Serious Antimicrobial Resistance Status of Pathogens Causing Hospital-acquired Lower Respiratory Tract Infections in North China

Spreading of extended-spectrum β-lactamase-producing Escherichia coli ST131 and Klebsiella pneumoniae ST11 in patients with pneumonia: a molecular epidemiological study

Supplemental Digital Content is available in the text

Background:

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the important pathogens causing pneumonia. This study aimed to investigate the clinical characteristics and molecular epidemiology of ESBL-producing E. coli and K. pneumoniae causing pneumonia at a large teaching hospital in China.

Methods:

We collected patient's clinical data and ESBL-producing E. coli and K. pneumoniae strains causing pneumonia (from December 2015 to June 2016) at a hospital in Wuhan. The susceptibilities, multi-locus sequence typing, homologous analysis, ESBL genes by polymerase chain reaction and sequencing were determined.

Results:

A total of 59 ESBL-producing strains (31 E. coli and 28 K. pneumoniae) isolated from patients with pneumonia were analyzed. The majority of strains were isolated from patients were with hospital-acquired pneumonia (37/59, 62.7%), followed by community-acquired pneumonia (13/59, 22.0%), and ventilator-related pneumonia (9/59, 15.3%). The E. coli ST131 (9 isolates, 29.0%) and K. pneumoniae ST11 (5 isolates, 17.9%) were the predominant sub-types. The most prevalent ESBL gene was CTX-M-14, followed by SHV-77, CTX-M-3, SHV-11, and CTX-M-27. At least 33 (55.9%) of the ESBL-producing strains carried two or more ESBL genes. The ISEcp1 and IS26 were found upstream of all blaCTX-M (CTX-Ms) and of most blaSHV (SHVs) (57.6%), respectively. Moreover, three ESBL-producing K. pneumoniae ST11 strains which were resistant to carbapenems carried the bla_NDM-1 and bla_KPC-2, two of which also bearing bla_OXA-48 were resistant to all antibiotics (including Tigecycline).

Conclusions:

Hospital-acquired pneumonia is more likely correlated with ESBL-producing E. coli and K. pneumoniae. ESBL-producing E. coli ST131 and multi-drug resistance ESBL-producing, as well as New Delhi metallo-β-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemases-2 (KPC-2) bearing K. pneumoniae ST11 are spreading in patients with pneumonia in hospital.

Trimethoprim/sulfamethoxazole for Acinetobacter spp.: A review of current microbiological and clinical evidence

Clinicians nowadays are confronted with an epidemic of multidrug-resistant (MDR) Acinetobacter infections and are forced to consider every treatment alternative, including older antibiotic agents, not conventionally used. This review aimed to evaluate the published evidence on the antimicrobial activity and clinical effectiveness of trimethoprim/sulfamethoxazole (TMP-SMX) against Acinetobacter spp. Selected in vitro studies included antimicrobial surveillance reports, microbiological studies regarding the activity of TMP-SMX against MDR Acinetobacter isolates, and clinical studies published after the year 2000. Non-susceptibility rates for Acinetobacter spp. in surveillance studies ranged from 4% to 98.2%; in 23 of 28 studies, non-susceptibility to TMP-SMX was >50% and in a subset of 15 studies non-susceptibility was >70%. In studies regarding MDR Acinetobacter spp., non-susceptibility rates ranged from 5.9% to 100%; however, 19 of 21 studies reported >70% non-susceptibility. Extensively drug-resistant Acinetobacter baumannii complex had total (100%) resistance in five of six studies. Carbapenem-resistant Acinetobacter spp. had non-susceptibility rates to TMP-SMX of >80% in 22 of 26 studies. One study on polymyxin-resistant A. baumannii showed a susceptibility rate of 54.2% (13/24). Only seven case reports evaluated TMP-SMX for Acinetobacter spp. infections, mainly in combination with other agents; all cases were deemed therapeutic successes. Although TMP-SMX is not usually active against Acinetobacter spp., it might be considered in cases where there are no other options.

Microbiologic Spectrum and Antibiotic Susceptibility Pattern among Patients with Urinary and Respiratory Tract Infection

Aim. To demonstrate the prevalence of isolated organisms in urinary/respiratory tract infections and their antibiotic susceptibilities in a tertiary care center. Methods and Material. Between January 2008 and January 2010, patients referring to the clinic of cardiology or those admitted to the cardiac wards were enrolled in this cross-sectional descriptive study. Urine and sputum sampling was done for all the patients and the specimens underwent microbiologic examination and, in case of isolation of microorganism, antibiotic disk diffusion test was performed. Results. Escherichia coli (E. coli) was the most prevalent isolated organism in-hospital and community-acquired UTIs and was highly resistant to cephalothin in all the samples followed by cotrimoxazole, and ceftriaxone. It revealed high sensitivity to imipenem, amikacin, and nitrofurantoin. Acinetobacter constituted the most prevalent organism isolated from respiratory secretions and represented the highest resistance to ceftriaxone and the greatest sensitivity to imipenem. Conclusions. E. coli and Acinetobacter remain the most common uropathogenic and respiratory organisms, respectively. However, their increasing resistance to wide-spectrum imipenem, meropenem, and vancomycin is a major concern.

Changing trend of antimicrobial resistance among pathogens isolated from lower respiratory tract at a university-affiliated hospital of China, 2006-2010

OBJECTIVE

To investigate the distribution and the antimicrobial resistance of pathogens in lower respiratory tract infection from 2006 to 2010.

METHODS

The sputum specimens from inpatients with lower respiratory tract infection in the First Affiliated Hospital of Nanjing Medical University during the past five years were cultured and identified; the antimicrobial resistance was analyzed by the software WHONET 5.4.

RESULTS

A total of 12,191 isolates were characterized in sputum samples: 73.5% were Gram-negative bacteria, 13.7% were Gram-positive bacteria, and 12.8% were fungi. The isolation rate of Acinetobacter was significantly increasing from 12.8% in 2006 to 26.4% in 2010. The Gram-negative bacterial resistance rate to the second and third generation cephalosporin increased year by year. Decreasing trend, 78.7% in 2006 decreased to 63.5% in 2010 (R(2)=0.93 and P<0.01), in resistance to clindamycin against Staphylococcus aureus was observed. Worth noting is the drug resistance of Acinetobacter and Klebsiella pneumoniae to carbapenem significantly increased (R(2)>0.3 and P≤0.05).

CONCLUSIONS

The antimicrobial resistance of pathogens in lower respiratory tract infection increased in recent years. The hospitals and government departments should strengthen management of the use of some antibiotics, such as the second/third generation cephalosporin and carbapenem, in order to enhance the effectiveness of medication.

Coexistence of blaOXA48 and aac(6′)-Ib-cr Genes in Klebsiella Pneumoniae Isolates from Istanbul, Turkey

This study evaluated the presence of carbapenem hydrolysing β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 22 Klebsiella pneumoniae isolates collected from the Istanbul Medical Faculty, Turkey, which reduced the susceptibility or resistance to carbapenem. The VITEK® 2 system and E-tests were used to determine the minimum inhibitory concentrations needed to inhibit bacterial growth. Genes were screened by polymerase chain reaction, and gene transferability was evaluated by transconjugation. Strain clonality was investigated by pulsed-field gel electrophoresis (PFGE). All strains were OXA-48 β-lactamase producers and three (13.6%) were also positive for the aac(6′)-Ib-cr gene. Most of the strains harboured other b-lactamase (bla) genes such as blaTEM, blaSHV, blaCTX-M and blaVEB-1. The transconjugants mostly harboured blaOXA-48 and other β-lactamases separately. PFGE revealed eight pulsotypes among the isolates. The coexistence of blaOXA-48 and PMQR in K. pneumoniae isolates may present a significant threat to health, especially in the nosocomial setting.