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Woodford N, Xu-McCrae L, Mushtaq S, Wu HHT, Ellington MJ, Lancaster O, Davies F, Donaldson H, Rao GG, Verma A, Wareham DW, Ciesielczuk H, Stone GG, Irani PM, Bracher S, Hawkey PM. Prevalence of carbapenem resistance and carbapenemase production among Enterobacteriaceae isolated from urine in the UK: results of the UK infection-Carbapenem Resistance Evaluation Surveillance Trial (iCREST-UK). J Antimicrob Chemother 2019; 73:698-702. [PMID: 29253163 DOI: 10.1093/jac/dkx471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/10/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives Although carbapenem susceptibility testing has been recommended for all Enterobacteriaceae from clinical specimens, for practical reasons a carbapenem is not included in many primary antibiotic panels for urine specimens. The 'iCREST' study sought carbapenemase-producing Enterobacteriaceae (CPE) in routine urine specimens yielding Gram-negative growth in five diagnostic laboratories in the UK. We sought also to compare locally and centrally determined MICs of meropenem and ceftazidime/avibactam. Methods Positive growth from up to 2000 urine specimens per laboratory was plated onto chromID® CARBA SMART agar. Suspected CPE colonies were tested locally by Etest for susceptibility to meropenem and ceftazidime/avibactam, and referred to central laboratories for PCR confirmation of CPE status and microbroth MIC determination. Results Twenty-two suspected CPE were identified from 7504 urine specimens. Ten were confirmed by PCR to have NDM (5), IMP (2), KPC (2) or OXA-48-like (1) carbapenemases. Locally determined ceftazidime/avibactam MICs showed complete categorical agreement with those determined centrally by microbroth methodology. The seven ceftazidime/avibactam-resistant isolates (MICs ≥256 mg/L) had NDM or IMP metallo-carbapenemases. Conclusions The frequency of confirmed CPE among Gram-negative urinary isolates was low, at 0.13% (10/7504), but CPE were found in urines at all five participating sites and the diversity of carbapenemase genes detected reflected the complex epidemiology of CPE in the UK. These data can inform local policies about the cost-effectiveness and clinical value of testing Gram-negative bacteria from urine specimens routinely against a carbapenem as part of patient management and/or infection prevention and control strategies.
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Affiliation(s)
- Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Li Xu-McCrae
- Specialist Microbiology Service, National Infection Service, Public Health England, Birmingham B9 5SS, UK
| | - Shazad Mushtaq
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Houdini Ho Tin Wu
- Specialist Microbiology Service, National Infection Service, Public Health England, Birmingham B9 5SS, UK.,Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, UK
| | - Matthew J Ellington
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Owen Lancaster
- Specialist Microbiology Service, National Infection Service, Public Health England, Birmingham B9 5SS, UK
| | | | | | - G Gopal Rao
- London North West Healthcare NHS Trust, London, UK
| | - Anita Verma
- King's College Hospital, NHS Foundation Trust, London, UK
| | - David W Wareham
- Division of Infection, Barts Health NHS Trust, London E1 2ES, UK
| | | | | | | | | | - Peter M Hawkey
- Specialist Microbiology Service, National Infection Service, Public Health England, Birmingham B9 5SS, UK.,Institute of Microbiology and Infection, University of Birmingham, Birmingham B15 2TT, UK
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Sims RE, Wu HHT, Dale N. Sleep-wake sensitive mechanisms of adenosine release in the basal forebrain of rodents: an in vitro study. PLoS One 2013; 8:e53814. [PMID: 23326515 PMCID: PMC3543262 DOI: 10.1371/journal.pone.0053814] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 12/05/2012] [Indexed: 12/24/2022] Open
Abstract
Adenosine acting in the basal forebrain is a key mediator of sleep homeostasis. Extracellular adenosine concentrations increase during wakefulness, especially during prolonged wakefulness and lead to increased sleep pressure and subsequent rebound sleep. The release of endogenous adenosine during the sleep-wake cycle has mainly been studied in vivo with microdialysis techniques. The biochemical changes that accompany sleep-wake status may be preserved in vitro. We have therefore used adenosine-sensitive biosensors in slices of the basal forebrain (BFB) to study both depolarization-evoked adenosine release and the steady state adenosine tone in rats, mice and hamsters. Adenosine release was evoked by high K+, AMPA, NMDA and mGlu receptor agonists, but not by other transmitters associated with wakefulness such as orexin, histamine or neurotensin. Evoked and basal adenosine release in the BFB in vitro exhibited three key features: the magnitude of each varied systematically with the diurnal time at which the animal was sacrificed; sleep deprivation prior to sacrifice greatly increased both evoked adenosine release and the basal tone; and the enhancement of evoked adenosine release and basal tone resulting from sleep deprivation was reversed by the inducible nitric oxide synthase (iNOS) inhibitor, 1400 W. These data indicate that characteristics of adenosine release recorded in the BFB in vitro reflect those that have been linked in vivo to the homeostatic control of sleep. Our results provide methodologically independent support for a key role for induction of iNOS as a trigger for enhanced adenosine release following sleep deprivation and suggest that this induction may constitute a biochemical memory of this state.
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Affiliation(s)
- Robert Edward Sims
- School of Life Sciences, University of Warwick, Coventry, West Midlands, United Kingdom.
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