubhagini Sahoo
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
| | - Bibhudutta Rautaraya
- Central Laboratory (Microbiology), AMRI Hospital, Bhubaneswar, Odisha 751030 India
| | - Manish Kumar Rout
- Central Laboratory (Microbiology), AMRI Hospital, Bhubaneswar, Odisha 751030 India
| | - Enketeswara Subudhi
- Centre for Biotechnology, School of Pharmaceutical Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha 751003 India
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Parajuli R, Limbu T, Chaudhary R, Gautam K, Dahal P. Phenotypical Detection of β-Lactamases in a Multidrug-Resistant and Extensively Drug-Resistant Chryseobacterium indologens: A Rare Human Pathogen With Special References to Risk Factor. Microbiol Insights 2023; 16:11786361221150755. [PMID: 36741473 PMCID: PMC9893352 DOI: 10.1177/11786361221150755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/26/2022] [Indexed: 02/01/2023] Open
Abstract
Chryseobacterium indologenes is gram-negative bacteria that cause infection in humans. It is less frequently isolated in the laboratory. The development of drug-resistant and its intrinsic ability to resist a wide range of antimicrobials enables them to cause mortality in an immunocompromised patient with a longer hospital stay. Our study objectives are to investigate antimicrobial-resistant patterns, drug-resistant enzymes, and the risk factor analysis associated with multidrug-resistant (MDR), extensively drug-resistant (XDR), and Pan-drug resistant (PDR) within 2 years. Altogether 53 strains of Chryseobacterium indologens were obtained from 5000 specimens that were processed for routine bacterial culture. The bacterial identification was done using conventional techniques (colony morphology, gram staining, flexirubin test, and biochemical tests) as well as the VITEK-2 System to further confirm. The bacterial isolate were processed to observe antimicrobial susceptibility test (AST) using disk diffusion method. MDR XDR and PDR were classified following European Centre for Disease Prevention and Control guidelines. C. indologens strains with beta-lactamases such as extended-spectrum beta-lactamases (ESBL), metallo beta-lactamases (MBL), and Amp-C beta-lactamases (Amp-C) were detected phenotypically. The highest isolation of C. indologens was observed in a sputum sample. In vitro antimicrobial susceptibility test revealed susceptibility to tigecycline followed by levofloxacin, cotrimoxazole, and piperacillin-tazobactam. From 53 isolates of C. indologens, MDR accounts for 56.60% and 22.64% for XDR. Combined antimicrobial therapy and longer hospital stay were found to be the leading risk factor. All 53 C. indologenes strains were detected as MBL. Total ESBL was detected in 16.98% of MBL producer strains and Amp-C was observed in 13.20% of MBL-producing strains. All 3 enzyme co-oproducers were seen in only 5.66% of C. indologens. Although it is rarely encountered in the laboratory, it showed a remarkable effect in patients with underlying predisposing factors and prolonged hospital stays. The presence of betalactamases determined the drug-resistant activity on a wide spectrum of tested antibiotics.
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Affiliation(s)
- Ranjana Parajuli
- Department of Microbiology, Grande
International Hospital, Kathmandu, Nepal
| | - Trishant Limbu
- Department of Intensive Care Unit and
Critical Care Medicine, Grande International Hospital, Kathmandu, Nepal
| | - Raina Chaudhary
- Department of Microbiology, Nepalese
Army Institute of Health Sciences, Kathmandu, Nepal
| | - Kundan Gautam
- Department of Microbiology, Grande
International Hospital, Kathmandu, Nepal
| | - Pragyan Dahal
- Department of Microbiology, Grande
International Hospital, Kathmandu, Nepal,Pragyan Dahal, Grande International
Hospital, Kathmandu 44608, Nepal.
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Herald F, Burgos RM. Clinical Evaluation of Meropenem-Vaborbactam Combination for the Treatment of Urinary Tract Infection: Evidence to Date. Infect Drug Resist 2023; 16:555-568. [PMID: 36726388 PMCID: PMC9885963 DOI: 10.2147/idr.s187360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/16/2021] [Indexed: 01/27/2023] Open
Abstract
As antimicrobial resistance continues to grow, one of the biggest threats includes the members of the Enterobacterales order presenting with carbapenem resistance (CRE). Meropenem-vaborbactam, along with other beta-lactam/beta-lactamase agents, has been developed to help combat this growing concern and is currently approved to treat complicated urinary tract infections (cUTI), as well as acute pyelonephritis (AP), in the USA. Vaborbactam is a novel beta-lactamase inhibitor designed specifically to optimize and restore the activity of meropenem against resistant Enterobacterales. Vaborbactam inhibits a number of beta-lactamases, including in vitro activity against extended-spectrum beta-lactamases (ESBL) and the Klebsiella pneumoniae carbapenemase (KPC) group. KPC represents one of the most clinically relevant carbapenemase in the USA, accounting for the majority of carbapenemase-producing CRE. Meropenem-vaborbactam has been studied in the two Phase 3, noninferiority trials, TANGO I and TANGO II. TANGO I compared meropenem-vaborbactam against piperacillin-tazobactam in patients with cUTIs and was found to be noninferior for overall success and microbial eradication. TANGO II expanded to other disease states (bacteremia, hospital-acquired/ventilator-associated bacterial pneumonia [HAP/VAP], complicated intra-abdominal infection [cIAI], cUTI/AP) and was found to be noninferior against best available therapy (BAT) with respect to clinical cure at the end of treatment and the test of cure. Meropenem-vaborbactam maintained the established safety profile of meropenem alone, with headache as the most common adverse event in both phase 3 studies. Overall, clinical efficacy has been demonstrated and suggests the use of meropenem-vaborbactam for the treatment of cUTI is an option.
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Affiliation(s)
- Fischer Herald
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA,Correspondence: Fischer Herald 833 South Wood Street, Room 164, M/C 886, Chicago, IL, 60612, USATel +1 312 996 1654Fax +1 312 413 1797 Email
| | - Rodrigo M Burgos
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA,Department of Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
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Rodríguez A, Moreno G, Bodi M, Martín-Loeches I. Antibiotics in development for multiresistant gram-negative bacilli. Med Intensiva 2022; 46:630-640. [PMID: 36302707 DOI: 10.1016/j.medine.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/26/2022] [Indexed: 06/16/2023]
Abstract
The rapid increase in antibiotic(ATB) resistance among Gram-negative bacilli(BGN), especially in strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii, with high resistance patterns (XDR), poses a huge threat to health systems worldwide. In the last decade, different ATBs have been developed against XDR, some of which combine a lactam β along with a β-lactamase inhibitor, while others use non-β-lactam inhibitors. Most of them have adequate "in vitro" activity on several β-lactamases of class A, C and D of Ambler. However, combinations such as Ceftazidime/avibactam, Ceftolozane/Tazobactam and Meropenem/vaborbactam have no activity against metallo-β-lactamases(MβL). New combinations such as Aztreonan/AVI, Cefepime/Zidebactam, or new cephalosporins such as Cefiderocol, have efficacy against MβL enzymes. Although some of these combinations are already approved and in the commercialization phase, many of them have yet to define their place within the treatment of microorganisms with high resistance through clinical studies.
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Affiliation(s)
- A Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; IISPV/CIBERES, Tarragona, Spain.
| | - G Moreno
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - M Bodi
- Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain; IISPV/CIBERES, Tarragona, Spain
| | - I Martín-Loeches
- Trinity College Dublin, School of Medicine, Intensive Care Medicine St James's Hospital, Dublín, Ireland
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Chakrapani G, Zare M, Ramakrishna S. Current Trends and Definitions in High-performance Antimicrobial Strategies. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2022. [DOI: 10.1016/j.cobme.2022.100407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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8
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Rodríguez A, Moreno G, Bodi M, Martín-Loeches I. Antibióticos en desarrollo para bacilos gram negativos multirresistentes. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Miftode IL, Pasare MA, Miftode RS, Nastase E, Plesca CE, Lunca C, Miftode EG, Timpau AS, Iancu LS, Dorneanu OS. What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe. Antibiotics (Basel) 2022; 11:antibiotics11050548. [PMID: 35625192 PMCID: PMC9137815 DOI: 10.3390/antibiotics11050548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: The evolution of bacterial resistance to antibiotics is one of the factors that make infectious pathology an extremely dynamic field, also inducing a significant burden on public health systems; therefore, continuous updates on the bacterial resistance to antibiotics and their particular regional patterns is crucial for the adequate approach of various infectious diseases. (2) Methods: We retrospectively analyzed 354 patients with Enterobacterales urinary tract infections (UTIs), determined their antibiotic resistance pattern, thus aiming to correlate them with the outcome and other specific markers of poor prognosis. (3) Results: The most frequent causative agent was Escherichia coli, representing 64.6% of all UTIs. We identified 154 patients resistant to multiple antibiotic classes, of which 126 were multidrug-resistant (MDR), 17 were extensive drug-resistant (XDR) and 11 were pandrug-resistant (PDR). Moreover, 25 isolates were resistant to carbapenems (CRE), 25 were difficult-to-treat (DTR), and 84 were extended-spectrum cephalosporin-resistant (ESC), with only 95 isolates susceptible to all tested antibiotics. Mortality ranged from 1% for UTIs caused by isolates susceptible to all tested antibiotics, to 24% for the ones caused by DTR or CRE isolates. Other significant risk factors associated with mortality were: prolonged hospital stay (p = 0.0001), Charlson comorbidity index ≥ 3 (p = 0.02), urinary catheterization (p = 0.001), associated respiratory pathologies (p = 0.004), obesity (p = 0.047), a history of previous hospitalizations (p = 0.007), inappropriate empiric antibiotic regimen (p = 0.001), or hyper inflammatory status (p = 0.006). Basically, we observed that a multiple regression model comprising urinary catheterization, inappropriate empiric anti-biotherapy, obesity, and respiratory comorbidities exhibits the best correlation with mortality rate in patients with UTI (R = 0.347, R2 = 0.12). (4) Conclusions: By focusing on the novel resistance patterns, our study provides complementary evidence concerning the resistance profiles found in an Eastern European region, as well as their prognostic implications in patients with UTI.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Maria-Antoanela Pasare
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Radu-Stefan Miftode
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Eduard Nastase
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Claudia Elena Plesca
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
| | - Catalina Lunca
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Egidia-Gabriela Miftode
- Department of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (I.-L.M.); (E.N.); (C.E.P.)
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Correspondence: (R.-S.M.); (E.-G.M.); Tel.: +40-742067839 (R.-S.M.); +40-744118866 (E.-G.M.)
| | - Amalia-Stefana Timpau
- Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania;
| | - Luminita Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
| | - Olivia Simona Dorneanu
- St. Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (M.-A.P.); (O.S.D.)
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iasi, Romania; (C.L.); (L.S.I.)
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Does the COVID Pandemic Modify the Antibiotic Resistance of Uropathogens in Female Patients? A New Storm? Antibiotics (Basel) 2022; 11:antibiotics11030376. [PMID: 35326839 PMCID: PMC8944623 DOI: 10.3390/antibiotics11030376] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022] Open
Abstract
Urinary tract infections (UTIs) represent a common pathology among female patients, leading to overprescribing antibiotics, globally. The emergence of the COVID-19 pandemic has dramatically increased the incidence of this particular viral pneumonia with secondary bacterial superinfection, resulting in continuous therapeutic or prophylactic recommendations of antibiotic treatment; thus, an updated analysis of current antimicrobial resistance among uropathogens is mandatory. This cross-sectional retrospective study conducted in two university hospitals in Bucharest, Romania analyzed 2469 positive urine cultures, among two different periods of 6 months, before and during the COVID-19 pandemic. The most common pathogen was Escherichia coli 1505 (60.95%), followed by Klebsiella spp. 426 (17.25%). Enterococcus spp. was the leading Gram-positive pathogen 285 (11.54%). In gram negative bacteria, in almost all cases, an increased in resistance was observed, but the highest increase was represented by quinolones in Klebsiella spp., from 16.87% to 35.51% and Pseudomonas from 30.3% to 77.41%; a significant increase in resistance was also observed for carbapenems. Surprisingly, a decrease in resistance to Penicillin was observed in Enterococcus spp., but the overall tendency of increased resistance is also maintained for gram positive pathogens. The lack of data on the influence of the COVID-19 pandemic on uropathogens’ resistance promotes these findings as important for every clinician treating UTIs and for every specialist in the medical field in promoting reasonable recommendations of antibiotic therapies.
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Association of Proteus mirabilis and Providencia stuartii Infections with Diabetes. Medicina (B Aires) 2022; 58:medicina58020271. [PMID: 35208593 PMCID: PMC8880118 DOI: 10.3390/medicina58020271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 01/13/2023] Open
Abstract
Background and Objectives: Proteus and Providencia are related genera of opportunistic pathogens belonging to the Morganellaceae family, often a cause of infections in the immunocompromised hosts, such as diabetic patients. Their clinical significance has increased due to their intrinsic resistance to polymyxins, which is often associated with acquired resistance mechanisms. In this study we evaluated the infections caused by Proteus mirabilis and Providencia stuartii in two groups of patients, with diabetes (group 1) and without diabetes (group 2) admitted to the intensive care unit and surgical wards. The infections were investigated in terms of infection type, risk factors, clinical course, predictive factors for unfavourable outcomes and antibiotic resistance profile. Materials and Methods: An observational, retrospective, cross-sectional study was conducted, comprising all patients infected with these pathogens. Bacterial identification and antibiotic sensitivity testing were performed using the Vitek2C automated system. Results: Comparison of the two groups showed that the statistically significant common infectious risk factors were found less frequently among diabetic patients when compared with non-diabetic patients, and that antimicrobial resistance was significantly lower in the diabetic patient group. However, survival rates did not differ between the two groups, drawing attention to the implications of diabetes as comorbidity. Additionally, with regard to the antibiotic resistance profile, 38.89% of P. stuartii strains isolated from diabetic patients belonged to the difficult-to-treat (DTR) phenotype, contributing to the severity of these infections compared with those caused by P. mirabilis, of which 32% were wild type strains and 0% were DTR phenotype. The DTR/extended spectrum beta-lactamase producing P. stuartii isolates more than doubled the risk of mortality, while the presence of nasogastric nutrition tripled the risk. Conclusions: P. stuartii infections that occurred in diabetic patients proved to be more difficult to treat, the majority of them being healthcare-associated bacteremias.
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The Magnitude of Carbapenemase and ESBL Producing Enterobacteriaceae Isolates from Patients with Urinary Tract Infections at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1369:117-128. [PMID: 34914083 DOI: 10.1007/5584_2021_687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The emergence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), and carbapenemase-producing Enterobacteriaceae (CPE) is a public health concern. Therefore, this study aimed to determine the magnitude of carbapenemase and ESBL producing bacteria isolated from patients affected by Urinary Tract Infection (UTI). METHODS A cross-sectional study was conducted from December 2018 to March 2019 at Tikur Anbessa Specialized Hospital. A total of 120 Enterobacteriaceae isolates from UTI patients were collected and identified on species level using standard microbiological methods. Antimicrobial susceptibility test was determined according to the guidelines of the Clinical and Laboratory Standards Institute. Detection of ESBL production was carried out by using ESBL ChromoSelect Agar medium and the combined disk diffusion. Production of carbapenemase was determined by using Hodge-test and modified carbapenem inactivation method as described in CLSI guidelines. RESULTS Out of the total 120 Enterobacteriaceae isolates, 74 (61.7%) were ESBL-producers, and 8 (6.7%) were carbapenemase producers. The most common ESBL producing isolate was E.coli 38 (51.4%) and the most common carbapenemase-producing isolate was K.pneumoniae five (62.5%). Most of the ESBL and carbapenemase-producing isolates were recovered from hospitalized patients 46 (62.2%) and 7 (87.5%) respectively. The rate of ESBL and CPE production was observed high among patients taking antibiotics 64.8% (59/91) and 7.7% (7/91) respectively, but no significant association was observed p > 0.05. Furthermore, about 1.7% (2/120) isolates were found both ESBL and carbapenemase producers. Significant resistances rates were observed in ESBL and CPE isolates. CONCLUSION Enterobacteriaceae isolates showed a significantly higher rate of ESBL production. A significant figure of carbapenemase production was observed among Enterobacteriaceae isolates causing UTI. The production of ESBL and CPE enhanced for an increased rate of MDR patterns. Efforts need to be made to introduce a system for tracking and detecting ESBL-PE and CPE-producing bacteria in hospitals, and monitoring dissemination of ESBL and CPE-producing Enterobacteriaceae is strongly recommended.
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Alanazi MQ. Clinical Efficacy and Cost Analysis of Antibiotics for Treatment of Uncomplicated Urinary Tract Infections in the Emergency Department of a Tertiary Hospital in Saudi Arabia. Ther Clin Risk Manag 2021; 17:1209-1217. [PMID: 34848965 PMCID: PMC8615137 DOI: 10.2147/tcrm.s334886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Uncomplicated urinary tract infections (uUTIs) are one of the main reasons for emergency department (ED) visits. Many antibiotics can be used for uUTI treatment. Currently, no data concerning uUTIs and cost-effectiveness have been reported in Saudi Arabia. This study aimed to investigate antibiotic and cost-effectiveness of beta-lactams, fluoroquinolones, and nitrofurantoin as first-line uUTI treatment. Patients and Methods This study was a retrospective cohort based on a five-arm comparative outcome analysis. A cost-effectiveness analysis and comparative group of uUTI treatments in the ED at King Abdulaziz Medical City (KAMC) in Saudi Arabia over a three-month follow-up period was done. The patient group consisted of those presenting to the ED with uUTIs who were treated initially with one of five antibiotics: (1) amoxicillin/clavulanic acid, (2) cefuroxime, (3) ciprofloxacin, (4) nitrofurantoin, or (5) norfloxacin. The main outcomes were effectiveness in terms of cure rates, symptom-free days (SFDs), and estimations of cost-effectiveness among this group. Results A total of 865 adult patients who presented with uUTIs were enrolled. Most patients (89.5%) completely recovered, whereas 10.5% of patients were readmitted to the ED with recurrent infections. Effectiveness in terms of the highest cure rate was observed with nitrofurantoin and amoxicillin/clavulanic acid (93.2% and 92.2%, respectively) followed by norfloxacin, cefuroxime, and ciprofloxacin; no significant differences in cure rates were found among these antibiotics. Antibiotic effectiveness in terms of SFDs showed that nitrofurantoin produced the longest SFD period (76 days) followed by amoxicillin/clavulanic acid (69 days). A cost-effectiveness analysis in terms of uUTI cure rates and number of SFDs indicated that nitrofurantoin presented the highest cost-effectiveness followed by amoxicillin/clavulanic acid, norfloxacin, ciprofloxacin, and cefuroxime. Conclusion A comparison of five antibiotics for uUTI treatment did not yield clinically significant differences in cure rates. Nitrofurantoin was more cost-effective than the other antibiotics.
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Affiliation(s)
- Menyfah Q Alanazi
- Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Relationship between the Biofilm-Forming Capacity and Antimicrobial Resistance in Clinical Acinetobacter baumannii Isolates: Results from a Laboratory-Based In Vitro Study. Microorganisms 2021; 9:microorganisms9112384. [PMID: 34835509 PMCID: PMC8618777 DOI: 10.3390/microorganisms9112384] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
The relationship between the multidrug-resistant (MDR) phenotype and biofilm-forming capacity has been a topic of extensive interest among biomedical scientists, as these two factors may have significant influence on the outcomes of infections. The aim of the present study was to establish a possible relationship between biofilm-forming capacity and the antibiotic-resistant phenotype in clinical Acinetobacter baumannii (A. baumannii) isolates. A total of n = 309 isolates were included in this study. Antimicrobial susceptibility testing and the phenotypic detection of resistance determinants were carried out. The capacity of isolates to produce biofilms was assessed using a crystal violet microtiter-plate-based method. Resistance rates were highest for ciprofloxacin (71.19%; n = 220), levofloxacin (n = 68.61%; n = 212), and trimethoprim-sulfamethoxazole (n = 66.02%; n = 209); 42.72% (n = 132) of isolates were classified as MDR; 22.65% (n = 70) of tested isolates were positive in the modified Hodge-test; the overexpression of efflux pumps had significant effects on the susceptibilities of meropenem, gentamicin, and ciprofloxacin in 14.24% (n = 44), 6.05% (n = 19), and 27.51% (n = 85), respectively; 9.39% (n = 29), 12.29% (n = 38), 22.97% (n = 71), and 55.35% (n = 170) of isolates were non-biofilm-producing and weak, moderate, and strong biofilm producers, respectively. A numerical, but statistically not significant, difference was identified between the MDR and non-MDR isolates regarding their biofilm-forming capacity (MDR: 0.495 ± 0.309 vs. non-MDR: 0.545 ± 0.283; p = 0.072), and no association was seen between resistance to individual antibiotics and biofilm formation. Based on numerical trends, MER-resistant isolates were the strongest biofilm producers (p = 0.067). Our study emphasizes the need for additional experiments to assess the role biofilms have in the pathogenesis of A. baumannii infections.
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Aslam A, Zin CS, Ab Rahman NS, Gajdács M, Ahmed SI, Jamshed S. Self-Medication Practices with Antibiotics and Associated Factors among the Public of Malaysia: A Cross-Sectional Study. DRUG HEALTHCARE AND PATIENT SAFETY 2021; 13:171-181. [PMID: 34737648 PMCID: PMC8560071 DOI: 10.2147/dhps.s331427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/06/2021] [Indexed: 12/28/2022]
Abstract
Background Self-medication with antibiotics (SMA) is an important public health issue, which can result in the facilitated development of antibiotic resistance, and may increase the risk of inappropriate utilization of antibiotics. So, the objective of the present study was to estimate the prevalence rate of SMA and to also explore SMA practices among the lay population of Kuala Lumpur (Malaysia). Methods The current study was cross-sectional population-based and used a convenient sampling technique. Moreover, Lorenz’s formula was used to calculate the sample size and the required sample size was 480. Data were collected through face-to-face interviews with a pre-validated questionnaire and the study was conducted in Kuala Lumpur (Malaysia). Descriptive statistics, cross-tabulation, and logistic regression were executed by using SPSS version 24. Results Out of 480 participants, 45.8% were polled male and the prevalence of SMA in this study was found to be 15.1%. The majority of participants 23.1% indicated that they practiced antibiotics at least once in the last six months. The commonly self-medicated antibiotics were amoxicillin-clavulanate 20.6%, ampicillin/cloxacillin 14.2%, and levofloxacin 8.3%. Moreover, 64.8% of participants indicated that they bought their antibiotics from pharmacies. Whereas, most of the participants practice antibiotics to save money 19.2% and time 23.1%. Findings from multivariate logistic regressions showed that predictors of SMA were male gender, (95% CI: 0.300–0.877) occupation (95% CI: 0.122–10.797), health insurance (95% CI: 0.025–0.472), and education (95% CI: 0.084–0.800). Conclusion The results of this study indicate that SMA persists among the community and education level has a significant impact on this behavior. Thus, concerning health management authorities should step in with developing legislation to stop this practice, and by implementing such interventions and policies to educate and to raise awareness about the risk of SMA for the future.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, 6720, Hungary
| | - Syed Imran Ahmed
- School of Pharmacy, College of Science, University of Lincoln, Lincoln, UK
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin, Besut, Terengganu, 22200, Malaysia
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Garduno A, Martín-Loeches I. Efficacy and appropriateness of novel antibiotics in response to antimicrobial-resistant Gram-negative bacteria in patients with sepsis in the ICU. Expert Rev Anti Infect Ther 2021; 20:513-531. [PMID: 34727820 DOI: 10.1080/14787210.2022.1999804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION There is an ever-increasing range of antibiotic-resistant pathogens that have led to higher community-acquired infections, and substantial mortality rates in critically ill patients. AREAS COVERED We have critically appraised available evidence through a structured literature review, investigating effective empiric antibiotic administration and appropriateness on outcomes of critically ill patients with an increased risk of developing resistant pathogens. The use of new antibiotics should be determined based on relevant knowledge of their spectrum and properties to provide effective mode of action for critically ill patients. EXPERT OPINION Restricting severely ill patients access to new broad-spectrum empirical drugs is not the answer. Rather there should be a focus on identifying host response to infection to differentiate between colonization or contamination and true infection, and the sensitivity to antibiotics used in the intensive care unit (ICU). Management relies on adequate antibiotic administration, the ability to monitor response, and facilitate the cessation of antibiotic treatment. The major determinant of patient success in a patient with a severe infection is the 'right' antibiotic or complementary course of treatment. As an overarching criterion, the following 3 appropriate "Ds" should be considered: Dosing, Duration and De-escalation to empirically assess the right antibiotic optimal antimicrobial selection.
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Affiliation(s)
- Alexis Garduno
- Department of Clinical Medicine, Intensive Care Translational Research, Trinity College Dublin
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, (Ireland)
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Interplay between Phenotypic Resistance to Relevant Antibiotics in Gram-Negative Urinary Pathogens: A Data-Driven Analysis of 10 Years' Worth of Antibiogram Data. Life (Basel) 2021; 11:life11101059. [PMID: 34685429 PMCID: PMC8537761 DOI: 10.3390/life11101059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/18/2022] Open
Abstract
The global emergence of antimicrobial resistance (AMR) has become a critical issue for clinicians, as it puts the decades of developments in the medical field in jeopardy, by severely limiting the useful therapeutic arsenal of drugs, both in nosocomial and community-acquired infections. In the present study, a secondary analysis of taxonomic and resistance data was performed, corresponding to urinary tract infections (UTIs) caused by Gram-negative bacteria, detected between 1 January 2008 to 31 December 2017 at the Albert Szent-Györgyi Health Center, University of Szeged. The following were identifiable from the data collected: year of isolation; outpatient (OP)/inpatient (IP) origin of the isolate; taxonomy; and susceptibility/resistance to selected indicator antibiotics. Principal component analysis (PCA) and a correlation matrix were used to determine the association between the presences of resistance against indicator antibiotics in each taxonomic group. Overall, data from n = 16,240 outpatient and n = 13,964 inpatient Gram-negative UTI isolates were included in the data analyses. In E. coli, strong positive correlations were seen between resistance to ciprofloxacin (CIP) and gentamicin (GEN) resistance (OP: r = 0.6342, p = 0.049; IP: r = 0.9602, p < 0.001), whereas strong negative correlations were shown for fosfomycin (FOS) and nitrofurantoin (NIT) resistance (OP: r = -0.7183, p = 0.019; IP: r = -0.7437; p = 0.014). For Klebsiella spp. isolates, CIP resistance showed strong positive correlation with resistance to third-generation cephalosporins (3GC) and GEN (r = 0.7976, p = 0.006 and r = 0.7428, p = 0.014, respectively) in OP isolates, and with resistance to trimethoprim-sulfamethoxazole (SXT) and FOS (r = 0.8144, p = 0.004 and r = 0.7758, p < 0.001, respectively) in IP isolates. For members of the Citrobacter-Enterobacter-Serratia group, the resistance among indicator antibiotics showed a strong positive correlation, with the exception of FOS resistance. In the Proteus-Providencia-Morganella group, the strongest association was noted between CIP and SXT resistance (OP: r = 0.9251, p < 0.001; IP: r = 0.8007; p = 0.005). In the case of OP Acinetobacter spp., CIP showed strong and significant positive correlations with most indicator antibiotics, whereas for IP isolates, strong negative correlations arose among imipenem (IMI) resistance and resistance to other drugs. For Pseudomonas spp., strong and positive correlations were noted among resistance to β-lactam antibiotics and aminoglycosides, with the exception of ceftazidime (CEFT), showing strong, but negative correlations. Though molecular tests and sequencing-based platforms are now considered as the gold-standard for AMR surveillance, standardized collection of phenotypic resistance data and the introduction of Big Data analytic methods may be a viable alternative for molecular surveillance, especially in low-resource settings.
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Dankul P, Karaketklang K, Jitmuang A. Nosocomial Fever in General Medical Wards: A Prospective Cohort Study of Clinical Characteristics and Outcomes. Infect Drug Resist 2021; 14:3873-3881. [PMID: 34584431 PMCID: PMC8464320 DOI: 10.2147/idr.s328395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Nosocomial fever (NF) is a common sign of healthcare-associated infection; however, infection is not always followed up. We studied the etiology, clinical characteristics, and outcomes of nosocomial fever in hospitalized patients. Patients and Methods Between October 2019 and December 2020, we enrolled subjects from general medical wards who developed fever ≥48 hours after hospital admission or who were admitted with fever, defervesced, and then developed a fever ≥7 days later that was unrelated to the cause for admission. Subjects with NF underwent a comprehensive clinical evaluation and laboratory investigations. Results Eighty-six cases of NF were identified and completely followed, the mean age was 69.29 years, and 35 were male. Fifty-seven were from infectious etiologies, 28 from non-infectious etiologies, and one case was unable to be determined. Hospital-associated pneumonia (47.4%) and urinary tract infection (22.8%) were the most common infectious causes, and malignancy (17.8%) and large hematoma (14.3%) were the most common non-infectious causes. The median day of onset of NF following hospitalization was 12 (4.7–21.2) days. Acute physiology and chronic health evaluation II (APACHE II) score (14.70 vs 11.97, p = 0.02), sequential organ failure assessment (SOFA) scores (4 vs 2, p < 0.01), pertinent clinical findings (82.5% vs 42.9%, p < 0.01), blood urea nitrogen (BUN) (37.30 vs 21.10, p = 0.03) and creatinine (1.41 vs 0.97, p = 0.05) levels, and abnormal chest radiography (45.6% vs 3.6%, p < 0.01) had significant differences between infectious and non-infectious etiologies. Twenty-three subjects (26.7%) died. The presence of end-stage renal disease (ESRD) [OR 19.49 (1.77–214.18), p = 0.015], SOFA score >6 [OR 5.18 (1.04–25.90), p = 0.045], and abnormal chest radiography [OR 3.45 (1.16–10.29), p = 0.026] were significantly associated with mortality. Conclusion Nosocomial infections, malignancy, and hematoma were the leading causes of NF. Severity scores, clinical findings, renal function tests, and chest radiography were distinguishing features between infectious and non-infectious etiologies. ESRD, high SOFA scores, and abnormal chest radiography were associated with mortality.
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Affiliation(s)
- Parita Dankul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anupop Jitmuang
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Wang Y, Liu H, Zhang L, Sun B. Application of Modified Carbapenem Inactivation Method and Its Derivative Tests for the Detection of Carbapenemase-Producing Aeromonas. Infect Drug Resist 2021; 14:3949-3960. [PMID: 34594118 PMCID: PMC8478511 DOI: 10.2147/idr.s330115] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Infection and transmission of carbapenem-resistant Aeromonas is a serious threat to public health. Rapid and accurate detection carbapenem-resistant of these organisms is essential for reasonable treatment and infection control. This study aimed to find a simple and effective method to detect carbapenem-resistant phenotype in Aeromonas. METHODS A total of 131 clinical preserved Aeromonas strains were used in this study. The carbapenemase genes were detected by PCR. Modified carbapenem inactivation method (mCIM) in conjunction with EDTA-modified carbapenem inactivation method (eCIM) and simplified carbapenem inactivation method (sCIM) were performed to detect carbapenemases. We also designed a simple method, carbapenem inactivation method using supernatant (CIM-s), to detect the carbapenemase activity in the medium. RESULTS Of the 131 Aeromonas strains, 79 contained carbapenemase genes, including 68 blaCphA , 6 blaKPC-2 , 2 blaNDM-1 and 3 blaKPC-2+CphA . However, routine antibiotic susceptibility testing could not completely identify carbapenemase-producing Aeromonas. In phenotypic assays, the sensitivity and specificity of mCIM were 100%. The combined mCIM and eCIM could distinguish serine carbapenemase and metallo-β-carbapenemases except co-producing organisms. The sensitivity and specificity of sCIM were 92.4% and 100%, respectively, which could not detect CphA totally. CIM-s results indicate that these carbapenemases could secrete into the medium to perform their hydrolytic activities and had a sensitivity and specificity of 97.5% and 100%, respectively. CONCLUSION The combination of mCIM and eCIM can effectively detect and distinguish different types of carbapenemase in Aeromonas, and could be used as an important supplement approach to the antibiotic susceptibility testing.
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Affiliation(s)
- Yunying Wang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hui Liu
- Department of Blood Transfusion, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Lijun Zhang
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Bin Sun
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Shi HJ, Wee JH, Eom JS. Challenges to Early Discharge of Patients with Upper Urinary Tract Infections by ESBL Producers: TMP/SMX as a Step-Down Therapy for Shorter Hospitalization and Lower Costs. Infect Drug Resist 2021; 14:3589-3597. [PMID: 34511950 PMCID: PMC8422030 DOI: 10.2147/idr.s321888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/30/2021] [Indexed: 12/25/2022] Open
Abstract
Background Urinary tract infections (UTIs) caused by extended spectrum beta-lactamase (ESBL) producing pathogens have increased and are treated with carbapenem in general. Carbapenem use is associated with prolonged hospitalization or daily outpatient visit. The aim of this study was to investigate patients with UTIs by ESBL-producing pathogens for early discharge using an old oral antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), which is susceptible to ESBL-producing pathogens. Methods Data on UTIs caused by ESBL-producing pathogens from a single tertiary hospital were collected retrospectively. Patients who had been treated with intravenous carbapenems or oral TMP/SMX were included. Patients’ clinical and microbiological outcomes were compared between oral TMP/SMX and ertapenem treatment groups. Results A total of 103 patients were included, 21 of whom had been treated with TMP/SMX, whereas 82 with ertapenem. Clinical outcomes between the two groups were not significantly different (TMP/SMX: 90.5%; ertapenem: 84.1%, p = 0.73). The microbiological cure rate was higher in the TMP/SMX group than in the ertapenem group (90.5% vs 58.5%, respectively, p = 0.01). The mean duration of hospitalization was significantly shorter in the TMP/SMX group than in the ertapenem group (8.00 ± 10.50 days vs 14.00 ± 37.00 days, p = 0.07). The mean duration of antibiotic treatment was longer in the ertapenem group than in the TMP/SMX group (16.45 ± 4.77 vs 12.76 ± 5.37 days, p = 0.006). Conclusion For susceptible pathogens, TMP/SMX may enable early discharge as an effective oral antibiotic treatment option for UTIs caused by ESBL-positive pathogens. Additionally, use of oral antibiotics can shorten hospital stays and reduce medical costs.
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Affiliation(s)
- Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Hee Wee
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Li J, Huang Z, Tang M, Min C, Xia F, Hu Y, Wang H, Zhou H, Zou M. Clonal Dissemination of Multiple Carbapenemase Genes in Carbapenem-Resistant Enterobacterales Mediated by Multiple Plasmids in China. Infect Drug Resist 2021; 14:3287-3295. [PMID: 34434053 PMCID: PMC8382312 DOI: 10.2147/idr.s327273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Carbapenem-resistant Enterobacterales (CRE) are rapidly increasing worldwide in last two decades and lead few antibiotics for treatment. The molecular epidemiology of CRE in China was investigated to provide basis for clinical rational use of antibiotics and prevent its spread. Methods All CRE isolates in this study were collected from 11 hospitals from October 2015 to July 2018. The isolates were subjected to antimicrobial susceptibility tests, PCR molecular identification, pulsed-field gel electrophoresis, and multilocus sequence typing. Results Among the 399 CRE isolates, 51.6% (206/399) harbored carbapenemase genes. Three carbapenemase genes were detected, namely bla KPC-2, bla NDM-1, and bla IMP at rates of 29.8% (119/399), 17.5% (70/399), and 4.0% (16/399), respectively. In Klebsiella pneumoniae (350) and Escherichia coli (26), bla KPC-2 (33.4%, 117/350) and bla NDM-1 (61.5%, 16/26) were the predominant genes. The most common genes in the CRE isolates were bla KPC (85.5%) and bla NDM-1 (76.5%) from adults and children, respectively. Particularly, ST11 K. pneumoniae with bla KPC-2 harbored by IncFII plasmids were distributed in both general and primary hospitals, suggesting a clonal transmission pattern at these sites. In addition, the clonal distribution of ST2407 K. pneumoniae with bla NDM-1 located on IncX3 plasmids and bla IMP-38-positive ST307 K. pneumoniae were detected in a children's hospital. Conclusion The distribution of carbapenemase genes differed among strains and age groups. Multiple carbapenemase genes in the CRE strains were clonally disseminated in the tested regions mediated by multiple plasmids. Therefore, CRE monitoring should be increased and measures should be adopted to prevent its transmission.
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Affiliation(s)
- Jun Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Ziyan Huang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Mengli Tang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Changhang Min
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Fengjun Xia
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Yongmei Hu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Haichen Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Mingxiang Zou
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
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El-Mahdy R, Mahmoud R, Shrief R. Characterization of E. coli Phylogroups Causing Catheter-Associated Urinary Tract Infection. Infect Drug Resist 2021; 14:3183-3193. [PMID: 34429618 PMCID: PMC8378909 DOI: 10.2147/idr.s325770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Characterization of different uropathogenic E. coli (UPEC) phylogroups is crucial to understand pathogenesis of urinary tract infection (UTI). The objective of our study was to evaluate the antibiotic resistance pattern, biofilm formation and pathogenicity islands (PAIs) of UPEC phylogroups isolated from catheter-associated UTI (CAUTI) compared to community UTI (Com-UTI). PATIENTS AND METHODS This study included 90 UPEC strains recovered from CAUTI and Com-UTI. Antimicrobial susceptibility was tested by the Kirby-Bauer method and extended spectrum beta-lactamase (ESBL) production was confirmed using the combined disk. The biofilm formation was tested using the microtiter plate assay. Main E. coli phylogroups (A, B1, B2 and D) were detected by multiplex PCR and 2 multiplex PCR detected the 8 PAIs. RESULTS Antibiotic resistance of UPEC strains showed a similar high resistance in CAUTI and Com-UTI. Isolates from CAUTI significantly produced biofilm higher than Com-UTI strains (68.9% vs 44.4%). In CAUTI and Com-UTI isolates, phylogroup A was the commonest (53.3% vs 48.9%, respectively). PAI IV536 was the most common in the strains from CAUTI (71.1%) and Com-UTI (73.3%). No significant relationship was detected between the studied characters and different phylogroups except the significant resistance to cefotaxime, ceftazidime and aztreonam among phylogroups from CAUTI isolates. CONCLUSION Increased antibiotic resistance and ESBLs were detected in UPEC strains from CAUTI and Com-UTI. The strains from CAUTI significantly produced biofilm higher than Com-UTI strains. Phylogroup A was the predominate phylogroup and PAI IV536 was the most prevalent marker in all phylogroups from both types of UTI.
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Affiliation(s)
- Rasha El-Mahdy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha Mahmoud
- Internal Medicine Department, Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Raghdaa Shrief
- Medical Microbiology and Immunology Department, Faculty of Medicine, Damietta University, Damietta, Egypt
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Arbune M, Gurau G, Niculet E, Iancu AV, Lupasteanu G, Fotea S, Vasile MC, Tatu AL. Prevalence of Antibiotic Resistance of ESKAPE Pathogens Over Five Years in an Infectious Diseases Hospital from South-East of Romania. Infect Drug Resist 2021; 14:2369-2378. [PMID: 34194233 PMCID: PMC8238535 DOI: 10.2147/idr.s312231] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/26/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE This study aimed at identifying the main antimicrobial resistance of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli) pathogens in a Romanian infectious diseases hospital. This antimicrobial resistance is a global threat, having high rates of multidrug resistance and limited treatment options. PATIENTS AND METHODS This retrospective study (2016-2020) assessed the antimicrobial resistance of ESKAPE pathogens isolated from the patient's biological samples. The microbiological diagnosis was performed by classical culture methods. The antimicrobial susceptibility analysis used the Kirby-Bauer disk-diffusion method and the method of minimum inhibiting concentration with the automated Vitek, according to the CLSI (Clinical and Laboratory Standards Institute) standards. RESULTS Included in this study were 4293 bacterial isolates: 67% Gram-negative bacilli, 31% Gram-positive cocci and 2% other morphotinctorial bacteria. ESKAPE pathogens were found in 97% of the bacterial isolates strains; E. coli (38.26%) and Staphylococcus aureus (26%) were the most prevalent. Most bacterial strains were isolated from urine cultures (45.6%), skin and soft tissue secretions/collections (35.9%) and also blood cultures (4.2%). Increased antimicrobial resistance was observed for methicillin-resistant Staphylococcus aureus (MRSA)s, extended spectrum beta-lactamase producing (ESBL) Enterobacterales, carbapenem-resistant (CR) Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. No vancomycin resistance was found for Enterococcus faecium. The highest prevalence rates of multidrug resistance were found in methicillin-resistant Staphylococcus aureus (86.6%), Acinetobacter baumannii (36.8%), Pseudomonas aeruginosa (29.1%) and Klebsiella pneumoniae (24.4%). CONCLUSION ESKAPE pathogens are frequently isolated in the infectious diseases hospital, with main antimicrobial resistance: ESBL, MRSA and CR. The local antimicrobial resistance pattern is essential in updating the local protocols and for appropriately prescribing antibiotics. Streamlining microbiological diagnosis and aligning with the European standards for antimicrobial susceptibility testing are necessary steps in harmonizing the regional network for good antimicrobial resistance control practices.
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Affiliation(s)
- Manuela Arbune
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, Clinical Hospital of Infectious Diseases “Sf. Cuvioasa Parascheva”, Galati, Romania
| | - Gabriela Gurau
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
- Department of Pathology, “Sf. Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Alina Viorica Iancu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
- Medical Laboratory Department, Clinical Hospital of Infectious Diseases “Sf. Cuvioasa Parascheva”, Galati, Romania
| | - Gabriela Lupasteanu
- Infectious Diseases Department, Clinical Hospital of Infectious Diseases “Sf. Cuvioasa Parascheva”, Galati, Romania
- Medical Doctoral School, “Ovidius” University, Constanta, Romania
| | - Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
| | - Mihaela Camelia Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Infectious Diseases Department, Clinical Hospital of Infectious Diseases “Sf. Cuvioasa Parascheva”, Galati, Romania
| | - Alin Laurentiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galati, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galati, Romania
- Dermatology Department, Clinical Hospital of Infectious Diseases “Sf. Cuvioasa Parascheva”, Galati, Romania
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Rapid and Accurate Detection of Escherichia coli and Klebsiella pneumoniae Strains Susceptible/Resistant to Cotrimoxazole through Evaluation of Cell Elongation. Antibiotics (Basel) 2021; 10:antibiotics10060720. [PMID: 34203917 PMCID: PMC8232604 DOI: 10.3390/antibiotics10060720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/03/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022] Open
Abstract
Trimethoprim-sulfamethoxazole is a well-known antibiotic that inhibits folic acid synthesis, a topic of renewed interest. Since resistant strains are increasingly more common, an early and accurate discrimination of susceptibility may assure confident therapy. Two morphological assays were performed in Escherichia coli (n = 50; 27 non-susceptible) and Klebsiella pneumoniae (n = 52; 18 non-susceptible). First, the strains were incubated with the CLSI breakpoint of cotrimoxazole for 150 min, which induced cell lengthening in the susceptible strains. Second, the bacteria were incubated with mitomycin C (MMC) (0.5 mg/L) for 120 min to induce a SOS-linked cell enlargement higher than that obtained by cotrimoxazole alone. When cotrimoxazole was added 30 min before MMC, the inhibition of folic acid synthesis in the susceptible strain resulted in the suppression of MMC-induced extra elongation. In the non-susceptible strains, folic acid synthesis continued despite the antibiotic, so that the MMC-induced extra cell lengthening could not be impeded. Whereas the first assay resulted in five false negatives and four false positives of resistance, the results of the second assay matched those of the conventional antibiogram. This simple morphological procedure is performed in 2 h and 45 min and may allow a rapid selection of useful and relatively inexpensive therapy, thereby preserving the newer broad-spectrum antibiotics.
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Grünzweil OM, Palmer L, Cabal A, Szostak MP, Ruppitsch W, Kornschober C, Korus M, Misic D, Bernreiter-Hofer T, Korath ADJ, Feßler AT, Allerberger F, Schwarz S, Spergser J, Müller E, Braun SD, Monecke S, Ehricht R, Walzer C, Smodlaka H, Loncaric I. Presence of β-Lactamase-producing Enterobacterales and Salmonella Isolates in Marine Mammals. Int J Mol Sci 2021; 22:ijms22115905. [PMID: 34072783 PMCID: PMC8199236 DOI: 10.3390/ijms22115905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
Marine mammals have been described as sentinels of the health of marine ecosystems. Therefore, the aim of this study was to investigate (i) the presence of extended-spectrum β-lactamase (ESBL)- and AmpC-producing Enterobacterales, which comprise several bacterial families important to the healthcare sector, as well as (ii) the presence of Salmonella in these coastal animals. The antimicrobial resistance pheno- and genotypes, as well as biocide susceptibility of Enterobacterales isolated from stranded marine mammals, were determined prior to their rehabilitation. All E. coli isolates (n = 27) were screened for virulence genes via DNA-based microarray, and twelve selected E. coli isolates were analyzed by whole-genome sequencing. Seventy-one percent of the Enterobacterales isolates exhibited a multidrug-resistant (MDR) pheno- and genotype. The gene blaCMY (n = 51) was the predominant β-lactamase gene. In addition, blaTEM-1 (n = 38), blaSHV-33 (n = 8), blaCTX-M-15 (n = 7), blaOXA-1 (n = 7), blaSHV-11 (n = 3), and blaDHA-1 (n = 2) were detected. The most prevalent non-β-lactamase genes were sul2 (n = 38), strA (n = 34), strB (n = 34), and tet(A) (n = 34). Escherichia coli isolates belonging to the pandemic sequence types (STs) ST38, ST167, and ST648 were identified. Among Salmonella isolates (n = 18), S. Havana was the most prevalent serotype. The present study revealed a high prevalence of MDR bacteria and the presence of pandemic high-risk clones, both of which are indicators of anthropogenic antimicrobial pollution, in marine mammals.
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Affiliation(s)
- Olivia M. Grünzweil
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
| | - Lauren Palmer
- Marine Mammal Care Center, Los Angeles, CA 90731, USA;
| | - Adriana Cabal
- Austrian Agency for Health and Food Safety (AGES), Institute of Medical Microbiology and Hygiene, 1090 Vienna, Austria; (A.C.); (W.R.); (F.A.)
| | - Michael P. Szostak
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
| | - Werner Ruppitsch
- Austrian Agency for Health and Food Safety (AGES), Institute of Medical Microbiology and Hygiene, 1090 Vienna, Austria; (A.C.); (W.R.); (F.A.)
| | - Christian Kornschober
- Austrian Agency for Health and Food Safety (AGES), National Reference Centre for Salmonella, 8010 Graz, Austria;
| | - Maciej Korus
- Department of Functional Food Products Development, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wroclaw, Poland; (M.K.); (D.M.)
| | - Dusan Misic
- Department of Functional Food Products Development, Faculty of Biotechnology and Food Science, Wroclaw University of Environmental and Life Sciences, 51-630 Wroclaw, Poland; (M.K.); (D.M.)
| | - Tanja Bernreiter-Hofer
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
- Department for Farm Animals and Veterinary Public Health, University Clinic for Swine, University of Veterinary Medicine, 1210 Vienna, Austria
| | - Anna D. J. Korath
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
| | - Andrea T. Feßler
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany; (A.T.F.); (S.S.)
| | - Franz Allerberger
- Austrian Agency for Health and Food Safety (AGES), Institute of Medical Microbiology and Hygiene, 1090 Vienna, Austria; (A.C.); (W.R.); (F.A.)
| | - Stefan Schwarz
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany; (A.T.F.); (S.S.)
| | - Joachim Spergser
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
| | - Elke Müller
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (E.M.); (S.D.B.); (S.M.); (R.E.)
- InfectoGnostics Research Campus, 07743 Jena, Germany
| | - Sascha D. Braun
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (E.M.); (S.D.B.); (S.M.); (R.E.)
- InfectoGnostics Research Campus, 07743 Jena, Germany
| | - Stefan Monecke
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (E.M.); (S.D.B.); (S.M.); (R.E.)
- InfectoGnostics Research Campus, 07743 Jena, Germany
- Institute for Medical Microbiology and Hygiene, Technical University of Dresden, 01307 Dresden, Germany
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), 07745 Jena, Germany; (E.M.); (S.D.B.); (S.M.); (R.E.)
- InfectoGnostics Research Campus, 07743 Jena, Germany
- Institute of Physical Chemistry, Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Chris Walzer
- Research Institute of Wildlife Ecology, University of Veterinary Medicine, 1160 Vienna, Austria;
- Health Program, Wildlife Conservation Society, Bronx, New York City, NY 10460, USA
| | - Hrvoje Smodlaka
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91766-1854, USA;
| | - Igor Loncaric
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (O.M.G.); (M.P.S.); (T.B.-H.); (A.D.J.K.); (J.S.)
- Correspondence: ; Tel.: +43-125-077-2115
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Ong A, Mahobia N, Browning D, Schembri M, Somani BK. Trends in antibiotic resistance for over 700,000 Escherichia coli positive urinary tract infections over six years (2014-2019) from a university teaching hospital. Cent European J Urol 2021; 74:249-254. [PMID: 34336246 PMCID: PMC8318021 DOI: 10.5173/ceju.2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/04/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Antibiotic microbial resistance (AMR) is a global health problem. Our aim was to review the resistance of Escherichia (E.coli) to antibiotics at our university hospital over a six-year period and see whether our protocol based antibiotic policy over this time led to any change in the resistance patterns. Material and methods Sensitivities of E.coli urine isolates between 2014–2019 (6-years) were sourced from the hospital and general practitioners in the community and collected from the microbiology department. Trends of resistance for amoxicillin, tazocin, cefalexin, ciprofloxacin, co-amoxiclav, gentamicin, nitrofurantoin, trimethoprim, amikacin, and pivmecillinam were examined using the Cochran-Armitage test. Results 712,004 urine samples tested positive for E. coli. The overall resistance trends for cefalexin, nitrofurantoin and amikacin remained equivocal; increased for ciprofloxacin, co-amoxiclav, gentamicin, and tazocin; and decreased for fosfomycin, pivmecillinam, and trimethoprim. Conclusions Despite our protocol based antibiotic policy, although the overall antibiotic resistance remained stable, there was an increasing trend in antibiotic resistance for more commonly used antibiotics including ciprofloxacin, co-amoxiclav, gentamicin, and tazocin reflecting their overall use for prophylaxis and treatment. We plan to continue our policy of reviewing our antibiotic usage and the prescribing protocol with the microbiology department to minimize antibiotic resistance.
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Affiliation(s)
- Andrea Ong
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Nitin Mahobia
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Dave Browning
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Matthew Schembri
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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Wang G, Yu W, Cui Y, Shi Q, Huang C, Xiao Y. Optimal empiric treatment for KPC-2-producing Klebsiella pneumoniae infections in critically ill patients with normal or decreased renal function using Monte Carlo simulation. BMC Infect Dis 2021; 21:307. [PMID: 33771113 PMCID: PMC8004468 DOI: 10.1186/s12879-021-06000-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/18/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Limited clinical studies describe the pharmacodynamics of fosfomycin (FOS), tigecycline (TGC) and colistin methanesulfonate (CMS) in combination against KPC-producing Klebsiella pneumoniae (KPC-Kp). Population pharmacokinetic models were used in our study. Monte Carlo simulation was conducted to calculate probability of target attainment (PTA) and cumulative fraction of response (CFR) of each agent alone and in combination against KPC-Kp in patients with normal or decreased renal function. RESULTS The simulated regimen of FOS 6 g q8h reached ≥90% PTA against a MIC of 64 mg/L in patients with normal renal function. For patients with renal impairment, FOS 4 g q8h could provide sufficient antimicrobial coverage against a MIC of 128 mg/L. And increasing the daily dose could result to the cut-off value to 256 mg/L in decreased renal function. For TGC, conventional dosing regimens failed to reach 90% PTA against a MIC of 2 mg/L. Higher loading and daily doses (TGC 200/400 mg loading doses followed by 100 mg q12h/200 mg q24h) were needed. For CMS, none achieved 90% PTA against a MIC of 2 mg/L in normal renal function. Against KPC-Kp, the regimens of 200/400 mg loading dose followed by 100 q12h /200 mg q24h achieved > 80% CFRs regardless of renal function, followed by CMS 9 million IU loading dose followed by 4.5/3 million IU q12h in combination with FOS 8 g q8h (CFR 75-91%). CONCLUSIONS The use of a loading dose and high daily dose of TGC and CMS in combination with FOS can provide sufficient antimicrobial coverage against critically ill patients infected with KPC-Kp.
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Affiliation(s)
- Guoan Wang
- Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315000, China
| | - Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yushan Cui
- Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315000, China
| | - Qingyi Shi
- Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315000, China
| | - Chen Huang
- Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, 315000, China.
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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Tesfa T, Baye Y, Sisay M, Amare F, Gashaw T. Bacterial uropathogens and susceptibility testing among patients diagnosed with urinary tract infections at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. SAGE Open Med 2021; 9:20503121211001162. [PMID: 33796299 PMCID: PMC7970184 DOI: 10.1177/20503121211001162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Urinary tract infection is a common infection posing a significant healthcare
burden globally. Currently, it is becoming hard to manage due to the drug
resistance of uropathogens. This study aimed to evaluate the rate of culture
positivity and the susceptibility pattern of isolates among clinically
diagnosed patients with urinary tract infection. Methods: An institution-based cross-sectional study was conducted on patients
clinically diagnosed with urinary tract infections and received a drug
prescription at Hiwot Fana Specialized University Hospital from August 2018
to June 2019. A clean-catch mid-stream urine specimen was collected and
bacterial identification and susceptibility test were performed using
standard microbiological methods. Data were entered into EpiInfo 7 and
exported to STATA 15 for analysis. Data were analyzed using descriptive
analysis and bi-variate and multivariate regression analyses and presented
with graphs, frequency, and tables. Results: A total of 687 urine samples were collected from patients with clinically
diagnosed urinary tract infections. The mean age was 31 years and 56.62%
were female. 28.38% of the participants had a culture-positive result, of
which 86.15% had monomicrobial infections. Inpatients (AOR = 3.8, 95% CI =
(1.8–7.9)) and hypertensive patients (AOR = 2.1, 95% CI = (1.1–4.4)) had
higher odds of culture-positive results. Staphylococcus
species (35.3%), E. coli (25.34%),
Pseudomonas species (6.8%), and other Enterobacterales
are isolated. Most isolates showed resistance to more than one drug, and
amikacin, gentamicin, and nitrofurantoin showed relatively higher activity
against isolates. Conclusion: About one-third of the clinically diagnosed patients with urinary tract
infection were culture-positive with many types of bacterial uropathogens.
Inpatients and hypertensive patients had a higher risk of developing
bacterial infections. Bacterial isolates showed different percentages of
susceptibility to the tested antibiotics.
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Affiliation(s)
- Tewodros Tesfa
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Paediatrics & Child Health Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Pharmaceutical Analysis, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mouanga Ndzime Y, Onanga R, Kassa Kassa RF, Bignoumba M, Mbehang Nguema PP, Gafou A, Lendamba RW, Mbombe Moghoa K, Bisseye C. Epidemiology of Community Origin Escherichia coli and Klebsiella pneumoniae Uropathogenic Strains Resistant to Antibiotics in Franceville, Gabon. Infect Drug Resist 2021; 14:585-594. [PMID: 33623399 PMCID: PMC7896796 DOI: 10.2147/idr.s296054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/06/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Urinary tract infection is one of the major causes of consultation, microbiologic exploration, intensive use of antibiotics worldwide, and the second leading cause of clinical consultation in community practice. Many bacteria play a role in the urinary tract infections etiology, including Enterobacteriaceae such as Escherichia coli (E. coli) and Klebsiella spp. Objective The study’s main objective was to examine the epidemiology of E. coli and Klebsiella pneumoniae (K. pneumoniae) uropathogenic strains resistant to antibiotics in Franceville. Methodology The study was carried out between January 2018 and June 2019 in Franceville South-East Gabon. We examined a total of 1086 cytobacteriological urine samples. The identification of E. coli and K. pneumoniae strains was carried out using the Vitek-2 compact automated system and the antibiogram with the disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing recommendations. Results The prevalence of urinary tract infections was 29.2% (317/1086), of which 25.1% and 4.1% were mono-infections and co-infections, respectively. The prevalence of UTIs with E. coli was 28.7% (91/317) with a predominance of isolation in women. K. pneumoniae was responsible for 16.2% (61/317) of UTIs. E. coli and K. pneumoniae Uropathogenic strains showed resistance to beta-lactams, quinolones and cotrimoxazole, whereas Nitrofurantoin, Amikacin, Imipenem and Ertapenem were the most active antibiotics against E. coli and K. pneumoniae uropathogenic strains. Conclusion This study showed a high prevalence of urinary tract infections with a major implication of E.coli and K. pneumoniae strains. E. coli and K. pneumoniae presented high frequency of resistance to antibiotics, highlighting the need to adapt their use accordingly at the local level.
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Affiliation(s)
- Yann Mouanga Ndzime
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
| | - Richard Onanga
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roland Fabrice Kassa Kassa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Michelle Bignoumba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Pierre Philippe Mbehang Nguema
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon.,Institut de Recherche en Ecologie Tropicale, Centre National de la Recherche Scientifique et Technologique (CENAREST), Libreville, BP 13354, Gabon
| | - Amahani Gafou
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Roméo Wenceslas Lendamba
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Kelly Mbombe Moghoa
- Unité de Recherche et d'Analyses Médicales, Laboratoire de Bactériologie, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, BP 769, Gabon
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku, Franceville, BP 943, Gabon
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Abd El-Ghany WA. A spotlight on Raoultella ornithinolytica: A newly emerging life-threatening zoonotic pathogen. INTERNATIONAL JOURNAL OF ONE HEALTH 2021. [DOI: 10.14202/ijoh.2021.1-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The genus Raoultella contains Raoultella ornithinolytica (R. ornithinolytica), which was previously named as Klebsiella ornithinolytica. R. ornithinolytica is a Gram-negative bacillus that belongs to the family Enterobacteriaceae. This pathogen is normally present in aquaculture, and it has been isolated from fish, insects, and wild and domestic birds. Seafood and poultry products are incriminated as sources of R. ornithinolytica infection. Community-acquired human infection with R. ornithinolytica is common. This infection is commonly associated with sepsis, bacteremia, food poisoning, purities, and urinary and respiratory tracts' infections. Rapid acquired resistance of R. ornithinolytica strains is common, and it is related to the development of resistant genes. R. ornithinolytica is considered as a newly emerging life-threatening pathogen world-wide. Hence, it is very important to determine the role of animals and birds in the epidemiological situation of this pathogen as well as the detection of antibiotic resistance genes before treatment.
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Affiliation(s)
- Wafaa A. Abd El-Ghany
- Department of Poultry Diseases, Faculty of Veterinary Medicine, Cairo University, Egypt
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Chelkeba L, Melaku T, Mega TA. Gram-Negative Bacteria Isolates and Their Antibiotic-Resistance Patterns in Patients with Wound Infection in Ethiopia: A Systematic Review and Meta-Analysis. Infect Drug Resist 2021; 14:277-302. [PMID: 33542636 PMCID: PMC7853426 DOI: 10.2147/idr.s289687] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia. METHODS Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses. RESULTS The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52-65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14-20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9-14%], Klebsiella pneumonia, 11% [95% CI: 9-13%], Proteus mirabilis, 8% [95% CI: 6-10%], Acinetobacter species, 4% [95% CI: 2-6%], Enterobacter species, 4% [95% CI: 3-5%], and Citrobacter species, 3% [95% CI: 2-4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66-86%], 84% [95% CI: 78-91%], 66% [95% CI:43-88%], 83% [95% CI:75-91%], 87% [95% CI:78-96%], 68% [95% CI:50-87%] and 71% [95% CI:46-96%], respectively. CONCLUSION There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.
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Affiliation(s)
- Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
- Jimma Medical Center, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teshale Ayele Mega
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abstract
Abstract
Introduction: Resistance to first-line antibiotics of the Proteeae strains within the difficult-to-treat (DTR) phenotype is a cause of limitation of therapeutic options. The study aimed to characterize these strains, to identify the factors that influence their acquisition and the predictive factors for the patient’s evolution.
Material and methods: Between July 2017 and January 2019, 400 of Proteeae strains were isolated from samples of patients admitted to intensive care units (ICUs) and surgical wards of a university hospital in Romania. The identification and testing of antibiotic sensitivity was performed using the Vitek 2 Compact system. The DTR phenotype was defined as the resistance (or intermediate resistance) to all categories of β-lactams, carbapenems and fluoroquinolones.
Results: Out of 400 Proteeae strains, 21% were of the DTR type, most of them from the species Providencia stuartii and Proteus mirabilis, identified predominantly on the ICUs. The excess fatality in the DTR subsample compared to the non-DTR subsample was 16.37%. The multivariate analysis identified as independent risk factors: the number of antibiotics administered, the number of days of urinary catheterization, the presence of tracheostomy, nasogastric nutrition, respectively belonging to the species P. stuartii. The probabilities of survival were reduced by the presence of the central venous catheter (CVC), tracheostomy, by the increase of the number of hospitalization days respectively of the number of antibiotics administered.
Conclusion: The DTR phenotype in the case of Proteeae strains has been associated especially with the species P. stuartii, with invasive exogenous factors and with an increased fatality.
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Mechal T, Hussen S, Desta M. Bacterial Profile, Antibiotic Susceptibility Pattern and Associated Factors Among Patients Attending Adult OPD at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Infect Drug Resist 2021; 14:99-110. [PMID: 33469325 PMCID: PMC7813457 DOI: 10.2147/idr.s287374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Urinary tract infection (UTI) is a common health problem occurring when infectious agents colonize, invade, and propagate the urinary tract including the urethra, bladder, renal pelvis, or renal parenchyma. The study aimed to determine the prevalence of symptomatic UTI, drug resistance pattern, and its associated factors among patients attending adult outpatient department (OPD) at Hawassa University Comprehensive Specialized Hospital (HUCSH). Methods A cross-sectional study was conducted from October 2018 to February 2019 among adults ≥18 years old with symptoms of UTI. Processing of specimens for culture and identification was done. Antimicrobial susceptibility was done for positive urine cultures. Data entry and analysis were performed using SPSS version 23.0 software. Bivariate and multivariate logistic regression analysis test results were used. Results The overall prevalence of symptomatic urinary tract infection was 32.8% (95% CI: 28.3–37.6). The predominant isolated bacteria was E. coli 46 (36.2%) followed by S. aureus 21 (16.5%). Gram-negative bacteria were a high level of resistance to ampicillin (71.4%), and tetracycline (68.2%). Gram-positive bacteria were highly resistant to norfloxacin (77.7%). The overall prevalence of multi-drug resistant isolates was 102 (80.3%). Being female, no formal education, and self-medication history had more likely cause UTI. Conclusion Urinary tract infection (UTI) among adults was prevalent in the study area. Being female, educational status and self-medication history had a significant association with UTI. Resistance to ampicillin, tetracycline, and norfloxacin was high. Therefore, culture and antibiotic susceptibility testing should be routinely used for the proper management of patients with UTI.
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Affiliation(s)
- Tigist Mechal
- Department of Medical Laboratory Science, Hawassa College of Health Sciences, Hawassa, South Nations and Nationalities Peoples Region, Ethiopia
| | - Siraj Hussen
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Moges Desta
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Behzadi P, Baráth Z, Gajdács M. It's Not Easy Being Green: A Narrative Review on the Microbiology, Virulence and Therapeutic Prospects of Multidrug-Resistant Pseudomonas aeruginosa. Antibiotics (Basel) 2021; 10:42. [PMID: 33406652 PMCID: PMC7823828 DOI: 10.3390/antibiotics10010042] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022] Open
Abstract
Pseudomonas aeruginosa is the most frequent cause of infection among non-fermenting Gram-negative bacteria, predominantly affecting immunocompromised patients, but its pathogenic role should not be disregarded in immunocompetent patients. These pathogens present a concerning therapeutic challenge to clinicians, both in community and in hospital settings, due to their increasing prevalence of resistance, and this may lead to prolonged therapy, sequelae, and excess mortality in the affected patient population. The resistance mechanisms of P. aeruginosa may be classified into intrinsic and acquired resistance mechanisms. These mechanisms lead to occurrence of resistant strains against important antibiotics-relevant in the treatment of P. aeruginosa infections-such as β-lactams, quinolones, aminoglycosides, and colistin. The occurrence of a specific resistotype of P. aeruginosa, namely the emergence of carbapenem-resistant but cephalosporin-susceptible (Car-R/Ceph-S) strains, has received substantial attention from clinical microbiologists and infection control specialists; nevertheless, the available literature on this topic is still scarce. The aim of this present review paper is to provide a concise summary on the adaptability, virulence, and antibiotic resistance of P. aeruginosa to a readership of basic scientists and clinicians.
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Affiliation(s)
- Payam Behzadi
- Department of Microbiology, College of Basic Sciences, Shahr-e-Qods Branch, Islamic Azad University, Tehran 37541-374, Iran;
| | - Zoltán Baráth
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos körút 62-64, 6720 Szeged, Hungary;
| | - Márió Gajdács
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Hungary
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary
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Alkofide H, Alhammad AM, Alruwaili A, Aldemerdash A, Almangour TA, Alsuwayegh A, Almoqbel D, Albati A, Alsaud A, Enani M. Multidrug-Resistant and Extensively Drug-Resistant Enterobacteriaceae: Prevalence, Treatments, and Outcomes - A Retrospective Cohort Study. Infect Drug Resist 2020; 13:4653-4662. [PMID: 33380815 PMCID: PMC7769089 DOI: 10.2147/idr.s283488] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background Drug-resistant gram-negative bacteria (GNB) are a global public health threat, especially in intensive care units (ICU). This study explored the prevalence of drug-resistant Enterobacteriaceae infections in an ICU in Saudi Arabia. The appropriateness of the antibiotic therapies used and their ability to improve the clinical outcomes were also assessed. Methods A retrospective study was conducted from 2015 to 2018 in the different ICUs of a tertiary-care hospital in Saudi Arabia. Positive cultures for multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Enterobacteriaceae, including Klebsiella pneumoniae, Escherichia coli, and Enterobacter sp., were included. The primary outcomes involved microbiological cure and 30 days in-hospital mortality rate, while the secondary outcome included the length of hospital stay (LOS). Regression models were used to assess the relationship between appropriateness of the antibiotic therapy and clinical outcomes. Results Of the 227 Enterobacteriaceae cultures included in this study, 60% were either MDR (n= 130) or XDR (n= 8) infections; no PDR Enterobacteriaceae cultures were identified. Majority of the patients were female (54%), and the average age was 60.1 ± 17.7 years. MDR/XDR cultures primarily comprised E. coli (51.4%), followed by K. pneumoniae (33%) and Enterobacter sp. (16%). Most commonly used antibiotics were piperacillin/tazobactam (53%), carbapenems (47%), and cephalosporins (21.3%). Antibiotic therapy was considered appropriate in only 85 of 138 (61.59%) patients. Microbiological cure rate was achieved in 40% of the cases, and in-hospital death rate was 84%. The average LOS was 27 days. Appropriateness of the antibiotic therapy prescribed could not predict any of the study outcomes. Conclusion The study revealed a high prevalence of drug-resistant Enterobacteriaceae infections, which were associated with a high mortality rate. Therefore, it is essential to assess the effectiveness of antimicrobial stewardship program and infection prevention and control practices, particularly in critically ill patients.
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Affiliation(s)
- Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Department of Pharmacy Services, King Khalid University Hospital - King Saud University Medical City, Riyadh, Saudi Arabia
| | - Alya Alruwaili
- Department of Clinical Pharmacy, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Thamer A Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Aseel Alsuwayegh
- Department of Pharmacy Services, King Khalid University Hospital - King Saud University Medical City, Riyadh, Saudi Arabia
| | - Daad Almoqbel
- Credit Department, Saudi Industrial Development Fund, Riyadh, Saudi Arabia
| | - Aljohara Albati
- Benefit Risk Assessment Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Aljohara Alsaud
- Biomedical Sciences, Alfaisal University, Riyadh, Saudi Arabia
| | - Mushira Enani
- Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia
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Li L, Yuan Z, Chen D, Xie X, Zhang B. Clinical and Microbiological Characteristics of Invasive and Hypervirulent Klebsiella pneumoniae Infections in a Teaching Hospital in China. Infect Drug Resist 2020; 13:4395-4403. [PMID: 33328744 PMCID: PMC7734077 DOI: 10.2147/idr.s282982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/11/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To investigate the clinical and microbiological characteristics of invasive and hypervirulent Klebsiella pneumoniae (HvKP) in a teaching hospital in Southern China. Patients and Methods A total of 495 non-repetitive K. pneumoniae strains were isolated from Dongguan People’s Hospital affiliated to Southern Medical University in 2018. Multivariate analysis was performed using the patients’ clinical data to identify the risk factors for HvKP. Results Eighty-one isolates were HvKP (16.4%, 81/495), of which 43 (53.1%) were invasive HvKP, whereas 38 (46.9%) were non-invasive HvKP. The incidence of extended spectrum beta-lactamases (ESBLs) in HvKP and classic K. pneumoniae (cKP) were 7.4% (6/81) and 28.0% (116/414), respectively (p<0.05). Multivariate analysis indicated that diabetes mellitus (odds ratio [OR]=12.849, 95% confidence interval [CI]: 1.494–110.511, P=0.020) was an independent risk factor for invasive HvKP infection. Altogether, 51.2% (22/43) of invasive HvKP infections were treated with antimicrobial therapy combined with surgical drainage, and achieved good prognosis. K1-ST23 HvKP accounted for a higher proportion of invasive infections than non-invasive infections (P<0.05), but there was no statistical difference in the prognosis between the two groups (P>0.05). The most prevalent virulence genes in HvKP were rmpA 98.7% (80/81), followed by rmpA2 (82.7%, 67/81), iroN (98.7%, 80/81), and iutA 90.1% (70/81). There was no significant difference in the distribution of virulence genes between invasive HvKP and non-invasive HvKP isolates (P>0.05). Conclusion Invasive HvKP infection in this study was positively associated with diabetes as independent risk factors. Antibiotic therapy combined with surgical drainage is one of the most effective treatment measures of HvKP infection. Adequate attention should be paid to HvKP infection in clinical and microbiological laboratories.
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Affiliation(s)
- Lijuan Li
- Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China
| | - Ziyang Yuan
- Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China
| | - Danna Chen
- Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China
| | - Xiaoyan Xie
- Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China
| | - Bashan Zhang
- Department of Clinical Laboratory, Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, Guangdong 523059, People's Republic of China
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Almomani BA, Khasawneh RA, Saqan R, Alnajjar MS, Al-Natour L. Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains. PLoS One 2020; 15:e0243741. [PMID: 33315921 PMCID: PMC7735628 DOI: 10.1371/journal.pone.0243741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.
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Affiliation(s)
- Basima A. Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Rawand A. Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rola Saqan
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Munther S. Alnajjar
- Department of Biopharmaceutics & Clinical Pharmacy, College of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Lara Al-Natour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Kasanga M, Mudenda S, Siyanga M, Chileshe M, Mwiikisa MJ, Kasanga M, Solochi BB, Gondwe T, Kantenga T, L Shibemba A, Chitalu M, Nakazwe R, Wu J. Antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia at a tertiary hospital in Zambia. Future Microbiol 2020; 15:1735-1745. [PMID: 33315486 DOI: 10.2217/fmb-2020-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Bloodstream infections and antimicrobial resistance cause global increases in morbidity and mortality. Aim: We evaluated the antimicrobial susceptibility patterns of bacteria that commonly cause bacteremia in humans. Materials & methods: We conducted a retrospective cross-sectional study at the University Teaching Hospitals in Lusaka, Zambia, using Laboratory Information Systems. Results: The commonest isolated bacteria associated with sepsis were Klebsiella pneumoniae. The distribution of bacteria associated with bacteremia in different wards and departments pneumonia. The distribution of bacteria associated with bacteremia in different wards and departments at University Teaching Hospitals was were statistically significant (χ2 = 1211.518; p < 0.001). Conclusion: K. pneumoniae, Escherichia coli, Pantoea agglomerans and Enterococcus species have developed high resistance levels against ampicillin, cefotaxime, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole and a very low resistance levels against imipenem and Amikacin.
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Affiliation(s)
- Maisa Kasanga
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China.,University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Steward Mudenda
- The University of Zambia, School of Health Sciences, Department of Pharmacy, PO Box 50110, Lusaka, Zambia.,The University of Zambia, School of Veterinary Medicine, Department of Disease Control, PO Box 32379, Lusaka, Zambia
| | - Makomani Siyanga
- Zambia Medicines Regulatory Authority, Plot No. 2350/M, Off KK International Airport Road, PO Box 31890 Lusaka
| | - Misheck Chileshe
- Mary Begg Health Services, 56 Chintu Avenue, Northrise, PO Box 72221, Ndola
| | - Mark J Mwiikisa
- Lusaka Trust Hospital, Plot 2190, Nsumbu Rd, Woodlands, PO Box 35852, Lusaka Main, Lusaka, Zambia
| | - Maika Kasanga
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | | | - Theodore Gondwe
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
| | | | - Aaron L Shibemba
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia.,Directorate of Clinical Pathology & Laboratory Services, Ministry of Health, Lusaka
| | - Mwansa Chitalu
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Ruth Nakazwe
- University Teaching Hospitals, P/Bag RW1X, Lusaka, Zambia
| | - Jian Wu
- Zhengzhou University, College of Public Health, 100 Kexue Avenue, Zhengzhou, Henan, 450001, China
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Tang J, Chen Y, Wang X, Ding Y, Sun X, Ni Z. Contribution of the AbaI/AbaR Quorum Sensing System to Resistance and Virulence of Acinetobacter baumannii Clinical Strains. Infect Drug Resist 2020; 13:4273-4281. [PMID: 33262621 PMCID: PMC7699449 DOI: 10.2147/idr.s276970] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acinetobacter baumannii (A. baumannii) is one of the most important pathogens that cause serious nosocomial infections worldwide. However, there are few reports on the virulence of A. baumannii clinical isolates, and little is known about the mechanism regulating virulence and drug resistance. The aim of this study was to determine the prevalence of drug resistance and virulence profiles and explore features related to quorum sensing (QS). METHODS A total of 80 clinical A. baumannii isolates were collected from Jilin province of China from 2012 to 2017. We investigated these clinical isolates with respect to biofilm formation, surface motility, adherence, invasion into A549 human alveolar epithelial cells, and virulence to Galleria mellonella. We also explored the prevalence of the AbaI/AbaR QS system and its correlation with bacterial virulence and drug resistance. RESULTS The resistance rates of the isolates to 17 commonly used antibiotics were higher than 50%, and 75% of the isolates were multi-drug resistant. Approximately 95% (76/80) of the isolates showed the ability to form biofilms, of which 38 showed strong biofilm formation ability (+++). Only 5 strains showed strong surface-related motility. A high level of variability was found in adherence and invasion into A549 epithelial cells, and 16 isolates showed strong virulence to Galleria mellonella (none survived after 6 days of infection). Of the 61 isolates carrying abaI and abaR genes, 24 were found to produce N-acyl homoserine lactones (AHLs) detectable by biosensor bacteria. Correlation analysis revealed that abaI and abaR genes positively correlated with bacterial resistance rates. All strains showing obvious surface-related motility carried abaI and abaR genes and produced AHLs. The isolates with detectable QS systems also showed stronger invasiveness into A549 cells and pathogenicity toward G. mellonella than the QS-deficient isolates. CONCLUSION Our study demonstrates that the AbaI/AbaR QS system was widely distributed among the A. baumannii clinical isolates, was necessary for surface-related motility, and significantly correlated with drug resistance, invasion into epithelial cells, and virulence to G. mellonella.
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Affiliation(s)
- Jie Tang
- Department of Pathogen Biology, The Key Laboratory of Zoonosis, Chinese Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin130021, People’s Republic of China
| | - Yan Chen
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, China130041, People’s Republic of China
| | - Xinlei Wang
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun130041, People’s Republic of China
| | - Yue Ding
- Department of Pathogen Biology, The Key Laboratory of Zoonosis, Chinese Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin130021, People’s Republic of China
| | - Xiaoyu Sun
- Department of Pathogen Biology, The Key Laboratory of Zoonosis, Chinese Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin130021, People’s Republic of China
| | - Zhaohui Ni
- Department of Pathogen Biology, The Key Laboratory of Zoonosis, Chinese Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun, Jilin130021, People’s Republic of China
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Zhang Y, Li Y, Zeng J, Chang Y, Han S, Zhao J, Fan Y, Xiong Z, Zou X, Wang C, Li B, Li H, Han J, Liu X, Xia Y, Lu B, Cao B. Risk Factors for Mortality of Inpatients with Pseudomonas aeruginosa Bacteremia in China: Impact of Resistance Profile in the Mortality. Infect Drug Resist 2020; 13:4115-4123. [PMID: 33209041 PMCID: PMC7669529 DOI: 10.2147/idr.s268744] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/02/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Pseudomonas aeruginosa bacteremia presents a severe challenge to hospitalized patients. However, to date, the risk factors for mortality among inpatients with P. aeruginosa bacteremia in China remain unclear. Patients and Methods This retrospective multicenter study was performed to analyze 215 patients with culture-confirmed P. aeruginosa bacteremia in five healthcare centers in China during the years 2012–2019. Results Of 215 patients with P. aeruginosa bacteremia, 61 (28.4%) died during the study period. Logistic multivariable analysis revealed that cardiovascular disease (OR=3.978, P=0.001), blood transfusion (OR=5.855, P<0.001) and carbapenem-resistant P. aeruginosa (CRPA) phenotype (OR=4.485, P=0.038) constituted the independent risk factors of mortality. Furthermore, both CRPA and multidrug-resistant P. aeruginosa (MDRPA) phenotypes were found to be significantly associated with 5-day mortality (Log-rank, P<0.05). Conclusion This study revealed a high mortality rate amongst hospitalized patients with P. aeruginosa bacteremia, and those with cardiovascular diseases, CRPA and MDRPA phenotypes, should be highlighted and given appropriate management in China.
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Affiliation(s)
- Yulin Zhang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yi Li
- Department of Laboratory Medicine, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Ji Zeng
- Department of Laboratory Medicine, Wuhan Pu Ai Hospital of Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yanzi Chang
- Department of Laboratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, People's Republic of China
| | - Shouhua Han
- Department of Laboratory Medicine, Weifang No.2 People's Hospital, Weifang, People's Republic of China
| | - Jiankang Zhao
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yanyan Fan
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Zhujia Xiong
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xiaohui Zou
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Chunlei Wang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Binbin Li
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Haibo Li
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Jiajing Han
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Xinmeng Liu
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Yudi Xia
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Binghuai Lu
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, People's Republic of China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, People's Republic of China.,Tsinghua University-Peking University, Joint Center for Life Sciences, Beijing, People's Republic of China
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Syahrul F, Wahyuni CU, Notobroto HB, Wasito EB, Adi AC, Dwirahmadi F. Transmission Media of Foodborne Diseases as an Index Prediction of Diarrheagenic Escherichia coli: Study at Elementary School, Surabaya, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8227. [PMID: 33171702 PMCID: PMC7664320 DOI: 10.3390/ijerph17218227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022]
Abstract
Foodborne diseases (FBDs) have a large disease burden among children. The major type of FBD in children is diarrhea, caused mainly by contaminated food. One of the diarrhea pathogens is Diarrheagenic Escherichia coli (DEC). The aim of this study was to establish a model of microbial prediction (DEC) in stool, caused by the transmission of FBDs in elementary schoolchildren. An observational analytic study was conducted, with a nested case-control study design. In Stage I, the study population was children in a selected elementary school at Surabaya. The sample size for Stage I was 218 children. In Stage II, the case sample was all children with a positive test for DEC (15 children), and the control sample was all children who had tested negative for DEC (60 children). The result of the laboratory tests showed that the proportion of DEC in children was 6.88% (15 of 218 children) and the proportion of Escherichia coli O157:H7 in children was only 0.46%. The most significant mode of transmission included in the model was the snacking frequency at school and the risk classification of food that was often purchased at school. The formulation of the predicting model of DEC in stool can be used as an early warning against the incidence of FBDs in elementary schoolchildren.
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Affiliation(s)
- Fariani Syahrul
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Chatarina U. Wahyuni
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Hari B. Notobroto
- Department of Biostatistic, Faculty of Public Health Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Eddy B. Wasito
- Department of Microbiology, Faculty of Medicine Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Annis C. Adi
- Department of Nutrition, Faculty of Public Health Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Febi Dwirahmadi
- Center for Environment and Population Health, School of Medicine, Griffith University, Queensland 4215, Australia;
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Gajdács M. The Importance of Reporting Clinical and Epidemiological Data in Urology: Local Experiences and Insights from the International Literature. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E581. [PMID: 33143077 PMCID: PMC7693886 DOI: 10.3390/medicina56110581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022]
Abstract
Pathologies of the genito-urinary tract are responsible for a considerable disease burden worldwide, leading to significant losses of income, lost working days, increased expenditures for national healthcare systems, and decreased quality of life (QoL) in the affected patients. Among these diseases, infections and malignancies in this anatomical region are some of the most important illnesses in human medicine; nevertheless, benign prostate hyperplasia (BPH), erectile dysfunction, hypospadias, urinary incontinence, and vesicoureteral reflux are also relevant disorders affecting millions. The publication of various microbiological and clinical studies in urology from different geographical regions has important ramifications from the standpoint of epidemiology: on one hand, reported data may influence the development of therapeutic guidelines for urinary tract infections (UTIs) (empiric antibiotic-therapy) and malignancies (including classical cytotoxic drug protocols and next-generation anticancer therapies) both locally and internationally; on the other hand, the relevant stakeholders and government representatives often base their decisions on published evidence. Therefore, novel studies in the field of urology are strongly encouraged to maintain and improve the high standard of patient care internationally and to ensure continuous information supply for international datasets on the causative agents of UTIs and cancer registries. The present Editorial aims to highlight some relevant studies published from the field of urology in Medicina over the last several years.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary; or ; Tel.: +36-62-341-330
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Hungary
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Mengesha Y, Manaye B, Moges G. Assessment of Public Awareness, Attitude, and Practice Regarding Antibiotic Resistance in Kemissie Town, Northeast Ethiopia: Community-Based Cross-Sectional Study. Infect Drug Resist 2020; 13:3783-3789. [PMID: 33144831 PMCID: PMC7594193 DOI: 10.2147/idr.s280036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Antibiotic resistance is increasing to dangerously high levels globally with subsequent higher medical costs, prolonged hospital stays and increased levels of mortality. Ensuring patients' knowledge, attitude, and proper use of antimicrobials is one of the strategies to control resistance. The aim of this study is to evaluate the public awareness, attitude, and practice regarding antimicrobial use and resistance in Kemissie Town, Northeast Ethiopia. METHODS A community-based, cross-sectional study was conducted on 385 adults selected using systematic random sampling in Kemissie town from March 1 to May 1, 2019. A home-to-home visit interview was done using a structured interview guide. The data were coded individually and entered into a computer using Epi-info version 3.5.1 and then exported to SPSS version 23.0 for analysis. Univariate analyses were used to describe the categorical variables. RESULTS Of the 345 respondents who took antibiotics, three quarters (74.78%) received antibiotics with a prescription. Of the total respondents, 17.7% of the participants believed unnecessary use of antibiotics enhances resistance to bacteria. Of those who took antibiotics, the majority (72.5 %) finished the full course of treatment. Out of the total 374 respondents, 41.6% had awareness on the fact that antibiotics resistance can affect the development of resistance in the whole community. More than half (51.9%) of the respondents believed that the rational use of antibiotics can reduce the risk of antimicrobial resistance. CONCLUSION The majority of the respondents were still unaware of antibiotic resistance and its implications. This requires close attention from policy-makers and healthcare professionals. The community of Kemissie town had a positive attitude towards finishing antibiotic regimens. This study also identified crucial gaps in the practices of the community about the use of antibiotics.
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Affiliation(s)
- Yohannes Mengesha
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bekele Manaye
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getachew Moges
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Increasing relevance of Gram-positive cocci in urinary tract infections: a 10-year analysis of their prevalence and resistance trends. Sci Rep 2020. [PMID: 33077890 DOI: 10.1038/s41598-020-7483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. There is increasing appreciation for the pathogenic role of Gram-positive cocci (GPC) in UTIs, as they have a plethora of virulence factors, maintaining their pathogenicity and high affinity for the epithelial cells of the urinary tract. The study was carried out using microbiological data collected corresponding to the period between 2008 and 2017. Antimicrobial susceptibility testing was performed using the disk diffusion method and E-tests. The age range of patients affected from the outpatient and inpatient groups differed significantly (43 [range 0.7-99] vs. 68 [range 0.4-99] years; p = 0.008). 3962 GPCs were obtained from inpatient and 4358 from outpatient samples, corresponding to 20.5 ± 2.8% (range 17.5-26.8%) and 20.6 ± 2.6% (range 17.8-26.0%) of all positive urine samples (p > 0.05); in both groups, Enterococcus spp. were the most prevalent (outpatients: 79.6%; inpatients: 88.5%). High-level aminoglycoside resistance in enterococci was noted in 31.0-46.6% of cases. A pronounced increase in the number of MRSA was seen in the second half of the study period (0.6-1.9% vs. 9.8-11.6%; p = 0.038). The ratio of VRE isolates was 0.16%, no VISA/VRSA isolates were detected.
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Gajdács M, Ábrók M, Lázár A, Burián K. Increasing relevance of Gram-positive cocci in urinary tract infections: a 10-year analysis of their prevalence and resistance trends. Sci Rep 2020; 10:17658. [PMID: 33077890 PMCID: PMC7573585 DOI: 10.1038/s41598-020-74834-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are the third most common types of infection in human medicine worldwide. There is increasing appreciation for the pathogenic role of Gram-positive cocci (GPC) in UTIs, as they have a plethora of virulence factors, maintaining their pathogenicity and high affinity for the epithelial cells of the urinary tract. The study was carried out using microbiological data collected corresponding to the period between 2008 and 2017. Antimicrobial susceptibility testing was performed using the disk diffusion method and E-tests. The age range of patients affected from the outpatient and inpatient groups differed significantly (43 [range 0.7–99] vs. 68 [range 0.4–99] years; p = 0.008). 3962 GPCs were obtained from inpatient and 4358 from outpatient samples, corresponding to 20.5 ± 2.8% (range 17.5–26.8%) and 20.6 ± 2.6% (range 17.8–26.0%) of all positive urine samples (p > 0.05); in both groups, Enterococcus spp. were the most prevalent (outpatients: 79.6%; inpatients: 88.5%). High-level aminoglycoside resistance in enterococci was noted in 31.0–46.6% of cases. A pronounced increase in the number of MRSA was seen in the second half of the study period (0.6–1.9% vs. 9.8–11.6%; p = 0.038). The ratio of VRE isolates was 0.16%, no VISA/VRSA isolates were detected.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Eötvös utca 6, Szeged, 6720, Hungary.
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Semmelweis utca 6, Szeged, 6725, Hungary.,Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Dóm tér 10, Szeged, 6720, Hungary
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Zhang P, Wang J, Hu H, Zhang S, Wei J, Yang Q, Qu T. Clinical Characteristics and Risk Factors for Bloodstream Infection Due to Carbapenem-Resistant Klebsiella pneumoniae in Patients with Hematologic Malignancies. Infect Drug Resist 2020; 13:3233-3242. [PMID: 33061470 PMCID: PMC7519809 DOI: 10.2147/idr.s272217] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose The aim was to examine the clinical characteristics and risk factors for bloodstream infection (BSI) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients with hematologic malignancies. Materials and Methods A single-centre, retrospective case–control study representing 734 patients with hematologic malignancies between January 1, 2017, and December 31, 2018, was conducted. Demographic and clinical data were collected from the hospital electronic medical records system. Results Among the 734 patients with hematologic malignancies, 3% (22/734) of the patients developed CRKP BSI during their hospitalization. Overall 28-day all-cause mortality reached 77.3% (17/22). Patients with Pitt bacteremia score (PBS) >4, pneumonia and septic shock were more frequent in the non-survivors versus the survivors. Compared with the non-survivors in antimicrobial treatment, combination therapy of tigecycline and polymyxin B was more common in the survivors. The independent risk factors associated with CRKP BSI were CRKP rectal colonization (OR, 11.067; CI=4.43–27.644; P<0.001; 3 points), severe neutropenia (OR, 4.095; CI=0.876–19.141; P=0.073; 1 point) and invasive mechanical ventilation (IMV) within the previous 30 days to onset of BSI (OR, 18.444; CI=1.787–190.343; P=0.014; 4 points). The total risk score of ≥5 indicated that the probability of CRKP BSI occurrence was above 48%. Conclusion CRKP BSI in patients with hematologic malignancies is associated with high mortality. The risk factor-based prediction model might help clinicians to start prompt effective anti-infective therapy in patients with suspicion of CRKP BSI and improve outcomes.
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Affiliation(s)
- Piaopiao Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Jie Wang
- Respiratory Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Hangbin Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Sheng Zhang
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Juying Wei
- Hematological Diseases Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Qing Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Tingting Qu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
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Benkő R, Gajdács M, Matuz M, Bodó G, Lázár A, Hajdú E, Papfalvi E, Hannauer P, Erdélyi P, Pető Z. Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey. Antibiotics (Basel) 2020; 9:antibiotics9090624. [PMID: 32961770 PMCID: PMC7560131 DOI: 10.3390/antibiotics9090624] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Antibiotic treatments initiated on Emergency Departments (ED) are empirical. Therefore, knowledge of local susceptibility patterns is important. Despite this, data on expected pathogens and their resistance profile are scarce from EDs internationally. The study aim was to assess the epidemiology and resistance patterns of bacterial isolates from a tertiary-care ED over 5 years, focusing on ESKAPE bacteria (including the Enterobacterales group). After removal of duplicates, n = 6887 individual bacterial isolates were recovered, out of which n = 4974 (72.22%) were ESKAPE isolates. E. coli was the most frequent isolate (2193, 44.1%), followed by the Klebsiella genus (664; 13.4%). The third most frequent isolate was S. aureus (561, 11.3%). In total, multi-drug resistance (MDR) was present in 23.8% and was most prevalent in A. baumanii (65.5%), P. mirabilis (42.7%), and K. pneumoniae (32.6%). MRSA was isolated in 19.6%, while ESBL-producing Enterobacterales in 17.7%, and these were associated with remarkably higher resistance to other antibacterials as well. Difficult-to-treat resistance (DTR) was detected in 0.5%. The frequent isolation of some ESKAPE bacteria and the detected considerable acquired resistance among ED patients raise concern. The revealed data identified problematic pathogens and will guide us to set up the optimal empiric antibiotic protocol for clinicians.
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Affiliation(s)
- Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary;
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
- Correspondence: ; Tel.: +36-62-342572
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary;
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary;
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
| | - Gabriella Bodó
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary;
| | - Edit Hajdú
- Infectious Disease Ward, 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Medical Center, 6725 Szeged, Hungary; (E.H.); (E.P.)
| | - Erika Papfalvi
- Infectious Disease Ward, 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Medical Center, 6725 Szeged, Hungary; (E.H.); (E.P.)
| | - Peter Hannauer
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
| | - Péter Erdélyi
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
| | - Zoltán Pető
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
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Kassahun H, Ayfokru T. Antimicrobial Drug Therapy Problems Among Patients in the Outpatient Department of Ataye Hospital, Northeast Ethiopia. Infect Drug Resist 2020; 13:2717-2722. [PMID: 32821134 PMCID: PMC7417642 DOI: 10.2147/idr.s257086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Antimicrobial drug therapy problems refer to incorrect and inappropriate utilization of antimicrobials which affect patient’s health outcomes and results in bacterial resistance. Incorrect use of antimicrobial agents is a key driver for the spread of antimicrobial drug resistance. Improving drug therapy problems has an important effect on the patients’ health, treatment costs, and enhancing patients’ quality of life. Hence, the aim of the present study was to assess antimicrobial drug therapy problems among patients in the Outpatient Department of Ataye hospital, Northeast Ethiopia. Methods A hospital-based retrospective cross-sectional study design was used to assess antimicrobial drug therapy problems among patients in Ataye hospital from September 2018 to February 2019. Data were collected by trained graduating pharmacy students by reviewing medical records of patients using checklists and questionnaires. Results A total of 248 patient cards were included in this study. At least one antimicrobial drug therapy problem had occurred among 96 (38.7%) of the study participants. The most common drug therapy problem was the need for additional drug therapy which was incurred by 38 (15.3%) of the study participants and ineffective antimicrobial therapy was experienced by 22 (8.9%) of the patients. Tetracyclines 25 (26%), fluoroquinolones 19 (19.8%), and penicillins 18 (18.8%) were the most common classes of antimicrobials prone to drug therapy problems. Conclusion The current study revealed that nearly two-fifths of the study participants had experienced at least one form of antimicrobial drug therapy problem. The most common drug therapy problem was the need for additional drug therapy and the use of ineffective antimicrobial therapy. Tetracyclines, fluoroquinolones, and penicillins were the main classes of antimicrobials involved in the drug therapy problem.
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Affiliation(s)
- Haile Kassahun
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Ayfokru
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Iwu CD, du Plessis EM, Korsten L, Nontongana N, Okoh AI. Antibiogram Signatures of Some Enterobacteria Recovered from Irrigation Water and Agricultural Soil in two District Municipalities of South Africa. Microorganisms 2020; 8:microorganisms8081206. [PMID: 32784678 PMCID: PMC7463487 DOI: 10.3390/microorganisms8081206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
This study was undertaken to evaluate the antibiogram fingerprints of some Enterobacteria recovered from irrigation water and agricultural soil in two District Municipalities of the Eastern Cape Province, South Africa using standard culture-based and molecular methods. The prevalent resistance patterns in the isolates follow the order: Salmonella enterica serovar Typhimurium [tetracycline (92.3%), ampicillin (69.2%)]; Enterobacter cloacae [amoxicillin/clavulanic acid (77.6%), ampicillin (84.5%), cefuroxime (81.0%), nitrofurantoin (81%), and tetracycline (80.3%)]; Klebsiella pneumoniae [amoxicillin/clavulanic acid (80.6%), ampicillin (88.9%), and cefuroxime (61.1%)]; and Klebsiella oxytoca [chloramphenicol (52.4%), amoxicillin/clavulanic acid (61.9%), ampicillin (61.9%), and nitrofurantoin (61.9%)]. Antibiotic resistance genes detected include tetC (86%), sulII (86%), and blaAmpC (29%) in Salmonella enterica serovar Typhimurium., tetA (23%), tetB (23%), tetC (12%), sulI (54%), sulII (54%), catII (71%), blaAmpC (86%), blaTEM (43%), and blaPER (17%) in Enterobacter cloacae., tetA (20%), tetC (20%), tetD (10%), sulI (9%), sulII (18%), FOX (11%) and CIT (11%)-type plasmid-mediated AmpC, blaTEM (11%), and blaSHV (5%) in Klebsiella pneumoniae and blaAmpC (18%) in Klebsiella oxytoca. Our findings document the occurrence of some antibiotic-resistant Enterobacteria in irrigation water and agricultural soil in Amathole and Chris Hani District Municipalities, Eastern Cape Province of South Africa, thus serving as a potential threat to food safety.
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Affiliation(s)
- Chidozie Declan Iwu
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa; (N.N.); (A.I.O.)
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
- Correspondence:
| | - Erika M du Plessis
- Department of Plant and Soil Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa; (E.M.d.P.); (L.K.)
| | - Lise Korsten
- Department of Plant and Soil Sciences, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria 0002, South Africa; (E.M.d.P.); (L.K.)
| | - Nolonwabo Nontongana
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa; (N.N.); (A.I.O.)
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
| | - Anthony Ifeanyi Okoh
- SAMRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Alice 5700, South Africa; (N.N.); (A.I.O.)
- Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, South Africa
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Chen L, Ou B, Zhang M, Chou CH, Chang SK, Zhu G. Coexistence of Fosfomycin Resistance Determinant fosA and fosA3 in Enterobacter cloacae Isolated from Pets with Urinary Tract Infection in Taiwan. Microb Drug Resist 2020; 27:415-423. [PMID: 32667841 DOI: 10.1089/mdr.2020.0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To analyze the characteristics of fosA and fosA3 in Enterobacter cloacae isolated from aspirated and catheterized urine culture specimens of companion pets in Taiwan. A total of 19 E. cloacae isolates from pets with urinary tract infection were screened for the presence of fosA, fosA3, and fosC2 and for the genetic context of them by PCR amplification and sequencing. The transferability, resistance phenotypes, plasmid replicon typing properties and genetic environments of fosA- and/or fosA3-positive strains were characterized. Five E. cloacae isolates were positive for fosA and three coharbored fosA and fosA3. No fosC determinant was detected. Transconjugants of fosA3 were successfully acquired, while the acquisition of fosA transconjugants was failed. The minimum inhibitory concentrations (MICs) of the three fosA3-positive isolates and their transconjugants were ≥256 mg/L, whereas the MICs of the five fosA-positive isolates ranged from 64 mg/L to 256 mg/L. Three plasmid replicons (InCFrepB, InCL/M, and InCHI2) were identified in fosA- and fosA3-positive E. cloacae isolates. Different genetic contexts lay in the downstream region of fosA and fosA3, respectively. Eight distinct patterns based on the similarity value of more than 80% were typed for all the 8 fosA-positive isolates. In conclusion, the fosA concomitant with fosA3 were found in E. cloacae isolates. The fosA3 not only exhibits stronger activity of inactivating fosfomycin than fosA but also possesses stronger potential to spread than fosA. Different genetic backgrounds exist in these fosA- and fosA3-positive isolates, and different mobile elements may confer the dissemination of fosA and fosA3.
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Affiliation(s)
- Lin Chen
- School of Veterinary Medicine, Jiangsu Agri-animal Husbandry Vocational College, Taizhou, China
| | - Bingming Ou
- College of Life Science, Zhaoqing University, Zhaoqing, China.,College of Veterinary Medicine, Yangzhou University, Yangzhou, China
| | - Minyu Zhang
- College of Life Science, Zhaoqing University, Zhaoqing, China
| | - Chung-Hsi Chou
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Shao-Kuang Chang
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Guoqiang Zhu
- College of Veterinary Medicine, Yangzhou University, Yangzhou, China
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