Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study

Objectives

To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).

Methods

In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.

Results

We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).

Conclusions

Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.

Outbreak of Colonization and Infection With Vancomycin-ResistantEnterococcus faeciumin a French University Hospital

An outbreak of infection with vancomycin-resistantEnterococcus faeciumoccurred at Hôtel-Dieu Hospital (Clermont-Ferrand, France). A case-control study was performed in the infectious diseases and hematology units of the hospital. Urinary catheter use (odds ratio [OR], 12 [95% confidence interval {CI}, 1.5-90];P<.02), prior exposure to a third-generation cephalosporin (OR, 22 [95% CI, 3-152];P= .002), and prior exposure to antianaerobials (OR, 11 [95% CI, 1.5-88];P<.02) were independently predictive of vancomycin-resistantEnterococcus faeciumcarriage.

Frequency and diversity of Class A extended-spectrum beta-lactamases in hospitals of the Auvergne, France: a 2 year prospective study

OBJECTIVES

To evaluate the frequency and diversity of extended-spectrum beta-lactamases (ESBLs) produced by Enterobacteriaceae and Pseudomonas aeruginosa in one French region.

METHODS

During 2001-2002, all the non-duplicate isolates of P. aeruginosa resistant to ceftazidime and of Enterobacteriaceae intermediate or resistant to ceftazidime and/or cefotaxime and/or aminoglycosides with an AAC(6') I phenotype were collected in nine hospitals of the area. ESBL isoelectric points were determined, bla genes were amplified and sequenced and epidemic isolates were genotyped with ERIC2-PCR.

RESULTS

ESBLs were observed in 297 Enterobacteriaceae (0.8%). The most frequent were TEM-3 like (n=152; 51.2%) and TEM-24 (n=115; 38.7%). Four new enzymes were observed, TEM-112 (pI 5.4), TEM-113 (pI 6.3), TEM-114 (pI 5.9) and TEM-126 (pI 5.4). Other TEMs were TEM-8, TEM-12, TEM-16, TEM-19, TEM-20, TEM-21, TEM-29 and TEM-71. The other ESBLs were SHV-4, SHV-5 and SHV-12, CTX-M-1, CTX-M-3, CTX-M-14 and CTX-M-15. In 37 P. aeruginosa (0.7%) only one ESBL was observed, PER-1. Five epidemic strains were detected, Serratia marcescens TEM-3 and four observed in several hospitals, Enterobacter aerogenes TEM-24, Citrobacter koseri TEM-3, Proteus mirabilis TEM-3 and P. aeruginosa PER-1.

CONCLUSION

ESBL frequency was lower than in 1998, and CTX-M-type frequency higher (2.1% of ESBLs in 2001, 4.9% in 2002). This long-term survey detected new sporadic enzymes (TEM-112, TEM-113, TEM-114 and TEM-126) and interhospital epidemic strains while avoiding any overestimation of ESBL frequency that may otherwise have occurred because of acute epidemics.

Clinical characteristics and outcome of patients with invasive pneumococcal disease, Puy-de-Dôme, France, 1994-1998

A surveillance program for invasive pneumococcal disease was undertaken in Puyde-Dĵme, an administrative district of the region Auvergne in France, from 1 January 1994 to 31 December 1998. A total of 214 cases were identified. The annual incidence of invasive pneumococcal disease increased (P=0.04) from 5.5 in 1994 to 9.3 cases per 10(5) person-years in 1998. The highest incidences were for children <2 years of age (59.2 cases per 10(5) person-years) and for adults > or = 65 years (18 cases per 10(5) person-years). Clinical diagnoses, available in 200 patients, included acute pneumonia (62%), meningitis (10%), sepsis without focus (20%), and others (8%). The most frequent chronic medical conditions of the patients included smoking, alcoholism, cardiovascular and pulmonary diseases, and malignancies. Thirty-one percent of the isolates were nonsusceptible to penicillin. Penicillin resistance (MIC > or = 0.1 mg/l) was more frequent (P=0.02) in cancer patients. The overall case-fatality rate was 21.5%. Risk factors for death were age, sex, and underlying diseases of the patients, along with the severity of illness. These population-based findings should convince clinicians to offer pneumococcal vaccine to patients at high risk for invasive pneumococcal disease, thereby increasing vaccination coverage levels in France.

Human and animal epidemic of Yersinia enterocolitica O:9, 1989-1997, Auvergne, France

Yersinia enterocolitica O:9 infections were reported in Auvergne in 1988 to 1989, while brucellosis due to Brucella abortus was almost eliminated. The serologic cross-reactions between the two bacteria complicated the diagnosis of brucellosis cases. In 1996, human cases of Yersinia enterocolitica O:9 infection were detected, with a peak incidence of 12 cases. Veterinary surveillance could have predicted the emergence of this disease in humans.

Survey of prevalence of extended spectrum beta-lactamases among enterobacteriaceae

During the first six months of 1990 and 1994 respectively, 3179 and 2721 non-repetitive strains of Enterobacteriaceae were isolated at the teaching hospital of Clermont-Ferrand. Extended-spectrum beta-lactamases were found in 147 isolates, mainly in Klebsiella pneumoniae (n = 73), Enterobacter aerogenes (n = 37) and Proteus mirabilis (n = 15). TEM-3/CTX-1, SHV-4/CAZ-5 and TEM-24/CAZ-6 were the prevalent enzymes. However, the most frequently involved enzyme in 1990 was TEM-3 (48.6%) whereas in 1994 it was SHV-4 (56.0%). Two salient features emerged from this study: the high frequency of TEM-3 production in P. mirabilis and the production of SHV-4 enzyme, heretofore observed solely in K. pneumoniae, in two other species, E. aerogenes and Escherichia coli.

[Detection of pneumococci with reduced susceptibility to penicillin G using the ATB++STREP strip]

Antibiotic susceptibility of 104 clinical isolates of Streptococcus pneumoniae was routinely tested using ATB STREP strips (Bio-Mérieux), and interpreted with ATB PLUS Expert V 2.3.1 software. In parallel, CMI of penicillin G was determined by Etest, strains with MIC < or = 0.06 mg/l were classified as penicillin susceptible. ATB system proved to be both sensitive and specific for the detection of strains of reduced susceptibility to penicillin G, accurately detecting 70 out of the 71 susceptible strains, and all of the 33 resistant strains. However the level of resistance cannot be deduced from ATB results.

[Detection of beta-lactamases resistant to inhibitors (IRT) by the disk diffusion method]

85 E. coli strains producing various beta-lactamase were studied: TEM low level: n = 11, TEM high level: n = 4, oxacillinase (OXA): n = 5, céphalosporinase (CASE) +/- TEM: n = 5, inhibitor resistant TEM (IRT) n = 50, IRT+TEM: n = 3, IRT+

CASE

n = 7. Their susceptibility to amoxicillin (AMX), amoxicillin+clavulanate (AMC), ticarcillin (TIC), ticarcillin+clavulanate (TCC), piperacillin (PIP), piperacillin+tazobactam (TAZ), mecillinam (MEC), cephalotin (CF), cefoxitin (FOX) et ceftazidime (CAZ) were evaluated by a disk diffusion method, in order to determine the resistance pattern which allows a reliable detection of IRT-producing strains. The phenotype AMX R, TIC R, AMCI/R, TCCI/R et CFS was observed in 46 out of 53 IRT +/- TEM strains, 4/5 of OXA strains and 1/11 of TEM low level strains. A better sensitivity could be obtained by a modification of breakpoints for AMC, TCC and CF, however OXA-producing strains remain indistinguishable from IRT-strains.

[Detection and analysis of cryoglobulins: comparative study of a population of patients and one of healthy controls]

During an 11-month period, 270 cryoglobulins were identified in 735 sera from patients versus 34 in 82 sera from apparently healthy blood donors. Western-blot analysis of the cryoglobulins was performed and cryoglobulin protein content was determined using a colorimetric assay. Comparison of findings in the two groups suggested that a substantial proportion of cryoglobulins identified in the sera of patients are quantitatively and qualitatively indistinguishable from cryoglobulins identified in healthy controls.