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Background/Aims Improved knowledge of local epidemiology and predicting risk factors of multidrug-resistant (MDR) bacteria are required to optimize the management of infections. This study examined local epidemiology and antibiotic resistance patterns of liver cirrhosis (LC) patients and evaluated the predictors of MDR bacteremia in Korea. Methods This was a retrospective study including 140 LC patients diagnosed with bacteremia between January 2017 and December 2022. Local epidemiology and antibiotic resistance patterns and the determinants of MDR bacteremia were analyzed using logistic regression analysis. Results The most frequently isolated bacteria, from the bloodstream, were Escherichia coli (n = 45, 31.7%) and Klebsiella spp. (n = 35, 24.6%). Thirty-four isolates (23.9%) were MDR, and extended-spectrum beta-lactamase E. coli (52.9%) and methicillin-resistant Staphylococcus aureus (17.6%) were the most commonly isolated MDR bacteria. When Enterococcus spp. were cultured, the majority were MDR (MDR 83.3% vs. 16.7%, p = 0.003), particularly vancomycin-susceptible Enterococcus faecium. Antibiotics administration within 30 days and/or nosocomial infection was a significant predictor of MDR bacteremia (OR: 3.40, 95% CI: 1.24–9.27, p = 0.02). MDR bacteremia was not predicted by sepsis predictors, such as positive systemic inflammatory response syndrome (SIRS) or quick Sequential Organ Failure Assessment (qSOFA). Conclusions More than 70% of strains that can be treated with a third-generation cephalosporin have been cultured. In cirrhotic patients, antibiotic administration within 30 days and/or nosocomial infection are predictors of MDR bacteremia; therefore, empirical administration of broad-spectrum antibiotics should be considered when these risk factors are present.

Abstract Introduction Gram-negative resistance is a well-acknowledged public health threat. Surveillance data can be used to monitor resistance trends and identify strategies to mitigate their threat. The objective of this study was to assess antibiotic resistance trends in Gram-negative bacteria. Methods The first cultures of Pseudomonas aeruginosa, Citrobacter, Escherichia coli, Enterobacter, Klebsiella, Morganella morganii, Proteus mirabilis, and Serratia marcescens per hospitalized patient per month collected from 125 Veterans Affairs Medical Centers (VAMCs) between 2011 to 2020 were included. Time trends of resistance phenotypes (carbapenem, fluoroquinolone, extended-spectrum cephalosporin, multi-drug, and difficult-to-treat) were analyzed with Joinpoint regression to estimate average annual percent changes (AAPC) with 95% confidence intervals and p values. A 2020 antibiogram of reported antibiotic percent susceptibilities was also created to evaluate resistance rates at the beginning of the COVID-19 pandemic. Results Among 40 antimicrobial resistance phenotype trends assessed in 494,593 Gram-negative isolates, there were no noted increases; significant decreases were observed in 87.5% (n = 35), including in all P. aeruginosa, Citrobacter, Klebsiella, M. morganii, and S. marcescens phenotypes (p

Background Helicobacter pylori (H. pylori) infection is the main cause of gastric cancer, but with the increase of H. pylori antibiotic resistance, the eradication rate has not substantially improved in many areas. Objective To understand the H. pylori antibiotic resistance situation in Wenzhou from 2013—2020, and analyse the difference of H. pylori antibiotic resistance with time period, age and gender. Methods From 2013-01-01 to 2020-12-31, a total of 47 658 patients undergoing gastroscopy in Wenzhou Central Hospital were selected. Gastric mucosa specimens were collected for H. pylori isolation and culture, and the isolated H. pylori strains obtained from the culture were analyzed for drug susceptibility to six antibiotics, including levofloxacin, clarithromycin, amoxicillin, metronidazole, tetracycline and furazolidone. A chi-square test was used to compare H. pylori antibiotic resistance rate between years, age groups and sexes. Results Multiple antibiotic resistance existed in 16 847 H. pylori strains isolated in Wenzhou from 2013—2020. Separate statistics on the resistance rates of H. pylori to the six commonly used antibiotics revealed that the resistance rates to levofloxacin, clarithromycin and metronidazole were high in the region, respectively 32.81% (5 536/16 874) 、26.02% (4 390/16 874) 、95.67% (16 144/16 874) . The resistance rate to amoxicillin was low, only 0.28% (47/16 874) , and 1.36% (25/1 844) in 2017. No strains were found with resistance to tetracycline hydrochloride and furazolidone. From 2013 to 2020, there were statistically significant differences in H. pylori resistance rates to levofloxacin, clarithromycin and amoxicillin (P88.00%) with no statistical difference (P>0.05) . There was statistically significant difference in the H. pylori resistance rate for evofloxacin, clarithromycin and metronidazole between female and male (P0.05) . There was statistically significant difference in the H. pylori resistance rate for levofloxacin or clarithromycin among different age groups in the region (P0.05) . Conclusion The H. pylori antibiotic resistance rate differed by year, and varied across different age and sex groups of H. pylori-positive cases in Wenzhou during the period. The overall H. pylori resistance rate was high. The eradication regimens based on metronidazole, clarithromycin or levofloxacin are difficult to achieve satisfactory results, so clinical H. pylori eradication treatment based on drug sensitivity test results should be encouraged.

Background Deaths can occur after a patient has survived treatment for a serious illness in an intensive care unit (ICU). Mortality rates after leaving the ICU can be considered indicators of health care quality. This study aims to describe risk factors and mortality of surviving patients discharged from an ICU in a university hospital. Methods Retrospective cohort study carried out from January 2017 to December 2018. Data on age, sex, length of hospital stay, diagnosis on admission to the ICU, hospital discharge outcome, presence of infection, and Simplified Acute Physiology Score (SAPS) III prognostic score were collected. Infected patients were considered as those being treated for an infection on discharge from the ICU. Patients were divided into survivors and non-survivors on leaving the hospital. The association between the studied variables was performed using the logistic regression model. Results A total of 1,025 patients who survived hospitalization in the ICU were analyzed, of which 212 (20.7%) died after leaving the ICU. When separating the groups of survivors and non-survivors according to hospital outcome, the median age was higher among non-survivors. Longer hospital stays and higher SAPS III values were observed among non-survivors. In the logistic regression, the variables age, length of hospital stay, SAPS III, presence of infection, and readmission to the ICU were associated with hospital mortality. Conclusions Infection on ICU discharge, ICU readmission, age, length of hospital stay, and SAPS III score increased risk of death in ICU survivors.

Background Multidrug-resistant organisms (MDROs) may increase the risk of nosocomial infection and impose great economic burden on patients' families and society. So it is of great significance to analyze the status, especially hotspots of research on MDROs for further research. Objective To analyze the research hotspots of MDROs in China from 2000 to 2020. Methods CiteSpace and bibliometric methods were used to conduct a visualization analysis of studies related to MDROs included in CNKI database of China in recent 20 years, involving the regularity of growth, high-frequency keywords, evolution of research hotspots and so on. Results In all, 3 808 studies were included. The number of these studies published during 2000—2020 demonstrated an upward trend in general, and could be divided into five stages: low output (2000—2004) , slow growth (2005—2009) , rapid growth (2010—2015) , relatively stable growth (2016—2018) and further development (2019—2020) . A total of 221 nodes and 302 edges were found by keywords co-occurrence network analysis. And besides MDROs and multidrug resistance, the central value of other 10 of the top 20 most frequently used keywords was equal or over 0.10, including nosocomial infection, multiple drug-resistant bacterial infections, Pseudomonas aeruginosa, ICU, Escherichia coli, drug resistance, antibiotics, Klebsiella pneumoniae, drug sensitivity test, and intensive care unit. The keywords were clustered into 15 clusters by cluster analysis, mainly included the following four themes: multiple resistant strains, multidrug-resistant bacteria infection and prognosis, diseases leading to multiple drug-resistant bacteria infections, generation mechanism and prevention and control of MDROs. The highly cited burst-related words mainly were drug resistant strains, drug resistance, antibacterial agents, and integron from 2000 to 2013, but there were no burst-related words after 2013. Conclusion The number of studies about MDROs in China demonstrated an overall upward trend from 2000 to 2020, with nosocomial infection, antibacterial agents, key drug-resistant strains and integron as the research hotspots, but few of them were about surveillance of drug resistance.

ABSTRACT OBJECTIVES To assess the determining factors of late healthcare-associated infections (HAIs) and bacterial multiple drug resistance in neonatal intensive care. METHODS This is a case-control study, conducted between January 2013 and December 2017, in a neonatal intensive care unit in the state of Ceará, Brazil. Newborns showing late HAIs were considered cases and those without infection, the control. Variables with p-values ≤ 0.05 in our initial bivariate regressive analysis were included in a non-conditional hierarchical logistic model for multivariate analysis. P-values below 0.01 were considered significant. RESULTS Of the 1,132 participants, 427 (37.7%) showed late healthcare-associated infections. Of these, 54 (12.6%), positive blood cultures, of which 14.9% contained multidrug-resistant bacteria. Bivariate analysis showed the protective effect of the feminine phenotype (OR = 0.71; 95%CI: 0.56–0.90) and of gestational ages ≥ 34 weeks (OR = 0.48; 95%CI: 0.30–0.75). In earlier-born preterm infants, late infections were 18 times more likely in those with less than 30 week-gestations (OR = 18.61; 95%CI: 9.84–35.22) and four times higher in those weighing less than 1,500 g (OR = 4.18; 95%CI: 3.12–5.61). Mechanical ventilation increased infection odds by more than seven times (OR = 7.14; 95%CI: 5.26–9.09); as did parenteral nutrition (OR = 5.88; 95%CI: 4.54–7.69); central venous catheters (OR = 10.00; 95%CI: 6.66–16.66); the number of catheters used (OR = 3.93; 95%CI: 3.02–5.12); surgery (OR = 4.00; 95%CI: 2.27–7.14); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07). The association between preterm infants with less than 30 week-gestations (OR = 5.62; 95%CI: 1.83–17.28); mechanical ventilation (OR = 1.84; 95%CI: 1.26–2.68); central venous catheters (OR = 2.48; 95%CI: 1.40–4.37); and hospitalization time (OR = 1.06; 95%CI: 1.05–1.07) remained significant after adjustment. Among deaths, 41 (55.4%) were associated with late infections. CONCLUSION Better practices should be adopted in caring for the premature, as well as in the rational use of procedures, to avoid late healthcare-associated infections, preventable deaths, and risks of bacterial multiple drug resistance and environmental contamination.

ABSTRACT Objective To investigate the prevalence of factors related to healthcare-associated infections, caused by multidrug-resistant bacteria, in a pediatric intensive care unit. Methods A retrospective case-control study conducted from January 1, 2007 to December 31, 2018, in São Paulo (SP), Brazil. The study was carried out at the pediatric intensive care unit of a high-complexity, tertiary care general hospital. The study included patients aged 1 month to 19 years, admitted to the pediatric intensive care unit, diagnosed as healthcare-associated infections. Results There was significant evidence of infection by multidrug-resistant bacteria associated with immunosuppressed patients (p

Introducción. Las enterobacterias resistentes a la gentamicina se asocian frecuentemente a infecciones hospitalarias. Objetivo. Verificar la presencia de los genes que confieren resistencia a los aminoglucósidos, específicamente a la gentamicina, en cepas de Klebsiella pneumoniae y Escherichia coli multirresistentes, obtenidas de pacientes internados en un hospital universitario de Río de Janeiro. Materiales y métodos. Se recolectaron y evaluaron 10 cepas de colonización y 20 de infección entre 1980 y 2010, utilizando medios selectivos enriquecidos con gentamicina (8 μg/ml). Se obtuvieron 30 cepas en las que se determinó la resistencia a los antibióticos por medios fenotípicos. Veintidós muestras se sometieron a extracción de ADN plasmídico y se hicieron ensayos de hibridización en 12 de ellas, usando como sonda un fragmento de ADN plasmídico de 1,9 kb obtenido de una cepa de K. pneumoniae aislada de muestra fecal. Este fragmento fue secuenciado y correspondió al registro GQ422439 del GenBank. Se verificó la presencia de genes de enzimas modificadoras de aminoglucósidos mediante reacción en cadena de la polimerasa. Resultados. En las cepas analizadas se evidenció la presencia de la acetilasa accC2, además de transposones y secuencias de inserción. Veinticuatro aislamientos (80 %) fueron positivos para el gen aacC2 en concordancia con los perfiles de sensibilidad a los antibióticos, lo que indicó su persistencia a lo largo de las tres décadas. Se detectaron plásmidos de alto peso molecular en 54,5 % de las cepas. El 91 % de las cepas analizadas mostró signos positivos en las pruebas de hibridación. Conclusión. Se detectó la persistencia de un gen codificador de una enzima modificadora de aminoglucósidos a lo largo de las tres décadas. Los resultados indican que las medidas de prevención, tales como un uso más responsable de los agentes antimicrobianos en el ambiente hospitalario, pueden contribuir al control de la diseminación de microorganismos que albergan plásmidos de genes de resistencia.

Introducción. La resistencia bacteriana es un problema de salud pública a nivel mundial que compromete seriamente la capacidad de tratar las infecciones. Objetivo. Describir el perfil de resistencia a los antimicrobianos marcadores en enterobacterias identificadas en hospitales colombianos. Materiales y métodos. Se hizo una revisión bibliográfica sistemática de las publicaciones indexadas en Medline, Embase y Lilacs, además de la búsqueda manual de todos los números de revistas colombianas reconocidas en el campo de la infectología y otros afines para identificar referencias no disponibles electrónicamente. Resultados. Se identificaron 43 estudios y reportes de vigilancia epidemiológica con información sobre la resistencia de las enterobacterias en hospitales, principalmente de Bogotá, Cali y Medellín. La tasa de resistencia en Escherchia coli oscila entre 3 y 11 %, 5 y 20 % y 0,2 a 0,8 % para piperacilina-tazobactam, cefalosporinas de tercera generación y carbapenémicos, respectivamente. En aislamientos de Klebsiella pneumoniae, la resistencia oscila entre 21,8 y 48,1 % frente a piperacilina-tazobactam, 20 y 35 % frente a cefalosporinas de amplio espectro y 3 y 8 % frente a carbapenémicos, con variaciones importantes por ciudades, niveles de atención y circunstancias clínicas. Conclusiones. La diseminación de la resistencia bacteriana en enterobacterias aisladas en hospitales colombianos es un problema creciente que requiere medidas prontas para cortar las cadenas de transmisión.

OBJECTIVE: To evaluate ertapenem disk performance to predict Klebsiella pneumonie carbapenemase production by Gram-negative bacilli. METHODS: All Gram-negative bacilli isolated between January 2010 and June 2011 were tested by disk diffusion (OxoidTM) for sensitivity to ertapenem, meropenem and imipenem. Resistant or intermediate sensitivity strains (diameter

ABSTRACT OBJECTIVE To analyze the prevalence and factors associated with multidrug-resistant tuberculosis in Espírito Santo, Brazil. METHODS This is a cross-sectional study of cases of tuberculosis tested for first-line drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin) in Espírito Santo between 2002 and 2012. We have used laboratory data and registration of cases of tuberculosis – from the Sistema Nacional de Agravos de Notificação and Sistema para Tratamentos Especiais de Tuberculose. Individuals have been classified as resistant and non-resistant and compared in relation to the sociodemographic, clinical, and epidemiological variables. Some variables have been included in a logistic regression model to establish the factors associated with resistance. RESULTS In the study period, 1,669 individuals underwent anti-tuberculosis drug susceptibility testing. Of these individuals, 10.6% showed resistance to any anti-tuberculosis drug. The rate of multidrug resistance observed, that is, to rifampicin and isoniazid, has been 5%. After multiple analysis, we have identified as independent factors associated with resistant tuberculosis: history of previous treatment of tuberculosis [recurrence (OR = 7.72; 95%CI 4.24–14.05) and re-entry after abandonment (OR = 3.91; 95%CI 1.81–8.43)], smoking (OR = 3.93; 95%CI 1.98–7.79), and positive culture for Mycobacterium tuberculosis at the time of notification of the case (OR = 3.22; 95%CI 1.15–8.99). CONCLUSIONS The partnership between tuberculosis control programs and health teams working in the network of Primary Health Care needs to be strengthened. This would allow the identification and monitoring of individuals with a history of previous treatment of tuberculosis and smoking. Moreover, the expansion of the offer of the culture of tuberculosis and anti-tuberculosis drug susceptibility testing would provide greater diagnostic capacity for the resistant types in Espírito Santo.