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Jenkins DR, Auckland C, Chadwick C, Dodgson AR, Enoch DA, Goldenberg SD, Hussain A, Martin J, Spooner E, Whalley T. A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals. BMC Infect Dis 2024; 24:444. [PMID: 38671365 DOI: 10.1186/s12879-024-09307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges. METHODS A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE. KEY FINDINGS Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks. CONCLUSION Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources- such as upscaled screening- to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.
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Affiliation(s)
- D R Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - C Auckland
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - C Chadwick
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - A R Dodgson
- Manchester University NHS FT, Manchester, UK
| | - D A Enoch
- Cambridge University NHS Foundation Trust, Cambridge, UK
| | - S D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - A Hussain
- University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Spooner
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - T Whalley
- Lancashire & South Cumbria ICB, Preston, UK
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2
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Seo H, Kim S, Lee YW, Oh HS, Kim HS, Kim YK. Comparison of clinical outcomes of patients with serial negative surveillance cultures according to a subsequent polymerase chain reaction test for carbapenemase-producing Enterobacterales. J Hosp Infect 2024; 146:93-101. [PMID: 38369061 DOI: 10.1016/j.jhin.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/19/2024] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) are of serious concern worldwide due to high morbidity and mortality. AIM To evaluate the impact of the result of a subsequent polymerase chain reaction (PCR) test for carbapenemase after serial negative surveillance cultures on positive culture conversion in patients with three consecutive negative surveillance cultures for CPE, and to identify risk factors for conversion. METHODS A retrospective study of patients with positive CPE cultures on CHROMagar KPC medium was performed in a Korean tertiary hospital from October 2018 to December 2022. PCR for blaKPC, blaNDM, blaIMP, blaVIM, blaGES, and blaOXA-48 was performed after three consecutive negative rectal swab cultures. Clinical characteristics and outcomes of patients were compared according to whether follow-up PCR was positive (CNPP) or negative (CNPN). FINDINGS Of 1075 patients with positive CPE cultures, 150 (14.0%) yielded three consecutive negative rectal swab cultures. Of these, 50 (33.3%) were CNPP, and 100 (66.7%) were CNPN. Risk factors associated with a positive PCR result on multivariate analysis were: age, central venous catheter, and Escherichia coli infection. CNPP patients were more likely to have positive culture conversion for CPE than CNPN patients (39/44 (88.6%) vs 21/50 (42.0%), P<0.001). In multivariate analysis, independent risk factors for culture conversion were: a positive PCR result after surveillance cultures, diabetes mellitus, central venous catheter, and Klebsiella pneumoniae. CONCLUSION CNPP patients have higher rates of culture conversion than CNPN patients, and a follow-up PCR test after serial negative surveillance cultures is useful in deciding whether or not to discontinue contact precautions.
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Affiliation(s)
- H Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - S Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y W Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - H S Oh
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - H-S Kim
- Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Y K Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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Huang Q, Zhang J, Liao G. Abdominal abscess caused by Raoultella ornithinolytica secondary to postoperative gastric fistula: case report and review of literature. BMC Infect Dis 2024; 24:363. [PMID: 38553710 PMCID: PMC10981363 DOI: 10.1186/s12879-024-09234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia. CASE PRESENTATION We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome. CONCLUSIONS To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient's pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium.
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Affiliation(s)
- Qiuxia Huang
- The Central Hospital of Shaoyang, Shaoyang, Hunan, China.
| | - Jihong Zhang
- The Central Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Gang Liao
- The Central Hospital of Shaoyang, Shaoyang, Hunan, China.
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Duque M, Bonnin RA, Dortet L. Evaluation of the French novel disc diffusion-based algorithm for the phenotypic screening of carbapenemase-producing Enterobacterales. Clin Microbiol Infect 2024; 30:397.e1-397.e4. [PMID: 38065362 DOI: 10.1016/j.cmi.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES The early identification of carbapenemase-producing Enterobacterales (CPE) is required to prevent their spread and initiate proper therapy. Accordingly, it is crucial to develop efficient algorithms using susceptibility testing results to discriminate non-carbapenemase producers (non-CPE) from those that require complementary tests. In 2022, to adapt its recommendations to the evolution of CPE epidemiology (increased prevalence of OXA-244 producers), the Antibiogram Committee of the French Society of Microbiology (CA-SFM) proposed a new algorithm for the screening of CPE. We compared this algorithm to the former algorithm (2015-2021). METHODS From July 2022 to January 2023, all nonduplicate enterobacterial isolates referred to French National Reference Centre for carbapenemase detection (n = 518) were subjected to the former CA-SFM algorithm (2015 to 2021) using inhibition diameters of ertapenem, ticarcillin-clavulanate, temocillin and meropenem or imipenem, and the novel CA-SFM algorithm (since 2022) using inhibition diameters of ceftazidime-avibactam, temocillin, and meropenem or imipenem. RESULTS Sensitivity, specificity, negative predictive value, and positive predictive value were of 80.8% (CI95 76.3%-84.6%), 66.2% (58.1%-73.5%), 59.3% (51.5%-66.6%), and 85.0% (80.7% - 88.5%) for the old CA-SFM algorithm and 97.8% (95.5%-99.0%), 45.5% (37.5%-53.7%), 89.7% (80.3%-95.2%), and 80.9% (76.9%-84.4%) for the novel CA-SFM algorithm. DISCUSSION The novel CA-SFM algorithm possesses the best performance for the screening of CPE particularly in countries with a high prevalence of OXA-48-like producers.
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Affiliation(s)
- Mathilde Duque
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Rémy A Bonnin
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Laurent Dortet
- Team Resist UMR1184 Immunology of Viral, Auto-Immune, Hematological and Bacterial Diseases (IMVA-HB), INSERM, Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-Producing Enterobacteriales, Le Kremlin-Bicêtre, France; Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
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Kalogeropoulos D, Asproudis C, Priavali E, Pappa C, Kalogeropoulos C, Asproudis I. A novel case of Raoultella planticola - associated acute dacryocystitis. Orbit 2024; 43:157-159. [PMID: 35730243 DOI: 10.1080/01676830.2022.2089168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 10/17/2022]
Abstract
This study aims to report an acute dacryocystitis associated with Raoultella planticola infection. The patient's medical records and laboratory were thoroughly assessed. A thorough literature search was performed in PubMed database. An additional search was made in Google Scholar to complete the collected items. This is the first recorded case of acute dacryocystitis attributed to Raoultella planticola infection. A limited number of studies has related this pathogen with conjunctivitis. Acute dacryocystitis on rare occasions can also be caused by atypical organisms. Swabs must be obtained and patients must be started on empirical treatment while waiting for the laboratory results.
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Affiliation(s)
- Dimitrios Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Christopher Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Efthalia Priavali
- Department of Microbiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chrysavgi Pappa
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chris Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Asproudis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Koeffer J, Kolb M, Sorel O, Ulekleiv C, Feenstra JDM, Eigner U. Clinical performance evaluation of TAQPATH Enteric Bacterial Select Panel for the detection of common enteric bacterial pathogens in comparison to routine stool culture and other qPCR-based diagnostic tests. Microbiol Spectr 2024; 12:e0317223. [PMID: 38054723 PMCID: PMC10783074 DOI: 10.1128/spectrum.03172-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE Enteric bacterial infections caused by Salmonella, Shigella, pathogenic Escherichia coli, and Campylobacter represent one of the most common causes of infectious enteritis worldwide. The timely and accurate diagnosis of pathogens causing gastroenteritis is crucial for patient care, public health, and disease surveillance. While stool culture has long been the standard and highly specific method for detecting enteric pathogens, it is labor-intensive and time-consuming with limited sensitivity. To improve patient outcomes, there is a need to implement new cost-effective approaches for the detection of bacterial enteric pathogens with higher sensitivity and faster time to result. This study shows that multiplex real-time polymerase chain reaction-based tests, such as the TAQPATH Enteric Bacterial Select Panel, are accurate and cost-effective diagnostic alternatives for the detection and differentiation of the most common enteric bacterial pathogens, offering quicker time to result and higher sensitivity compared to routine stool culture.
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Affiliation(s)
- Jasmin Koeffer
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | - Melissa Kolb
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | - Oceane Sorel
- Thermo Fisher Scientific, South San Francisco, California, USA
| | | | | | - Ulrich Eigner
- Department of Infectious Diseases, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
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7
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Cole SD, Dietrich J, Rankin SC. Use of a chromogenic medium with and without selective enrichment to screen for carbapenemase-producing Enterobacterales (CPE) from canine and feline fecal specimens during an outbreak of NDM-5-producing Escherichia coli. J Vet Diagn Invest 2024; 36:124-127. [PMID: 37919965 PMCID: PMC10734579 DOI: 10.1177/10406387231204560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Carbapenemase-producing Enterobacterales (CPE) are one of the most urgent threats to human healthcare globally. Descriptions of CPE outbreaks in veterinary hospitals suggest the need for screening strategies for CPE from companion animals. Our aim was to optimize a chromogenic agar method with and without selective enrichment to isolate CPE from companion animal feces in an ongoing outbreak of New Delhi metallo-β-lactamse-5 Escherichia coli. A limit of detection (LOD) assay for spiked canine and feline feces was performed for both methods using a carbapenamase-producing E. coli (24213-18); the LOD (1.5 × 103 cfu/g of feces) was equivalent to that reported for human fecal specimens. We screened 1,247 companion animal fecal specimens for carriage of CPE by 1) direct plating to chromogenic agar and 2) plating to chromogenic agar following selective enrichment. Twenty-one specimens were positive for CPE by both direct culture and enrichment culture. No specimens were positive with selective enrichment and negative by direct culture. A selective enrichment step did not result in any increased recovery of CPE from companion animals, which suggests that enrichment broth may not be necessary for outbreak surveillance testing. It is important to continue to validate methods for the detection of CPE in companion animals as outbreaks become more common in veterinary facilities.
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Affiliation(s)
- Stephen D. Cole
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jaclyn Dietrich
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shelley C. Rankin
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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Pople D, Kypraios T, Donker T, Stoesser N, Seale AC, George R, Dodgson A, Freeman R, Hope R, Walker AS, Hopkins S, Robotham J. Model-based evaluation of admission screening strategies for the detection and control of carbapenemase-producing Enterobacterales in the English hospital setting. BMC Med 2023; 21:492. [PMID: 38087343 PMCID: PMC10717398 DOI: 10.1186/s12916-023-03007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Globally, detections of carbapenemase-producing Enterobacterales (CPE) colonisations and infections are increasing. The spread of these highly resistant bacteria poses a serious threat to public health. However, understanding of CPE transmission and evidence on effectiveness of control measures is severely lacking. This paper provides evidence to inform effective admission screening protocols, which could be important in controlling nosocomial CPE transmission. METHODS CPE transmission within an English hospital setting was simulated with a data-driven individual-based mathematical model. This model was used to evaluate the ability of the 2016 England CPE screening recommendations, and of potential alternative protocols, to identify patients with CPE-colonisation on admission (including those colonised during previous stays or from elsewhere). The model included nosocomial transmission from colonised and infected patients, as well as environmental contamination. Model parameters were estimated using primary data where possible, including estimation of transmission using detailed epidemiological data within a Bayesian framework. Separate models were parameterised to represent hospitals in English areas with low and high CPE risk (based on prevalence). RESULTS The proportion of truly colonised admissions which met the 2016 screening criteria was 43% in low-prevalence and 54% in high-prevalence areas respectively. Selection of CPE carriers for screening was improved in low-prevalence areas by adding readmission as a screening criterion, which doubled how many colonised admissions were selected. A minority of CPE carriers were confirmed as CPE positive during their hospital stay (10 and 14% in low- and high-prevalence areas); switching to a faster screening test pathway with a single-swab test (rather than three swab regimen) increased the overall positive predictive value with negligible reduction in negative predictive value. CONCLUSIONS Using a novel within-hospital CPE transmission model, this study assesses CPE admission screening protocols, across the range of CPE prevalence observed in England. It identifies protocol changes-adding readmissions to screening criteria and a single-swab test pathway-which could detect similar numbers of CPE carriers (or twice as many in low CPE prevalence areas), but faster, and hence with lower demand on pre-emptive infection-control resources. Study findings can inform interventions to control this emerging threat, although further work is required to understand within-hospital transmission sources.
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Affiliation(s)
- Diane Pople
- HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK.
| | - Theodore Kypraios
- School of Mathematical Sciences, University Park, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Tjibbe Donker
- University Medical Center Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Breisacher Strasse, 79106, Freiburg im Breisgau, Germany
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infections, University of Oxford and UKHSA, Oxford, UK
| | - Anna C Seale
- University of Warwick, Warwick, UK
- London School of Hygiene & Tropical Medicine, London, UK
- UK Health Security Agency, London, UK
| | - Ryan George
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Dodgson
- UK Health Security Agency, Manchester Public Health Laboratory, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Rachel Freeman
- IQVIA, The Point, 37 North Wharf Road, London, W2 1AF, UK
| | - Russell Hope
- HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Ann Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Susan Hopkins
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infections, University of Oxford and UKHSA, Oxford, UK
- UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- Division of Infection and Immunity, UCL, Gower St, London, UK
| | - Julie Robotham
- HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, 61 Colindale Avenue, London, NW9 5EQ, UK
- NIHR Health Protection Research Unit in Antimicrobial Resistance and Healthcare Associated Infections, University of Oxford and UKHSA, Oxford, UK
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Bar Ilan M, Kjerulf A. Who should be screened for carbapenemase-producing Enterobacterales and when? A systematic review. J Hosp Infect 2023; 142:74-87. [PMID: 37802236 DOI: 10.1016/j.jhin.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
Carbapenemase-producing Enterobacterales (CPE) cases increases every year in Denmark and the proportion of CPE-positive cases with a travel history decreases. Several epidemiological links show transmission in Danish healthcare setting indicating infection prevention and control challenges and raising questions about the Danish CPE screening protocol. The aim of this review was to identify additional risk factors to those described in the Danish CPE-screening protocol in order to detect the Danish CPE-positive patients and thereby reduce the risk of transmission and outbreaks. A systematic literature search was conducted in PubMed, Embase and Cochrane Library during March 2022. A total of 1487 articles were screened, and 19 studies were included. Retrieved studies dealt with patients with laboratory-confirmed CPE (colonization and/or infection) and associated risk factors. Antimicrobial therapy, especially broad-spectrum antimicrobial agents, prior or current hospitalization of approximately one week in ICU and 20-28 days in other wards and travel history with or without hospitalization abroad were significant risk factors associated with CPE acquisition. Comorbidities and invasive procedures were identified as risk factors, but without identifying specific comorbidities or invasive procedures associated with risk for CPE-acquisition. This study suggests the need to develop an additional algorithm for CPE-screening in Denmark. In addition to risk-based screening on admission, screening of inpatients should be considered. The screening protocol might include screening of inpatients with comorbidities who are hospitalized >1 week in ICU or >3 weeks in other wards and who have previously received or currently are receiving antibiotic treatment. Further research is needed to develop a new CPE-screening algorithm.
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Affiliation(s)
- M Bar Ilan
- Infection Prevention and Control Unit, Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
| | - A Kjerulf
- National Center for Infection Control, Department for Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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10
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An L, Chan JL, Nguyen M, Yang S, Deville JG. Case Report: Disseminated Edwardsiella tarda infection in an immunocompromised patient. Front Cell Infect Microbiol 2023; 13:1292768. [PMID: 38053529 PMCID: PMC10694257 DOI: 10.3389/fcimb.2023.1292768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
Human infection caused by bacteria of the Edwardsiella genus is rare and most often presents with gastroenteritis that rarely requires antibiotics. Our case report describes a medically complex patient with chronic steroid use contributing to an immunocompromised state, who presented with fever and abdominal pain. The patient was later found to have Edwardsiella tarda (E. tarda) bacteremia and underwent paracentesis confirming E. tarda bacterial peritonitis requiring a prolonged antibiotic course. This case report aims to illustrate the presentation, diagnosis, and management of an uncommon infection that can have severe complications especially among immunocompromised patients.
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Affiliation(s)
- Lucia An
- University of California, Los Angeles (UCLA) Mattel Children’s Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Los Angeles, CA, United States
| | - June L. Chan
- University of California, Los Angeles (UCLA) Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Margaret Nguyen
- University of California, Los Angeles (UCLA) Mattel Children’s Hospital, Department of Pediatrics, Division of Pediatric Hospital Medicine, Los Angeles, CA, United States
| | - Shangxin Yang
- University of California, Los Angeles (UCLA) Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Jaime G. Deville
- University of California, Los Angeles (UCLA) Mattel Children’s Hospital, Department of Pediatrics, Division of Pediatric Infectious Disease, Los Angeles, CA, United States
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Lee KH, Kim D, Hong JS, Park SY, Cho NH, Kim MN, Lee YJ, Wi Y, Lee EH, Han SH, Jeong SH, Song YG. Prevalence of carbapenemase producing Enterobacterales colonization and risk factor of clinical infection. J Infect Public Health 2023; 16:1860-1869. [PMID: 37837922 DOI: 10.1016/j.jiph.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) are global concerns in infection control, and the number of CPE outbreaks in hospitals is increasing despite the strengthening of contact precautions. This study aimed to confirm the prevalence and transition rate of CPE infection from stool surveillance culture and to identify the acquisition pathway of CPE. METHODS This is a longitudinal review of patients with stool surveillance cultures at a tertiary center in Seoul, South Korea, from July 2018 to June 2020. Pulsed-field gel electrophoresis, multi-locus sequence typing, and whole genome sequencing were performed for carbapenemase-producing Klebsiella pneumoniae and Escherichia coli strains. RESULTS Among 1620 patients who had undergone stool CPE surveillance cultures, only 7.1% of active surveillance at the Emergency Room (ER) and 4.4% of universal surveillance in the Intensive Care Unit (ICU) were stool CPE positive. The transition rates from stool carriers to clinical CPE infections were 29.4% in the ER and 31.3% in the ICU. However, it was significantly high (55.0%) in the initial stool CPE-negative ICU patients. Among the initial stool CPE-positive patients, hypertension (61% vs. 92.3%, P = 0.004), malignancy (28.8% vs. 53.8%, P = 0.027), and mechanical ventilation (25.4% vs. 53.8%, P = 0.011) were significant risk factors for clinical CPE infection. Molecular typing revealed that sequence type (ST) 307 and ST 395 were dominant in K. pneumoniae, and ST 410 was dominant in E. coli isolates. CONCLUSIONS Active surveillance showed a higher detection rate than universal stool CPE screening, and one-third of positive stool CPE specimens ultimately developed subsquent clinical CPE infection. According to the molecular typing of the identified CPE strains, in-hospital spread prevailed over external inflow, and the transition rate to clinical CPE was particularly high in the ICU. Therefore, in order to control CPE propagation, not only active surveillance to block inflow from outside, but also continuous ICU monitoring within the hospital is necessary.
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Affiliation(s)
- Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dokyun Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Sung Hong
- Department of Companion Animal Health and Science, Silla University, Busan, Republic of Korea
| | - Soon Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Mi Na Kim
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yun Jung Lee
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Yeonji Wi
- Department of Infection Control, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Eun Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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12
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Ben Natan O, Stein M, Reisfeld S. Audit and feedback as a tool to increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening and decrease CPE transmission in the hospital. Infect Control Hosp Epidemiol 2023; 44:1788-1792. [PMID: 36081188 PMCID: PMC10665877 DOI: 10.1017/ice.2022.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/29/2022] [Accepted: 08/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To increase compliance with carbapenemase-producing Enterobacteriaceae (CPE) screening through real-time audit and feedback in our hospital and decrease CPE transmissions. DESIGN A before-and-after trial, using active enhanced surveillance of CPE carriers. SETTING A 500-bed, secondary, university-affiliated hospital that serves a population of 450,000 in a northern district in Israel. METHODS The study was conducted during 2016-2019 and included patients who were admitted to the hospital and fulfilled CPE screening criteria upon admission and during prolonged hospitalizations. On January 1, 2017, the infection control team implemented a new strategy of real-time feedback toward compliance with in-hospital screening guidelines. Other infection control measurements were performed without interventions. The primary outcome was compliance with appropriate CPE screening. Secondary outcomes included CPE acquisition and compliance with hand hygiene and contact precaution practices. Data were analyzed to calculate differences between compliance with CPE screening during the study period and to test the correlation between contact precautions and hand hygiene practices according to compliance with CPE screening. RESULTS During the study period, 3,131 patients were eligible for CPE screening. We detected a statistically significant increase in compliance to CPE screening from 74% during 2017 to 92% in 2018 and 95% in 2019 (P < .0001 for both comparisons). We detected a decrease in CPE transmission from 12% in 2017 to 2% in 2019 (P < .0001). We did not find any correlation between other infection control interventions and CPE screening and acquisition. CONCLUSION Audit and feedback can improve appropriate CPE screening and may reduce CPE transmission in the hospital.
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Affiliation(s)
- Orna Ben Natan
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
| | - Michal Stein
- Pediatric Infectious Diseases Unit, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Reisfeld
- Infectious Diseases and Infection Control Units, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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13
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Pallitto CR, Feuerstein JL, Baer AZ, Bishara JD, Bhavsar SM. Enterobacter cloacae Complex Meningitis in a Full-term Neonate. Clin Pediatr (Phila) 2023; 62:1150-1154. [PMID: 36908064 DOI: 10.1177/00099228231155391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Candace R Pallitto
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jessica L Feuerstein
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Aryeh Z Baer
- Division of Pediatric Infectious Disease, Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Joanne D Bishara
- Division of Neonatology, Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Sejal M Bhavsar
- Division of Pediatric Infectious Disease, Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
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Maechler F, Schwab F, Hansen S, Behnke M, Bonten MJ, Canton R, Diaz Agero C, Fankhauser C, Harbarth S, Huttner BD, Kola A, Gastmeier P. Quantification of time delay between screening and subsequent initiation of contact isolation for carriers of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales: A post hoc subgroup analysis of the R-GNOSIS WP5 Trial. Infect Control Hosp Epidemiol 2023; 44:1410-1416. [PMID: 36912321 PMCID: PMC10507499 DOI: 10.1017/ice.2022.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The aim of this study was to quantify the time delay between screening and initiation of contact isolation for carriers of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E). METHODS This study was a secondary analysis of contact isolation periods in a cluster-randomized controlled trial that compared 2 strategies to control ESBL-E (trial no. ISRCTN57648070). Patients admitted to 20 non-ICU wards in Germany, the Netherlands, Spain, and Switzerland were screened for ESBL-E carriage on admission, weekly thereafter, and on discharge. Data collection included the day of sampling, the day the wards were notified of the result, and subsequent ESBL-E isolation days. RESULTS Between January 2014 and August 2016, 19,122 patients, with a length of stay ≥2 days were included. At least 1 culture was collected for 16,091 patients (84%), with a median duration between the admission day and the day of first sample collection of 2 days (interquartile range [IQR], 1-3). Moreover, 854 (41%) of all 2,078 ESBL-E carriers remained without isolation during their hospital stay. In total, 6,040 ESBL-E days (32% of all ESBL-E days) accrued for patients who were not isolated. Of 2,078 ESBL-E-carriers, 1,478 ESBL-E carriers (71%) had no previous history of ESBL-E carriage. Also, 697 (34%) were placed in contact isolation with a delay of 4 days (IQR, 2-5), accounting for 2,723 nonisolation days (15% of ESBL-E days). CONCLUSIONS Even with extensive surveillance screening, almost one-third of all ESBL-E days were nonisolation days. Limitations in routine culture-based ESBL-E detection impeded timely and exhaustive implementation of targeted contact isolation.
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Affiliation(s)
- Friederike Maechler
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
| | - Marc J. Bonten
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid
| | - Cristina Diaz Agero
- Servicio de Medicina Preventiva y Salud Pública Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid
| | - Carolina Fankhauser
- Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Benedikt D. Huttner
- Infection Control Program, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Universitätsmedizin – CharitéBerlin, Germany
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Salomão MC, Freire MP, Lázari CS, Cury AP, Rossi F, Segurado AAC, Costa SF, Levin AS, Boszczowski Í. Transmission of Carbapenem-Resistant Enterobacterales in an Overcrowded Emergency Department: Controlling the Spread to the Hospital. Clin Infect Dis 2023; 77:S46-S52. [PMID: 37406046 PMCID: PMC10321690 DOI: 10.1093/cid/ciad263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Overcrowded emergency departments (EDs) may increase the risk of carbapenem-resistant Enterobacterales (CRE) transmission. METHODS We conducted a quasi-experimental study divided into 2 phases (baseline and intervention) to investigate the impact of an intervention on the acquisition rate and identify risk factors for CRE colonization in an ED of a tertiary academic hospital in Brazil. In both phases, we did universal screening with rapid molecular test (blaKPC, blaNDM, blaOXA48, blaOXA23, and blaIMP) and culture. At baseline, both screening test results were not reported, and patients were put under contact precautions (CP) based on previous colonization or infection by multidrug-resistant organisms. During the intervention, all patients hospitalized in the ED were placed in empiric CP and the result of CRE screening was reported; if negative, patients were released from CP. Patients were rescreened if they stayed >7 days in the ED or were transferred to an intensive care unit. RESULTS A total of 845 patients were included: 342 in baseline and 503 in intervention. Colonization at admission was 3.4% by culture and molecular test. Acquisition rates during ED stay dropped from 4.6% (11/241) to 1% (5/416) during intervention (P = .06). The aggregated antimicrobial use in the ED decreased from phase 1 to phase 2 (804 defined daily doses [DDD]/1000 patients to 394 DDD/1000 patients, respectively). Length of stay >2 days in the ED was a risk factor for CRE acquisition (adjusted odds ratio, 4.58 [95% confidence interval, 1.44-14.58]; P = .01). CONCLUSIONS Early empiric CP and rapid identification of CRE-colonized patients reduce cross-transmission in ED. Nevertheless, staying >2 days in ED compromised efforts.
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Affiliation(s)
- Matias C Salomão
- Department of Infectious Diseases, Faculdade de Medicina
- Infection Control Department
| | - Maristela P Freire
- Department of Infectious Diseases, Faculdade de Medicina
- Infection Control Department
| | - Carolina S Lázari
- Divisão de Patologia Clínica, Departamento de Patologia, Laboratório de Investigação Medica (LIM03)
| | - Ana P Cury
- Departamento de Patologia, Central Microbiology Laboratory, LIM03 Division
| | - Flávia Rossi
- Departamento de Patologia, Central Microbiology Laboratory, LIM03 Division
| | - Aluisio A C Segurado
- Department of Infectious Diseases, Faculdade de Medicina
- Department of Infectious Diseases, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Silvia F Costa
- Department of Infectious Diseases, Faculdade de Medicina
- Infection Control Department
- Department of Infectious Diseases, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious Diseases, Faculdade de Medicina
- Infection Control Department
- Department of Infectious Diseases, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Ícaro Boszczowski
- Department of Infectious Diseases, Faculdade de Medicina
- Infection Control Department
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16
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Krupanandan RK, Kapalavai SK, Ekka AS, Balusamy I, Sadasivam K, Nambi P S, Ramachandran B. Active surveillance for carbapenem resistant enterobacteriaceae (CRE) using stool cultures as a method to decrease CRE infections in the pediatric intensive care unit (PICU). Indian J Med Microbiol 2023; 44:100370. [PMID: 37356850 DOI: 10.1016/j.ijmmb.2023.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/25/2022] [Accepted: 04/05/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient's clinical condition. OBJECTIVES To determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU). METHODS Retrospective observational study done in the 10-bed PICU of a tertiary care teaching children's hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared. RESULTS Total of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p < 0.0001). CONCLUSION Active CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.
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Affiliation(s)
- Ravi Kumar Krupanandan
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India.
| | - Sudeep Kumar Kapalavai
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India.
| | - Alok Shimee Ekka
- Department of Pediatric Critical Care, Royal Manchester Children Hospital, Manchester, United Kingdom.
| | - Indhiradevi Balusamy
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India.
| | - Kalaimaran Sadasivam
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India.
| | | | - Bala Ramachandran
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India.
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Haston JC, Miko S, Cope JR, McKeel H, Walters C, Joseph LA, Griswold T, Katz LS, Andújar AA, Tourdot L, Rounds J, Vagnone P, Medus C, Harris J, Geist R, Neises D, Wiggington A, Smith T, Im MS, Wheeler C, Smith P, Carleton HA, Lee CC. Cronobacter sakazakii Infections in Two Infants Linked to Powdered Infant Formula and Breast Pump Equipment - United States, 2021 and 2022. MMWR Morb Mortal Wkly Rep 2023; 72:223-226. [PMID: 36862586 PMCID: PMC9997662 DOI: 10.15585/mmwr.mm7209a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Cronobacter sakazakii, a species of gram-negative bacteria belonging to the Enterobacteriaceae family, is known to cause severe and often fatal meningitis and sepsis in young infants. C. sakazakii is ubiquitous in the environment, and most reported infant cases have been attributed to contaminated powdered infant formula (powdered formula) or breast milk that was expressed using contaminated breast pump equipment (1-3). Previous investigations of cases and outbreaks have identified C. sakazakii in opened powdered formula, breast pump parts, environmental surfaces in the home, and, rarely, in unopened powdered formula and formula manufacturing facilities (2,4-6). This report describes two infants with C. sakazakii meningitis reported to CDC in September 2021 and February 2022. CDC used whole genome sequencing (WGS) analysis to link one case to contaminated opened powdered formula from the patient's home and the other to contaminated breast pump equipment. These cases highlight the importance of expanding awareness about C. sakazakii infections in infants, safe preparation and storage of powdered formula, proper cleaning and sanitizing of breast pump equipment, and using WGS as a tool for C. sakazakii investigations.
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Papafotiou C, Roussos S, Sypsa V, Bampali S, Spyridopoulou K, Karapanou A, Moussouli A, Samarkos M, Daikos GL, Psichogiou M. Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area. J Antimicrob Chemother 2022; 77:3331-3339. [PMID: 36203392 DOI: 10.1093/jac/dkac321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/30/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. METHODS The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. RESULTS Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. CONCLUSIONS This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures.
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Affiliation(s)
- Chrysanthe Papafotiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Sofia Bampali
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Kalliopi Spyridopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Amalia Karapanou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Anastasia Moussouli
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Michael Samarkos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George L Daikos
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Mina Psichogiou
- First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
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Manoukian S, Stewart S, Dancer SJ, Mason H, Graves N, Robertson C, Leonard A, Kennedy S, Kavanagh K, Parcell B, Reilly J. Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom. Eur J Health Econ 2022; 23:1173-1185. [PMID: 34932169 PMCID: PMC8689289 DOI: 10.1007/s10198-021-01419-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients. OBJECTIVE We assess the relative cost-effectiveness of screening programmes compared with no- screening. METHODS A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective. RESULTS In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs. CONCLUSION The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.
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Affiliation(s)
- Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - Sally Stewart
- Safeguarding Health Through Infection Prevention Research Group, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire and School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
| | | | - Sharon Kennedy
- Information Services Division, Public Health Scotland, Edinburgh, Scotland, UK
| | - Kim Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
| | - Benjamin Parcell
- Medical Microbiology, NHS Tayside, Ninewells Hospital and School of Medicine, Dundee, Scotland, UK
| | - Jacqui Reilly
- Safeguarding Health Through Infection Prevention Research Group, Glasgow Caledonian University, Glasgow, Scotland, UK
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Harper H, Logan J, Kubat R, Jones M. Leclercia adecarboxylata catheter-related bacteraemia in an immunocompromised patient. BMJ Case Rep 2022; 15:e247496. [PMID: 35332006 PMCID: PMC8948387 DOI: 10.1136/bcr-2021-247496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 06/14/2023] Open
Abstract
A 34-year-old man on active chemotherapy was hospitalised with fever, chills and rigours after power-washing a pig pen on a farm. His blood cultures grew Leclercia adecarboxylata, a gram-negative rod in the Enterobacteriaceae family, which has been isolated from a variety of environments including soil, surface water, as well as in the gastrointestinal flora of farm animals. The likely source of infection was his tunnelled central venous catheter exposed to water contaminated by faeces when he was washing the pig pen. While there have been several cases reported of catheter-related L. adecarboxylata bacteraemia, to our knowledge there are very few reports of infection spread in this manner.
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Affiliation(s)
- Haleigh Harper
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - John Logan
- Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Ryan Kubat
- Internal Medicine, Division of Infectious Disease, The University of Kansas Health System, Kansas City, Kansas, USA
| | - Matthew Jones
- Internal Medicine, The University of Kansas Health System, Kansas City, Kansas, USA
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Zhang Z, Wang D, Li Y, Liu Y, Qin X. Comparison of the Performance of Phenotypic Methods for the Detection of Carbapenem-Resistant Enterobacteriaceae (CRE) in Clinical Practice. Front Cell Infect Microbiol 2022; 12:849564. [PMID: 35265537 PMCID: PMC8899507 DOI: 10.3389/fcimb.2022.849564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
In order to investigate the diagnostic performance characteristics of four phenotypic assays in detecting carbapenem-resistant Enterobacteriaceae (CRE), we collected the CRE strains from infected patients. The results of carbapenemase gene detection, blaKPC-2, blaOXA-23, blaNDM-1, blaNDM-4, blaNDM-5, blaIMP-4, and blaIMP-8, were used as a standard to evaluate the performances of combined disk test (CDT), modified carbapenem inactivation method(mCIM)/EDTA-modified carbapenem inactivation method(eCIM), NG-Test CARBA 5 (CARBA), and color developing immunoassay (CDI). The compliance of phenotype results based on CDT, mCIM/eCIM, CARBA, and CDI with genetic detection results was 94% (231/247), 95% (235/247), 98% (242/247), and 99% (246/247), respectively. CDT demonstrated a low specificity for carbapenemase detection, low negative predictive value (NPV), and low sensitivity for metallo-β-lactamase (79%, 55%, and 88%, respectively); it also failed to accurately detect IMP. The mCIM/eCIM assay had serious problems in detecting OXA-23-like carbapenemases. The sensitivity and specificity of CARBA and CDI were higher than those of the first two methods. However, CARBA did not cover the detection of OXA-23, while CDI cannot detect IMP-8, resulting in low NPVs (70% and 88%, respectively). In conclusion, CARBA and CDI assays are highly accurate except individual rare genes and allow direct genotype detections. CDT and mCIM/eCIM assays are moderately accurate and can only distinguish serine-β-lactamases from metallo-β-lactamases. Laboratories should choose the appropriate method that meets their needs based on its characteristic.
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Affiliation(s)
- Zhijie Zhang
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dayan Wang
- Department of Laboratory Medicine, Tacheng Hospital of China Medical University, Tacheng, China
| | - Yahui Li
- Department of Laboratory Medicine, Cancer Hospital of Anshan, Anshan, China
| | - Yong Liu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaosong Qin
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Xiaosong Qin,
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Kriger O, Shatzman-Steuerman R, Smollan G, Belausov N, Sarkisian G, Amit S. Rapid Detection of Carbapenemase-producing Enterobacteriaceae From Blood Culture Bottles of Known CPE Carriers: Real-world Experience. Pediatr Infect Dis J 2022; 41:45-47. [PMID: 34471083 DOI: 10.1097/inf.0000000000003311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We used a rapid antigen test for the detection of carbapenemases directly from positive blood culture bottles of pediatric hemato-oncologic patients, known carriers of carbapenemase-producing enterobacteriaceae. Resistance mechanism was detected within 15 minutes of observing Gram-negative bacilli from a positive bottle, leading to treatment modification. This simple-to-use, inexpensive assay shortens the interval between empiric to tailored antimicrobial therapy.
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Affiliation(s)
- Or Kriger
- From the Clinical Microbiology Laboratory, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
| | - Rachel Shatzman-Steuerman
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
| | - Gillian Smollan
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
| | - Natasha Belausov
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
| | - Gayane Sarkisian
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
| | - Sharon Amit
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Israel
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Hernandez-Alonso E, Barreault S, Augusto LA, Jatteau P, Villet M, Tissieres P, Doucet-Populaire F, Bourgeois-Nicolaos N. dnaJ: a New Approach to Identify Species within the Genus Enterobacter. Microbiol Spectr 2021; 9:e0124221. [PMID: 34937187 PMCID: PMC8694106 DOI: 10.1128/spectrum.01242-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/19/2021] [Indexed: 01/19/2023] Open
Abstract
The taxonomy of the genus Enterobacter can be confusing and has been considerably revised in recent years. We propose a PCR and amplicon sequencing technique based on a partial sequence of the dnaJ gene for species assignment consistent with DNA-DNA digital hybridization (dDDH) and pairwise average nucleotide identity (ANI). We performed a validation of the method by comparing the type strains of each species, sequences obtained from the GenBank database, and clinical specimens. Our results show that the polymorphism of the target sequence of dnaJ allows the identification of species. Using this gene, we assigned the species to 100 strains deposited in the GenBank database that were consistent with the species assignment by dDDH and ANI. The analysis showed that using the partial dnaJ sequence is congruent with WGS as far as correct identification of Enterobacter species is concerned. Finally, we applied our dnaJ method on a national collection of 68 strains identified as Enterobacter isolated from the blood cultures of premature babies using an algorithm based on a type-strain library and the SeqScape software. For the first time, we identified Enterobacter quasihormaechei in blood cultures from four neonatal sepsis cases. We also noticed a higher prevalence of E. bugandensis (36.3%; 32/88) and E. xiangfangensis (46.5%; 41/88). E. bugandensis is a novel species recently described specifically in instances of neonatal sepsis. In conclusion, sequencing a part of the dnaJ gene could be a quick, more economical, and highly discriminating method of identifying Enterobacter species in clinical practice and research. IMPORTANCE We propose a new approach for Enterobacter species identification based on the diversity of the gene encoding the heat shock protein DnaJ. This new tool can be easily implemented in clinical laboratories in addition to identification by MALDI-TOF.
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Affiliation(s)
- Enrique Hernandez-Alonso
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
- Department of Bacteriology-Hygiene, AP-HP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Simon Barreault
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
- Department of Pediatrics Intensive Care and Neonatal Medicine, AP-HP Université Paris-Saclay, Bicêtre Hospital, Paris, France
| | - Luis A. Augusto
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
| | - Pierre Jatteau
- Department of Bacteriology-Hygiene, AP-HP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Millie Villet
- Department of Bacteriology-Hygiene, AP-HP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Pierre Tissieres
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
- Department of Pediatrics Intensive Care and Neonatal Medicine, AP-HP Université Paris-Saclay, Bicêtre Hospital, Paris, France
- FHU Sepsis, AP-HP/Université Paris-Saclay/Inserm, Le Kremlin-Bicêtre, France
| | - Florence Doucet-Populaire
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
- Department of Bacteriology-Hygiene, AP-HP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
| | - Nadege Bourgeois-Nicolaos
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell (I2BC), Gif-sur-Yvette, France
- Department of Bacteriology-Hygiene, AP-HP Université Paris-Saclay, Antoine Beclere Hospital, Clamart, France
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Saliba R, Lomont A, Eudesson JL, Seytre D, Zahar JR, Pilmis B. Significant variation in the faecal relative abundance of carbapenemase-producing Enterobacteriaceae of colonised patients during hospitalisation: a preliminary study. Int J Antimicrob Agents 2021; 59:106479. [PMID: 34801676 DOI: 10.1016/j.ijantimicag.2021.106479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Rindala Saliba
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France; Laboratoire des pathogènes émergents, Université Saint-Joseph de Beyrouth, Beirut, Lebanon
| | - Alexandra Lomont
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Jean-Louis Eudesson
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Delphine Seytre
- Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France
| | - Jean-Ralph Zahar
- IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 rue de Stalingrad, 93000 Bobigny, France.
| | - Benoit Pilmis
- Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France; Institut Micalis UMR 1319, Université Paris Saclay, INRAe, AgroParisTech, Châtenay Malabry, France; Service de microbiologie clinique, GH Paris Saint-Joseph, 75014 Paris, France
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25
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Mbehang Nguema PP, Onanga R, Ndong Atome GR, Tewa JJ, Mabika Mabika A, Muandze Nzambe JU, Obague Mbeang JC, Bitome Essono PY, Bretagnolle F, Godreuil S. High level of intrinsic phenotypic antimicrobial resistance in enterobacteria from terrestrial wildlife in Gabonese national parks. PLoS One 2021; 16:e0257994. [PMID: 34637441 PMCID: PMC8509864 DOI: 10.1371/journal.pone.0257994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/07/2020] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Data on the prevalence of antibiotic resistance in Enterobacteriaceae in African wildlife are still relatively limited. The aim of this study was to estimate the prevalence of phenotypic intrinsic and acquired antimicrobial resistance of enterobacteria from several species of terrestrial wild mammals in national parks of Gabon. Colony culture and isolation were done using MacConkey agar. Isolates were identified using the VITEK 2 and MALDI-TOF methods. Antibiotic susceptibility was analysed and interpreted according to the European Committee on Antimicrobial Susceptibility Testing guidelines. The preliminary test for ESBL-producing Enterobacteriaceae was performed by replicating enterobacterial colonies on MacConkey agar supplemented with 2 mg/L cefotaxime (MCA+CTX). Extended-spectrum beta-lactamase (ESBL) production was confirmed with the double-disc synergy test (DDST). The inhibition zone diameters were read with SirScan. Among the 130 bacterial colonies isolated from 125 fecal samples, 90 enterobacterial isolates were identified. Escherichia coli (61%) was the most prevalent, followed by Enterobacter cloacae (8%), Proteus mirabilis (8%), Klebsiella variicola (7%), Klebsiella aerogenes (7%), Klebsiella oxytoca (4%), Citrobacter freundii (3%), Klebsiella pneumoniae (1%) and Serratia marcescens (1%). Acquired resistance was carried by E. coli (11% of all E. coli isolates) and E. cloacae (3% of all E. cloacae) isolates, while intrinsic resistance was detected in all the other resistant isolates (n = 31); K. variicola, K. oxytoca, K. pneumoniae, E. cloacae, K. aerogenes, S. marcescens and P. mirabilis). Our data show that most strains isolated in protected areas in Gabon are wild type isolates and carry intrinsic resistance rather than acquired resistance.
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Affiliation(s)
- Pierre Philippe Mbehang Nguema
- Departement Ecologie Animal, Institut de Recherche en Ecologie Tropicale (IRET), Libreville, Gabon
- Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- UMR CNRS/uB 6282 Biogéosciences, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Richard Onanga
- Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
- * E-mail:
| | - Guy Roger Ndong Atome
- Department de Chemie, Faculté des Sciences, Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | - Jean Jules Tewa
- Departement de Mathematiques et Informatique, Faculté des Sciences, Université de Douala, Douala, Cameroun
| | - Arsène Mabika Mabika
- Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville, Gabon
| | | | | | | | - François Bretagnolle
- UMR CNRS/uB 6282 Biogéosciences, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Sylvain Godreuil
- Centre Hospitalier Universitaire de Montpellier, Laboratoire de Bactériologie, Université de Montpellier, Montpellier, France
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26
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Choi H, Hwang M, Chatterjee P, Jinadatha C, Navarathna DH. Rare Lelliottia nimipressuralis from a wound infection case report using whole genome sequencing-based bacterial identification. Diagn Microbiol Infect Dis 2021; 101:115538. [PMID: 34619568 DOI: 10.1016/j.diagmicrobio.2021.115538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
Identification of clinical bacterial isolates is an essential first step to provide guidelines for treatment of pathogenic bacterial infection. Infection occurred in a laceration along the medial aspect of left upper arm of a 71-year-old female. Conventional biochemical testing and MALDI-TOF MS identification failed to correctly identify a bacterial isolate. Using whole genome sequencing, the isolate was identified as Lelliottia nimipressuralis. WGS can overcome the limitations of conventional phenotypic and molecular identification methods and successfully identified a rare pathogen. This case is the first report of a human infection of L. nimipressuralis.
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Affiliation(s)
- Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Munok Hwang
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Piyali Chatterjee
- Department of Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Chetan Jinadatha
- Department of Medicine, Central Texas Veterans Health Care System, Temple, TX, USA; Department of Medicine, College of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
| | - Dhammika H Navarathna
- Department of Pathology and Laboratory Medicine Services, Central Texas Veterans Health Care System, Temple, TX, USA.
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27
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Hu S, Lv Z, Wang Y, Shen J, Ke Y. Novel Quadruplex PCR for detecting and genotyping mobile colistin resistance genes in human samples. Diagn Microbiol Infect Dis 2021; 101:115419. [PMID: 34610496 DOI: 10.1016/j.diagmicrobio.2021.115419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/18/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
Since 2016, several mobile colistin resistance (mcr) genes have been identified worldwide. It's worth noting that only mcr-1, mcr-3, mcr-8, and mcr-10 have been reported isolated directly from clinical samples which created greater risk to human health than other mcr gene types. A novel Quadruplex polymerase chain reaction (Quad-PCR) protocol was developed to detect and genotype transferable colistin-resistance genes (mcr-1, mcr-3, mcr-8, mcr-10) in Enterobacteria for clinical laboratory purposes. The protocol was validated by testing 11 clinical isolates of Escherichia coli and 3 clinical isolates of Klebsiella of human origin, each well characterized and prospectively validated. The Quad-PCR assay showed full concordance with whole-genome sequence data and displayed higher sensitivity and 100% specificity. The Quad-PCR assay achieved genotyping of mcr alleles (as singleton and mixture with double or triple gene types) described in one test.
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Affiliation(s)
- Shuangfang Hu
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen City, Guangdong Province, PR China; Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Ziquan Lv
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen City, Guangdong Province, PR China
| | - Yang Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, PR China
| | - Jianzhong Shen
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, PR China.
| | - Yuebin Ke
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Shenzhen City, Guangdong Province, PR China.
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Abstract
BACKGROUND To investigate the epidemics of plasmid-mediated quinolone resistance (PMQR) gene in carbapenem-resistant Enterobacteriaceae (CRE) and the resistance mechanism. METHODS We collected CRE bacteria isolated clinically between December 2017 and December 2018 for identification and drug sensitivity testing using a VITEK2 Compact Analyzer. Furthermore, genes, including qnrA, qnrB, qnrS, qepA, and acc (6') Ib-cr, were determined through the polymerase chain reaction and sequencing. The hori-zontal transfer of PMQR gene was validated through the plasmid conjugational test. RESULTS Drug resistance rate of carbapenem-resistant Escherichia coli against quinolones was 100%, while the rate of carbapenem-resistant Klebsiella pneumoniae ranged from 15.56% to 33.33%. The detection rate of acc (6') Ib-cr was the highest (87.72%), followed by qnrB (77.19%) and qnrS (17.54%). Additionally, there were two bacteria carrying the qnrA gene (3.51%), but qepA gene was not isolated from the samples. In total, 84.21% of these bacteria carried 2 or 3 kinds of PMQR genes. Among 8 bacteria with successful plasmid conjugation, PMQR gene transfer was detected in all of them, but with no significant change in the minimum inhibitory concentration of quinolones. CONCLUSIONS CRE remain sensitive to quinolones in spite of the high detection rate of PMQR gene in this hospital.
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Hu S, Lv Z, Wang Y, Shen J, Ke Y. Rapid detection of human origin colistin-resistance genes mcr-1, mcr-3, mcr-8, mcr-10 in clinical fecal samples. Arch Microbiol 2021; 203:4405-4417. [PMID: 34125247 DOI: 10.1007/s00203-021-02407-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Abstract
Plasmid-mediated colistin-resistance genes have been reported in human origin clinical samples worldwide which raises its threats to human infections. Notably, mcr-1, mcr-3, mcr-8, and mcr-10 have been reported isolated directly from clinical samples which creates more seriously threaten to human health than other mcr gene types. A multiplex polymerase chain reaction (Multi-PCR) protocol was developed to detect and genotype mobile colistin-resistance genes (mcr-1, mcr-3, mcr-8, mcr-10) in Enterobacteria for clinical laboratory purposes. We first designed four pairs of new primers for the amplification of mcr-1, mcr-3, mcr-8, and mcr-10 gene respectively to achieve stepwise separation of amplicons between 216 and 241 bp, and complete this Multi-PCR system with the assistance of another pair of universal primer. Among which the forward primers for mcr-8 and mcr-10 amplicons were identical. The protocol was validated by testing 11 clinical isolates of Escherichia coli and 3 clinical isolates of Klebsiella from human origin, each well characterized and prospectively validated. The Multi-PCR assay showed full concordance with whole-genome sequence data and displayed higher sensitivity and 100% specificity. The assay could detect all variants of the various mcr alleles described. The Multi-PCR assay successfully genotyped of mcr alleles described in one test.
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Affiliation(s)
- Shuangfang Hu
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Guangdong Province, No. 8 Longyuan Road, Nanshan district, Shenzhen City, 518055, People's Republic of China
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 10083, People's Republic of China
| | - Ziquan Lv
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Guangdong Province, No. 8 Longyuan Road, Nanshan district, Shenzhen City, 518055, People's Republic of China
| | - Yang Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 10083, People's Republic of China
| | - Jianzhong Shen
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing, 10083, People's Republic of China.
| | - Yuebin Ke
- Key Laboratory of Molecular Epidemiology of Shenzhen, Shenzhen Center for Disease Control and Prevention, Guangdong Province, No. 8 Longyuan Road, Nanshan district, Shenzhen City, 518055, People's Republic of China.
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30
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Kuwelker K, Langeland N, Löhr IH, Gidion J, Manyahi J, Moyo SJ, Blomberg B, Klingenberg C. Use of probiotics to reduce infections and death and prevent colonization with extended-spectrum beta-lactamase (ESBL)-producing bacteria among newborn infants in Tanzania (ProRIDE Trial): study protocol for a randomized controlled clinical trial. Trials 2021; 22:312. [PMID: 33926519 PMCID: PMC8082054 DOI: 10.1186/s13063-021-05251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) has emerged as an urgent global health threat and is by the World Health Organization ranked as priority 1 among pathogens in need of new treatment. Studies have shown high mortality in Tanzanian children with ESBL-E infections. Gut colonization of ESBL-E, which is a potential risk factor of ESBL-E infections, is reported to be very high among children in Tanzania. Probiotics may potentially reduce gut colonization of multidrug-resistant bacteria. However, there is limited data on whether probiotics may reduce ESBL-E carriage in infants. The ProRIDE Trial aims to evaluate whether the use of probiotics can reduce morbidity and mortality among infants in Haydom, Tanzania, and whether this effect is associated with a reduction in ESBL-E colonization and/or infections. METHODS/DESIGN This large randomized double-blinded placebo-controlled trial aims to recruit 2000 newborn infants at Haydom Lutheran Hospital and the surrounding area in the period of November 2020 to November 2021. Participants will be enrolled from days 0 to 3 after birth and randomized to receive probiotics or placebo for 4 weeks. Participants will be followed-up for 6 months, during which three visits will be made to collect clinical and demographic information, as well as rectal swabs and fecal samples which will be subjected to laboratory analysis. The primary composite outcome is the prevalence of death and/or hospitalization at 6 months of age. DISCUSSION As the use of probiotics may give a more favorable gut composition, and thereby improve health and reduce morbidity and mortality, the results may have implications for future therapy guidelines in Africa and internationally. TRIAL REGISTRATION ClinicalTrials.gov NCT04172012. Registered on November 21, 2019.
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Affiliation(s)
- Kanika Kuwelker
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
| | - Nina Langeland
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Iren Høyland Löhr
- Department of Medical Microbiology, Stavanger University Hospital, Gerd Ragna Bloch Thorsens gate, 4011 Stavanger, Norway
| | - Joshua Gidion
- Department of Paediatrics, Haydom Lutheran Hospital, Mbulu, Manyara Tanzania
| | - Joel Manyahi
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, MUHAS, P.O. Box 65005, Dar es Salaam, Tanzania
| | - Sabrina John Moyo
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, MUHAS, P.O. Box 65005, Dar es Salaam, Tanzania
| | - Bjørn Blomberg
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Haukelandsbakken, 5009 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Claus Klingenberg
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
- Paediatric Research Group, Faculty of Health Sciences, University of Tromsø-Arctic University of Norway, Tromsø, Norway
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31
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Romero Pérez P. [Tract infections by the genus Raoultella. Literature review and contribution of 1 case of Raoultella ornithinolytica.]. ARCH ESP UROL 2021; 74:276-286. [PMID: 33818423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Emerging urinary infections by rare germs are a public health problem. The objectives of this article are to review urinary tract infections caused by an emerging genus of bacteria called Raoultella and to report a case of asymptomatic urinary tract infection by Raoultella ornithinolytica. MATERIALS AND METHODS A review of publications on urinary tract infections caused by the genus Raoultella between 2009 and 2018 is carried out and a case of asymptomatic urinary tract infection by Raoultella ornithinolytica is reported. The search of articles in Medline/ Pubmed and Google was performed with the keywords: Raoultella, Raoultella ornithinolytica, urinary tract infection. Twelve variables were studied: year of publication, authors, specialty, type of infection, number of cases, sex, age, immunosuppression, oncological patient, urological instrumentation, urological surgery and neurogenic bladder. Results were analyzed using descriptive statistics. A new case is described. RESULTS 24 publications were found with 120 cases of urinary infections of the genus Raoultella between 2009 and 2018, corresponding to Raoultella ornithinolytica 40.8%, Raoultella planticola 28.3%, Raoultella terrigena 30.8% and Raoultella electrica 0%. The series included 43 men (35.8%), 53 women (44.1%) and 24 patients with this data not provided (20%). The minimum age was 14 days, the maximum was 97 years and the average age was 56.6. The types of infection detected were: uncomplicated UTI 94.1%, UTI in newborn 1.6%, acute prostatitis 0.8%, chronic prostatitis 0.8%, giant kidney cyst infection 0.8%, calculous pyelonephritis 0.8% and recurrent cystitis 0.8%. CONCLUSIONS Urinary tract infections by species of the genus Raoultella occur in immunocompromised, oncological, instrumented or basic urological patients. The species Raoultella ornithinolytica described in 2011 is an emerging germ in urinary infections. This contribution is the second Spanish publication and twelfth worldwide of urinary infection by Raoultella ornithinolytica.
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Affiliation(s)
- Pedro Romero Pérez
- Facultativo Especialista de Urología. Doctor en Medicina y Cirugía. Dénia. Alicante. España
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Sattler J, Brunke A, Hamprecht A. Evaluation of CARBA PAcE, a novel rapid test for detection of carbapenemase-producing Enterobacterales. J Med Microbiol 2021; 70:001290. [PMID: 33270001 PMCID: PMC8131015 DOI: 10.1099/jmm.0.001290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/19/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction. Carbapenemase-producing Enterobacterales (CPE) are an increasing threat to global health. Fast detection is crucial for patient management and outbreak control.Hypothesis/Gap statement. Recently, a new commercial colorimetric test, CARBA PAcE, was released that has not yet been scientifically evaluated.Aim. Our goals were to evaluate the performance of CARBA PAcE using a large variety of different CPE.Methodology. CARBA PAcE was challenged with 107 molecularly characterized CPE and 53 non-CPE controls. Isolates were grown on Mueller-Hinton agar (MHA); in the case of a false-negative result, isolates were additionally inoculated on Columbia blood agar (CBA) and CARBA PAcE was repeated. The test was performed according to the manufacturer's protocol.Results. CARBA PAcE showed an overall sensitivity and specificity of 72 % [confidence interval (CI) 62-80 %] and 91 % (CI 79-97 %), respectively, when isolates were grown on MHA. With growth on CBA, detection improved (especially of metallo-β-lactamases), resulting in an extrapolated sensitivity of 89 % (CI 81-94 %) for all carbapenemases and 96 % (CI 89-99 %) for the four major carbapenemases (NDM, OXA-48-like, KPC, VIM).Conclusion. CARBA PAcE is a simple and very rapid test for the detection of CPE which performs well for the major carbapenemases when isolates are grown on CBA. Laboratories should be aware of the limitations of this assay, such as moderate sensitivity when isolates are grown on more challenging agars such as MHA and the poor detection of some rare carbapenemases (e.g. IMI, OXA-58).
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Affiliation(s)
- Janko Sattler
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, University Hospital of Cologne, Cologne, Germany
- DZIF (German Centre for Infection Research), partner site Bonn-Cologne, Cologne, Germany
| | - Anne Brunke
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, University Hospital of Cologne, Cologne, Germany
- DZIF (German Centre for Infection Research), partner site Bonn-Cologne, Cologne, Germany
| | - Axel Hamprecht
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, University Hospital of Cologne, Cologne, Germany
- DZIF (German Centre for Infection Research), partner site Bonn-Cologne, Cologne, Germany
- Institute for Medical Microbiology and Virology, University of Oldenburg, Oldenburg, Germany
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Logre E, Bert F, Khoy-Ear L, Janny S, Giabicani M, Grigoresco B, Toussaint A, Dondero F, Dokmak S, Roux O, Francoz C, Soubrane O, Durand F, Paugam-Burtz C, Weiss E. Risk Factors and Impact of Perioperative Prophylaxis on the Risk of Extended-spectrum β-Lactamase-producing Enterobacteriaceae-related Infection Among Carriers Following Liver Transplantation. Transplantation 2021; 105:338-345. [PMID: 32217945 DOI: 10.1097/tp.0000000000003231] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage is frequent among liver transplant (LT) recipients, thereby fostering a large empirical carbapenem prescription. However, ESBL-E infections occur in only 10%-25% of critically ill patients with rectal colonization. Our aim was to identify risk factors for post-LT ESBL-E infection in colonized patients. The effect of perioperative antimicrobial prophylaxis (AP) was also analyzed in patients with prophylaxis lasting <48 hours and without proven intraoperative infection. METHODS Retrospective study from a prospective database including patients with a positive ESBL-E rectal screening transplanted between 2010 and 2016. RESULTS Among the 749 patients transplanted, 100 (13.3%) were colonized with an ESBL-E strain. Thirty-nine (39%) patients developed an infection related to the same ESBL-E (10 pulmonary, 11 surgical site, 13 urinary, 5 bloodstream) within 11 postoperative days in median. Klebsiella pneumoniae carriage, model for end-stage liver disease ≥25, preoperative spontaneous bacterial peritonitis prophylaxis, and antimicrobial exposure during the previous month were independent predictors of ESBL-E infection. We propose a colonization to infection risk score built on these variables. The prevalence of infection for colonization to infection score of 0, 1, 2, and ≥3 were 7.4%, 26.3%, 61.9%, and 91.3%, respectively. Of note, the incidence of post-LT ESBL-E infection was lower in case of perioperative AP targeting colonizing ESBL-E (P = 0.04). CONCLUSIONS Thirty-nine percentage of ESBL-E carriers develop a related infection after LT. We identified predictors for ESBL-E infection in carriers that may help in rationalizing carbapenem prescription. Perioperative AP targeting colonizing ESBL-E may be associated with a reduced risk of post-LT ESBL-E infections.
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Affiliation(s)
- Elsa Logre
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Frédéric Bert
- Department of Microbiology, Beaujon Hospital, AP-HP.Nord, Clichy, France
| | - Linda Khoy-Ear
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Sylvie Janny
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Mikhaël Giabicani
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Bénédicte Grigoresco
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Amélie Toussaint
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
| | - Fédérica Dondero
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, AP-HP.Nord, Clichy, France
| | - Safi Dokmak
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, AP-HP.Nord, Clichy, France
| | - Olivier Roux
- Department of Hepatology, Beaujon Hospital, AP-HP.Nord, Clichy, France
| | - Claire Francoz
- Department of Hepatology, Beaujon Hospital, AP-HP.Nord, Clichy, France
- Inserm UMR_S 1149, Centre de recherche sur l'inflammation, Paris, France
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Beaujon Hospital, AP-HP.Nord, Clichy, France
- Inserm UMR_S 1149, Centre de recherche sur l'inflammation, Paris, France
- Université de Paris, Paris, France
| | - François Durand
- Department of Hepatology, Beaujon Hospital, AP-HP.Nord, Clichy, France
- Inserm UMR_S 1149, Centre de recherche sur l'inflammation, Paris, France
- Université de Paris, Paris, France
| | - Catherine Paugam-Burtz
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
- Inserm UMR_S 1149, Centre de recherche sur l'inflammation, Paris, France
- Université de Paris, Paris, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Clichy, France
- Inserm UMR_S 1149, Centre de recherche sur l'inflammation, Paris, France
- Université de Paris, Paris, France
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Roth S, Berger FK, Link A, Nimmesgern A, Lepper PM, Murawski N, Bittenbring JT, Becker SL. Application and clinical impact of the RESIST-4 O.K.N.V. rapid diagnostic test for carbapenemase detection in blood cultures and clinical samples. Eur J Clin Microbiol Infect Dis 2021; 40:423-428. [PMID: 32895756 PMCID: PMC7817559 DOI: 10.1007/s10096-020-04021-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Abstract
Invasive infections caused by carbapenemase-producing bacteria are associated with excess mortality. We applied a rapid diagnostic test (RDT) on clinical samples with an elevated likelihood of carbapenemase-producing bacteria and documented its impact on antibiotic treatment decisions. Among 38 patients, twelve tested positive for infections caused by carbapenemase-producing bacteria (31.6%), mainly in blood cultures. KPC (n = 10) was more frequent than OXA-48 (n = 2). RDT-based carbapenemase detection led to a treatment modification to ceftazidime/avibactam-containing regimens in all patients before detailed antibiotic testing results became available. Eleven patients (92%) survived the acute infection, whereas one patient with a ceftazidime/avibactam- and colistin-resistant OXA-48-positive isolate died.
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Affiliation(s)
- Sophie Roth
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Fabian K Berger
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Andreas Link
- Department of Internal Medicine III, Saarland University, Homburg, Germany
| | - Anna Nimmesgern
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V, Saarland University, Homburg, Germany
| | - Niels Murawski
- Department of Internal Medicine I, Saarland University, Homburg, Germany
| | - Jörg T Bittenbring
- Department of Internal Medicine I, Saarland University, Homburg, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
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Jiménez-Castillo RA, Aguilar-Rivera LR, Carrizales-Sepúlveda EF, Gómez-Quiroz RA, Llantada-López AR, González-Aguirre JE, Náñez-Terreros H, Rendón-Ramírez EJ. A case of round pneumonia due to Enterobacter hormaechei: the need for a standardized diagnosis and treatment approach in adults. Rev Inst Med Trop Sao Paulo 2021; 63:e3. [PMID: 33503151 PMCID: PMC7816868 DOI: 10.1590/s1678-9946202163003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/23/2020] [Indexed: 01/13/2023] Open
Abstract
Round pneumonia is an unusual radiological manifestation of a bacterial lung infection. We present the case of an elderly male patient who arrived at the emergency room with a productive cough and exertional dyspnea. His chest x-ray and CT showed a round opacity and air bronchograms in the right upper lobe. Taken together, the patient's symptoms and images strongly suggest a pulmonary infection. Empirical antibiotic therapy with ceftriaxone and clarithromycin was started. The sputum culture was positive for Enterobacter hormaechei and the bacterium was sensitive to levofloxacin; therefore, the antibiotic therapy was changed. Despite the treatment, the patient progressed to respiratory failure and septic shock, dying six days after admission. Although round pneumonia is uncommon, it is a potentially curable disease and clinicians should always consider it in their differential diagnosis.
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Affiliation(s)
- Raúl Alberto Jiménez-Castillo
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Leonardo René Aguilar-Rivera
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Edgar Francisco Carrizales-Sepúlveda
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Cardiología, Monterrey, México
| | - Ricardo Andrés Gómez-Quiroz
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Anabella Rosalía Llantada-López
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Julio Edgardo González-Aguirre
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Homero Náñez-Terreros
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
| | - Erick Joel Rendón-Ramírez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Departamento de Medicina Interna, Monterrey, México
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Kumudunie WGM, Wijesooriya LI, Wijayasinghe YS. Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings. PLoS One 2021; 16:e0245290. [PMID: 33434203 PMCID: PMC7802922 DOI: 10.1371/journal.pone.0245290] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/07/2020] [Accepted: 12/25/2020] [Indexed: 01/27/2023] Open
Abstract
Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.
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Abstract
Carbapenemase-producing organisms (CPO) have been identified as an urgent healthcare threat. Various methods have been used for the detection of CPO using rectal swabs. Recently, an on-demand polymerase chain reaction (PCR) assay, namely, the Xpert Carba-R assay, that requires less than an hour of turnaround time, had been developed for CPO detection in clinical samples. This study focused on the use of this assay to determine the intestinal colonization rate of CPO in patients admitted to emergency rooms (ERs).A retrospective review of medical records was conducted at a tertiary hospital between July 2017 and June 2018. CPO screening using rectal swabs was performed for patients transferred from other hospitals or for those who tested positive in CPO culture tests in the previous three months. The Xpert Carba-R assay and culture tests were used as the CPO screening methods, and the results of both tests were compared.Medical records of 705 patients admitted to our hospital during the study period were reviewed. Of these, 31 (4.4%) showed positive results for CPO using the Xpert Carba-R assay, and these patients were then transferred from the ERs to isolation rooms. Fifteen of the Xpert Carba-R assay-positive patients were also positive for the culture test; hence, early detection enabled the rapid isolation of CPO-infected patients and prevented the spread of the CPO.The Xpert Carba-R assay is a rapid test to identify and guide infection control programs to contain the spread of the rectal colonization of CPO within a hospital.
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Affiliation(s)
- Sol Jin
- Department of Infectious Disease, Kosin University Gospel Hospital
| | - Jin Young Lee
- Department of Infectious Disease, Kosin University Gospel Hospital
| | - Ji Young Park
- Department of Infectious Disease, Hubhue Hospital, Busan
| | - Min Ji Jeon
- Department of Infectious Disease, Samsung Medical Center, Seoul, Republic of Korea
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Ong KM, Phillips MS, Peskin CS. A mathematical model and inference method for bacterial colonization in hospital units applied to active surveillance data for carbapenem-resistant enterobacteriaceae. PLoS One 2020; 15:e0231754. [PMID: 33180781 PMCID: PMC7660488 DOI: 10.1371/journal.pone.0231754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/10/2019] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
Widespread use of antibiotics has resulted in an increase in antimicrobial-resistant microorganisms. Although not all bacterial contact results in infection, patients can become asymptomatically colonized, increasing the risk of infection and pathogen transmission. Consequently, many institutions have begun active surveillance, but in non-research settings, the resulting data are often incomplete and may include non-random testing, making conventional epidemiological analysis problematic. We describe a mathematical model and inference method for in-hospital bacterial colonization and transmission of carbapenem-resistant Enterobacteriaceae that is tailored for analysis of active surveillance data with incomplete observations. The model and inference method make use of the full detailed state of the hospital unit, which takes into account the colonization status of each individual in the unit and not only the number of colonized patients at any given time. The inference method computes the exact likelihood of all possible histories consistent with partial observations (despite the exponential increase in possible states that can make likelihood calculation intractable for large hospital units), includes techniques to improve computational efficiency, is tested by computer simulation, and is applied to active surveillance data from a 13-bed rehabilitation unit in New York City. The inference method for exact likelihood calculation is applicable to other Markov models incorporating incomplete observations. The parameters that we identify are the patient-patient transmission rate, pre-existing colonization probability, and prior-to-new-patient transmission probability. Besides identifying the parameters, we predict the effects on the total prevalence (0.07 of the total colonized patient-days) of changing the parameters and estimate the increase in total prevalence attributable to patient-patient transmission (0.02) above the baseline pre-existing colonization (0.05). Simulations with a colonized versus uncolonized long-stay patient had 44% higher total prevalence, suggesting that the long-stay patient may have been a reservoir of transmission. High-priority interventions may include isolation of incoming colonized patients and repeated screening of long-stay patients.
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Affiliation(s)
- Karen M. Ong
- New York University School of Medicine, New York, New York, United States of America
- Courant Institute of Mathematical Sciences, New York, New York, United States of America
- * E-mail:
| | - Michael S. Phillips
- New York University School of Medicine, New York, New York, United States of America
| | - Charles S. Peskin
- Courant Institute of Mathematical Sciences, New York, New York, United States of America
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Abstract
Antimicrobial resistance is a common iatrogenic complication of modern life and medical care. One of the most demonstrative examples is the exponential increase in the incidence of extended-spectrum β-lactamases (ESBLs) production among Enterobacteriaceae, that is, the most common human pathogens outside of the hospital setting. Infections resulting from ESBL-producing bacteria are associated with devastating outcomes, now affecting even previously healthy individuals. This poses an enormous burden and threat to public health. This article aims to narrate the evolving epidemiology of ESBL infections and highlights current challenges in terms of management and prevention of these common infections.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, 6 Weizmann Street, Tel-Aviv 6423906 Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David E Katz
- Division of Internal Medicine, Shaare Zedek Medical Center, 12 Shmuel Bait Street, Jerusalem 9103102, Israel
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
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Park JJ, Seo YB, Lee J, Eom JS, Song W, Choi YK, Kim SR, Son HJ, Cho NH. Positivity of Carbapenemase-producing Enterobacteriaceae in Patients Following Exposure within Long-term Care Facilities in Seoul, Korea. J Korean Med Sci 2020; 35:e303. [PMID: 32924341 PMCID: PMC7490199 DOI: 10.3346/jkms.2020.35.e303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/21/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) are emerging as a worldwide threat. Long-term care facilities (LTCFs) are considered a reservoir for CPE and play a central role in transmission to acute care hospitals. We investigated the CPE positivity in patients exposed to CPE in LTCFs. Furthermore, we analyzed the CPE positivity rates in the environment exposed to CPE. METHODS We collected rectal swab specimens from patients residing in LTCFs who were exposed to CPE. Environmental sampling was performed by infection control practitioners from sites classified as patient private space, common space in the patient room, common space other than patient rooms, and nursing station. Each sample was cultured on a Chrom Klebsiella pneumoniae carbapenemase (KPC) agar for CPE screening. The positive isolates were subjected to a polymerase chain reaction to identify the presence of blaKPC, blaVIM, blaIMP, blaOXA-48, and blaNDM and determine CPE genotype. RESULTS From 65 index cases, a total of 24 hospitals and 481 patients were enrolled; 414 patients who had resided in the same patient room as a patient with confirmed CPE and 67 patients who were newly admitted to that patient room. A total of 117 (24.3%) patients were positive for CPE among which 93 (22.5%, 93/414) were already admitted patients and 24 (35.8%, 24/67) were newly admitted patients. A total of 163 CPEs were detected and K. pneumoniae (n = 104, 63.8%) was the most common bacteria followed by Escherichia coli (n = 43, 26.4%) and Citrobacter koseri (n = 11, 6.7%). Environmental sampling was performed in 24 hospitals and 604 sites. A total of 12 sites (2.0%) were positive for CPE and sink in the nursing station (n = 6, 4.2%) was the most contaminated space. CONCLUSION CPE colonization rates in patients exposed to CPE in LTCFs were higher than those found in acute care hospitals. Proper infection control measures for detecting and reducing CPE colonization in patients residing in LTCFs are required. Newly admitted patients could also be carriers; therefore, infection control for newly admitted patients also needs to be thorough.
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Affiliation(s)
- Jin Ju Park
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.
| | - Joong Sik Eom
- Division of Infectious Disease, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Wonkeun Song
- Department of Laboratory Medicine, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
| | - Young Kyun Choi
- Department of Critical Care Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Sung Ran Kim
- Department of Infection Control, Korea University Guro Hospital, Seoul, Korea
| | - Hee Jung Son
- Department of Infection Control, Ewha Womens University Mokdong Hospital, Seoul, Korea
| | - Nan Hyoung Cho
- Department of Infection Control, Kangnam Severance Hospital, Seoul, Korea
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Cai Z, Tao J, Jia T, Fu H, Zhang X, Zhao M, Du H, Yu H, Shan B, Huang B, Chen L, Tang YW, Jia W, Qu F. Multicenter Evaluation of the Xpert Carba-R Assay for Detection and Identification of Carbapenemase Genes in Sputum Specimens. J Clin Microbiol 2020; 58:e00644-20. [PMID: 32522829 PMCID: PMC7448655 DOI: 10.1128/jcm.00644-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
Rapid diagnosis of infections caused by carbapenem-resistant Enterobacteriaceae (CRE) is crucial for proper treatment and infection control. The Xpert Carba-R assay is a qualitative multiplex real-time PCR method that qualitatively detects and differentiates five common carbapenemase genes (blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP) directly from rectal swabs or purified colonies within approximately 1 h. We performed a multicenter evaluation of the investigational use of the Carba-R assay for detection and differentiation of carbapenemase genes from sputum specimens in patients with a clinical diagnosis of pneumonia. The intra- and interassay coefficients of variation values for the Carba-R assay were 0.2% to 2.0% and 1.4% to 2.3%, respectively. A total of 301 sputum specimens were collected and tested. Compared to bacterial culture followed by PCR identification of resistance genes from colonies, the Carba-R assay reduced turnaround time from 56 to 84 h to less than 2 h. Carbapenemase genes were detected by the Carba-R assay in Klebsiella pneumoniae (n = 236), Escherichia coli (n = 22), Enterobacter cloacae (n = 23), Klebsiella oxytoca (n = 8), Serratia marcescens (n = 6), Citrobacter freundii (n = 4), and Klebsiella aerogenes (n = 2). The Carba-R assay detected 112 blaKPC (33.5%), 70 blaNDM (21.0%), 8 blaIMP (2.4%), and 2 blaVIM (0.6%) genes, with positive percent agreement, negative percent agreement, and concordance rates of 92.9%, 86.7%, and 88.3%, respectively, for the dominant blaKPC and 85.0%, 87.8%, and 87.4%, respectively, for the blaNDM genes. Neither method detected the blaOXA-48 carbapenemase gene. The convenient, rapid, and simple characteristics of the Xpert Carba-R assay make it a potential tool for CRE detection and identification directly in sputum specimens.
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Affiliation(s)
- Zhen Cai
- China Aviation General Hospital of China Medical University, Beijing, China
| | - Jia Tao
- Center of Medical Laboratory, the General Hospital of Ningxia Medical University, Yinchuan, China
| | - Tianye Jia
- The Center of Clinical Diagnosis Laboratory, 302 Hospital of PLA, Beijing, China
| | - Hongyu Fu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Zhang
- Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mei Zhao
- Center of Medical Laboratory, the General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hong Du
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hua Yu
- Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Bin Shan
- Department of Laboratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Bin Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liang Chen
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, New Jersey, USA
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, New Jersey, USA
| | - Yi-Wei Tang
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York, USA
- Cepheid, Shanghai, China
| | - Wei Jia
- Center of Medical Laboratory, the General Hospital of Ningxia Medical University, Yinchuan, China
| | - Fen Qu
- China Aviation General Hospital of China Medical University, Beijing, China
- The Center of Clinical Diagnosis Laboratory, 302 Hospital of PLA, Beijing, China
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Bartsch SM, Wong KF, Stokes-Cawley OJ, McKinnell JA, Cao C, Gussin GM, Mueller LE, Kim DS, Miller LG, Huang SS, Lee BY. Knowing More of the Iceberg: How Detecting a Greater Proportion of Carbapenem-Resistant Enterobacteriaceae Carriers Influences Transmission. J Infect Dis 2020; 221:1782-1794. [PMID: 31150539 PMCID: PMC7213567 DOI: 10.1093/infdis/jiz288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Clinical testing detects a fraction of carbapenem-resistant Enterobacteriaceae (CRE) carriers. Detecting a greater proportion could lead to increased use of infection prevention and control measures but requires resources. Therefore, it is important to understand the impact of detecting increasing proportions of CRE carriers. METHODS We used our Regional Healthcare Ecosystem Analyst-generated agent-based model of adult inpatient healthcare facilities in Orange County, California, to explore the impact that detecting greater proportions of carriers has on the spread of CRE. RESULTS Detecting and placing 1 in 9 carriers on contact precautions increased the prevalence of CRE from 0% to 8.0% countywide over 10 years. Increasing the proportion of detected carriers from 1 in 9 up to 1 in 5 yielded linear reductions in transmission; at proportions >1 in 5, reductions were greater than linear. Transmission reductions did not occur for 1, 4, or 5 years, varying by facility type. With a contact precautions effectiveness of ≤70%, the detection level yielding nonlinear reductions remained unchanged; with an effectiveness of >80%, detecting only 1 in 5 carriers garnered large reductions in the number of new CRE carriers. Trends held when CRE was already present in the region. CONCLUSION Although detection of all carriers provided the most benefits for preventing new CRE carriers, if this is not feasible, it may be worthwhile to aim for detecting >1 in 5 carriers.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kim F Wong
- Center for Simulation and Modeling, University of Pittsburgh, Pennsylvania
| | - Owen J Stokes-Cawley
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James A McKinnell
- Infectious Disease Clinical Outcomes Research Unit, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California
- Torrance Memorial Medical Center, Torrance, California
| | - Chenghua Cao
- Division of Infectious Diseases, University of California–Irvine Health School of Medicine, Irvine, California
- Health Policy Research Institute, University of California–Irvine Health School of Medicine, Irvine, California
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California–Irvine Health School of Medicine, Irvine, California
- Health Policy Research Institute, University of California–Irvine Health School of Medicine, Irvine, California
| | - Leslie E Mueller
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diane S Kim
- Division of Infectious Diseases, University of California–Irvine Health School of Medicine, Irvine, California
- Health Policy Research Institute, University of California–Irvine Health School of Medicine, Irvine, California
| | | | - Susan S Huang
- Division of Infectious Diseases, University of California–Irvine Health School of Medicine, Irvine, California
- Health Policy Research Institute, University of California–Irvine Health School of Medicine, Irvine, California
| | - Bruce Y Lee
- Public Health Computational and Operations Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Cury AP, Almeida Junior JN, Costa SF, Salomão MC, Boszczowski Í, Duarte AJS, Rossi F. Diagnostic performance of the Xpert Carba-R™ assay directly from rectal swabs for active surveillance of carbapenemase-producing organisms in the largest Brazilian University Hospital. J Microbiol Methods 2020; 171:105884. [PMID: 32142746 DOI: 10.1016/j.mimet.2020.105884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The global spread of carbapenemase-producing organisms (CPO) has been considered by international health authorities as a critical public health concern. Brazil has a high CPO prevalence according to distinct publications but many routine microbiology laboratories have only phenotypic resources to evaluate this epidemiological situation, which is time-consuming and detects only carbapenem-resistant isolates missing CPO susceptible expressing a slightly decreased susceptibility. New molecular platforms can detect CPO faster but a local evaluation is essential. AIM To evaluate the performance of CPO detection direct from rectal swabs with the Xpert Carba-R™ assay (Cepheid, Sunnyvale, CA) in the largest Brazilian University Hospital. METHODS A prospective diagnostic accuracy study of CPO was performed with the collection of rectal swabs from patients admitted into the Intensive Care Unit (ICU) and into the Emergency Department (ED) between April and July 2016. The Xpert Carba-R™ assay results were compared with carbapenem-resistant Enterobacterales (CRE) surveillance cultures plus in-house PCR carbapenemase detection (reference method). In case of discordant results between methods, additional tests were performed. The limit of detection (LoD) for the CRE culture and the Xpert Carba-R™ assay were performed with contrived isolates of known carbapenemases genes. RESULTS A total of 921 clinical rectal swabs were analyzed being 21% (196/921) from the ICU and 79% (725/921) from the ED. Overall, the Xpert Carba-R™ assay detected 9.9% (91/921) of CPOs being 9.5% (87/921) positive only for blaKPC and 0.4% (4/921) positive only for blaNDM. The reference method detected 9.1% (84/921) CPO being 77 (8.4%) blaKPC, 5 blaVIM (0.5%) and 2 blaNDM (0.2%). No IMP or OXA-48 like gene was detected. Overall, twelve samples, 1.3% (10 blaKPC, 2 blaNDM) were Xpert Carba-R™ positive but negative by the reference method. Five isolates (0.5%) were positive for blaVIM only by in-house PCR and confirmed to be blaVIM-2 by DNA sequencing. The Kappa value, sensitivity, specificity, positive/negative predictive values and accuracy of the Xpert Carba-R™ assay were; 0.893 (95% confidence interval [CI], 0.842-0.944), 94% (86.7-98.0), 98.6% (97.5-99.3), 86.8% (78.1-93.0), 99.4% (98.6-99.8) and 98.2% (97.3-99.1), respectively. The LoD for blaKPC of the Xpert Carba-R™ assay and the CRE cultures were 101 CFU/swab. CONCLUSION The Xpert Carba-R™ assay is an accurate test to detect CPO directly from the rectal swabs with significant lower turnaround time (TAT) when compared to the reference method (CRE culture plus in-house PCR). Xpert Carba-R™ may, therefore, be regarded as a good and fast epidemiological tool.
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Affiliation(s)
- Ana Paula Cury
- Microbiology Laboratory, LIM 03, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil.
| | - J N Almeida Junior
- Microbiology Laboratory, LIM 03, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Silvia F Costa
- Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, Brazil; LIM 54, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Matias C Salomão
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, Brazil; Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Ícaro Boszczowski
- Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, Brazil
| | - Alberto J S Duarte
- Central Laboratory Division (CLD), LIM 03, Hospital das Clínicas, Universidade de São Paulo, Brazil
| | - Flávia Rossi
- Microbiology Laboratory, LIM 03, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Brazil
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Anderson REV, Boerlin P. Carbapenemase-producing Enterobacteriaceae in animals and methodologies for their detection. Can J Vet Res 2020; 84:3-17. [PMID: 31920216 PMCID: PMC6921994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
Carbapenemase-producing bacteria are difficult to treat and pose an important threat for public health. Detecting and identifying them can be a challenging and time-consuming task. Due to the recent rise in prevalence of infections with these organisms, there is an increased demand for rapid and accurate detection methods. This review describes and contrasts current methods used for the identification and detection of carbapenemase-producing bacteria to help control their spread in animal populations and along the food chain. The methods discussed include cultures used for screening clinical samples and primary isolation, susceptibility testing, culture-based and molecular confirmation tests. Advantages and disadvantages as well as limitations of the methods are discussed.
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Affiliation(s)
- Rebecca E V Anderson
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario NIG 2W1
| | - Patrick Boerlin
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario NIG 2W1
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Abstract
PURPOSE We present a case of endogenous endophthalmitis because of an unusual bacterium, Citrobacter koseri. PATIENT A 57-year-old woman without previous history of eye surgery or trauma presented with diabetic ketoacidosis and a painful right eye with the reduction of vision. C. koseri was identified in blood culture; thus, a diagnosis of right eye endogenous endophthalmitis was made. Intravenous and intravitreal antibiotics were both started, and vitreous culture further confirmed C. koseri as the causative organism. Computed tomography of the abdomen and pelvis revealed a right C-shaped perinephric abscess, which was drained under ultrasound guidance. RESULTS Because of rapid progression to corneal melting, evisceration was performed. CONCLUSION Cases of endogenous endophthalmitis caused by Citrobacter are very limited, and a review of all published cases in the English literature and the present case revealed that endogenous Citrobacter endophthalmitis arose almost entirely from Citrobacter renal infection. Early recognition and drainage of renal abscess may lower the chance of uncontrolled infection and endogenous spread to the eyes. Despite prompt and intensive treatment, the clinical outcome of Citrobacter endogenous endophthalmitis seems to be poor.
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Affiliation(s)
- Daniel H T Wong
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Candice C H Liu
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Justin M K Tong
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
| | - Wei-Kwang Luk
- Pathology, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong SAR, China
| | - Kenneth K W Li
- Department of Ophthalmology, United Christian Hospital, Kwun Tong, Hong Kong SAR, China; and
- Departments of Ophthalmology, and
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Abstract
The Enterobacterial genus Pantoea contains both free-living and host-associating species, with considerable debate as to whether documented reports of human infections by members of this species group are accurate. MALDI-TOF-based identification methods are commonly used in clinical laboratories as a rapid means of identification, but its reliability for identification of Pantoea species is unclear. In this study, we carried out cpn60-based molecular typing of 54 clinical isolates that had been identified as Pantoea using MALDI-TOF and other clinical typing methods. We found that 24% had been misidentified, and were actually strains of Citrobacter, Enterobacter, Kosakonia, Klebsiella, Pseudocitrobacter, members of the newly described Erwinia gerundensis, and even several unclassified members of the Enterobacteriaceae. The 40 clinical strains that were confirmed to be Pantoea were identified as Pantoea agglomerans, Pantoea allii, Pantoea dispersa, Pantoea eucalypti, and Pantoea septica as well as the proposed species group, Pantoea latae. Some species groups considered largely environmental or plant-associated, such as P. allii and P. eucalypti were also among clinical specimens. Our results indicate that MALDI-TOF-based identification methods may misidentify strains of the Enterobacteriaceae as Pantoea.
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Affiliation(s)
- Craig D. Soutar
- Department of Biology, University of Regina, Regina, Saskatchewan, Canada
| | - John Stavrinides
- Department of Biology, University of Regina, Regina, Saskatchewan, Canada
- * E-mail:
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47
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Jean SS, Hsueh PR. Antimicrobial susceptibilities of the ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales isolates causing intra-abdominal infections in the Asia-Pacific region during 2008-2014: Results from the Study for Monitoring the Antimicrobial Resistance Trends (SMART). J Glob Antimicrob Resist 2019; 21:91-98. [PMID: 31627023 DOI: 10.1016/j.jgar.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/01/2019] [Accepted: 10/06/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the susceptibility profiles amongst ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales (ETP-NS-non-CPE) isolates. METHODS Minimum inhibitory concentrations (MICs) of 404 ETP-NS-non-CPE isolates collected from different intra-abdominal infection (IAI) sites amongst patients in the Asia-Pacific region during 2008-2014 were determined using the broth microdilution method. The susceptibility results were interpreted according to the MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2018. The MICs data of several agents were evaluated based on their published pharmacokinetic/pharmacodynamic (PK/PD) profiles. RESULTS The majority (>84%) of IAI-ETP-NS-non-CPE isolates - including Escherichia coli (n=83), Klebsiella pneumoniae (n=91) and Enterobacter species (n=210) - were susceptible to imipenem and amikacin. The 193 hepatobiliary ETP-NS-non-CPE isolates exhibited a trend of lower cefepime MIC (≤4mg/L) distribution than those (n=145) cultured from the peritoneal space (P=0.058). Amongst the ETP-NS-non-CP Enterobacter isolates, 65.7% displayed a cefepime MIC≤4mg/L. In addition, compared with Escherichia coli and Klebsiella pneumoniae isolates, 82.9% and 72.9% of the ETP-NS-non-CP Enterobacter isolates were susceptible to levofloxacin and ciprofloxacin, respectively. Of note, 74.5% and 70.3% of the ETP-NS-non-CP Enterobacter isolates cultured from the hepatobiliary tract and peritoneal space exhibited a ciprofloxacin MIC≤2mg/L and ≤0.25mg/L, respectively. Imipenem and amikacin showed good in vitro susceptibility rates against the IAI-ETP-NS-non-CPE isolates. The hepatobiliary ETP-NS-non-CPE displayed lower cefepime MICs than those cultured from the peritoneal space. Additionally, a significant fraction of IAI-ETP-NS-non-CP Enterobacter isolates exhibited ciprofloxacin MIC ≤ 2mg/L. CONCLUSION Based upon the PK/PD analyses, ciprofloxacin, imipenem and cefepime are probably effective against IAI-ETP-NS-non-CPE isolates.
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Affiliation(s)
- Shio-Shin Jean
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Griffin MJ, Petty BD, Ware C, Fogelson SB. Recovery and confirmation of Edwardsiella piscicida from a black crappie Pomoxis nigromaculatus (Lesueur, 1829). J Fish Dis 2019; 42:1457-1461. [PMID: 31309579 DOI: 10.1111/jfd.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/03/2019] [Accepted: 05/07/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Matt J Griffin
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, Mississippi
| | - B Denise Petty
- North Florida Aquatic Veterinary Services, Fort White, Florida
| | - Cynthia Ware
- Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Stoneville, Mississippi
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Bonnet I, Bozzi B, Fourniols E, Mitrovic S, Soulier-Escrihuela O, Brossier F, Sougakoff W, Robert J, Jauréguiberry S, Aubry A. Erwinia billingiae as Unusual Cause of Septic Arthritis, France, 2017. Emerg Infect Dis 2019; 25:1587-1589. [PMID: 31310207 PMCID: PMC6649348 DOI: 10.3201/eid2508.181073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In 2017 in France, we treated a patient with knee septic arthritis caused by Erwinia billingiae after trauma involving a palm tree. This rare pathogen could only be identified through 16S rRNA gene sequencing. For bacterial infections after injuries with plants, 16S rRNA gene sequencing might be required for species identification.
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MESH Headings
- Aged
- Humans
- Male
- Anti-Bacterial Agents/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/microbiology
- Enterobacteriaceae Infections/diagnosis
- Enterobacteriaceae Infections/epidemiology
- Enterobacteriaceae Infections/microbiology
- Erwinia/classification
- Erwinia/genetics
- Erwinia/isolation & purification
- France
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 16S/isolation & purification
- Sequence Analysis, DNA
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
- Treatment Outcome
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50
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Telenchana-Chimbo P, Barrera-Carmona C, Cevallos-Quintero E, Jiménez-Prieto F, Solórzano L, Soria C, Soria C. [Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum -lactamases]. Acta Ortop Mex 2019; 33:232-236. [PMID: 32246593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Infections of enterobacteria producing extended-spectrum -lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. MATERIAL AND METHODS Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. RESULTS 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. DISCUSSION The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.
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Affiliation(s)
| | | | | | | | | | - C Soria
- Universidad de Guayaquil, Ecuador
| | - C Soria
- Hospital Luis Vernaza, Guayaquil, Ecuador
- Universidad Católica de Santiago de Guayaquil, Ecuador
- Universidad San Francisco de Quito, Ecuador
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