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Ventura M, Oporto-Llerena R, Espinoza K, Guibert F, Quispe AM, Vilar N, López M, Rojo-Bezares B, Sáenz Y, Ruiz J, J. Pons M. Antimicrobial resistance and associated risk factors in Escherichia coli isolated from Peruvian dogs: A focus on extended-spectrum β-lactamases and colistin. Vet World 2024; 17:880-887. [PMID: 38798292 PMCID: PMC11111722 DOI: 10.14202/vetworld.2024.880-887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background and Aim Established antimicrobial resistance (AMR) surveillance in companion animals is lacking, particularly in low-middle-income countries. The aim of this study was to analyze AMR and its risk factors in Escherichia coli isolated from dogs at two veterinary centers in Lima (Peru). Materials and Methods Ninety dogs were included in the study. Antimicrobial susceptibility was established by disk diffusion, whereas microdilution was used to determine colistin susceptibility. Mechanisms related to extended-spectrum β-lactamases (ESBL) and colistin resistance were determined by polymerase chain reaction. Clonal relationships of colistin-resistant isolates were assessed by XbaI-pulsed-field gel electrophoresis. Results Thirty-five E. coli strains were isolated. High levels of resistance to ampicillin (57.1%), nalidixic acid (54.3%), tetracycline (48.6%), and azithromycin (25.7%) were detected. Cephalosporin resistance levels were ≥20% and those for colistin were 14.3%. Twelve (34.2%) isolates were ESBL producers; of these, six blaCTX-M-55 (50.0%), 2 (16.6%) blaCTX-M-15, and 2 (16.6%) blaCTX-M-8-like genes were found. The five colistin-resistant isolates were clonally unrelated, with four of them presenting amino acid codon substitutions in the mgrB gene (V8A) or mutations in the mgrB promoter (a12g, g98t, and c89t). Furthermore, dog age, <6 years (p = 0.027) and raw diet (p = 0.054) were associated with resistance to a greater number of antibiotic families. Conclusion Despite small number of samples included, the study found that dogs studied were carriers of multidrug-resistant E. coli, including last-resort antimicrobials, representing a public health problem due to close contact between dogs and humans. This issue suggests the need for larger studies addressed to design strategies to prevent the spread of resistant micro-organisms in small animal clinics and domestic settings.
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Affiliation(s)
- Margot Ventura
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - ”One Health”, Universidad Científica del Sur, Lima, Peru
| | | | - Kathya Espinoza
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - ”One Health”, Universidad Científica del Sur, Lima, Peru
| | - Fernando Guibert
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - ”One Health”, Universidad Científica del Sur, Lima, Peru
| | | | - Nidia Vilar
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), 26006 Logroño, Spain
| | - María López
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), 26006 Logroño, Spain
| | - Beatriz Rojo-Bezares
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), 26006 Logroño, Spain
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), 26006 Logroño, Spain
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - ”One Health”, Universidad Científica del Sur, Lima, Peru
| | - Maria J. Pons
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - ”One Health”, Universidad Científica del Sur, Lima, Peru
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Cuicapuza D, Loyola S, Velásquez J, Fernández N, Llanos C, Ruiz J, Tsukayama P, Tamariz J. Molecular characterization of carbapenemase-producing Enterobacterales in a tertiary hospital in Lima, Peru. Microbiol Spectr 2024; 12:e0250323. [PMID: 38193666 PMCID: PMC10846045 DOI: 10.1128/spectrum.02503-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024] Open
Abstract
Carbapenemase-producing Enterobacterales (CPE) are a growing threat to global health and the economy. Understanding the interactions between resistance and virulence mechanisms of CPE is crucial for managing difficult-to-treat infections and informing outbreak prevention and control programs. Here, we report the characterization of 21 consecutive, unique clinical isolates of CPE collected in 2018 at a tertiary hospital in Lima, Peru. Isolates were characterized by phenotypic antimicrobial susceptibility testing and whole-genome sequencing to identify resistance determinants and virulence factors. Seven Klebsiella pneumoniae isolates were classified as extensively drug-resistant. The remaining Klebsiella, Enterobacter hormaechei, and Escherichia coli isolates were multidrug-resistant. Eighteen strains carried the metallo-β-lactamase NDM-1, two the serine-carbapenemase KPC-2, and one isolate had both carbapenemases. The blaNDM-1 gene was located in the truncated ΔISAba125 element, and the blaKPC-2 gene was in the Tn4401a transposon. ST147 was the most frequent sequence type among K. pneumoniae isolates. Our findings highlight the urgent need to address the emergence of CPE and strengthen control measures and antibiotic stewardship programs in low- and middle-income settings.IMPORTANCEGenomic surveillance of antimicrobial resistance contributes to monitoring the spread of resistance and informs treatment and prevention strategies. We characterized 21 carbapenemase-producing Enterobacterales collected at a Peruvian tertiary hospital in 2018, which exhibited very high levels of resistance and carried numerous resistance genes. We detected the coexistence of carbapenemase-encoding genes (blaNDM-1 and blaKPC-2) in a Klebsiella pneumoniae isolate that also had the PmrB(R256G) mutation associated with colistin resistance. The blaKPC-2 genes were located in Tn4401a transposons, while the blaNDM-1 genes were in the genetic structure Tn125 (ΔISAba125). The presence of high-risk clones among Klebsiella pneumoniae (ST11 and ST147) and Escherichia coli (ST410) isolates is also reported. The study reveals the emergence of highly resistant bacteria in a Peruvian hospital, which could compromise the effectiveness of current treatments and control.
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Affiliation(s)
- Diego Cuicapuza
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Genómica Microbiana, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge (Emerging Diseases and Climate Change Research Unit), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Steev Loyola
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Jorge Velásquez
- Departamento de Patología Clínica y Banco de Sangre, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Nathaly Fernández
- Departamento de Patología Clínica y Banco de Sangre, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Carlos Llanos
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos-“One Health”, Universidad Científica de Sur, Lima, Peru
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge (Emerging Diseases and Climate Change Research Unit), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Jesús Tamariz
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
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Guibert F, Espinoza K, Taboada-Blanco C, Alonso CA, Oporto R, Castillo AK, Rojo-Bezares B, López M, Sáenz Y, Pons MJ, Ruiz J. Traditional marketed meats as a reservoir of multidrug-resistant Escherichia coli. Int Microbiol 2023:10.1007/s10123-023-00445-y. [PMID: 37995017 DOI: 10.1007/s10123-023-00445-y] [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: 08/19/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
This study aimed to analyze Escherichia coli from marketed meat samples in Peru. Sixty-six E. coli isolates were recovered from 21 meat samples (14 chicken, 7 beef), and antimicrobial resistance levels and the presence of mechanisms of antibiotic resistance, as well as clonal relationships and phylogeny of colistin-resistant isolates, were established. High levels of antimicrobial resistance were detected, with 93.9% of isolates being multi-drug resistant (MDR) and 76.2% of samples possessing colistin-resistant E. coli; of these, 6 samples from 6 chicken samples presenting mcr-1-producer E. coli. Colistin-resistant isolates were classified into 22 clonal groups, while phylogroup A (15 isolates) was the most common. Extended-spectrum β-lactamase- and pAmpC-producing E. coli were found in 18 and 8 samples respectively, with blaCTX-M-55 (28 isolates; 16 samples) and blaCIT (8 isolates; 7 samples) being the most common of each type. Additionally, blaCTX-M-15, blaCTX-M-65, blaSHV-27, blaOXA-5/10-like, blaDHA, blaEBC and narrow-spectrum blaTEM were detected. In addition, 5 blaCTX-M remained unidentified, and no sought ESBL-encoding gene was detected in other 6 ESBL-producer isolates. The tetA, tetE and tetX genes were found in tigecycline-resistant isolates. This study highlights the presence of MDR E. coli in Peruvian food-chain. The high relevance of CTX-M-55, the dissemination through the food-chain of pAmpC, as well as the high frequency of unrelated colistin-resistant isolates is reported.
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Affiliation(s)
- Fernando Guibert
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru
| | - Kathya Espinoza
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru
| | - Clara Taboada-Blanco
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja, Logroño, Spain
| | - Carla A Alonso
- Servicio de Análisis Clínicos, Laboratorio de Microbiología, Hospital San Pedro, Logroño, Spain
| | - Rosario Oporto
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru
| | - Angie K Castillo
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru
| | - Beatriz Rojo-Bezares
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja, Logroño, Spain
| | - María López
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja, Logroño, Spain
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja, Logroño, Spain
| | - Maria J Pons
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru.
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos - "One Health", Universidad Científica del Sur, Antigua Panamericana Sur Km 19, Villa El Salvador, 15067, Lima, Peru.
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Gomez AC, Ortiz T, Valenzuela A, Egoávil-Espejo R, Huerto-Huanuco R, Pinto JA, Lagos J, Ruiz J. Super-infection by multiple microorganisms in COVID-19 patients. Front Mol Biosci 2023; 10:1113969. [PMID: 36994427 PMCID: PMC10040592 DOI: 10.3389/fmolb.2023.1113969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: This study aimed to describe the clinical characteristics of patients with COVID-19 co-infected with multiple multidrug-resistant bacteria.Methods: Patients hospitalized in the AUNA network between January and May 2021, diagnosed with COVID-19 and at least two other infecting microorganisms, were retrospectively included in the analysis. Clinical and epidemiological data were extracted from clinical records. The susceptibility levels of the microorganisms were determined using automated methods. Antibiotic resistance was established among infecting bacteria accounting for ≥5 isolates.Results: A total of 27 patients (21 male and 6 female patients) met the inclusion criteria, with a maximum of eight co-infecting bacteria or fungi during admission time. Seven patients (25.9%) died, with a higher but not significant lethality among women (50% vs. 19.0%). A total of 15 patients presented at least one established comorbidity, with hypertension being the most frequent. The time elapsed between COVID-19 diagnosis and hospital attendance was 7.0 days, with that of patients with a fatal outcome being longer than that of living patients (10.6 vs. 5.4). Up to 20 different microorganisms were isolated, with Pseudomonas aeruginosa being the most common (34 isolates). In general, antibiotic resistance levels were high, especially in Acinetobacter baumannii isolates, with resistance levels of 88.9% to all antimicrobial agents tested, except colistin (0%).Conclusion: In conclusion, the present results show the presence of multiple microorganisms that co-infect COVID-19 patients. When fatal outcome rates are in the range of other reports, the presence of a series of multidrug-resistant microorganisms is of concern, showing the need to reinforce control measures to limit the expansion of almost untreatable microorganisms.
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Affiliation(s)
- Andrea C. Gomez
- Centro de Investigación Básica y Translacional, AUNA IDEAS, Lima, Peru
| | - Tamin Ortiz
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Angélica Valenzuela
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Rocío Egoávil-Espejo
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
| | - Rosario Huerto-Huanuco
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
| | - Joseph A. Pinto
- Centro de Investigación Básica y Translacional, AUNA IDEAS, Lima, Peru
- *Correspondence: Joseph A. Pinto, ; Joaquim Ruiz,
| | - Jose Lagos
- Servicio de Microbiología y Biología Molecular, Laboratorios AUNA, Lima, Peru
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos—“One Health”, Universidad Científica del Sur, Lima, Peru
- *Correspondence: Joseph A. Pinto, ; Joaquim Ruiz,
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Kang J, Li G, Ma M, Lan M, Kang Y, Yang N, Jia W, Zhao Z. Evidence of Sharing of Carbapenem-Resistant Klebsiella pneumoniae Strains Between Intensive Care Unit Patients and the Environment. Infect Drug Resist 2022; 15:7831-7839. [PMID: 36605851 PMCID: PMC9809384 DOI: 10.2147/idr.s388085] [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: 10/06/2022] [Accepted: 12/10/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose Carbapenem-resistant Klebsiella pneumoniae (CR-KP) has emerged as an important public health threat. Intestinal colonization with CR-KP increases the risk of infection and death, especially in intensive care unit patients. To clarify the source of colonizing bacteria is very important to prevent the spread of CR-KP, so the purpose of this study was to explore the relationship between the ward environment and intestinal colonization of CR-KP. Methods In this study, 353 environmental swabs from ICU (Intensive Care Unit) wards and 241 anal swab samples from ICU patients were collected and screened on MacConkey plates containing 2 μg/mL ertapenem, and the origin and genotype of CR-KP were analyzed by PCR and sequencing. The sequence type of the strains was also obtained by multi-locus sequence type (MLST) analysis, and plasmid conjugation test was used to clarify whether CR-KP can promote the transmission of drug resistance genes through plasmid integration and rearrangement. Results A total of 20 CR-KP environmental strains and 7 intestinal strains were obtained, most of which were bla OXA-48 resistant genotypes. Four different STs were identified by multi-locus sequence type (MLST) analysis, among which the large logarithm was ST485 type, and PFGE clustering showed that the similarity between them was >85%. In the plasmid transcoupling assay, we report that one of the Klebsiella pneumoniae drug-resistant plasmids was successfully transferred to E. coli, indicating that it may promote the spread of drug-resistant genes through plasmid integration and rearrangement. Conclusion Our research suggests that the environment may be a potential source of CR-KP and that there is a need for us to adopt more effective disinfection measures.
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Affiliation(s)
- Jia Kang
- Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Guangqi Li
- Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Miao Ma
- Clinical Laboratory Center, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Min Lan
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Yuting Kang
- Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ningai Yang
- Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Wei Jia
- Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China,Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China,Correspondence: Wei Jia; Zhijun Zhao, Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, 750001, People’s Republic of China, Tel +86 951-6743543, Email ;
| | - Zhijun Zhao
- Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China,Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China
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Antibiotic susceptibility among non-clinical Escherichia coli as a marker of antibiotic pressure in Peru (2009-2019): one health approach. Heliyon 2022; 8:e10573. [PMID: 36119856 PMCID: PMC9479018 DOI: 10.1016/j.heliyon.2022.e10573] [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: 12/09/2021] [Revised: 06/21/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Antimicrobial resistance is an increasing health problem worldwide with serious implications in global health. The overuse and misuse of antimicrobials has resulted in the spread of antimicrobial-resistant microorganisms in humans, animals and the environment. Surveillance of antimicrobial resistance provides important information contributing to understanding dissemination within these environments. These data are often unavailable in low- and middle-income countries, such as Peru. This review aimed to determine the levels of antimicrobial resistance in non-clinical Escherichia coli beyond the clinical setting in Peru. Methods We searched 2009–2019 literature in PUBMED, Google Scholar and local repositories. Results Thirty manuscripts including human, food, environmental, livestock, pets and/or wild animals’ samples were found. The analysis showed high resistance levels to a variety of antimicrobial agents, with >90% of resistance for streptomycin and non-extended-spectrum cephalosporin in livestock and food. High levels of rifamycin resistance were also found in non-clinical samples from humans. In pets, resistance levels of 70–>90% were detected for quinolones tetracycline and non-extended spectrum cephalosporins. The results suggest higher levels of antimicrobial resistance in captive than in free-ranging wild-animals. Finally, among environmental samples, 50–70% of resistance to non-extended-spectrum cephalosporin and streptomycin was found. Conclusions High levels of resistance, especially related to old antibacterial agents, such as streptomycin, 1st and 2nd generation cephalosporins, tetracyclines or first-generation quinolones were detected. Antimicrobial use and control measures are needed with a One Health approach to identify the main drivers of antimicrobial resistance due to interconnected human, animal and environmental habitats. In livestock and food >90% of streptomycin and cephalosporin resistance was detected. High levels of rifamycin resistance were found in non-clinical samples from humans. High levels to quinolones tetracycline and cephalosporins were detected in pets. Environmental samples showed 50–70% of resistance to cephalosporins and streptomycin. In general, high levels of resistance to ancient antibacterial agents was observed.
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Rodríguez-Noriega E, Garza-González E, Bocanegra-Ibarias P, Paz-Velarde BA, Esparza-Ahumada S, González-Díaz E, Pérez-Gómez HR, Escobedo-Sánchez R, León-Garnica G, Morfín-Otero R. A case–control study of infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase-1: Predictors and outcomes. Front Cell Infect Microbiol 2022; 12:867347. [PMID: 35967868 PMCID: PMC9366880 DOI: 10.3389/fcimb.2022.867347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/24/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Infections caused by antimicrobial-resistant bacteria are a significant cause of death worldwide, and carbapenemase-producing bacteria are the principal agents. New Delhi metallo-beta-lactamase-1 producing Klebsiella pneumoniae (KP-NDM-1) is an extensively drug-resistant bacterium that has been previously reported in Mexico. Our aim was to conduct a case–control study to describe the risk factors associated with nosocomial infections caused by K. pneumoniae producing NDM-1 in a tertiary-care hospital in Mexico. Methods A retrospective case–control study with patients hospitalized from January 2012 to February 2018 at the Hospital Civil de Guadalajara “Fray Antonio Alcalde” was designed. During this period, 139 patients with a culture that was positive for K. pneumoniae NDM-1 (cases) and 486 patients hospitalized in the same department and on the same date as the cases (controls) were included. Data were analyzed using SPSS v. 24, and logistic regression analysis was conducted to calculate the risk factors for KP-NDM-1 infection. Results One hundred and thirty-nine case patients with a KP-NDM-1 isolate and 486 control patients were analyzed. In the case group, acute renal failure was a significant comorbidity, hospitalization days were extended, and significantly more deaths occurred. In a multivariate analysis of risk factors, the independent variables included the previous use of antibiotics (odds ratio, OR = 12.252), the use of a urinary catheter (OR = 5.985), the use of a central venous catheter (OR = 5.518), the use of mechanical ventilation (OR = 3.459), and the length of intensive care unit (ICU) stay (OR = 2.334) as predictors of infection with NDM-1 K. pneumoniae. Conclusion In this study, the previous use of antibiotics, the use of a urinary catheter, the use of a central venous catheter, the use of mechanical ventilation, and ICU stay were shown to be predictors of infection with NDM-1 K. pneumoniae and were independent risk factors for infection with NDM-1 K. pneumoniae.
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Affiliation(s)
- Eduardo Rodríguez-Noriega
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
| | | | | | | | - Sergio Esparza-Ahumada
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
- Hospital Civil de Guadalajara. Epidemiology, Microbiology and Infectious Disease Department, Guadalajara, Mexico
| | - Esteban González-Díaz
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
- Hospital Civil de Guadalajara. Epidemiology, Microbiology and Infectious Disease Department, Guadalajara, Mexico
| | - Héctor R. Pérez-Gómez
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
| | - Rodrigo Escobedo-Sánchez
- Hospital Civil de Guadalajara. Epidemiology, Microbiology and Infectious Disease Department, Guadalajara, Mexico
| | - Gerardo León-Garnica
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
- Hospital Civil de Guadalajara. Epidemiology, Microbiology and Infectious Disease Department, Guadalajara, Mexico
| | - Rayo Morfín-Otero
- Instituto de Patología Infecciosa y Experimental “Dr. Francisco Ruiz Sánchez”, Centro Universitario de Ciencias de la Salud, Guadalajara, Mexico
- *Correspondence: Rayo Morfín-Otero,
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Carrillo-Larco RM, Guzman-Vilca WC, Leon-Velarde F, Bernabe-Ortiz A, Jimenez MM, Penny ME, Gianella C, Leguía M, Tsukayama P, Hartinger SM, Lescano AG, Cuba-Fuentes MS, Cutipé Y, Diez-Canseco F, Mendoza W, Ugarte-Gil C, Valdivia-Gago A, Zavaleta-Cortijo C, Miranda JJ. Peru - Progress in health and sciences in 200 years of independence. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100148. [PMID: 36777656 PMCID: PMC9904031 DOI: 10.1016/j.lana.2021.100148] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Peru celebrates 200 years of independence in 2021. Over this period of independent life, and despite the turbulent socio-political scenarios, from internal armed conflict to economic crisis to political instability over the last 40 years, Peru has experienced major changes on its epidemiological and population health profile. Major advancements in maternal and child health as well as in communicable diseases have been achieved in recent decades, and today Peru faces an increasing burden of non-communicable diseases including mental health conditions. In terms of the configuration of the public health system, Peru has also strived to secure country-wide optimal health care, struggling in particular to improve primary health care and intercultural services. The science and technology infrastructure has also evolved, although the need for substantial investments remains if advancing science is to be a national priority. Climate change will also bring significant challenges to population health given Peru's geographical and microclimates diversity. Looking back over the 200-years of independence, we present a summary of key advances in selected health-related fields, thus serving as the basis for reflections on pending agendas and future challenges, in order to look forward to ensuring the future health and wellbeing of the Peruvian population. Resumen translated abstract El Perú cumple 200 años de independencia en 2021. Durante estos dos siglos de vida independiente, junto con periodos sociales y políticos turbulentos, incluyendo un conflicto armado interno, hiperinflación y la inestabilidad política de los últimos 40 años, el Perú ha experimentado importantes cambios en su perfil epidemiológico con repercusiones directas en la salud de la población. En las últimas décadas, los indicadores de salud materno-infantil y de las enfermedades transmisibles muestran mejoría importante, pero el país se enfrenta de manera simultánea a una carga cada vez mayor de enfermedades no transmisibles y de salud mental. En cuanto a los sistemas de salud pública, se han realizado esfuerzos por aumentar la cobertura y calidad de la atención de salud en todo el país, apostándose en particular por mejorar la atención primaria. La ciencia y tecnología relacionadas con la salud también han mejorado, aunque si se quiere que la ciencia sea una prioridad nacional, son necesarias inversiones sustanciales. El cambio climático traerá importantes desafíos para la salud de la población, dada la diversidad geográfica y de microclimas del país. Para conmemorar los 200 años de vida independiente del Perú, presentamos un resumen de avances clave en diversas áreas y temas relacionados con la salud. Este repaso sirve como base para reflexionar sobre agendas y desafíos pendientes y futuros, con el fin de asegurar la salud y el bienestar de la población peruana en las próximas décadas.
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Affiliation(s)
- Rodrigo M. Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Fabiola Leon-Velarde
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Camila Gianella
- Departmento de Psicología, Facultad de Psicología, Pontificia Universidad Católica del Perú, Lima, Peru
- Chr. Michelsen Institute, Bergen, Norway
| | - Mariana Leguía
- Laboratorio de Genómica, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Stella M. Hartinger
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andres G. Lescano
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter Mendoza
- Fondo de Población de las Naciones Unidas (UNFPA), Lima, Peru
| | - Cesar Ugarte-Gil
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Lima, Peru
- TB Center, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Andrea Valdivia-Gago
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Intercultural Citizenship and Indigenous Health Unit (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carol Zavaleta-Cortijo
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Intercultural Citizenship and Indigenous Health Unit (UCISI), Universidad Peruana Cayetano Heredia, Lima, Peru
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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9
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Moya‐Salazar J, Sauñe SS, Valer R, Salazar‐Hernandez R, Loza W, Suxe E, Chicoma‐Flores K, Contreras‐Pulache H. Fungal, parasitological, and bacterial coinfection in a severely ill COVID‐19 patient in Peru. Clin Case Rep 2022; 10:e05395. [PMID: 35223005 PMCID: PMC8855487 DOI: 10.1002/ccr3.5395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
COVID‐19 patients are prone to coinfections during their hospitalization. These coinfections are challenging as they involve longer hospital stays, high costs, and higher risk of mortality. Here, we present a case of a patient with multi‐infection by resistant parasites, fungi, and bacteria during his hospitalization in a hospital in Lima, Peru.
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Affiliation(s)
- Jeel Moya‐Salazar
- Hospital Nacional Docente Madre Niño San Bartolomé Lima Peru
- South America Center for Education and Research in Public Health Universidad Norbert Wiener Lima Peru
- Infectious Unit Nesh Hubbs Lima Peru
| | - Sharon S. Sauñe
- Department of Pathology Hospital Carlos Lanfranco La Hoz Lima Peru
| | - Roxana Valer
- Department of Pathology Hospital Carlos Lanfranco La Hoz Lima Peru
| | | | - Wilfredo Loza
- Department of Pathology Hospital Carlos Lanfranco La Hoz Lima Peru
| | - Evelyn Suxe
- Department of Pathology Hospital Carlos Lanfranco La Hoz Lima Peru
| | | | - Hans Contreras‐Pulache
- South America Center for Education and Research in Public Health Universidad Norbert Wiener Lima Peru
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10
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Carlos CC, Masim MAL, Lagrada ML, Gayeta JM, Macaranas PKV, Sia SB, Facun MAM, Palarca JFC, Olorosa AM, Cueno GAC, Abrudan M, Abudahab K, Argimón S, Kekre M, Underwood A, Stelling J, Aanensen DM. Genome Sequencing Identifies Previously Unrecognized Klebsiella pneumoniae Outbreaks in Neonatal Intensive Care Units in the Philippines. Clin Infect Dis 2021; 73:S316-S324. [PMID: 34850834 PMCID: PMC8634409 DOI: 10.1093/cid/ciab776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a critically important pathogen in the Philippines. Isolates are commonly resistant to at least 2 classes of antibiotics, yet mechanisms and spread of its resistance are not well studied. METHODS A retrospective sequencing survey was performed on carbapenem-, extended spectrum beta-lactam-, and cephalosporin-resistant Klebsiella pneumoniae isolated at 20 antimicrobial resistance (AMR) surveillance sentinel sites from 2015 through 2017. We characterized 259 isolates using biochemical methods, antimicrobial susceptibility testing, and whole-genome sequencing (WGS). Known AMR mechanisms were identified. Potential outbreaks were investigated by detecting clusters from epidemiologic, phenotypic, and genome-derived data. RESULTS Prevalent AMR mechanisms detected include blaCTX-M-15 (76.8%) and blaNDM-1 (37.5%). An epidemic IncFII(Yp) plasmid carrying blaNDM-1 was also detected in 46 isolates from 6 sentinel sites and 14 different sequence types (STs). This plasmid was also identified as the main vehicle of carbapenem resistance in 2 previously unrecognized local outbreaks of ST348 and ST283 at 2 different sentinel sites. A third local outbreak of ST397 was also identified but without the IncFII(Yp) plasmid. Isolates in each outbreak site showed identical STs and K- and O-loci, and similar resistance profiles and AMR genes. All outbreak isolates were collected from blood of children aged < 1 year. CONCLUSION WGS provided a better understanding of the epidemiology of multidrug resistant Klebsiella in the Philippines, which was not possible with only phenotypic and epidemiologic data. The identification of 3 previously unrecognized Klebsiella outbreaks highlights the utility of WGS in outbreak detection, as well as its importance in public health and in implementing infection control programs.
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Affiliation(s)
- Celia C Carlos
- Research Institute for Tropic al Medicine, Muntinlupa, the Philippines
| | | | | | - June M Gayeta
- Research Institute for Tropic al Medicine, Muntinlupa, the Philippines
| | | | - Sonia B Sia
- Research Institute for Tropic al Medicine, Muntinlupa, the Philippines
| | | | | | | | | | - Monica Abrudan
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Khalil Abudahab
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Silvia Argimón
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Mihir Kekre
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Anthony Underwood
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
- Brigham and Women’s Hospital, Boston, MA, USA
| | | | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, Cambridge, UK
- Centre for Genomic Pathogen Surveillance, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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11
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Gonzales-Escalante E, Ruggiero M, Cerdeira L, Esposito F, Fontana H, Lincopan N, Gutkind G, Di Conza J. Whole-Genome Analysis of a High-Risk Clone of Klebsiella pneumoniae ST147 Carrying Both mcr-1 and blaNDM-1 Genes in Peru. Microb Drug Resist 2021; 28:171-179. [PMID: 34698586 DOI: 10.1089/mdr.2021.0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The increasing prevalence and dissemination of carbapenemase-producing Enterobacterales represent a serious concern for public health. We studied the genetic features of a multidrug-resistant isolate of high-risk clone ST147 Klebsiella pneumoniae coharboring mcr-1 and blaNDM-1 recovered from a human clinical urine sample in 2017 in Peru. Whole-genome sequencing and conjugation assays identified mcr-1 and blaNDM-1 genes on two different conjugative plasmids, which belong to IncI2 and IncFIB/HI1B incompatibility groups, respectively. The presence of blaCTX-M-15 (in the studied isolate, located on the chromosome) and mutations in GyrA S83I and ParC S80I were detected, as expected for ST147. In addition, other β-lactamases (blaTEM-26 and blaOXA-1) and PMQR (qnrE2 and aac(6')-Ib-cr) among several resistance determinants were identified. The coexistence not previously described of these genes in the same high-risk clone is a cause for serious concern that supports the need for implementation of genomic surveillance studies.
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Affiliation(s)
- Edgar Gonzales-Escalante
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales - CITBM, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Melina Ruggiero
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Louise Cerdeira
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia.,Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fernanda Esposito
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Herrison Fontana
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Nilton Lincopan
- Department of Microbiology, Instituto de Ciências Biomédicas, Universidade de São Paulo, Sao Paulo, Brazil
| | - Gabriel Gutkind
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
| | - Jose Di Conza
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Buenos Aires, Argentina
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12
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A multidrug-resistant Klebsiella pneumoniae outbreak in a Peruvian hospital: Another threat from the COVID-19 pandemic. Infect Control Hosp Epidemiol 2021; 43:267-268. [PMID: 33397537 PMCID: PMC7844176 DOI: 10.1017/ice.2020.1401] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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In Vitro and In Vivo Evaluations of β-Lactam/β-Lactamase Mono- and Combined Therapies against Carbapenem-Nonsusceptible Enterobacteriaceae in Taiwan. Microorganisms 2020; 8:microorganisms8121981. [PMID: 33322803 PMCID: PMC7764198 DOI: 10.3390/microorganisms8121981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/10/2020] [Indexed: 12/28/2022] Open
Abstract
Increasing carbapenem resistance rates worldwide underscored the urgent need of novel antimicrobials. Ceftazidime–avibactam and aztreonam–avibactam combinations are developed to combat carbapenem resistance, but biological and geographic variations must be considered for antibiotic susceptibility patterns varied. Thus, we sought to assess the susceptibilities of ceftazidime–avibactam and aztreonam–avibactam against 660 carbapenem-nonsusceptible Enterobacteriaceae isolates (472 Klebsiella pneumoniae and 188 Escherichia coli) collected during an earlier Taiwan surveillance study. Agar dilution method was used to determine ceftazidime–avibactam and aztreonam–avibactam susceptibility. Metallo-carbapenemase’s contribution to resistance were investigated with EDTA addition. The in vivo efficacies were evaluated using a Caenorhabditis elegans model. High susceptibility rates were observed for ceftazidime–avibactam and aztreonam–avibactam against the 472 carbapenem-nonsusceptible K. pneumoniae (CnsKP) (85.2% and 95.3%, respectively) and 188 carbapenem-nonsusceptible E. coli (CnsEC) isolates (91.5% and 94.1%, respectively). For non-metallo-carbapenemase producers, the susceptibility rates for ceftazidime–avibactam were 93.6% for CnsKP and 97.7% for CnsEC, whereas only 7.1% CnsKP and 11.1% CnsEC in metallo-carbapenemase producers were susceptible to ceftazidime–avibactam. Of all isolates, 95.3% CnsKP and 94.1% CnsEC were susceptible to aztreonam–avibactam. In C. elegans model, ceftazidime–avibactam and aztreonam–avibactam revealed effective against a blaKPC-producing K. pneumoniae isolate in vivo. Our results propose a positive therapeutic approach for both combinations against carbapenem-nonsusceptible Enterobacteriaceae in Taiwan.
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