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Blanco-Martín T, Alonso-García I, González-Pinto L, Outeda-García M, Guijarro-Sánchez P, López-Hernández I, Pérez-Vázquez M, Aracil B, López-Cerero L, Fraile-Ribot P, Oliver A, Vázquez-Ucha JC, Beceiro A, Bou G, Arca-Suárez J. Activity of cefiderocol and innovative β-lactam/β-lactamase inhibitor combinations against isogenic strains of Escherichia coli expressing single and double β-lactamases under high and low permeability conditions. Int J Antimicrob Agents 2024; 63:107150. [PMID: 38513748 DOI: 10.1016/j.ijantimicag.2024.107150] [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: 01/03/2024] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES To analyse the impact of the most clinically relevant β-lactamases and their interplay with low outer membrane permeability on the activity of cefiderocol, ceftazidime/avibactam, aztreonam/avibactam, cefepime/enmetazobactam, cefepime/taniborbactam, cefepime/zidebactam, imipenem/relebactam, meropenem/vaborbactam, meropenem/xeruborbactam and meropenem/nacubactam against recombinant Escherichia coli strains. METHODS We constructed 82 E. coli laboratory transformants expressing the main β-lactamases circulating in Enterobacterales (70 expressing single β-lactamase and 12 producing double carbapenemase) under high (E. coli TG1) and low (E. coli HB4) permeability conditions. Antimicrobial susceptibility testing was determined by reference broth microdilution. RESULTS Aztreonam/avibactam, cefepime/zidebactam, cefiderocol, meropenem/xeruborbactam and meropenem/nacubactam were active against all E. coli TG1 transformants. Imipenem/relebactam, meropenem/vaborbactam, cefepime/taniborbactam and cefepime/enmetazobactam were also highly active, but unstable against most of MBL-producing transformants. Combination of β-lactamases with porin deficiency (E. coli HB4) did not significantly affect the activity of aztreonam/avibactam, cefepime/zidebactam, cefiderocol or meropenem/nacubactam, but limited the effectiveness of the rest of carbapenem- and cefepime-based combinations. Double-carbapenemase production resulted in the loss of activity of most of the compounds tested, an effect particularly evident for those E. coli HB4 transformants in which MBLs were present. CONCLUSIONS Our findings highlight the promising activity that cefiderocol and new β-lactam/β-lactamase inhibitors have against recombinant E. coli strains expressing widespread β-lactamases, including when these are combined with low permeability or other enzymes. Aztreonam/avibactam, cefiderocol, cefepime/zidebactam and meropenem/nacubactam will help to mitigate to some extent the urgency of new compounds able to resist MBL action, although NDM enzymes represent a growing challenge against which drug development efforts are still needed.
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Affiliation(s)
- Tania Blanco-Martín
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Isaac Alonso-García
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Lucía González-Pinto
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Michelle Outeda-García
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Paula Guijarro-Sánchez
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Inmaculada López-Hernández
- Laboratorio de Referencia para tipado molecular y detección de mecanismos de resistencia a antimicrobianos de Andalucía (PIRASOA). Unidad de Gestión Clínica de Microbiología y Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla. Instituto de Biomedicina de Sevilla (IBIS), CSIC, Universidad de Sevilla, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Pérez-Vázquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Aracil
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lorena López-Cerero
- Laboratorio de Referencia para tipado molecular y detección de mecanismos de resistencia a antimicrobianos de Andalucía (PIRASOA). Unidad de Gestión Clínica de Microbiología y Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla. Instituto de Biomedicina de Sevilla (IBIS), CSIC, Universidad de Sevilla, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Fraile-Ribot
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases e Instituto de Investigación Sanitaria Illes Balears (IDISBA), Palma de Mallorca, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Oliver
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases e Instituto de Investigación Sanitaria Illes Balears (IDISBA), Palma de Mallorca, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Vázquez-Ucha
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Beceiro
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Germán Bou
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Arca-Suárez
- Servicio de Microbiología and Instituto de Investigación Biomédica A Coruña (INIBIC), Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Novais Â, Gonçalves AB, Ribeiro TG, Freitas AR, Méndez G, Mancera L, Read A, Alves V, López-Cerero L, Rodríguez-Baño J, Pascual Á, Peixe L. Development and validation of a quick, automated, and reproducible ATR FT-IR spectroscopy machine-learning model for Klebsiella pneumoniae typing. J Clin Microbiol 2024; 62:e0121123. [PMID: 38284762 PMCID: PMC10865814 DOI: 10.1128/jcm.01211-23] [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: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
The reliability of Fourier-transform infrared (FT-IR) spectroscopy for Klebsiella pneumoniae typing and outbreak control has been previously assessed, but issues remain in standardization and reproducibility. We developed and validated a reproducible FT-IR with attenuated total reflectance (ATR) workflow for the identification of K. pneumoniae lineages. We used 293 isolates representing multidrug-resistant K. pneumoniae lineages causing outbreaks worldwide (2002-2021) to train a random forest classification (RF) model based on capsular (KL)-type discrimination. This model was validated with 280 contemporaneous isolates (2021-2022), using wzi sequencing and whole-genome sequencing as references. Repeatability and reproducibility were tested in different culture media and instruments throughout time. Our RF model allowed the classification of 33 capsular (KL)-types and up to 36 clinically relevant K. pneumoniae lineages based on the discrimination of specific KL- and O-type combinations. We obtained high rates of accuracy (89%), sensitivity (88%), and specificity (92%), including from cultures obtained directly from the clinical sample, allowing to obtain typing information the same day bacteria are identified. The workflow was reproducible in different instruments throughout time (>98% correct predictions). Direct colony application, spectral acquisition, and automated KL prediction through Clover MS Data analysis software allow a short time-to-result (5 min/isolate). We demonstrated that FT-IR ATR spectroscopy provides meaningful, reproducible, and accurate information at a very early stage (as soon as bacterial identification) to support infection control and public health surveillance. The high robustness together with automated and flexible workflows for data analysis provide opportunities to consolidate real-time applications at a global level. IMPORTANCE We created and validated an automated and simple workflow for the identification of clinically relevant Klebsiella pneumoniae lineages by FT-IR spectroscopy and machine-learning, a method that can be extremely useful to provide quick and reliable typing information to support real-time decisions of outbreak management and infection control. This method and workflow is of interest to support clinical microbiology diagnostics and to aid public health surveillance.
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Affiliation(s)
- Ângela Novais
- UCIBIO, Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Ana Beatriz Gonçalves
- UCIBIO, Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Teresa G. Ribeiro
- UCIBIO, Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- CCP, Culture Collection of Porto, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Ana R. Freitas
- UCIBIO, Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- 1H-TOXRUN, One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU, CRL, Gandra, Portugal
| | - Gema Méndez
- CLOVER Bioanalytical Software, Granada, Spain
| | | | - Antónia Read
- Clinical Microbiology Laboratory, Local Healthcare Unit, Matosinhos, Portugal
| | - Valquíria Alves
- Clinical Microbiology Laboratory, Local Healthcare Unit, Matosinhos, Portugal
| | - Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Vírgen Macarena, Instituto de Biomedicina de Sevilla (IBIS; CSIC/Hospital Virgen Macarena/Universidad de Sevilla), Sevilla, Spain
- Departamentos de Microbiología y Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Vírgen Macarena, Instituto de Biomedicina de Sevilla (IBIS; CSIC/Hospital Virgen Macarena/Universidad de Sevilla), Sevilla, Spain
- Departamentos de Microbiología y Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Álvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Vírgen Macarena, Instituto de Biomedicina de Sevilla (IBIS; CSIC/Hospital Virgen Macarena/Universidad de Sevilla), Sevilla, Spain
- Departamentos de Microbiología y Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Luísa Peixe
- UCIBIO, Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- CCP, Culture Collection of Porto, Faculty of Pharmacy, University of Porto, Porto, Portugal
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López-Cerero L, Ballesta S, López CE, Sánchez-Yebra W, Rojo-Martin MD, Pascual A. Evaluation of three commercial methods of susceptibility testing for ceftolozane/tazobactam against carbapenem-resistant Pseudomonas aeruginosa. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:621-624. [PMID: 36737371 DOI: 10.1016/j.eimce.2022.09.014] [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] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/23/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ceftolozane/tazobactam has shown excellent activity against Pseudomonas aeruginosa, but this drug is not always included in commercial panels. The aim of the study was to evaluate the performance of 2 gradient strips (BioMérieux and Liofilchem) and a commercial microdilution panel (Sensititre, EURGNCOL panel) using this combination against carbapenem-resistant P. aeruginosa isolates. METHODS Three commercial methods were tested with 41 metallo-beta-lactamase-producing and 59 non-carbapenemase-producing P. aeruginosa isolates. Broth microdilution was used as reference. RESULTS All carbapenemase-producing isolates and only one non-producing isolate were resistant to this antibiotic. Both essential agreement and bias were outside the acceptance intervals since MIC values were higher than reference values for all three methods. The Kappa index indicated poor or weak agreement. Changes in clinical categories were observed in 3 isolates. CONCLUSIONS The three methods yielded poor agreement with the reference. Despite the differences in MIC values, fewer than 3% involved category changes.
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Affiliation(s)
- Lorena López-Cerero
- Unidad de Gestión Clínica de Microbiología y Enfermedades infecciosas, Hospital Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Facultad de Medicina de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Spain.
| | - Sofia Ballesta
- Departamento de Microbiología, Facultad de Medicina de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Spain
| | | | - Waldo Sánchez-Yebra
- Servicio de Microbiología, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | | | - Alvaro Pascual
- Unidad de Gestión Clínica de Microbiología y Enfermedades infecciosas, Hospital Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Facultad de Medicina de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Spain
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López-Cerero L, Ballesta S, López CE, Sánchez-Yebra W, Rojo-Martin MD, Pascual A. Evaluation of three commercial methods of susceptibility testing for ceftolozane/tazobactam against carbapenem-resistant Pseudomonas aeruginosa. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Salamanca-Rivera E, López-Cerero L, Rodríguez-Martínez JM, Pascual A, Rodríguez-Baño J. Prevalence, Incidence, and Risk Factors for Intestinal Colonization Due to Fluoroquinolone-Resistant ST131 Escherichia coli: a Longitudinal Study in Highly Dependent, Long-Term Care Facility Residents. Microbiol Spectr 2022; 10:e0167322. [PMID: 35943257 PMCID: PMC9431526 DOI: 10.1128/spectrum.01673-22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
Escherichia coli ST131 clade C is an important driver for fluoroquinolone resistance (FQ-R). We conducted a prospective observational study in residents from two long-term care facilities (LTCFs) in Seville, Spain, in 2018. Fecal swabs and environmental samples were obtained. E. coli isolates were screened for clade C, FQ-R ST131 by PCR, and molecular typing by PFGE; representatives from pulsotypes were studied by whole-genome-sequencing (WGS) and assigned to lineages (cgSTs). Prevalence of colonization at each time point, incidence density, and risk factors for acquisition were studied. Seventy-six FQ-R ST131 E. coli isolates belonging to 34 cgSTs were obtained; 24 belonging to subclade C1 (116 isolates, 65.9%) and 10 to C2 (60, 34.1%). C1 lineages showed lower virulence scores than C2 (median [IQR], 19 [18 to 20] versus 21 [20 to 21.5], P = 0.001) and higher number of plasmids (4 [3 to 5] versus 2 [2 to 3], P = 0.01). aac(6')-Ib-cr and blaOXA-1 were less frequent in C1 than C2 (2 [8.3%] versus 6 [60%], P = 0.003 for both); ESBL genes were detected in eight (33.3%) C1 (5 blaCTX-M-27) and three (30%) C2 (all blaCTX-M-15). Of the 82 residents studied, 49 were colonized at some point (59.7%), with a pooled prevalence of 38.6%. Incidence density of new lineage acquisition was 2.22 per 100 resident weeks (1.28 and 0.93 C1 and C2 subclades, respectively). Independent risk factors for acquisitions were having a colonized roommate (HR = 4.21; 95% CI = 1.71 to 10.36; P = 0.002) and urinary or fecal incontinence (HR = 2.82; 95% CI = 1.21 to 6.56; P = 0.01). LTCFs are important reservoirs of clade C ST131 E. coli. The risk factors found suggest that cross-transmission is the most relevant transmission mechanisms. IMPORTANCE We aimed at investigating the microbiological and epidemiological features of clade C fluoroquinolone-resistant ST131 E. coli isolates colonizing highly dependent residents in long-term care facilities (LTCFs) during 40 weeks and the risk factors of acquisition. Isolates from C1 and C2 subclades were characterized in this environment. The clonality of the isolates was characterized and they were assigned to lineages (cgSTs), Resistance genes, virulence factors, and plasmids were also described. This study suggests that cross-transmission is the most relevant transmission mechanisms; however, environmental colonization might also play a role. We believe the data provide useful information to depict the epidemiology of these bacteria by merging detailed microbiological and epidemiological information.
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Affiliation(s)
- Elena Salamanca-Rivera
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla and CSIC, Seville, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla and CSIC, Seville, Spain
- Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jose Manuel Rodríguez-Martínez
- Instituto de Biomedicina de Sevilla and CSIC, Seville, Spain
- Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Alvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla and CSIC, Seville, Spain
- Departamento de Microbiología, Universidad de Sevilla, Seville, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla and CSIC, Seville, Spain
- Departamento de Medicina, Universidad de Sevilla, Seville, Spain
- Centro de Investigación en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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López-Hernández I, López-Cerero L, Fernández-Cuenca F, Pascual Á. The role of the microbiology laboratory in the diagnosis of multidrug-resistant Gram-negative bacilli infections. The importance of the determination of resistance mechanisms. Med Intensiva 2022; 46:455-464. [PMID: 35643635 DOI: 10.1016/j.medine.2022.05.003] [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: 10/18/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Abstract
Early diagnosis and treatment has an important impact on the morbidity and mortality of infections caused by multidrug-resistant bacteria. Multidrug-resistant gram-negative bacilli (MR-GNB) constitute the main current threat in hospitals and especially in intensive care units (ICU). The role of the microbiology laboratory is essential in providing a rapid and effective response. This review updates the microbiology laboratory procedures for the rapid detection of BGN-MR and its resistance determinants. The role of the laboratory in the surveillance and control of outbreaks caused by these bacteria, including typing techniques, is also studied. The importance of providing standardized resistance maps that allow knowing the epidemiological situation of the different units is emphasized. Finally, the importance of effective communication systems for the transmission of results and decision making in the management of patients infected by BGN-MR is reviewed.
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Affiliation(s)
- I López-Hernández
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - L López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - F Fernández-Cuenca
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
| | - Á Pascual
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Red Española de Investigación en Patología Infecciosa (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
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López-Cerero L, Salamanca E, Delgado-Valverde M, Rodríguez-Martínez JM, Rodríguez-Baño J, Pascual Á. Higher prevalence of CTX-M-27-producing Escherichia coli belonging to ST131 clade C1 among residents of two long-term care facilities in Southern Spain. Eur J Clin Microbiol Infect Dis 2021; 41:335-338. [PMID: 34787750 DOI: 10.1007/s10096-021-04380-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/11/2021] [Indexed: 12/14/2022]
Abstract
Recently, the emergence of an international lineage of the CTX-M-27-producing clade C1 of Escherichia coli ST131 is being observed. The aim is to see if this strain has also been introduced in our area. Twenty-eight (33%) out of 86 individuals from two LTCFs in Seville were found to be colonized with fluoroquinolone-resistant E. coli ST131 and 46% isolates were ESBL/pAmpC producers. C1 isolates were more common than C2 and more frequently produced blaESBL/pAmpC genes (53% vs 33%). Strain sharing was observed in 6 groups of 2-5 cases (61%). A differentiated cluster of 5 C1-CTX-M-27 isolates was found which lacked the M27PP1 region.
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Affiliation(s)
- Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario, Virgen Macarena, Sevilla, Spain. .,Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain.
| | - Elena Salamanca
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario, Virgen Macarena, Sevilla, Spain
| | - Mercedes Delgado-Valverde
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario, Virgen Macarena, Sevilla, Spain
| | | | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario, Virgen Macarena, Sevilla, Spain.,Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
| | - Álvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario, Virgen Macarena, Sevilla, Spain.,Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
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Marín-Candón A, Rosso-Fernández CM, Bustos de Godoy N, López-Cerero L, Gutiérrez-Gutiérrez B, López-Cortés LE, Barrera Pulido L, Borreguero Borreguero I, León MJ, Merino V, Camean-Fernández M, Retamar P, Salamanca E, Pascual A, Rodriguez-Baño J. Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (ASTARTÉ): protocol for a randomised, pragmatic trial. BMJ Open 2021; 11:e049481. [PMID: 34580096 PMCID: PMC8477313 DOI: 10.1136/bmjopen-2021-049481] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Alternatives to carbapenems are needed in the treatment of third-generation cephalosporin-resistant Enterobacterales (3GCR-E). Temocillin is a suitable candidate, but comparative randomised studies are lacking. The objective is to investigate if temocillin is non-inferior to carbapenems in the targeted treatment of bacteraemia due to 3GCR-E. METHODS AND ANALYSIS Multicentre, open-label, randomised, controlled, pragmatic phase 3 trial. Patients with bacteraemia due to 3GCR-E will be randomised to receive intravenously temocillin (2 g three times a day) or carbapenem (meropenem 1 g three times a day or ertapenem 1 g once daily). The primary endpoint will be clinical success 7-10 days after end of treatment with no recurrence or death at day 28. Adverse events will be collected; serum levels of temocillin will be investigated in a subset of patients. For a 10% non-inferiority margin, 334 patients will be included (167 in each study arm). For the primary analysis, the absolute difference with one-sided 95% CI in the proportion of patients reaching the primary endpoint will be compared in the modified intention-to-treat population. ETHICS AND DISSEMINATION The study started after approval of the Spanish Regulatory Agency and the reference institutional review board. Data will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04478721.
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Affiliation(s)
- Alicia Marín-Candón
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Clara M Rosso-Fernández
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Natalia Bustos de Godoy
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Lorena López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Belén Gutiérrez-Gutiérrez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Luis Eduardo López-Cortés
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Lydia Barrera Pulido
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Irene Borreguero Borreguero
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - María José León
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Vicente Merino
- Unidad Clínica de Farmacia, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Farmacología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | | | - Pilar Retamar
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Elena Salamanca
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Alvaro Pascual
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Jesús Rodriguez-Baño
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamentos de Medicina y Microbiología, Universidad de Sevilla, Sevilla, Spain
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9
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Pérez-Palacios P, Palacios-Baena Z, López-Cerero L, Pascual Á. Successful outcome after treatment with a combination of meropenem and fosfomycin for VIM-1 and CTX-M-15 producing Klebsiella pneumoniae bloodstream infection. J Infect 2021; 83:e12-e13. [PMID: 34371076 DOI: 10.1016/j.jinf.2021.08.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Patricia Pérez-Palacios
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Avda Dr. Fedriani s/n, Sevilla 41009, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, Instituto de Salud Carlos III, RD16/CIII/0004/0002), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Zaira Palacios-Baena
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Avda Dr. Fedriani s/n, Sevilla 41009, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, Instituto de Salud Carlos III, RD16/CIII/0004/0002), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Lorena López-Cerero
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Avda Dr. Fedriani s/n, Sevilla 41009, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, Instituto de Salud Carlos III, RD16/CIII/0004/0002), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - Álvaro Pascual
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Avda Dr. Fedriani s/n, Sevilla 41009, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016, Instituto de Salud Carlos III, RD16/CIII/0004/0002), Madrid, Spain; Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
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10
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Mama OM, Aspiroz C, Lozano C, Ruiz-Ripa L, Azcona JM, Seral C, Cercenado E, López-Cerero L, Palacian P, Belles-Belles A, Berdonces P, Siller M, Aguirre-Quiñonero A, Zarazaga M, Torres C. Penicillin susceptibility among invasive MSSA infections: a multicentre study in 16 Spanish hospitals. J Antimicrob Chemother 2021; 76:2519-2527. [PMID: 34245259 DOI: 10.1093/jac/dkab208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To determine the prevalence of penicillin susceptibility among MSSA causing bloodstream infections (BSIs) in 16 Spanish hospitals and to characterize the penicillin-susceptible MSSA (MSSA-PENS) isolates. METHODS A total of 1011 Staphylococcus aureus isolates were collected from blood cultures in 16 Spanish hospitals during 2018-19 (6-12 months) and their susceptibility to 18 antimicrobials was determined. The MSSA-PENS isolates were selected and examined by PCR to determine the presence of the blaZ gene, other resistance genes and the genes lukF/lukS-PV, eta, etb and tst. The immune evasion cluster (IEC) type was also analysed. All the MSSA-PENS isolates were submitted to S. aureus protein A (spa) typing and the clonal complexes (CCs) were assigned according to their spa type. RESULTS The prevalence of MSSA was 74.6% (754/1011) and 14.9% (151/1011) were MSSA-PENS-blaZnegative. MSSA-PENS-blaZnegative isolates (n = 151) were ascribed to 88 spa types and 11 CCs. The most frequent CCs were CC5 (35/151) and CC398 (25/151), with t002-CC5 and t571-CC398 being the most common lineages. Pan-susceptibility was identified in 117 of the 151 MSSA-PENS-blaZnegative isolates (77.5%). In the remaining isolates, erythromycin and clindamycin resistance was the most frequent resistance found, although tobramycin, ciprofloxacin, fusidic acid, mupirocin and/or tetracycline resistance was also detected. Thirty-eight MSSA-PENS-blaZnegative isolates were IEC negative and four isolates were Panton-Valentine leucocidin ('PVL') positive. CONCLUSIONS A high penicillin susceptibility rate was detected among MSSA, opening therapeutic opportunities for BSIs. The emergence of new successful MSSA-PENS clones could be responsible for these data. The detection among MSSA-PENS-blaZnegative isolates of the clonal lineage CC398 or the absence of an IEC raises questions about their possible animal origin, requiring further analysis.
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Affiliation(s)
| | - Carmen Aspiroz
- Servicio Microbiología, Hospital Royo Villanova, Zaragoza, Spain
| | - Carmen Lozano
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Madre de Dios 53, 26006, Logroño, Spain
| | - Laura Ruiz-Ripa
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Madre de Dios 53, 26006, Logroño, Spain
| | | | - Cristina Seral
- Servicio Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Emilia Cercenado
- Servicio Microbiología, Hospital General Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Lorena López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Departamento de Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Pilar Palacian
- Servicio Microbiología, Hospital Universitario Miguel Servet/IIS Aragón, Zaragoza, Spain
| | - Alba Belles-Belles
- Servicio Microbiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | | | - María Siller
- Servicio Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Myriam Zarazaga
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Madre de Dios 53, 26006, Logroño, Spain
| | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Madre de Dios 53, 26006, Logroño, Spain
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Álvarez-Marín R, López-Cerero L, Guerrero-Sánchez F, Palop-Borras B, Rojo-Martín MD, Ruiz-Sancho A, Herrero-Rodríguez C, García MV, Lazo-Torres AM, López I, Martín-Hita L, Nuño-Álvarez E, Sánchez-Yebra W, Galán-Sánchez F, Reguera-Iglesias JM, Lepe JA, Peñalva G, Pascual Á, Cisneros JM. Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases. J Antimicrob Chemother 2021; 76:1928-1936. [PMID: 33769481 DOI: 10.1093/jac/dkab073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/05/2020] [Accepted: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Gram-negative bacilli (CR-GNB) are among the most threatening microorganisms worldwide and carbapenem use facilitates their spread. Antimicrobial stewardship programmes (ASPs) can help to optimize the use of antibiotics. This study evaluates the impact of a multifaceted educational ASP on carbapenem use and on the epidemiology of CR-GNB. METHODS We conducted a quasi-experimental, time-series study in seven hospitals, from January 2014 to September 2018. The key intervention was composed of educational interviews promoting the appropriate use of carbapenems. The primary endpoints were carbapenem consumption and incidence density (ID) of CR-GNB. All non-duplicated CR-GNB clinical isolates were tested using phenotypic assays and PCR for the presence of carbapenemases. Joinpoint regression and interrupted time-series analyses were used to determine trends. RESULTS A decrease in carbapenem consumption throughout the study period [average quarterly percentage change (AQPC) -1.5%, P < 0.001] and a -8.170 (-16.064 to -0.277) level change following the intervention were observed. The ID of CR-Acinetobacter baumannii decreased (AQPC -3.5%, P = 0.02) and the overall ID of CR-GNB remained stable (AQPC -0.4%, P = 0.52). CR-GNB, CR-Pseudomonas aeruginosa and CR-A. baumannii IDs per hospital correlated with the local consumption of carbapenems. The most prevalent carbapenem resistance mechanisms were OXA-23 for CR-A. baumannii (76.1%), OXA-48 for CR-Klebsiella pneumoniae (66%) and no carbapenemases for CR-P. aeruginosa (91.7%). The epidemiology of carbapenemases was heterogeneous throughout the study, especially for carbapenemase-producing Enterobacteriaceae. CONCLUSIONS In conclusion, a multifaceted, educational interview-based ASP targeting carbapenem prescribing reduced carbapenem use and the ID of CR-A. baumannii.
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Affiliation(s)
- Rocío Álvarez-Marín
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio/CSIC/University of Seville/Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Lorena López-Cerero
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Microbiology, University of Seville, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | | | - Begoña Palop-Borras
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
| | | | - Andrés Ruiz-Sancho
- Clinical Unit of Infectious Diseases, Hospital San Cecilio, Granada, Spain
| | | | | | - Ana María Lazo-Torres
- Clinical Unit of Internal Medicine, Department of Infectious Diseases, Hospital Torrecardenas, Almeria, Spain
| | - Inmaculada López
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Microbiology, University of Seville, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Lina Martín-Hita
- Department of Microbiology, Hospital Complex of Jaen, Jaen, Spain
| | - Enrique Nuño-Álvarez
- Clinical Unit of Infectious Diseases, Hospital Virgen de la Victoria, Malaga, Spain
| | | | | | - José María Reguera-Iglesias
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedical Research of Malaga (IBIMA), Regional University Hospital of Malaga, Malaga, Spain
| | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio/CSIC/University of Seville/Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Germán Peñalva
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio/CSIC/University of Seville/Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Álvaro Pascual
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Microbiology, University of Seville, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - José Miguel Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio/CSIC/University of Seville/Institute of Biomedicine of Seville (IBiS), Seville, Spain
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12
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López-Hernández I, Delgado-Valverde M, Fernández-Cuenca F, López-Cerero L, Machuca J, Pascual Á. Carbapenemase-Producing Gram-Negative Bacteria in Andalusia, Spain, 2014-2018. Emerg Infect Dis 2021; 26:2218-2222. [PMID: 32818413 PMCID: PMC7454067 DOI: 10.3201/eid2609.191772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The emergence and spread of carbapenemase-producing gram-negative bacteria is a major public health concern. We used data collected from microbiology laboratories as part of the PIRASOA program during 2014-2018 to study the epidemiology of carbapenemase-producing bacteria in Andalusia, Spain. Our findings highlight the importance of ongoing surveillance and epidemiologic studies for these bacteria.
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Mama OM, Aspiroz C, Ruiz-Ripa L, Ceballos S, Iñiguez-Barrio M, Cercenado E, Azcona JM, López-Cerero L, Seral C, López-Calleja AI, Belles-Belles A, Berdonces P, Siller M, Zarazaga M, Torres C. Prevalence and Genetic Characteristics of Staphylococcus aureus CC398 Isolates From Invasive Infections in Spanish Hospitals, Focusing on the Livestock-Independent CC398-MSSA Clade. Front Microbiol 2021; 12:623108. [PMID: 33717011 PMCID: PMC7945039 DOI: 10.3389/fmicb.2021.623108] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Livestock-associated (LA)-CC398-MRSA is closely related to pigs, being unfrequently detected in human invasive infections. CC398-MSSA is emerging in human invasive infections in some countries, but genetic and epidemiological characteristics are still scarcely reported. Objectives To determine the prevalence of Staphylococcus aureus (SA) CC398, both MRSA and MSSA, among blood cultures SA isolates recovered in Spanish hospitals located in regions with different pig-farming densities (PD) and characterize the recovered isolates. Methods One thousand twenty-two SA isolates (761 MSSA, 261 MRSA) recovered from blood cultures during 6–12 months in 17 Spanish hospitals (2018–2019) were studied. CC398 lineage identification, detection of spa-types, and antibiotic resistance, virulence and human immune evasion cluster (IEC) genes were analyzed by PCR/sequencing. Results Forty-four CC398-MSSA isolates (4.3% of SA; 5.8% of MSSA) and 10 CC398-MRSA isolates (1% of SA; 3.8% of MRSA) were detected. Eleven spa-types were found among the CC398-MSSA isolates with t571 and t1451 the most frequent spa-types detected (75%). Most of CC398-MSSA isolates were Immune-Evasion-Cluster (IEC)-positive (88.6%), tetracycline-susceptible (95.5%) and erythromycin/clindamycin–inducible-resistant/erm(T)-positive (75%). No statistical significance was detected when the CC398-MSSA/MSSA rate was correlated to PD (pigs/km2) (p = 0.108). On the contrary, CC398-MRSA isolates were all IEC-negative, predominately spa-t011 (70%), and the CC398-MRSA/MRSA rate was significantly associated to PD (p < 0.005). Conclusion CC398-MSSA is an emerging clade in invasive infections in Spanish hospitals. CC398-MRSA (mostly t011) and CC398-MSSA (mostly t571 and t1451) show important differences, possibly suggesting divergent steps in host-adaptation evolutionary processes. While CC398-MRSA is livestock-associated (lacking IEC-system), CC398-MSSA seems to be mostly livestock-independent, carrying human-adaptation markers.
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Affiliation(s)
| | - Carmen Aspiroz
- Servicio de Microbiología, Hospital Royo Villanova, Zaragoza, Spain
| | - Laura Ruiz-Ripa
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Sara Ceballos
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | | | - Emilia Cercenado
- Servicio de Microbiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Lorena López-Cerero
- Servicio de Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Cristina Seral
- Servicio de Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Alba Belles-Belles
- Servicio de Microbiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
| | - Pilar Berdonces
- Servicio de Microbiología, Hospital Galdakao, Galdakao, Spain
| | - María Siller
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Myriam Zarazaga
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
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Blanco G, López-Hernández I, Morinha F, López-Cerero L. Intensive farming as a source of bacterial resistance to antimicrobial agents in sedentary and migratory vultures: Implications for local and transboundary spread. Sci Total Environ 2020; 739:140356. [PMID: 32758969 DOI: 10.1016/j.scitotenv.2020.140356] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
The role of wild birds in the carriage and transmission of human and food animal bacteria with resistant genotypes has repeatedly been highlighted. However, few studies have focussed on the specific exposure sources and places of acquisition and selection for antimicrobial-resistant bacteria in vultures relying on livestock carcasses across large areas and different continents. The occurrence of bacterial resistance to antimicrobial agents was assessed in the faecal microbiota of sedentary Griffon vultures (Gyps fulvus) and trans-Saharan migratory Egyptian vultures (Neophron percnopterus) in central Spain. High rates (generally >50%) of resistant Escherichia coli and other enterobacteria to amoxicillin, cotrimoxazole and tetracycline were found. About 25-30% of samples were colonised by extended-spectrum beta-lactamases (ESBL) producing bacteria, while 5-17% were positive for plasmid mediated quinolone resistance (PMQR) phenotypes, depending on vulture species and age. In total, nine ESBL types were recorded (7 in griffon vultures and 5 in Egyptian vultures), with CTX-M-1 the most prevalent in both species. The most prevalent PMQR was mediated by qnrS genes. We found no clear differences in the occurrence of antimicrobial resistance in adult vultures of each species, or between nestling and adult Egyptian vultures. This supports the hypothesis that antimicrobial resistance is acquired in the European breeding areas of both species. Bacterial resistance can directly be driven by the regular ingestion of multiple active antimicrobials found in medicated livestock carcasses from factory farms, which should be not neglected as a contributor to the emergence of novel resistance clones. The One Health framework should consider the potential transboundary carriage and spread of epidemic resistance from high-income European to low-income African countries via migratory birds.
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Affiliation(s)
- Guillermo Blanco
- Department of Evolutionary Ecology, Museo Nacional de Ciencias Naturales, CSIC, José Gutiérrez Abascal 2, 28006 Madrid, Spain.
| | - Inmaculada López-Hernández
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Francisco Morinha
- Department of Evolutionary Ecology, Museo Nacional de Ciencias Naturales, CSIC, José Gutiérrez Abascal 2, 28006 Madrid, Spain
| | - Lorena López-Cerero
- Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
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Ceballos S, Aspiroz C, Ruiz-Ripa L, Reynaga E, Azcona-Gutiérrez JM, Rezusta A, Seral C, Antoñanzas F, Torres L, López C, López-Cerero L, Cercenado E, Zarazaga M, Torres C. Epidemiology of MRSA CC398 in hospitals located in Spanish regions with different pig-farming densities: a multicentre study. J Antimicrob Chemother 2020; 74:2157-2161. [PMID: 31098612 DOI: 10.1093/jac/dkz180] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tetracycline resistance (TetR) is a marker of livestock-associated MRSA of lineage CC398. OBJECTIVES To determine the MRSA CC398 prevalence among TetR-MRSA recovered in Spanish hospitals located in regions with different pig-farming densities, and the influence of pig density as a key risk factor for its acquisition. METHODS TetR-MRSA isolates (n = 232) recovered from clinical and epidemiological samples during January-June 2016 in 20 hospitals in 13 regions with different pig-farming densities were analysed. MRSA CC398 identification, detection of spa types, methicillin resistance genes and immune evasion cluster (IEC) genes were performed by PCR/sequencing. Statistical analyses were performed to establish the relationships between MRSA CC398 prevalence and pig density. RESULTS The global MRSA prevalence was 29.7% (6.9% TetR-MRSA/MRSA), with 137 CC398 isolates recovered, representing 4.1% of total MRSA and 59.1% of TetR-MRSA. Among MRSA CC398, 16 different spa types were recorded (t011: 72.3%), and all but two strains were IEC negative. Higher pig-density regions were associated with significant MRSA CC398 increases in hospitals located in adjacent regions (P < 0.001). Linear regression models explained the relationships between MRSA CC398 and pig density (P < 0.001), with an increase of 6.6 MRSA CC398 cases per 100 MRSA per increase of 100 pigs/km2 in a region. CONCLUSIONS High pig density leads to a significant increase in MRSA CC398 in hospitals in Spain, and its combination with a high human population could help its dissemination. In Spain, the prevalence of the zoonotic CC398 lineage is closely related to pig-farming density; therefore, specific tools could be implemented in order to detect its dissemination.
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Affiliation(s)
- Sara Ceballos
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Carmen Aspiroz
- Servicio Microbiología, Hospital Royo Villanova, Zaragoza, Spain
| | - Laura Ruiz-Ripa
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Esteban Reynaga
- Servicio Microbiología, Hospital Universitari de Vic, Vic, Spain
| | | | - Antonio Rezusta
- Servicio Microbiología, Hospital Universitario Miguel Servet/IIS Aragón, Zaragoza, Spain
| | - Cristina Seral
- Servicio Microbiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Luis Torres
- Servicio Microbiología, Hospital San Jorge, Huesca, Spain
| | | | | | - Emilia Cercenado
- Servicio Microbiología, Hospital Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Myriam Zarazaga
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Carmen Torres
- Área Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
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Cantón R, Oliver A, Alós JI, de Benito N, Bou G, Campos J, Calvo J, Canut A, Castillo J, Cercenado E, Domínguez MÁ, Fernández-Cuenca F, Guinea J, Larrosa N, Liñares J, López-Cerero L, López-Navas A, Marco F, Mirelis B, Moreno-Romo MÁ, Morosini MI, Navarro F, Oteo J, Pascual Á, Pérez-Trallero E, Pérez-Vázquez M, Soriano A, Torres C, Vila J, Martínez-Martínez L. Recommendations of the Spanish Antibiogram Committee (COESANT) for selecting antimicrobial agents and concentrations for in vitro susceptibility studies using automated systems. Enferm Infecc Microbiol Clin 2020; 38:182-187. [PMID: 30878313 DOI: 10.1016/j.eimc.2019.01.017] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/06/2019] [Indexed: 02/05/2023]
Abstract
Automated antimicrobial susceptibility testing devices are widely implemented in clinical microbiology laboratories in Spain, mainly using EUCAST (European Committee on Antimicrobial Susceptibility Testing) breakpoints. In 2007, a group of experts published recommendations for including antimicrobial agents and selecting concentrations in these systems. Under the patronage of the Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) and the Study Group on Mechanisms of Action and Resistance to Antimicrobial Agents (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and aligned with the Spanish National Plan against Antimicrobial Resistance (PRAN), a group of experts have updated this document. The main modifications from the previous version comprise the inclusion of new antimicrobial agents, adaptation of the ranges of concentrations to cover the EUCAST breakpoints and epidemiological cut-off values (ECOFFs), and the inference of new resistance mechanisms. This proposal should be considered by different manufacturers and users when designing new panels or cards. In addition, recommendations for selective reporting are also included. With this approach, the implementation of EUCAST breakpoints will be easier, increasing the quality of antimicrobial susceptibility testing data and their microbiological interpretation. It will also benefit epidemiological surveillance studies as well as the clinical use of antimicrobials aligned with antimicrobial stewardship programs.
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Affiliation(s)
- Rafael Cantón
- Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Oliver
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Juan Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Madrid, Spain
| | - Natividad de Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma, Barcelona, Spain
| | - Germán Bou
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología-INIBIC, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Campos
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jorge Calvo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Andrés Canut
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria, Spain
| | - Javier Castillo
- Servicio de Microbiología, Hospital Clínico Universitario, Zaragoza, Spain
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Ángeles Domínguez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Felipe Fernández-Cuenca
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Jesús Guinea
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nieves Larrosa
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Josefina Liñares
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Lorena López-Cerero
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Francesc Marco
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Microbiología, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Universidad de Barcelona, and ISGlobal, Barcelona, Spain
| | - Beatriz Mirelis
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - María Isabel Morosini
- Servicio de Microbiología, Hospital Universtario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Ferran Navarro
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús Oteo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Álvaro Pascual
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Virgen Macarena, Sevilla, Spain
| | - Emilio Pérez-Trallero
- Servicio de Microbiología, Hospital Universitario Donostia-IIS Biodonostia, San Sebastián, Spain
| | - María Pérez-Vázquez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - Carmen Torres
- Facultad de Ciencias y Tecnología, Área de Bioquímica y Biología Molecular, Universidad de La Rioja, Logroño, Spain
| | - Jordi Vila
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Microbiología, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Universidad de Barcelona, and ISGlobal, Barcelona, Spain
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unidad de Gestión Clínica de Microbiología, Hospital Reina Sofía, Departamento de Microbiología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
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Pérez-Palacios P, López-Cerero L, Lupión C, Pascual A. Assessment of a semi-automated enrichment system (Uroquattro HB&L) for detection of faecal carriers of ESBL-/AmpC-producing Enterobacterales. Enferm Infecc Microbiol Clin 2019; 38:367-370. [PMID: 31818497 DOI: 10.1016/j.eimc.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Early detection of patients carrying multiresistant bacteria is an effective implement in surveillance programs. Our objective was to compare the semi-automatic Uroquattro HB&L "ESBL/AmpC Screening" (Alifax®) system with the routine culture on selective media to detect ESBL/pAmpC-producing microorganisms (3CGRE). METHODS A total of 201 rectal swabs samples were processed by inoculating them into the Uroquattro HB&L system, performing growth curve measurements at 6.5 and 10h, and into direct culture medium. RESULTS Thirty-five samples yielded 3CGRE. Measurements at 10h incremented the positive 3GCRE detection 5.7% in comparison with routine culture medium. In negative rectal swabs, the overall percent agreement at 6.5h and 10h versus routine culture medium was 93% and 90%, respectively. CONCLUSIONS The Uroquattro HB&L system increased the detection of ESBL/pAmpC-producing bacteria compared to direct plating with an incubation time of 10h and shortens the time to report a negative sample.
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Affiliation(s)
- Patricia Pérez-Palacios
- Microbiology and Infectious Diseases Unit, University Hospital Virgen Macarena, Sevilla, Spain
| | - Lorena López-Cerero
- Microbiology and Infectious Diseases Unit, University Hospital Virgen Macarena, Sevilla, Spain.
| | - Carmen Lupión
- Microbiology and Infectious Diseases Unit, University Hospital Virgen Macarena, Sevilla, Spain
| | - Alvaro Pascual
- Microbiology and Infectious Diseases Unit, University Hospital Virgen Macarena, Sevilla, Spain; Department of Microbiology, School of Medicine of University of Seville, Spain
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18
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Soria-Segarra C, González-Bustos P, López-Cerero L, Fernández-Cuenca F, Rojo-Martín MD, Fernández-Sierra MA, Gutiérrez-Fernández J. Tracking KPC-3-producing ST-258 Klebsiella pneumoniae outbreak in a third-level hospital in Granada (Andalusia, Spain) by risk factors and molecular characteristics. Mol Biol Rep 2019; 47:1089-1097. [PMID: 31792747 DOI: 10.1007/s11033-019-05203-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/21/2019] [Indexed: 12/26/2022]
Abstract
The objective of this study was to determine clinical-epidemiological characteristics of the patients and the genetic characteristics of carbapenemase KPC-3-producing Klebsiella pneumoniae isolates belonging to sequence type ST258. The eligible study population was all patients with isolates detected between October 2015 and March 2017. Clinical-epidemiological and microbiological data were gathered on risk factors associated with infection by this clone. Antimicrobial susceptibility was determined using MicroScan system and diffusion in agar. Genes encoding carbapenemases were detected using PCR and Sanger sequencing. The sequence type was assigned by MLST, and the genetic relationship among clinical isolates was determined by pulsed field electrophoresis and by analysis of the genetic environment. The study included 23 individuals with isolates of KPC-3/ST258; the mean age was 77 year, and mean stay pre-isolation was 32 days; 81% received empirical antimicrobial treatment. Isolates were only susceptible to gentamicin (CIM ≤ 2 mg/L), tigecycline (CIM ≤ 1 mg/L), and colistin (CIM ≤ 2 mg/L). The isolates belonged to ST258, with five pulse types or subgroups. All isolates showed amplification of KPC, which was identified as KPC-3 variant. Gene blaKPC-3 was flanked by insertion sequences Kpn6 and Kpn7 within Tn4401 transposon isoform a. We report, for the first time in Spain, an 18-month outbreak by KPC-3-producing ST258 K. pneumoniae. Its acquisition was associated with a history of antimicrobial therapy, with three treatment options, and with high mortality. The detection of different pulse types is attributable to different introductions of the clone in our setting, supporting the need for multi-resistant isolate surveillance studies.
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Affiliation(s)
- Carmen Soria-Segarra
- Department of Internal Medicine, School of Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Program in Clinical Medicine and Public Health, University of Granada-Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - Pablo González-Bustos
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
| | - Lorena López-Cerero
- Department of Microbiology and Infectious Diseases. Laboratorio de Tipado Molecular de Andalucía, Programa PIRASOA, Hospital Virgen Macarena, Seville, Spain
| | - Felipe Fernández-Cuenca
- Department of Microbiology and Infectious Diseases. Laboratorio de Tipado Molecular de Andalucía, Programa PIRASOA, Hospital Virgen Macarena, Seville, Spain
| | - María Dolores Rojo-Martín
- Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria - ibs.Granada, Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain
| | - María Amelia Fernández-Sierra
- Department of Preventive Medicine, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria - ibs.Granada, Granada, Spain
| | - José Gutiérrez-Fernández
- Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria - ibs.Granada, Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain. .,Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria - ibs.Granada, Granada, Spain.
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19
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Ceballos S, Aspiroz C, Ruiz-Ripa L, Azcona-Gutierrez JM, López-Cerero L, López-Calleja AI, Álvarez L, Gomáriz M, Fernández M, Torres C, Ezpeleta C, Martín C, Arribas J, Navarro C, Arias A, Fortuño B, Pereira J, Milagro A, Torres L, Soria-Blanco LM, Canut A, Cordón ML, Megías G, Calvo J, Rezusta A. Multicenter study of clinical non-β-lactam-antibiotic susceptible MRSA strains: Genetic lineages and Panton-Valentine leukocidin (PVL) production. Enferm Infecc Microbiol Clin 2019; 37:509-513. [DOI: 10.1016/j.eimc.2019.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/19/2022]
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Ceballos S, Aspiroz C, Ruiz-Ripa L, Azcona-Gutierrez JM, López-Cerero L, López-Calleja AI, Álvarez L, Gomáriz M, Fernández M, Torres C, Ezpeleta C, Martín C, Arribas J, Navarro C, Arias A, Fortuño B, Pereira J, Milagro A, Torres L, Soria-Blanco LM, Canut A, Cordón ML, Megías G, Calvo J, Rezusta A. Multicenter study of clinical non-β-lactam-antibiotic susceptible MRSA strains: Genetic lineages and Panton-Valentine leukocidin (PVL) production. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.eimce.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Luque-González P, López-Cerero L, Díaz-de-Alba P, Rodríguez-Martínez JM. Association of bla OXA-1, and aac(6')-Ib-cr with ST405 K. pneumoniae clone. Enferm Infecc Microbiol Clin 2019; 37:417-418. [PMID: 31155040 DOI: 10.1016/j.eimc.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Affiliation(s)
- P Luque-González
- Departamento de Microbiologia, Facultad de Medicina, Seville, Spain
| | - L López-Cerero
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Microbiología, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
| | - P Díaz-de-Alba
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Microbiología, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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Sghaier S, Abbassi MS, Pascual A, Serrano L, Díaz-De-Alba P, Said MB, Hassen B, Ibrahim C, Hassen A, López-Cerero L. Extended-spectrum β-lactamase-producing Enterobacteriaceae from animal origin and wastewater in Tunisia: first detection of O25b-B23-CTX-M-27-ST131 Escherichia coli and CTX-M-15/OXA-204-producing Citrobacter freundii from wastewater. J Glob Antimicrob Resist 2019; 17:189-194. [DOI: 10.1016/j.jgar.2019.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/22/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022] Open
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Fernández-Cuenca F, Pérez-Palacios P, Galán-Sánchez F, López-Cerero L, López-Hernández I, López Rojas R, Arca-Suárez J, Díaz-de Alba P, Rodríguez Iglesias M, Pascual A. First identification of bla NDM-1 carbapenemase in bla OXA-94-producing Acinetobacter baumannii ST85 in Spain. Enferm Infecc Microbiol Clin 2019; 38:11-15. [PMID: 31060865 DOI: 10.1016/j.eimc.2019.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/04/2019] [Accepted: 03/08/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION NDM-1 carbapenemase is spreading rapidly all over the world, but this metallo-beta-lactamase has just been detected for the first time in an Acinetobacter baumannii (Ab) isolate of the ST85 clone in Spain. The aim of this study was to characterize a NDM-1-producing carbapenem-resistant A. baumannii (CR-Ab) isolate submitted to the Andalusian PIRASOA [infection prevention program] referral laboratory. METHODS Carbapenemases were detected by PCR and Sanger DNA sequencing. Whole genome sequencing was performed by NGS (Miseq, Illumina). Resistance genes were identified with RESfinder, while MLSTfinder was used for sequence typing (ST). The genetic location of blaNDM-1 was determined by nuclease S-1/PFGE/hybridization with specific probe. RESULTS The isolate was susceptible to amikacin and tigecycline and belonged to the ST85 clone. blaOXA-94 and blaNDM-1 were identified by PCR and Sanger DNA sequencing, respectively. The resistance genes aadB, blaADC-25, blaNDM-1, blaOXA-94, msr(E), mph(E) and floR,sul2 were identified by NGS. The chromosome of the isolate contained a defective Tn125 transposon with blaNDM-1 flanked by the insertion sequences ISAbA125 and ISAba14. The blaNDM-1 gene was only detected in the chromosomal DNA. CONCLUSION This is the first time that blaNDM-1 has been detected and characterized in a blaOXA-94-producing CR-Ab isolate belonging to the ST85 clone in Spain.
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Affiliation(s)
- Felipe Fernández-Cuenca
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain; Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain.
| | - Patricia Pérez-Palacios
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain
| | - Fátima Galán-Sánchez
- Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain
| | - Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain; Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain
| | - Inmaculada López-Hernández
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain; Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain
| | - Rafael López Rojas
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain; Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain
| | - Jorge Arca-Suárez
- Hospital Universitario Puerta del Mar, Servicio de Microbiología, Cádiz, Spain
| | - Paula Díaz-de Alba
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain
| | | | - Alvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Hospital Universitario Virgen Macarena/Centro Superior de Investigaciones Científicas (CSIC)/Universidad de Sevilla, Sevilla, Spain; Spanish Network for Research in Infectious Diseases (REIPI; RD16/0016/0001), Spain
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Rodríguez-Revuelta MJ, López-Cerero L, Serrano L, Luna-Lagares S, Pascual A, Rodríguez-Baño J. Duration of Colonization by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Healthy Newborns and Associated Risk Factors: A Prospective Cohort Study. Open Forum Infect Dis 2018; 5:ofy312. [PMID: 30568982 PMCID: PMC6293479 DOI: 10.1093/ofid/ofy312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/16/2018] [Indexed: 01/23/2023] Open
Abstract
Duration of colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and factors associated with it were studied in 20 newborns in Seville, Spain. Median duration of colonization was 7.5 months; factors associated with prolonged colonization were delivery by caesarean section, colonization of the mother, and phylogroup B2 Eschericha coli isolate.
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Affiliation(s)
- María Jesús Rodríguez-Revuelta
- Unidad de Neonatología, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Seville, Spain
- Correspondence: M. J. Rodríguez Revuelta, MD, Unidad de Neonatología, Hospital Universitario Virgen Macarena, Avda Dr. Fedriani 3, 41009 Seville, Spain ()
| | - Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Departamentos de Microbiología y Enfermedades Infecciosas, Universidad de Sevilla, Spain
| | - Lara Serrano
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Departamentos de Microbiología y Enfermedades Infecciosas, Universidad de Sevilla, Spain
| | - Salud Luna-Lagares
- Unidad de Neonatología, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Departamentos de Microbiología y Enfermedades Infecciosas, Universidad de Sevilla, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Instituto de Biomedicina de Sevilla (IBiS)/CSIC/Departamentos de Microbiología y Enfermedades Infecciosas, Universidad de Sevilla, Spain
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Morales Barroso I, López-Cerero L, Navarro MD, Gutiérrez-Gutiérrez B, Pascual A, Rodríguez-Baño J. Intestinal colonization due to Escherichia coli ST131: risk factors and prevalence. Antimicrob Resist Infect Control 2018; 7:135. [PMID: 30473785 PMCID: PMC6238289 DOI: 10.1186/s13756-018-0427-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/30/2018] [Indexed: 11/10/2022] Open
Abstract
Background Escherichia coli sequence type 131 (ST131) is a successful clonal group that has dramatically spread during the last decades and is considered an important driver for the rapid increase of quinolone resistance in E. coli. Methods Risk factors for rectal colonization by ST131 Escherichia coli (irrespective of ESBL production) were investigated in 64 household members (18 were colonized) and 54 hospital contacts (HC; 10 colonized) of 34 and 30 index patients with community and nosocomial infection due to these organisms, respectively, using multilevel analysis with a p limit of < 0.1. Result Colonization among household members was associated with the use of proton-pump inhibitors (PPI) by the household member (OR = 3.08; 95% CI: 0.88–10.8) and higher age of index patients (OR = 1.05; 95% CI; 1.01–1.10), and among HC, with being bed-ridden (OR = 21.1; 95% CI: 3.61–160.0) and having a urinary catheter (OR = 8.4; 95% CI: 0.87–76.9). Conclusion Use of PPI and variables associated with higher need of person-to-person contact are associated with increased risk of rectal colonization by ST131. These results should be considered for infection control purposes.
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Affiliation(s)
- Isabel Morales Barroso
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain.,3Unidad Clínica de Urgencias, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lorena López-Cerero
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain
| | - María Dolores Navarro
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Belén Gutiérrez-Gutiérrez
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Alvaro Pascual
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Jesús Rodríguez-Baño
- 1Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.,2Departamentos de Medicina y Microbiología, Universidad de Sevilla / CSIC/ Instituto de Biomedicina de Sevilla, Seville, Spain
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Rodríguez-Revuelta MJ, López-Cerero L, Serrano L, Luna-Lagares S, Pascual A, Rodríguez-Baño J. Incidence and Risk Factors for Acquisition of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Newborns in Seville, Spain: A Prospective Cohort Study. Int J Antimicrob Agents 2018; 52:835-841. [PMID: 30236957 DOI: 10.1016/j.ijantimicag.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/02/2018] [Accepted: 09/09/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND ESBL-producing Enterobacteriaceae (ESBL-E) are an emerging cause of infections in children. Data are scarce on incidence rates and risk factors for acquisition of colonisation with ESBL-E. METHODS A total of 46 and 50 newborns from colonised and non-colonised mothers, respectively, were followed during one year after birth. Rectal swabs were performed every 3 months to detect ESBL-E; blaESBL were characterised and isolates were typed for comparison. Multivariate analysis for risk factors was performed using Cox regression. RESULTS Incidence density of any new acquisition and of first acquisition of ESBL-E was 2.7 and 1.9 episodes per 100 children-month, respectively, among children whose mothers were colonised, and 1.2 and 1.3, respectively, among children whose mothers were not. The weighted average prevalence of colonisation rates during the first year were 15.9% and 8%, respectively. No infections due to ESBL-E were detected. Living with pets at home, breastfeeding, sterilisation of feeding bottles and out-of-home childcare were protective for ESBL-E acquisition; having a colonised mother increased the risk. The most frequent ESBL types were CTX-M-14 and CTX-M-1. In 5/19 (26.3%) children with acquisition of new clones, the acquired ESBL-E was shared with their mothers. CONCLUSIONS Acquisition of ESBL-E colonisation is not rare during the first year of life. Breastfeeding and out-of-home childcare were protective for acquisition, and colonised mothers were associated with increased risk. However, the same clone was shared by mother and child in only a subset of acquisition episodes.
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Affiliation(s)
| | - Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Instituto de Biomedicina de Sevilla (IBiS) / CSIC / Universidad de Sevilla, Seville, Spain
| | - Lara Serrano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Instituto de Biomedicina de Sevilla (IBiS) / CSIC / Universidad de Sevilla, Seville, Spain
| | - Salud Luna-Lagares
- Unidad de Neonatología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alvaro Pascual
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Instituto de Biomedicina de Sevilla (IBiS) / CSIC / Universidad de Sevilla, Seville, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena / Instituto de Biomedicina de Sevilla (IBiS) / CSIC / Universidad de Sevilla, Seville, Spain
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Torres E, López-Cerero L, Morales I, Navarro M, Rodríguez-Baño J, Pascual A. Prevalence and transmission dynamics of Escherichia coli ST131 among contacts of infected community and hospitalized patients. Clin Microbiol Infect 2018; 24:618-623. [DOI: 10.1016/j.cmi.2017.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 07/18/2017] [Accepted: 09/12/2017] [Indexed: 11/24/2022]
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López-Cerero L. Control of the spread of resistant pathogens in health centers: Beyond the standard prevention measures. Enferm Infecc Microbiol Clin 2018; 36:207-208. [DOI: 10.1016/j.eimc.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
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Heras-Cañas VJ, López-Cerero L, Díaz de-Alba P, Pascual Á. Baja prevalencia de aislados mcr -1 positivos en enterobacterias en nuestra área. Enferm Infecc Microbiol Clin 2017; 35:467-468. [DOI: 10.1016/j.eimc.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/01/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022]
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Riazzo C, López-Cerero L, Rojo-Martín MD, Hoyos-Mallecot Y, Fernández-Cuenca F, Martín-Ruíz JL, Pascual-Hernández Á, Naas T, Navarro-Marí JM. First report of NDM-1-producing clinical isolate of Leclercia adecarboxylata in Spain. Diagn Microbiol Infect Dis 2017; 88:268-270. [PMID: 28506721 DOI: 10.1016/j.diagmicrobio.2017.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 01/18/2023]
Abstract
We describe the case of NDM-1-producing Leclercia adecarboxylata recovered from the clinical sample of a patient hospitalized for a trauma-related injury to his foot. The isolate was resistant to all beta-lactams, quinolones, trimetroprim-sulfametoxazol, gentamicin and tobramicyn. The blaNDM-1 gene was located in a conjugative plasmid that also contained the blaSHV-12 gene and was preceded by a disrupted insertion sequence of ISAba125. The plasmid belongs to the incompatibility group X3, which is known to be an important vector for NDM-1 dissemination in China. This is the first reported case of NDM-1L. adecarboxylata in our country and evidences that species of uncertain clinical relevance can act as hidden sources of clinically important resistance determinants.
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Affiliation(s)
- Cristina Riazzo
- Department of Microbiology, Virgen de las Nieves University Hospital-ibs, Granada, Spain.
| | - Lorena López-Cerero
- Department of Microbiology, Virgen Macarena University Hospital, Seville, Spain
| | | | - Yannick Hoyos-Mallecot
- Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris (AP-PH), Bicêtre Hospital, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France; EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France
| | | | - Jose Luis Martín-Ruíz
- Department of Preventive Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Thierry Naas
- Bacteriology-Hygiene unit, Assistance Publique/Hôpitaux de Paris (AP-PH), Bicêtre Hospital, Le Kremlin-Bicêtre, France; Associated French National Reference Center for Antibiotic Resistance: Carbapenemase-producing Enterobacteriaceae, Le Kremlin-Bicêtre, France; EA7361 "Structure, dynamic, function and expression of broad spectrum β-lactamases", Université Paris-Sud, Université Paris-Saclay, LabEx LERMIT, Faculty of Medicine, Le Kremlin-Bicêtre, France; Joint Research Unit EERA «Evolution and Ecology of Resistance to Antibiotics», Institut Pasteur - APHP - Université Paris Sud, Paris, France
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Morales-Barroso I, López-Cerero L, Molina J, Bellido M, Navarro MD, Serrano L, González-Galán V, Praena J, Pascual A, Rodríguez-Baño J. Bacteraemia due to non-ESBL-producing Escherichia coli O25b:H4 sequence type 131: insights into risk factors, clinical features and outcomes. Int J Antimicrob Agents 2017; 49:498-502. [DOI: 10.1016/j.ijantimicag.2016.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/15/2016] [Accepted: 12/17/2016] [Indexed: 11/29/2022]
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López-Cerero L, Almirante B. Epidemiology of infections caused by carbapenemase-producing Enterobacteriaceae: reservoirs and transmission mechanisms. Enferm Infecc Microbiol Clin 2016; 32 Suppl 4:10-6. [PMID: 25542047 DOI: 10.1016/s0213-005x(14)70169-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The dissemination of carbapenemase-producing Enterobacteriaceae has occurred very quickly and has crossed borders rapidly between countries and continents. In some areas, it has exceeded the holding capacity of health systems, reaching epidemic proportions. This form of dissemination has not been the same for all enzymes, with KPC, NDM and OXA-48 genes having a greater ability to spread. These enzymes have primarily been spread clonally in the case of KPC-producing Klebsiella pneumoniae from the initial epicenter located in New York, with a very small number of strains causing outbreaks. For NDM and OXA- 48, these resistance determinants have been vehiculized by clones with a high transmission capacity; however, simultaneous horizontal transmission is also playing an important role. The most important identified reservoirs are colonized or infected individuals from endemic areas or centers with outbreaks, but the contaminated goods from these endemic areas also play a part. An international effort is needed to control the spread of these multiresistant pathogens.
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Affiliation(s)
- Lorena López-Cerero
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Benito Almirante
- División de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Machuca J, López-Cerero L, Fernández-Cuenca F, Gracia-Ahufinger I, Ruiz-Carrascoso G, Rodríguez-López F, Pascual Á. Characterization of an outbreak due to CTX-M-15-producing Klebsiella pneumoniae lacking the blaOXA-48 gene belonging to clone ST405 in a neonatal unit in southern Spain. J Antimicrob Chemother 2016; 71:2353-5. [PMID: 27118773 DOI: 10.1093/jac/dkw137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Jesús Machuca
- Unidad intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Lorena López-Cerero
- Unidad intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Felipe Fernández-Cuenca
- Unidad intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Irene Gracia-Ahufinger
- Unidad de Microbiología Clínica, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain
| | | | - Fernando Rodríguez-López
- Unidad de Microbiología Clínica, Hospital Universitario Reina Sofía-IMIBIC-Universidad de Cordoba, Cordoba, Spain
| | - Álvaro Pascual
- Unidad intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain Department of Microbiology, University of Seville, Seville, Spain
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Rodríguez-Martínez JM, López-Cerero L, Díaz-de-Alba P, Chamizo-López FJ, Polo-Padillo J, Pascual Á. Assessment of a phenotypic algorithm to detect plasmid-mediated quinolone resistance in Enterobacteriaceae. J Antimicrob Chemother 2015; 71:845-7. [DOI: 10.1093/jac/dkv392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Torres E, López-Cerero L, Rodríguez-Martínez JM, Pascual Á. Reduced Susceptibility to Cefepime in Clinical Isolates of Enterobacteriaceae Producing OXA-1 Beta-Lactamase. Microb Drug Resist 2015; 22:141-6. [PMID: 26295796 DOI: 10.1089/mdr.2015.0122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An increase of Enterobacteriaceae isolates with reduced susceptibility to cefepime (FEP) and amoxicillin/clavulanate (AMC) has been observed in our area. The aim of this study was to characterize this antibiotic resistance phenotype and its molecular epidemiology. A total of 33 Enterobacteriaceae strains were studied. blaOXA-1 genes and their genetic environment were analyzed by polymerase chain reaction (PCR) and sequencing. Plasmids were transferred by conjugation and/or transformation and classified using PCR-based inc/rep typing and IncF subtyping. Escherichia coli isolates were typed by phylogroup, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Outer membrane proteins were studied by sodium dodecylsulfate-polyacrylamide gel electrophoresis and expression of blaOXA-1 genes by reverse transcription-PCR. FEP minimum inhibitory concentration yielded values of 1-16 mg/L. Twenty-nine (87.9%) isolates produced OXA-1, of which 24 (82.7%) were located in class 1 integron, and 9 (27.3%) produced TEM-1. Among the 24 E. coli OXA-1-producers, PFGE revealed two main clusters: one belonged to C-ST88 and the other to B23-ST131. Thirteen plasmids containing blaOXA-1 were transferred, nine belonged to IncF replicon (4 F2:A1:B-, 2 F1:A1:B1, 1 F1:A2:B-, 1 F18:A2:B1, 1 F5:A-:B1) and four were nontypeable. In conclusion, reduced susceptibility to FEP was mostly due to OXA-1 beta-lactamase. In E. coli, this increase is mainly due to the dissemination of two clones, which have captured different IncF plasmids. Among non-E. coli strains, five isolates produced OXA-1 and one isolate produced only TEM-1.
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Affiliation(s)
- Eva Torres
- 1 Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena , Seville, Spain
| | - Lorena López-Cerero
- 1 Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena , Seville, Spain .,2 Department of Microbiology, University of Seville , Seville, Spain
| | | | - Álvaro Pascual
- 1 Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena , Seville, Spain .,2 Department of Microbiology, University of Seville , Seville, Spain
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Rodríguez-Baño J, Cisneros JM, Cobos-Trigueros N, Fresco G, Navarro-San Francisco C, Gudiol C, Horcajada JP, López-Cerero L, Martínez JA, Molina J, Montero M, Paño-Pardo JR, Pascual A, Peña C, Pintado V, Retamar P, Tomás M, Borges-Sa M, Garnacho-Montero J, Bou G. Diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology. Enferm Infecc Microbiol Clin 2015; 33:337.e1-337.e21. [DOI: 10.1016/j.eimc.2014.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 12/21/2022]
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Díez-Aguilar M, Morosini MI, López-Cerero L, Pascual Á, Calvo J, Martínez-Martínez L, Marco F, Vila J, Ortega A, Oteo J, Cantón R. Performance of EUCAST and CLSI approaches for co-amoxiclav susceptibility testing conditions for clinical categorization of a collection of Escherichia coli isolates with characterized resistance phenotypes. J Antimicrob Chemother 2015; 70:2306-10. [PMID: 25900161 DOI: 10.1093/jac/dkv088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/18/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES There are different methodological recommendations for in vitro testing of the co-amoxiclav combination. Performance of co-amoxiclav MIC testing for Escherichia coli by the standard ISO microdilution method (ISO 20776-1) was compared using EUCAST (fixed 2 mg/L clavulanate concentration) and CLSI (2 : 1 ratio) interpretive criteria. METHODS MICs were determined by broth microdilution using a 2 : 1 ratio and fixed clavulanate concentrations (2 and 4 mg/L) for 160 clinical E. coli isolates with characterized resistance mechanisms. Essential agreements, categorical agreements and relative errors were determined. RESULTS For all isolates, essential agreement between microdilution using 2 mg/L clavulanate and a 2 : 1 ratio was 25.6%. For ESBL-producing isolates, considering EUCAST breakpoints, 55% of isolates tested with 2 mg/L clavulanate were classified as resistant; conversely, 95% of isolates tested with 4 mg/L clavulanate were susceptible. When using CLSI breakpoints and a 2 : 1 ratio, 90% of isolates were susceptible and 10% were intermediate. CONCLUSIONS Variation in the clavulanate concentration gave different susceptibility testing results, particularly among ESBL-producing E. coli isolates. The in vitro concentration of clavulanate that better correlates with clinical outcome is still under debate and should be established.
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Affiliation(s)
- María Díez-Aguilar
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain
| | - María-Isabel Morosini
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain
| | - Lorena López-Cerero
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Universitario Virgen Macarena and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Álvaro Pascual
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Universitario Virgen Macarena and Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
| | - Jorge Calvo
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Luis Martínez-Martínez
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain
| | - Francesc Marco
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología Clínica, Hospital Clínic, Facultad de Medicina and Centro de Investigación en Salud Internacional de Barcelona (CRESIB), Barcelona, Spain
| | - Jordi Vila
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Servicio de Microbiología Clínica, Hospital Clínic, Facultad de Medicina and Centro de Investigación en Salud Internacional de Barcelona (CRESIB), Barcelona, Spain
| | - Adriana Ortega
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Jesús Oteo
- Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain Laboratorio de Antibióticos, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain Red Española de Investigación en Patología Infecciosa (REIPI) Instituto de Salud Carlos III, Madrid, Spain
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Roca I, Akova M, Baquero F, Carlet J, Cavaleri M, Coenen S, Cohen J, Findlay D, Gyssens I, Heuer OE, Kahlmeter G, Kruse H, Laxminarayan R, Liébana E, López-Cerero L, MacGowan A, Martins M, Rodríguez-Baño J, Rolain JM, Segovia C, Sigauque B, Tacconelli E, Wellington E, Vila J. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect 2015; 6:22-9. [PMID: 26029375 PMCID: PMC4446399 DOI: 10.1016/j.nmni.2015.02.007] [Citation(s) in RCA: 620] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 12/11/2022] Open
Abstract
In the last decade we have witnessed a dramatic increase in the proportion and absolute number of bacterial pathogens resistant to multiple antibacterial agents. Multidrug-resistant bacteria are currently considered as an emergent global disease and a major public health problem. The B-Debate meeting brought together renowned experts representing the main stakeholders (i.e. policy makers, public health authorities, regulatory agencies, pharmaceutical companies and the scientific community at large) to review the global threat of antibiotic resistance and come up with a coordinated set of strategies to fight antimicrobial resistance in a multifaceted approach. We summarize the views of the B-Debate participants regarding the current situation of antimicrobial resistance in animals and the food chain, within the community and the healthcare setting as well as the role of the environment and the development of novel diagnostic and therapeutic strategies, providing expert recommendations to tackle the global threat of antimicrobial resistance.
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Affiliation(s)
- I Roca
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - M Akova
- Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey ; ESCMID Executive Committee, Basel, Switzerland
| | - F Baquero
- Department of Microbiology at the Ramón y Cajal University Hospital, Ramón y Cajal Institute for Health Research (IRYCIS), Division for Research in Microbial Biology and Evolution, CIBERESP, Madrid, Spain
| | - J Carlet
- Fondation Hôpital St, Joseph, Paris, France and World Alliance Against Antibiotic Resistance (WAAAR), Creteil, France
| | - M Cavaleri
- European Medicines Agency (EMA), London, UK
| | - S Coenen
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - J Cohen
- Brighton and Sussex Medical School, Brighton, UK
| | - D Findlay
- Global Commercial Lead, GlaxoSmithKline (GSK), London, UK
| | - I Gyssens
- Department of Medicine, Radboud University Medical Center and Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - O E Heuer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - G Kahlmeter
- Clinical Microbiology, Central Hospital, Växjö, Sweden ; ESCMID Executive Committee, Basel, Switzerland ; EUCAST Steering Committee, Växjö, Sweden
| | - H Kruse
- WHO Regional Office for Europe, UN City, Marmorvej, Copenhagen, Denmark
| | - R Laxminarayan
- Center for Disease Dynamics, Economics and Policy, Washington, DC, USA ; Princeton University, Princeton, NJ, USA
| | - E Liébana
- Scientific Unit on Biological Hazards, European Food Safety Authority (EFSA), Parma, Italy
| | - L López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - A MacGowan
- Department of Medical Microbiology, Southmead Hospital, Bristol, UK ; EUCAST Steering Committee, Växjö, Sweden
| | - M Martins
- School of Public Health, Physiotherapy and Population Science, UCD Centre for Food and Safety, Molecular Innovation and Drug Discovery, University College Dublin, Dublin, Ireland
| | - J Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, and Departamento de Medicina, Universidad de Sevilla, Seville, Spain ; ESCMID Executive Committee, Basel, Switzerland
| | - J-M Rolain
- Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Inserm, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, and APHM, CHU Timone, Pôle Infectieux, Marseille, France
| | - C Segovia
- Instituto de Salud Carlos III, ISCIII, Madrid, Spain
| | - B Sigauque
- Centro de Investigação em Saúde da Manhiça and Instituto Nacional de Saúde/Ministério de Saúde, Maputo, Mozambique
| | - E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany ; ESCMID Executive Committee, Basel, Switzerland
| | - E Wellington
- School of Life Sciences, University of Warwick, Coventry, UK
| | - J Vila
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain ; ESCMID Executive Committee, Basel, Switzerland
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Fernández-Romero N, Romero-Gómez MP, Mora-Rillo M, Rodríguez-Baño J, López-Cerero L, Pascual Á, Mingorance J. Uncoupling between core genome and virulome in extraintestinal pathogenic Escherichia coli. Can J Microbiol 2015; 61:647-52. [PMID: 26063294 DOI: 10.1139/cjm-2014-0835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Extraintestinal pathogenic Escherichia coli (ExPEC) are among the most frequently isolated bacterial pathogens in hospitals. They are considered opportunistic pathogens and are found mostly in urinary and bloodstream infections. They are genetically diverse, and many studies have sought associations between genotypes or virulence genes and infection site, severity, or outcome, with varied, often contradictory, results. To understand these difficulties, we have analyzed the diversity patterns in the core genomes and virulomes of more than 500 ExPEC isolates from 5 different collections. The core genome was analyzed using a multilocus sequence type-based single-nucleotide polymorphism (SNP) pyrosequencing approach, while the virulence gene content (the virulome) was studied by polymerase chain reaction detection of 25 representative genes. SNP typing showed a similar population structure in the different collections: half of the isolates belong to a few sequence types (5 to 8), while the other half is composed of a large diversity of sequence types that are found once or twice. Sampling analysis by rarefaction plots of SNP profiles showed saturation curves indicative of a limited diversity. Contrary to this, the virulome shows an extremely high diversity, with almost as many gene profiles as isolates, and linear, nonsaturating, rarefaction plots, even within sequence types. These data show that genetic exchange rates are very heterogeneous along the chromosome, being much higher in the virulome fraction of the genome than in the core genome.
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Affiliation(s)
- Natalia Fernández-Romero
- a Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana, 261 28046 Madrid, Spain
| | - María Pilar Romero-Gómez
- a Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana, 261 28046 Madrid, Spain
| | - Marta Mora-Rillo
- b Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Jesús Rodríguez-Baño
- c Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.,d Departamento de Medicina, Universidad de Sevilla, Spain.,e Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Lorena López-Cerero
- c Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.,e Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,f Departamento de Microbiología, Universidad de Sevilla, Spain
| | - Álvaro Pascual
- c Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain.,e Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.,f Departamento de Microbiología, Universidad de Sevilla, Spain
| | - Jesús Mingorance
- a Servicio de Microbiología, Hospital Universitario La Paz, IdiPAZ, Paseo de La Castellana, 261 28046 Madrid, Spain.,e Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
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Jesús Rodríguez-Baño J, García L, Ramírez E, Lupión C, Muniain MA, Velasco C, Gálvez J, del Toro MD, Millán AB, López-Cerero L, Pascual A. Long-Term Control of Endemic Hospital-Wide Methicillin-ResistantStaphylococcus aureus(MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers. Infect Control Hosp Epidemiol 2015; 31:786-95. [DOI: 10.1086/654003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective.To evaluate the long-term impact of successive interventions on rates of methicillin-resistantStaphylococcus aureus(MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.Design.Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.Setting.A 950-bed teaching hospital in Seville, Spain.Patients.All patients admitted to the hospital during the period from 1995 through 2008.Methods.Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.Results.Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptibleS. aureusdid not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.Conclusion.Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.
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López-Cerero L, Egea P, Gracia-Ahufinger I, González-Padilla M, Rodríguez-López F, Rodríguez-Baño J, Pascual A. Characterisation of the first ongoing outbreak due to KPC-3-producing Klebsiella pneumoniae (ST512) in Spain. Int J Antimicrob Agents 2014; 44:538-40. [PMID: 25446907 DOI: 10.1016/j.ijantimicag.2014.08.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to characterise carbapenem-resistant Klebsiella pneumoniae isolates that caused an outbreak in a hospital in the south of Spain, originating from a patient transferred in 2012 from Italy. Forty-four K. pneumoniae isolates, recovered from 28 patients, were screened by PCR for extended-spectrum β-lactamase (ESBL) and carbapenemase genes and the products were further sequenced. Plasmids were transferred by electroporation and were classified using PCR-based Inc/rep typing and IncF subtyping. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to determine the genetic relatedness of the isolates. All isolates yielded positive modified Hodge test results, harboured bla(SHV-11), bla(TEM-1) and bla(KPC-3) genes, showed an identical PFGE pattern, and were assigned to clone sequence type 512 (ST512). The bla(KPC-3) gene was located on a 140-kb K2:A-:B-plasmid. In conclusion, the successful K. pneumoniae ST512 clone caused a major outbreak in Spain from an imported case and is the first description of an outbreak in this country due to the KPC-3-producing K. pneumoniae ST512 clone.
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Affiliation(s)
- Lorena López-Cerero
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain.
| | - Pilar Egea
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain
| | | | | | - Fernando Rodríguez-López
- Hospital Universitario Reina Sofía, Córdoba, Spain; Department of Microbiology, University of Córdoba, Córdoba, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Alvaro Pascual
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Microbiology, University of Seville, Seville, Spain
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López-Cerero L. Papel del ambiente hospitalario y los equipamientos en la transmisión de las infecciones nosocomiales. Enferm Infecc Microbiol Clin 2014; 32:459-64. [DOI: 10.1016/j.eimc.2013.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022]
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Albertini M, López-Cerero L, O'Sullivan MG, Chereguini CF, Ballesta S, Ríos V, Herrero-Climent M, Bullón P. Assessment of periodontal and opportunistic flora in patients with peri-implantitis. Clin Oral Implants Res 2014; 26:937-941. [DOI: 10.1111/clr.12387] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Matteo Albertini
- Department of Periodontology; University of Seville; Seville Spain
| | | | | | | | - Sofia Ballesta
- Department of Microbiology; School of Medicine; Seville Spain
| | - Vicente Ríos
- Department of Periodontology; University of Seville; Seville Spain
| | | | - Pedro Bullón
- Department of Periodontology; University of Seville; Seville Spain
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Torres E, López-Cerero L, Del Toro MD, Pascual A. First detection and characterization of an OXA-48-producing Enterobacter aerogenes isolate. Enferm Infecc Microbiol Clin 2013; 32:469-70. [PMID: 24355605 DOI: 10.1016/j.eimc.2013.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/14/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Eva Torres
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Sevilla, Spain.
| | - Lorena López-Cerero
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Sevilla, Spain
| | - María Dolores Del Toro
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Sevilla, Spain
| | - Alvaro Pascual
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Sevilla, Spain; Department of Microbiology, University of Seville, Sevilla, Spain
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López-Cerero L, Navarro MD, Bellido M, Martín-Peña A, Viñas L, Cisneros JM, Gómez-Langley SL, Sánchez-Monteseirín H, Morales I, Pascual A, Rodríguez-Baño J. Escherichia coli belonging to the worldwide emerging epidemic clonal group O25b/ST131: risk factors and clinical implications. J Antimicrob Chemother 2013; 69:809-14. [PMID: 24123431 DOI: 10.1093/jac/dkt405] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Escherichia coli belonging to clonal group ST131 has emerged as a significant contributor to infection caused by antibiotic-resistant E. coli worldwide. We investigated the risk factors for infections caused by ST131 E. coli and their clinical implications. METHODS One thousand and seventy-seven E. coli isolates were screened for ST131 by molecular methods. Risk factors for ST131 were investigated separately for patients with E. coli producing and not producing extended-spectrum β-lactamases (ESBLs) in the Seville area, Spain. Multivariate analysis using logistic regression was performed. Patients with infections caused by ST131 and non-ST131 isolates were prospectively followed. RESULTS Independent risk factors for non-ESBL-producing ST131 were female gender (OR: 1.94; 95% CI: 1.07-3.51), diabetes mellitus (OR: 2.17; 95% CI: 1.29-3.67), bedridden status (OR: 7.75; 95% CI: 0.70-85.07) and exposure to amoxicillin/clavulanate (OR: 2.07; 95% CI: 1.08-3.96) or fluoroquinolones (OR: 2.48; 95% CI: 1.41-4.34). For ESBL-producing ST131, male gender was an independent risk factor (OR: 2.20; 95% CI: 0.94-5.11), while healthcare-related acquisition and exposure to any previous antibiotic were protective (OR: 0.30; 95% CI: 0.13-0.71; and OR: 0.43; 95% CI: 0.19-1.00, respectively). Overall, the severity of sepsis, bacteraemia and mortality were similar among ST131 and non-ST131 groups. The presence of typical factors predisposing to E. coli infection was more frequent in non-ESBL-producing ST131 than in controls (76% versus 57.2%, P = 0.005). CONCLUSIONS Previous use of antibiotics selecting for ST131 isolates was the main modifiable risk factor for infections caused by these isolates. Our results also suggest that the clinical virulence of ST131 is not higher than that of other common E. coli causing infections.
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Affiliation(s)
- Lorena López-Cerero
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain
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Pomba C, López-Cerero L, Bellido M, Serrano L, Belas A, Couto N, Cavaco-Silva P, Rodríguez-Baño J, Pascual A. Within-lineage variability of ST131 Escherichia coli isolates from humans and companion animals in the south of Europe. J Antimicrob Chemother 2013; 69:271-3. [PMID: 24022069 DOI: 10.1093/jac/dkt343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Pomba
- CIISA, Faculdade de Medicina Veterinária, Universidade Técnica de Lisboa, Lisbon, Portugal
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Rodríguez-Baño J, Mingorance J, Fernández-Romero N, Serrano L, López-Cerero L, Pascual A. Outcome of bacteraemia due to extended-spectrum β-lactamase-producing Escherichia coli: Impact of microbiological determinants. J Infect 2013; 67:27-34. [DOI: 10.1016/j.jinf.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/01/2013] [Accepted: 04/08/2013] [Indexed: 11/25/2022]
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Affiliation(s)
- Jesús Rodríguez-Baño
- Jesús Rodríguez-Baño is Head of Infectious Diseases and Professor of Medicine in the Hospital Universitario Virgen Macarena (Seville, Spain). His areas of interest include the epidemiology, control and treatment of multidrug-resistant pathogens and bacteremic infections
| | - Belén Gutiérrez
- Belén Gutiérrez is a Specialist in internal medicine. She is a Research Fellow in the infectious diseases and clinical microbiology department at Hospital Universitario Virgen Macarena. Her PhD program is focused in treatment of multidrug-resistant Enterobacteriaceae
| | - Lorena López-Cerero
- Lorena López-Cerero is a Clinical Microbiologist and a Researcher in Álvaro Pascual´s group. Her research is focused on molecular epidemiology of multidrug-resistant Enterobacteriaceae in community settings as well as nosocomial infection control
| | - Álvaro Pascual
- Álvaro Pascual is Professor of Microbiology at the University of Seville (Spain) and Head of the Clinical Microbiology Laboratory at University Hospital Virgen Macarena. He is an expert on the genetic basis of antimicrobial resistance and epidemiology of infections caused by multidrug-resistant Gram-negative bacteria
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Rodríguez-Baño J, Mingorance J, Fernández-Romero N, Serrano L, López-Cerero L, Pascual A. Virulence profiles of bacteremic extended-spectrum β-lactamase-producing Escherichia coli: association with epidemiological and clinical features. PLoS One 2012; 7:e44238. [PMID: 22970186 PMCID: PMC3436869 DOI: 10.1371/journal.pone.0044238] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/30/2012] [Indexed: 12/24/2022] Open
Abstract
There is scarce data about the importance of phylogroups and virulence factors (VF) in bloodstream infections (BSI) caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBLEC). A prospective multicenter Spanish cohort including 191 cases of BSI due to ESBLEC was studied. Phylogroups and 25 VF genes were investigated by PCR. ESBLEC were classified into clusters according to their virulence profiles. The association of phylogropus, VF, and clusters with epidemiological features were studied using multivariate analysis. Overall, 57.6%, 26.7%, and 15.7% of isolates belonged to A/B1, D and B2 phylogroups, respectively. By multivariate analysis (adjusted OR [95% CI]), virulence cluster C2 was independently associated with urinary tract source (5.05 [0.96–25.48]); cluster C4 with sources other than urinary of biliary tract (2.89 [1.05–7.93]), and cluster C5 with BSI in non-predisposed patients (2.80 [0.99–7.93]). Isolates producing CTX-M-9 group ESBLs and from phylogroup D predominated among cluster C2 and C5, while CTX-M-1 group of ESBL and phylogroup B2 predominantes among C4 isolates. These results suggest that host factors and previous antimicrobial use were more important than phylogroup or specific VF in the occurrence of BSI due to ESBLEC. However, some associations between virulence clusters and some specific epidemiological features were found.
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Affiliation(s)
- Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
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Egea P, López-Cerero L, Torres E, Gómez-Sánchez MDC, Serrano L, Navarro Sánchez-Ortiz MD, Rodriguez-Baño J, Pascual A. Increased raw poultry meat colonization by extended spectrum beta-lactamase-producing Escherichia coli in the south of Spain. Int J Food Microbiol 2012; 159:69-73. [PMID: 23072690 DOI: 10.1016/j.ijfoodmicro.2012.08.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/10/2012] [Accepted: 08/04/2012] [Indexed: 10/28/2022]
Abstract
The present study was conducted to assess the prevalence of retail chicken and turkey meat colonized by extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) in Seville, Spain. ESBLEC recovered from meat samples purchased in 2010 were characterized by specific PCR analysis for bla genes, phylogenetic groups and subgroups (genotypes) and O25b/pabB/B2 traits of ST131. Results were compared with those obtained in a previous study in 2007, when a high percentage of retail meat samples were found to be colonized by ESBLEC. The prevalence of retail poultry meat colonized by ESBLEC increased from 62.5% in 2007 to 93.3% in 2010 (p=0.005). Non-pathogenic B1 and A(1) genotypes accounted for more than 60% of the 60 isolates recovered. Sequence type ST131 or B2 phylogroup isolates were not detected. Clonal relatedness was detected in just 2 CTX-M-1-producing isolates from 2 chicken samples belonging to phylogenetic group A, genotype A(1). There continued to be a significantly high quinolone resistance, with 85.4% and 32.2% of isolates showing resistance to nalidixic acid and ciprofloxacin, respectively. SHV-12 was the most common ESBL harbored by E. coli, although it has decreased in prevalence since 2007. Meanwhile, CTX-M ESBLs prevalence has increased. We conclude that the trend of colonization by ESBLECs-particularly CTX-M-producing isolates-in raw poultry meat has increased in a short period of time in our area.
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Affiliation(s)
- Pilar Egea
- Microbiology Department, School of Medicine, University of Sevilla, Avda. Sánchez Pizjuán s/n. 41009, Sevilla, Spain
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