850 results on '"Gram-negative bacilli"'
Search Results
302. GRAM-NEGATIVE BACILLI INFECTIONS IN HIV INFECTED PATIENTS.
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GEORGESCU, ANCA MEDA, GÂRBOVAN, CRISTINA, and BODEA, ANDREEA
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GRAM-negative bacterial diseases , *HIV-positive persons , *DISEASE prevalence , *POPULATION health , *IMMUNOSUPPRESSION , *ANTIRETROVIRAL agents , *DISEASE risk factors , *DISEASES - Abstract
The epidemiology of bacterial infections during HIV (human immune deficiency virus) infection changed after the introduction of HAART (highly active antiretroviral therapy) and of the prophylaxis programmes addressing the associated infections, which led to an increased prevalence of some of them. Despite the relatively low incidence, the gram-negative bacilli (GNB) infections must be suspected in the case of bacterial complications in these patients, considering the severe potential of respiratory and systemic infections caused, and also the variable susceptibility to antibiotics. The study targets the peculiar etiologic and clinical aspects of GNB infections in seropositive patients vs. seronegative ones, the characterization of germs from the antibiotics sensitivity point of view and the connection with the severity of the immune suppression. The data are analyzed and the results are presented in a comparative manner with those obtained from non-infected HIV patients. The retrospective study supports the implication of deep immune suppression in causing the severe GNB infections, the role of HAART in preventing the respiratory complications caused by these germ and also the recommendation of the antibiotherapy uninfluenced by the seropositivity status. [ABSTRACT FROM AUTHOR]
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- 2014
303. Antibiotic Resistance of Gram-Negative Bacilli Isolated from Pediatric Patients with Nosocomial Bloodstream Infections in a Mexican Tertiary Care Hospital.
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ares, Miguel Ángel, alcántar-Curiel, Maria Dolores, Jiménez-Galicia, César, Rios-Sarabia, Nora, Pacheco, Sabino, and De la Cruz, Miguel Ángel
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ANTIBIOTICS , *DRUG resistance in bacteria , *BACILLUS (Bacteria) , *NOSOCOMIAL infections , *BLOOD disease treatment , *TERTIARY care - Abstract
Background: Gram-negative bacilli are the most common bacteria causing nosocomial bloodstream infections (NBSIs) in Latin American countries. Methods: The antibiotic resistance profiles of Gram-negative bacilli isolated from blood cultures in pediatric patients with NBSIs over a 3-year period in a tertiary care pediatric hospital in Mexico City were determined using the VITEK-2 system. Sixteen antibiotics were tested to ascertain the resistance rate and the minimum inhibitory concentration using the Clinical Laboratory Standards Institute (CLSI) broth micro-dilution method as a reference. Results: A total of 931 isolates were recovered from 847 clinically significant episodes of NBSI. Of these, 477 (51.2%) were caused by Gram-negative bacilli. The most common Gram-negative bacilli found were Klebsiella pneumoniae (30.4%), Escherichia coli (18.9%), Enterobacter cloacae (15.1%), Pseudomonas aeruginosa (9.9%), and Acinetobacter baumannii (4.6%). More than 45 and 60% of the K. pneumoniae and E. coli isolates, respectively, were resistant to cephalosporins, and 64% of the E. coli isolates were resistant to fluoroquinolones. A. baumannii exhibited low rates of resistance to antibiotics tested. In the E. cloacae and P. aeruginosa isolates, no rates of resistance higher than 38% were observed. Conclusions: In this study, we found that the proportion of NBSIs due to antibiotic-resistant organisms is increasing in a tertiary care pediatric hospital of Mexico. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]
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- 2014
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304. Burden of Antibiotic Resistance in Common Infectious Diseases: Role of Antibiotic Combination Therapy.
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MEHTA, KISHOR C., DARGAD, RAMESH R., BORADE, DHAMMRAJ M., and SWAMI, ONKAR C.
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ANTI-infective agents , *COMMUNICABLE disease treatment , *ETIOLOGY of diseases , *PHYSIOLOGICAL effects of antibiotics ,RESPIRATORY infection treatment - Abstract
Globally, antimicrobial resistance is alarming concern especially in commonly reported disease entities like respiratory tract infection, enteric fever and infections associated with gram-negative bacilli (GNB). Rational use of antimicrobial drugs reported significant decrease in bacterial burden and may also reduce the risk of disease progression. However, at times in particular indication, certain patient and pathogen factor limits the selection and use of specific antibiotic therapy while in some case, due to presence of additional risk factor, aggressive therapy is required to achieve clinical reemission and prevent complications. Delay in start of suitable antibiotic therapy is another imperative factor for treatment failure and rise of drug resistance. With rapidly increasing antibiotic resistance and decline in new antibiotic drug development, the toughest challenge remains to maintain and preserve the efficacy of currently available antibiotics. Therefore, the best rational approach to fight these infections is to 'hit early and hit hard' and kills drug-susceptible bacteria before they become resistant. The preferred approach is to deploy two antibiotics that produce a stronger effect in combination than if either drug were used alone. Various society guidelines in particular indications also justify and recommend the use of combination of antimicrobial therapy. Combination therapies have distinct advantage over monotherapy in terms of broad coverage, synergistic effect and prevention of emergence of drug resistance. [ABSTRACT FROM AUTHOR]
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- 2014
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305. Gram-negative bacilli causing infections in an intensive care unit of a tertiary care hospital in Istanbul, Turkey.
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Akcay, Seniha Senbayrak, Inan, Asuman, Cevan, Simin, Ozaydin, Ayse Nilufer, Cobanoglu, Naz, Ozyurek, Seyfi Celik, and Aksaray, Sebahat
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GRAM-negative bacterial diseases , *INTENSIVE care patients , *TERTIARY care , *EPIDEMIOLOGY , *DISEASE susceptibility , *RESPIRATORY infections , *CHI-square distribution - Abstract
Introduction: This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients. Methodology: A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing. Results: The most frequently isolated organisms were A. baumannii (37.3%), P. aeruginosa (30.3%), Enterobacter spp. (10.4%), E. coli (10.4%), and Klebsiella spp. (8.9%). A. baumannii was the most frequently isolated organism from the respiratory tract (43.4%); the susceptibility rates for imipenem and meropenem decreased to 7% and 6% (p < 0.0001), respectively. The percentage of multidrug-resistant (MDR) A. baumannii isolates continuously increased from 18.7% in 2004 to 69% in 2011 (p < 0.0001), whereas MDR P. aeruginosa isolates increased from 1.5% to 22% (p < 0.0001). Carbapenem-resistant Klebsiella isolates emerged in 2010 and increased to 20% in the next year. The rates of ESBL-producing Enterobacteriaceae in the ICU was very high in 2011 -- 50% for E. coli and 80% for Klebsiella strains. Conclusion: The most common isolated Gram-negative bacillus in our study was A. baumannii and that the prevalence of MDR isolates has increased markedly over. Accordingly, the comparison of antibiotic resistance of other pathogens in 2004 and 2011 displayed an increasing trend. These data imply the urgent need for new and effective strategies in our hospital and in the region. [ABSTRACT FROM AUTHOR]
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- 2014
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306. Skin and soft tissue infections in cirrhotics: A prospective analysis of clinical presentation and factors affecting outcome.
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Sood, Ajit, Midha, Vandana, Goyal, Omesh, Goyal, Prerna, Sood, Pramod, Sharma, Suresh, and Sood, Neena
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Skin and soft tissue infections (SSTI) are an important cause of morbidity and mortality in patients with cirrhosis. This prospective study aimed to analyze the clinical profile and factors affecting outcome of SSTIs in cirrhotics. All cirrhotics hospitalized between September 2007 and August 2010 were included. Frequency, site, extent, and type of SSTI were noted. Of 1,395 cirrhotics, 19.4 % ( n = 271) had bacterial infections, out of which 32.8 % (89/271) had SSTI. Alcohol was the predominant etiological factor for cirrhosis; 95.2 % belonged to Child class B/C, and 67 % gave history of barefoot walking. The most common site of SSTI was the lower limbs (87.1 %), cellulitis was the most common type (61.2 %), and gram-negative bacilli (GNB) is the most common organism (86.7 %). Mortality rate was 23.5 %. Serum creatinine and model for end-stage liver disease (MELD) score were independent predictors of mortality. SSTIs in cirrhotics were common and mostly involved the lower limbs. Cellulitis was the most common type, and GNB was the most common organism. Serum creatinine and MELD score were independent predictors of mortality. [ABSTRACT FROM AUTHOR]
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- 2014
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307. Multi-drug-resistant, non-fermenting, gram-negative bacilli in neonatal sepsis in Kolkata, India: a 4-year study.
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Viswanathan, Rajlakshmi, Singh, Arun Kumarendu, Basu, Sulagna, Chatterjee, Suparna, Roy, Subhasree, and Isaacs, David
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NEONATAL diseases , *MULTIDRUG resistance , *MEDICAL records , *BLOOD sampling , *SEPSIS , *PATIENTS - Abstract
Background: Non-fermenting gram-negative bacilli (NFGNB) are an emerging problem in neonatal sepsis. A major concern is multi-drug resistance which severely limits treatment options. Aims and Objectives: A retrospective observational study was conducted to analyse the role of non-fermenters in neonatal sepsis over a 4-year period, the factors leading to this trend and the pattern of antibiotic resistance. Methods: Demographic and clinical data were collected for all neonates with blood culture-positive sepsis during the study period, January 2007 to December 2010. Results: Blood cultures were positive in 186 (13%) of 1402 neonates, in 44 (32·1%) of whom the cause was NFGNB. Acinetobacter spp was the most common organism (n = 30). Infection by NFGNB showed a steady increase (P<0·0001), and was fairly evenly distributed between early- and late-onset sepsis. The infection rate was significantly higher in inborn neonates (P = 0·04) and those delivered vaginally (P = 0·002). Multi-drug resistance (MDR) occurred in 50% and carbapenem resistance in 30% of Acinetobacter spp isolates. In five cases there was panresistance of Acinetobacter spp to all antibiotics tested. Conclusion: The trend of increasing numbers of cases of NFGNB in neonatal sepsis compounded by MDR is of great concern. It is necessary to administer antibiotics judiciously, strengthen surveillance and laboratory services in neonatal intensive care units, and re-evaluate treatment guidelines for management of infection by these organisms. [ABSTRACT FROM AUTHOR]
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- 2014
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308. A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of Extended-Spectrum Beta-Lactamase (ESBL) and carbapenemase-encoding genes
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Krishna G. Prajapati, Stephen Baker, Sabina Dongol, Buddha Basnyat, Abhilasha Karkey, Guy E. Thwaites, Raphaël M. Zellweger, Sameer M Dixit, Nhukesh Maharjan, Sulochana Manandhar, Karkey, Abhilasha [0000-0002-5179-650X], and Apollo - University of Cambridge Repository
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Klebsiella ,Gram-negative bacilli ,medicine.medical_treatment ,lcsh:QR1-502 ,Drug resistance ,Antimicrobial resistance ,lcsh:Microbiology ,Tertiary Care Centers ,0302 clinical medicine ,Medical microbiology ,Drug Resistance, Multiple, Bacterial ,Prevalence ,030212 general & internal medicine ,0303 health sciences ,Acinetobacter ,General Medicine ,Enterobacter ,3. Good health ,Anti-Bacterial Agents ,Infectious Diseases ,Microbiology (medical) ,medicine.medical_specialty ,Bacilli ,ESKAPE ,Microbial Sensitivity Tests ,Biology ,beta-Lactamases ,Microbiology ,lcsh:Infectious and parasitic diseases ,Carbapenemase ,03 medical and health sciences ,Antibiotic resistance ,Nepal ,Bacterial Proteins ,Gram-Negative Bacteria ,medicine ,Escherichia coli ,Humans ,lcsh:RC109-216 ,Retrospective Studies ,030306 microbiology ,Research ,lcsh:RM1-950 ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Multi-drug resistance ,lcsh:Therapeutics. Pharmacology ,ESBL ,Beta-lactamase ,Gram-Negative Bacterial Infections - Abstract
Background Multi-drug resistance (MDR) and extensive-drug resistance (XDR) associated with extended-spectrum beta-lactamases (ESBLs) and carbapenemases in Gram-negative bacteria are global public health concerns. Data on circulating antimicrobial resistance (AMR) genes in Gram-negative bacteria and their correlation with MDR and ESBL phenotypes from Nepal is scarce. Methods A retrospective study was performed investigating the distribution of ESBL and carbapenemase genes and their potential association with ESBL and MDR phenotypes in E. coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. isolated in a major tertiary hospital in Kathmandu, Nepal, between 2012 and 2018. Results During this period, the hospital isolated 719 E. coli, 532 Klebsiella spp., 520 Enterobacter spp. and 382 Acinetobacter spp.; 1955/2153 (90.1%) of isolates were MDR and half (1080/2153) were ESBL producers. Upon PCR amplification, blaTEM (1281/1771; 72%), blaCTXM-1 (930/1771; 53%) and blaCTXM-8 (419/1771; 24%) were the most prevalent ESBL genes in the enteric bacilli. BlaOXA and blaOXA-51 were the most common blaOXA family genes in the enteric bacilli (918/1771; 25%) and Acinetobacter spp. (218/382; 57%) respectively. Sixteen percent (342/2153) of all isolates and 20% (357/1771) of enteric bacilli harboured blaNDM-1 and blaKPC carbapenemase genes respectively. Of enteric bacilli, Enterobacter spp. was the most frequently positive for blaKPC gene (201/337; 60%). The presence of each blaCTX-M and blaOXA were significantly associated with non-susceptibility to third generation cephalosporins (OR 14.7, p p blaTEM, blaCTXM and blaOXA family genes were significantly associated with ESBL positivity (OR 2.96, p p p p p p Conclusions This study documents an alarming level of AMR with high prevalence of MDR ESBL- and carbapenemase-positive ESKAPE microorganisms in our clinical setting. These data suggest a scenario where the clinical management of infected patients is increasingly difficult and requires the use of last-resort antimicrobials, which in turn is likely to intensify the magnitude of global AMR crisis.
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- 2020
309. Non-cephalosporin-susceptible, glucose non-fermentative Gram-negative bacilli meningitis in post-neurosurgical adults: Clinical characteristics and therapeutic outcome.
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Wei-An Lai, Shu-Fang Chen, Nai-Wen Tsai, Wen-Neng Chang, Cheng-Hsien Lu, Yao-Chung Chuang, Chiung-Chih Chang, and Chi-Ren Huang
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BACTERIAL disease treatment , *CEPHALOSPORINS , *THERAPEUTICS , *CENTRAL nervous system diseases , *PATHOGENIC microorganisms , *ACINETOBACTER infections - Abstract
Objective: The clinical and laboratory characteristics of non-cephalosporin-susceptible (non-CS) glucose non-fermentative Gram-negative (G(-)) infections in adults with postneurosurgical meningitis are rarely examined solely in the literature. Methods: The data of 28 post-neurosurgical adults meningitis with glucose non-fermentative G(-) infections, collected during a study period of 5 years (2006-2010), were reviewed. The clinical and laboratory data between the non-cephalosporin-susceptible groups and the cephalosporin-susceptible groups were compared. Results: A total of 30 G(-) strains were collected from the 28 enrolled cases. Among the implicated-glucose non-fermentative G(-) strains, 18 strains, belonging to 17 cases, were non-CS. Among the 18 non-cephalosporin-susceptible strains, Acinetobacter spp. (39%, 7/18) was the most common, followed by Pseudomonas spp. (22%, 4/18), Stenotrophomonas maltophilia (22%, 4/18) and Elizabethkingia meningoseptica (11%, 2/18). With a comparative analysis, there were no significant difference between the non-cephalosporin-susceptible and cephalosporin-susceptible glucose non-fermentative G(-) groups. The clinical and laboratory data were also of no statistical significance between the fatal (n = 4) and non-fatal (n = 13) non-cephalosporin-susceptible groups. Conclusion: Sixty percent (18/30) of implicated glucose non-fermentative G(-) strains of post-NS meningitis in adults are non-cephalosporin-susceptible. Among the non-cephalosporin-susceptible glucose non-fermentative G(-) strains, Acinetobacter spp., Pseudomonas spp., S. maltophilia and E. meningoseptica are the commonly implicated pathogens, and their emergence in this specific group of meningitis has caused a therapeutic dilemma. The clinical manifestations of non-cephalosporin-susceptible glucose non-fermentative G(-) meningitis were not unique; therefore, only bacterial culture and antimicrobial susceptibility test are the methods for identification confirmation. [ABSTRACT FROM AUTHOR]
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- 2014
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310. Antimicrobial co-resistance patterns of gram-negative bacilli isolated from bloodstream infections: a longitudinal epidemiological study from 2002–2011.
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Wong, Patrick H. P., von Krosigk, Marcus, Roscoe, Diane L., Lau, Tim T. Y., Yousefi, Masoud, and Bowie, William R.
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Background: Increasing multidrug resistance in gram-negative bacilli (GNB) infections poses a serious threat to public health. Few studies have analyzed co-resistance rates, defined as an antimicrobial susceptibility profile in a subset already resistant to one specific antibiotic. The epidemiologic and clinical utility of determining co-resistance rates are analyzed and discussed. Methods: A 10-year retrospective study from 2002–2011 of bloodstream infections with GNB were analyzed from three hospitals in Greater Vancouver, BC, Canada. Descriptive statistics were calculated for antimicrobial resistance and co-resistance. Statistical analysis further described temporal trends of antimicrobial resistance, correlations of resistance between combinations of antimicrobials, and temporal trends in co-resistance patterns. Results: The total number of unique blood stream isolates of GNB was 3280. Increasing resistance to individual antimicrobials was observed for E. coli, K. pneumoniae, K. oxytoca, E. cloacae, and P. aeruginosa. Ciprofloxacin resistance in E. coli peaked in 2006 at 40% and subsequently stabilized at 29% in 2011, corresponding to decreasing ciprofloxacin usage after 2007, as assessed by defined daily dose utilization data. High co-resistance rates were observed for ceftriaxone-resistant E. coli with ciprofloxacin (73%), ceftriaxone-resistant K. pneumoniae with trimethoprim-sulfamethoxazole (83%), ciprofloxacin-resistant E. cloacae with ticarcillin-clavulanate (91%), and piperacillin-tazobactam-resistant P. aeruginosa with ceftazidime (83%). Conclusions: Increasing antimicrobial resistance was demonstrated over the study period, which may partially be associated with antimicrobial consumption. The study of co-resistance rates in multidrug resistant GNB provides insight into the epidemiology of resistance acquisition, and may be used as a clinical tool to aid prescribing empiric antimicrobial therapy. [ABSTRACT FROM AUTHOR]
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- 2014
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311. Determination of antimicrobial and heavy metal resistance profiles of some bacteria isolated from aquatic amphibian and reptile species.
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Hacioglu, Nurcihan and Tosunoglu, Murat
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ANTI-infective agents ,SOIL profiles ,ANTIBIOTICS ,AQUATIC ecology ,HEAVY metal content of water ,CHLORAMPHENICOL - Abstract
The aim of the present study was to determine the level of antibiotic resistance patterns and distribution of heavy metal resistance of bacterial isolates from aquatic animals ( Lissotriton vulgaris, Pelophylax ridibundus, Emys orbicularis, Mauremys rivulata, and Natrix natrix) in Turkey (Kavak Delta). A total of 153 bacteria have been successfully isolated from cloaca and oral samples of the aquatic amphibians and reptilians which were found, namely, Aeromonas sp. ( n = 29), Plesiomonas sp. ( n = 7), Vibrio sp. ( n = 12), Citrobacter sp. ( n = 12), Enterobacter sp. ( n = 11), Escherichia sp. ( n = 22), Klebsiella sp. ( n = 22), Edwardsiella sp. ( n = 6), Hafnia sp. ( n = 1), Proteus sp. ( n = 19), Providencia sp. ( n = 8), and Pseudomonas sp. ( n = 4). In terms of antibiotic and heavy metal susceptibility testing, each isolate was tested against 12 antibiotics and 4 metals. There was a high incidence of resistance to cefoxitin (46.40 %), ampicillin (44.44 %), erythromycin (35.29 %), and a low incidence of resistance to gentamicin (6.53 %), kanamycin (8.49 %), chloramphenicol (9.15 %), and cefotaxime (10.45 %). The multiple antibiotic resistance index of each bacterial species indicated that bacteria from raised amphibians and reptiles have been exposed to tested antibiotics, with results ranging from 0 to 0.58. Most isolates showed tolerance to different concentrations of heavy metals, and minimal inhibition concentrations ranged from100 to >3,200 μg/mL. According to these results, a significant occurrence of bacteria in the internal organs of reptiles and amphibians, with a high incidence of resistance against antibiotics and heavy metals, may risk aquatic animals and the public health. These data appoint the importance of epidemiological surveillance and microbiological monitoring and reinforce the need to implement environment protection programs for amphibian and reptile species. [ABSTRACT FROM AUTHOR]
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- 2014
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312. The Detection of Antibiotic Susceptibility Patterns of Multi-Drug Resistant Bacteria especially those Producing Extended-Spectrum Beta-Lactamases (ESBL).
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Dixit, Tuhiram, Sharma, Mukta, and Sajwan, Nalin
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LACTAM derivatives ,ANTI-infective agents ,PENICILLIN-binding proteins ,BACTERIAL cell walls ,MICROBIAL polysaccharides - Abstract
Over the last few decades, β-lactams are the most widely used and favored antimicrobials worldwide, because of their efficacy, broad spectra and low toxicity. They inhibit the bacterial penicillin-binding proteins (PBPs), which are the enzymes that catalyze the final cross-linking of the bacterial cell wall polymer, peptidoglycan. However, due to heavy use of β-lactams antibiotics, bacteria developed various mechanism of resistance. Modification or substitution of the PBPs is important mechanism in gram-positive cocci, while production of β-lactamases is main cause of resistance among gram-negative bacilli. Mostly plasmid harbors the resistance gene and therefore, is crucial in disseminating resistance into previously susceptible species. Throughout the 1960s and 1970s there was a relentless rise in reports of resistance to β-lactams as a consequence of the selection of bacteria that produce β-lactamases. [ABSTRACT FROM AUTHOR]
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- 2014
313. Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: a case-case-control design in a prospective cohort study
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Elisangela M. Lima, Patrícia A. Cid, Debora S. Beck, Luiz Henrique Z. Pinheiro, João Pedro S. Tonhá, Marcio Z. O. Alves, Newton D. Lourenço, Roberto Q. Santos, Marise D. Asensi, José Aurélio Marques, Carolina S. Bandeira, Caio Augusto S. Rodrigues, Saint Clair S. Gomes Junior, Marisa Z. R. Gomes, and the Nucleus of Hospital Research study collaborators
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0301 basic medicine ,Male ,Carbapenem ,Gram-negative bacilli ,Antimicrobial resistance ,law.invention ,Tertiary Care Centers ,0302 clinical medicine ,law ,Recurrence ,Risk Factors ,Pharmacology (medical) ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Aged, 80 and over ,Cross Infection ,Middle Aged ,Intensive care unit ,Polymerase chain reaction ,Anti-Bacterial Agents ,Intensive Care Units ,Infectious Diseases ,Female ,Brazil ,medicine.drug ,Microbiology (medical) ,Adult ,medicine.medical_specialty ,Critical Illness ,030106 microbiology ,lcsh:Infectious and parasitic diseases ,Sepsis ,03 medical and health sciences ,Young Adult ,Internal medicine ,Gram-Negative Bacteria ,medicine ,Humans ,lcsh:RC109-216 ,Hospital infection ,Aged ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,medicine.disease ,Systemic inflammatory response syndrome ,Pneumonia ,Carbapenems ,Bacteremia ,Case-Control Studies ,Etiology ,business ,Gram-Negative Bacterial Infections - Abstract
BackgroundStudies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis.MethodsWe developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017.ResultsAmong the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77–10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17–15.18), carbapenem use (OR = 3.42; 95% CI 1.37–8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01–1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72–27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07–26.45) were factors associated with CS-GNB sepsis.ConclusionsThe investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.
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- 2020
314. A Survey of Genotype and Resistance Patterns of Ventilator-Associated Pneumonia Organisms in ICU Patients
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Shabnam, Tehrani, Vida, Saffarfar, Ali, Hashemi, and Sara, Abolghasemi
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ventilator-associated pneumonia ,Gram-negative bacilli ,antibiotic resistance ,ICU ,Original Article ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses - Abstract
Background: Ventilator-Associated Pneumonia (VAP) occurs in hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients referred to the Intensive Care Unit (ICU) are also affected by VAP due to specific conditions, especially by Gram-negative pathogens with advanced drug resistance. In this study, the pattern of antibiotic resistance of gram negative bacteria isolated from tracheal culture of VAP patients was investigated in ICU. Materials and Methods: In this cross-sectional study, tracheal samples were collected from VAP patients admitted in the hospital’s ICU from March 2017-February 2018. After isolation, bacterial isolates were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates was investigated using standard disc diffusion and E-test methods. Multiplex PCR were used to detect the blaOXA-23-like, blaOXA-51-like, blaOXA-24-like, and blaOXA-58-like genes among Acinetobacter baumannii (A. baumannii) isolates. Results: A total of 29 bacterial isolates were isolated from ICU patients, which were A. baumannii, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae) and candida spp, with prevalence of 38, 27.5, 13.8, and 20.7%, respectively. Antibiotic susceptibility test of isolates indicated that almost all isolates showed Multi-Drug Resistance (MDR) pattern. The A. baumannii isolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-sulbactam and colistin had better results. Ciprofloxacin, meropenem and colistin were effective against P. aeruginosa isolates, but other antibiotics were less effective and Colistin, Levofloxacin (LVX) and Piperacilin/Tazobactam were the best antibiotics that were effective on the isolates of K. pneumonia. Conclusion: According to the present study, high resistance to most antibiotics in gram negative bacilli showed that antibiotic therapy should be based on the type of bacteria isolated by tracheal culture and, as far as possible, combination therapies should be used to maximize the coverage of other possible pathogens, and antibiotic resistance in ICU.
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- 2020
315. Reduced susceptibility mechanism to cefiderocol, a siderophore cephalosporin, among clinical isolates from a global surveillance programme (SIDERO-WT-2014)
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Hideki Maki, Takafumi Sato, Miho Kuroiwa, Naoki Kohira, Meredith Hackel, Daniel F. Sahm, Yoshino Ishioka, and Yoshinori Yamano
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0301 basic medicine ,Microbiology (medical) ,Siderophore ,Surveillance study ,Gram-negative bacilli ,medicine.drug_class ,030106 microbiology ,Immunology ,Cephalosporin ,Siderophores ,Biology ,medicine.disease_cause ,Microbiology ,PER-type β-lactamase ,03 medical and health sciences ,Minimum inhibitory concentration ,0302 clinical medicine ,Cefiderocol non-susceptible ,Drug Resistance, Multiple, Bacterial ,medicine ,Immunology and Allergy ,Cefiderocol ,030212 general & internal medicine ,Escherichia coli ,Gram negative bacilli ,Siderophore cephalosporin ,QR1-502 ,Anti-Bacterial Agents ,Cephalosporins ,Multiple factors ,Reduced susceptibility - Abstract
Objective To investigate possible mechanistic factors to explain cefiderocol (CFDC) non-susceptibility, we characterized 38 clinical isolates with a CFDC minimum inhibitory concentration (MIC) of >4 μg/mL from a multi-national surveillance study. Methods The MIC measurement in the presence of β-lactamase inhibitors and whole genome sequencing were performed. Results The MIC decrease of CFDC by β-lactamase inhibitors was observed against all of the test isolates. Among the 38 isolates, NDM and PER genes were observed in 5 and 25 isolates, respectively. No other β-lactamases responsible for high MIC were identified in the other eight isolates. The MIC of CDFC against Escherichia coli isogenic strains introduced with NDM and PER β-lactamase increased by ≥16-fold, suggesting the contribution of NDM and PER to the non-susceptibility to CFDC. Against NDM producers, a ≥8-fold MIC increase was observed only when both serine- and metallo-type β-lactamase inhibitors were added. In addition, many of the PER or NDM producers remained susceptible to CFDC. These results suggested that the presence of only NDM or PER would not lead to non-susceptibility to CFDC and that multiple factors would be related to CFDC resistance. Conclusion Multiple factors including NDM and PER could be related to reduced susceptibility to CFDC.
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- 2020
316. Comparison of Agar Dilution to Broth Microdilution for Testing
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Mariana, Albano, Melissa J, Karau, Audrey N, Schuetz, and Robin, Patel
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Agar ,Gram-negative bacilli ,Enterobacterales ,Gram-negative bacteria ,Gram-Negative Bacteria ,cefiderocol ,Humans ,Bacteriology ,Microbial Sensitivity Tests ,broth microdilution ,Anti-Bacterial Agents ,Cephalosporins ,agar dilution - Abstract
Cefiderocol (CFDC) is a siderophore cephalosporin with activity against Gram-negative bacterial species that are resistant to carbapenems and other drugs. The MICs of CFDC were determined for 610 Gram-negative bacilli, including 302 multinational Enterobacterales isolates with characterized mechanisms of beta-lactam resistance, 180 clinical isolates from the Mayo Clinic and Mayo Clinic Laboratories not characterized for specific resistance mechanisms, and 128 isolates with CFDC MICs of ≥8 μg/ml obtained from International Health Management Associates, Inc., Cefiderocol (CFDC) is a siderophore cephalosporin with activity against Gram-negative bacterial species that are resistant to carbapenems and other drugs. The MICs of CFDC were determined for 610 Gram-negative bacilli, including 302 multinational Enterobacterales isolates with characterized mechanisms of beta-lactam resistance, 180 clinical isolates from the Mayo Clinic and Mayo Clinic Laboratories not characterized for specific resistance mechanisms, and 128 isolates with CFDC MICs of ≥8 μg/ml obtained from International Health Management Associates, Inc. (IHMA, Schaumburg, IL). Broth microdilution using standard cation-adjusted Mueller-Hinton broth (BMD) and iron-depleted cation-adjusted Mueller-Hinton broth (ID-BMD), and agar dilution (AD) using standard Mueller-Hinton agar were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. MICs were interpreted according to the investigational CLSI, FDA, and EUCAST breakpoints, and results were compared. MICs inhibiting 50 and 90% of organisms (MIC50 and MIC90, respectively), essential agreement (EA), categorical agreement (CA), and error of different types were determined. Results showed considerable discordance between AD and ID-BMD. CFDC showed low EA and CA rates and high error rates for AD in comparison to ID-BMD. Overall, this study does not support use of standard AD for determining CFDC MICs.
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- 2020
317. Long-Term Continuous Antimicrobial Resistance Surveillance Among Nosocomial Gram-Negative Bacilli in China from 2010 to 2018 (CMSS)
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Qi, Wang, Zhanwei, Wang, Feifei, Zhang, Chunjiang, Zhao, Bin, Yang, Ziyong, Sun, Yaning, Mei, Feng, Zhao, Kang, Liao, Dawen, Guo, Xiuli, Xu, Hongli, Sun, Zhidong, Hu, Yunzhuo, Chu, Yi, Li, Ping, Ji, and Hui, Wang
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CMSS ,carbapenem-resistant ,gram-negative bacilli ,polycyclic compounds ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,antimicrobial susceptibility surveillance ,Original Research - Abstract
Purpose The Chinese Meropenem Surveillance Study (CMSS) was conducted every 2 years from 2010 to 2018 to monitor the antimicrobial activity of commonly used antimicrobial agents against nosocomial gram-negative bacilli in China. Methods From 2010 to 2018, 6,537 gram-negative bacilli were collected from 14 teaching hospitals. The minimum inhibitory concentrations (MICs) of meropenem and other antimicrobial agents were determined using the agar dilution and broth microdilution methods. Results Continuous surveillance indicated that, except for Klebsiella pneumoniae, the susceptibility of Enterobacterales to carbapenems was relatively stable over time. Carbapenems had the highest activity against the tested isolates, with MIC90 values (MIC for 90% of organisms) ranging from 0.032 mg/L to 8 mg/L. More than 90% of bacteria were susceptible to either meropenem or imipenem; more than 80% were susceptible to ertapenem. The prevalence of extended-spectrum beta-lactamase (ESBL)-producing E. coli, K. pneumoniae, and P. mirabilis each year was 50.4–64.3%, 18–41.2%, and 1.9–33.8%, respectively. The prevalence of carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) continued to increase significantly over time, from 7.6% to 21.2% and 64.6% to 69.3%, respectively. The prevalence of CRKP was higher from urinary tract infections (25.4%) than from bloodstream infections (14.2%), intra-abdominal infections (14.5%), and respiratory infections (14.4%). In total, 129 CRKP isolates were evaluated by PCR; of these, 92 (71.3%) carried the blaKPC-2 gene. Colistin maintained very high in vitro antimicrobial activity against P. aeruginosa and A. baumannii (more than 95% of isolates exhibited susceptibility at all timepoints). Conclusion The results indicate an increase in K. pneumoniae resistance to carbapenems over time, mainly owing to KPC-type carbapenemase production. A. baumannii was severely resistant to carbapenems in China. Ongoing MIC-based resistance surveillance, like CMSS, provides additional data for clinical anti-infective treatment.
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- 2020
318. Secondary Bacterial Infections in Critical Ill Patients With Coronavirus Disease 2019
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Hua Zhou, Yake Yao, Yiqi Fu, Haishen Kong, Jianying Zhou, Qing Yang, Hongchao Chen, Yajie Fu, and Min Xu
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0301 basic medicine ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Gram-negative bacilli ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030106 microbiology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,030212 general & internal medicine ,critical ill ,Antibiotic prophylaxis ,Intensive care medicine ,Mechanical ventilation ,business.industry ,Critically ill ,antibiotic prophylaxis ,Brief Report ,bacterial infection ,COVID-19 ,Gram negative bacilli ,Intensive care unit ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,business - Abstract
Secondary bacterial infections occurred in 13.9% (5 of 36) of critical ill patients with coronavirus disease 2019. All 5 patients had been admitted to intensive care unit and received mechanical ventilation before developing bacterial infection. Active surveillance of culture should be performed for critically ill patients. Prevention of nosocomial infection should to be taken seriously.
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- 2020
319. Presencia de Bacilos Gram-negativos y Candida albicans en provisionales de polimetilmetacrilato (PMM)en pacientes de Clínica Integrada de la Universidad Autónoma de Asunción
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Invernizzi-Mendoza, Carlos Rafael, Ortiz-Mendoza, Williams Manuel, and Flores-Alatorre, José Francisco
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Gram-negative bacilli ,Polymethylmethacrylate ,Candida albicans ,polimetilmetacrilato ,Bacilos Gram-negativos - Abstract
RESUMEN Las resinas a base de polimetilmetacrilato (PMM) son una solución para la reposición de estructuras dentarias. Este material ha sido muy utilizado debido a su buena estética, pero las rugosidades, grietas y defectos de este material son propicios para la proliferación de microrganismos que podrían constituir un riesgo para la salud de los pacientes. Estudio observacional descriptivo de corte transversal, donde se tomaron muestras de provisorios de PMM de 20 pacientes de la cátedra de Clínica Integrada de Odontología de la Universidad Autónoma de Asunción. Los datos sobre el crecimiento de los microorganismos fueron anotados en planillas Excel para análisis estadísticos. De los 20 pacientes que participaron en esta investigación, 50% fueron de sexo femenino y 50% masculino, el promedio de edad fue de 32,35 años (DE±11,94). Se analizaron un total de 7 pónticos (6 pónticos de 3 piezas y 1 de 6 piezas) y 19 coronas unitarias, el tiempo de permanencia en boca fue de entre 4 a 20 semanas con una media de 8,6 semanas. El 65% de las muestras dio positivo al cultivo microbiológico. En algunas muestras se aislaron más de un género de microorganismos. Se aislaron 5 especies de bacterias Gram-negativas, la más frecuente fue K. pneumoniae con un 40%. Se aisló C. albicans en un 10% de las muestras. En el proceso de elección de los materiales para rehabilitación es fundamental considerar la situación global de cada paciente, pues exponerlos a un material con grandes capacidades retentivas de microrganismos conlleva un peligro. ABSTRACT Polymethylmethacrylate (PMM) based resins are a solution for the replacement of dental structures. This material has been widely used due to its good aesthetics, but the roughness, cracks and defects of this material are propitious for the proliferation of microorganisms that could constitute a risk to the health of patients. This was a descriptive cross-sectional observational study, where samples of PMM provisionals were taken from 20 patients of the Department of Integrated Dental Clinic of the Autonomous University of Asunción. Data on the growth of microorganisms were recorded in Excel spreadsheets for statistical analysis. Of the 20 patients who participated in this research, 50% was female and 50% male, and the average age was 32.35 years (SD±11.94). Seven pontics (6 pontics of 3 pieces and 1 of 6 pieces) and 19 unit crowns were analyzed, the time spent in the mouth was between 4 to 20 weeks with an average of 8.6 weeks. Sixty-five percent of the samples tested positive in the microbiological culture. In some samples, more than one genus of microorganisms was isolated. Five species of Gram-negative bacteria were isolated, the most frequent was Klebsiella pneumoniae with 40%. Candida albicans was isolated in 10% of the samples. In the process of choosing materials for rehabilitation, it is essential to consider the overall situation of each patient, since exposing them to a material with high retention capacities of microorganisms carries a danger.
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- 2020
320. Molecular epidemiology and drug resistance of Acinetobacter baumannii isolated from a regional hospital in the Brazilian Amazon region
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Irmtraut Araci Hoffmann Pfrimer, José Rodrigues do Carmo Filho, Ana Paula Streling de Oliveira, Danilo Dias Coelho, Edlainny Araujo Ribeiro, Rodrigo Alves de Oliveira, and Ana Cristina Gales
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0301 basic medicine ,Microbiology (medical) ,Acinetobacter baumannii ,Clonal dissemination ,Gram-negative bacilli ,Carbapenem resistance ,Short Communication ,RC955-962 ,030231 tropical medicine ,030106 microbiology ,Drug Resistance ,Drug resistance ,Microbial Sensitivity Tests ,Biology ,beta-Lactamases ,Microbiology ,Carbapenemase ,03 medical and health sciences ,0302 clinical medicine ,Bacterial Proteins ,Arctic medicine. Tropical medicine ,Pulsed-field gel electrophoresis ,Humans ,Molecular Epidemiology ,Molecular epidemiology ,Amazon rainforest ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Hospitals ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Regional hospital ,Infectious Diseases ,Parasitology ,Pfge analysis ,Brazil ,bla OXA-23 ,Acinetobacter Infections - Abstract
INTRODUCTION: In this study, we report a clonal dissemination of carbapenem resistant Acinetobacter baumannii isolates due to the acquisition of blaOXA-23 in a regional hospital located in Brazilian Amazon Region. METHODS: The isolates were identified by MALDI-TOF and the carbapenemase-encoding genes were detected by multiplex-PCR. The genetic similarity was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Only 10 (55.6%) isolates harbored the gene bla OXA-23. PFGE analysis revealed that these isolates belong to a single clone. CONCLUSIONS: This dissemination strategy indicates the need for surveillance, adoption of control procedures defined in guidelines, and the careful administration of antimicrobials should be reinforced.
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- 2020
321. Validating a prediction tool to determine the risk of nosocomial multidrug-resistant Gram-negative bacilli infection in critically ill patients: A retrospective case-control study
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Anthony C. Gordon, Alison Holmes, Anupama Vasudevan, Mark Gilchrist, Sara E Boyd, Céire Costelloe, Luke S. P. Moore, Christopher F Brewer, National Institute for Health Research, and NIHR
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0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Carbapenem ,Gram-negative bacilli ,medicine.medical_treatment ,Critical Illness ,030106 microbiology ,Immunology ,Disease ,Antimicrobial resistance ,Microbiology ,State Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Nosocomial infection ,law ,Intensive care ,Internal medicine ,Bedside prediction tool ,Immunology and Allergy ,Medicine ,Humans ,Intensive care unit ,030212 general & internal medicine ,Dialysis ,Retrospective Studies ,Cross Infection ,Singapore ,Receiver operating characteristic ,business.industry ,Case-control study ,Confidence interval ,QR1-502 ,Critical care ,Case-Control Studies ,business ,Gram-Negative Bacterial Infections ,medicine.drug - Abstract
Background: The Singapore GSDCS score was developed to enable clinicians predict the risk of nosocomial multidrug-resistant Gram-negative bacilli (RGNB) infection in critically ill patients. We aimed to validate this score in a UK setting. Method: A retrospective case–control study was conducted including patients who stayed for more than 24 h in intensive care units (ICUs) across two tertiary National Health Service hospitals in London, UK (April 2011–April 2016). Cases with RGNB and controls with sensitive Gram-negative bacilli (SGNB) infection were identified. Results: The derived GSDCS score was calculated from when there was a step change in antimicrobial therapy in response to clinical suspicion of infection as follows: prior Gram-negative organism, Surgery, Dialysis with end-stage renal disease, prior Carbapenem use and intensive care Stay of more than 5 days. A total of 110 patients with RGNB infection (cases) were matched 1:1 to 110 geotemporally chosen patients with SGNB infection (controls). The discriminatory ability of the prediction tool by receiver operating characteristic curve analysis in our validation cohort was 0.75 (95% confidence interval 0.65–0.81), which is comparable with the area under the curve of the derivation cohort (0.77). The GSDCS score differentiated between low- (0–1.3), medium- (1.4–2.3) and high-risk (2.4–4.3) patients for RGNB infection (P
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- 2020
322. Risk Factors for Positive Follow-Up Blood Cultures in Gram-Negative Bacilli Bacteremia: Implications for Selecting Who Needs Follow-Up Blood Cultures
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Young Im Lee, Hayato Mitaka, Tessa Gomez, and David C. Perlman
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follow-up blood culture ,medicine.medical_specialty ,Gram-negative bacilli ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Disease ,medicine.disease ,Logistic regression ,bacterial infections and mycoses ,Confidence interval ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Internal medicine ,Bacteremia ,Acute care ,medicine ,Major Article ,Blood culture ,Hemodialysis ,bacteremia ,business - Abstract
Background The value of follow-up blood cultures (FUBCs) to document clearance of bacteremia due to Gram-negative bacilli (GNB) has not been well established. Although previous studies suggested that the yield of FUBCs for GNB bacteremia is low, it remains to be elucidated for whom FUBC may be beneficial and for whom it is unnecessary. Methods A retrospective cohort study was performed at 4 acute care hospitals to identify risk factors for positive FUBCs with GNB bacteremia and to better guide clinicians’ decisions as to which patients may or may not benefit from FUBCs. Participants included adult patients with GNB bacteremia who had FUBCs and were admitted between January 2017 and December 2018. The primary outcomes were the factors associated with positive FUBCs and the yield of FUBCs with and without the factors. Results Of 306 patients with GNB bacteremia who had FUBCs, 9.2% (95% confidence interval, 6.2%–13.0%) had the same GNB in FUBCs. In the multivariate logistic regression analysis, end-stage renal disease on hemodialysis, intravascular device, and bacteremia due to extended-spectrum β-lactamase or carbapenemase-producing organism were identified as independent predictors of positive FUBCs with GNB bacteremia. Approximately 7 FUBCs and 30 FUBCs were needed for patients with ≥1 or no risk factors, respectively, to yield 1 positive result. SummaryThis multi-site retrospective cohort study found that among patients with gram-negative bacilli (GNB) bacteremia, having ESRD on hemodialysis, intravascular devices, or bacteremia due to multi-drug resistant GNB were each independently associated with having a positive follow-up blood culture. Conclusions Follow-up blood culture may not be necessary for all patients with GNB bacteremia and has the highest yield in patients with 1 or more risk factors.
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- 2020
323. Bartonella Endocarditis: A Case Series from Chennai, India
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Panneer Selvam Ganesan, Rayvathy Balasubramanian, Thangam Menon, Pierre-Edouard Fournier, University of Madras, Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche Biomédicale des Armées (IRBA)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Madras Medical College, and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA)
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Bartonella ,[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases ,biology ,infective endocarditis ,business.industry ,gram-negative bacilli ,real-time polymerase chain reaction ,lcsh:R ,Clinical Biochemistry ,lcsh:Medicine ,General Medicine ,biology.organism_classification ,medicine.disease ,[SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology ,Virology ,3. Good health ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology ,Medicine ,Endocarditis ,[SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology ,business - Abstract
International audience; Bartonella spp. are Gram-negative haemotropic bacteria transmitted by arthropod vectors. They are considered as important aetiologic agents of Blood Culture Negative Endocarditis (BCNE). The diagnosis of Bartonella endocarditis is often challenging because of its non-specific clinical presentation and difficulty in isolating the microorganism in culture using standard microbiological techniques as it is an intracellular bacterium. A combination of serological and molecular methods will aid in a comprehensive diagnosis of this condition. This study reports a series of four Bartonella endocarditis cases diagnosed in Chennai, Tamil Nadu, India. All of them were known Rheumatic Heart Disease (RHD) patients. The common valves affected in the patients were mitral and aortic valves. Three out of four cases showed presence of valvular vegetation in echocardiogram. One patient had a history of close contact with cats. Specific real time Polymerase Chain Reaction (PCR) targeting 16S-23S rRNA spacer region of Bartonella spp. was positive in three cases. Serology using Indirect Immunofluorescence Assay (IFA) was positive in one case. Western blot test was performed on serum samples of all four cases and Bartonella henselae was identified as the aetiological agent in one case. Extra cardiac complications were observed in three cases. Antibiotic treatment was successful in three out of four cases. One patient died due to acute renal failure.
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- 2020
324. Recombinase Polymerase Amplification Combined with Lateral Flow Strip for Rapid Detection of OXA-48-like Carbapenemase Genes in Enterobacterales.
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Hemwaranon P, Srisrattakarn A, Lulitanond A, Tippayawat P, Tavichakorntrakool R, Wonglakorn L, Daduang J, and Chanawong A
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Carbapenem-resistant Enterobacterales (CRE) possessing various carbapenemases, particularly the OXA-48 group, are now rapidly spreading and becoming a major public health concern worldwide. Phenotypic detection of OXA-48-like carbapenemases is still suboptimal due to their weak carbapenemase activity, whereas highly sensitive and specific polymerase chain reaction (PCR)-based methods take at least 3-4 h. We, therefore, developed a recombinase polymerase amplification (RPA) combined with lateral flow (LF) strip assay for the rapid detection of bla
OXA-48-like -carrying Enterobacterales isolates and 70 Gram-negative bacilli isolates containing other blaOXA-48-like -carrying Enterobacterales isolates and 70 Gram-negative bacilli isolates containing other bla genes were subjected to the RPA method performed under isothermal conditions at 37 °C within 10 min and visually inspected by LF strip within 5 min. The RPA-LF assay provided 100% sensitivity (95% confidence interval, 92.6-100%) and 100% specificity (93.5-100%) for detecting blaOXA-48-like genes from bacterial colonies. Its detection limit was 100 times less than that of the PCR method. This assay is rapid, easy to perform, and provides excellent performance without any special equipment. It may be applied for directly identifying the blaOXA-48-like genes in Enterobacterales obtained from blood culture. Rapid identification of carbapenemase types is essential for selecting appropriate antimicrobial options, particularly the β-lactams combined with novel β-lactamase inhibitors.- Published
- 2022
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325. Prevalence and Molecular Mechanisms of Carbapenem Resistance among Gram-Negative Bacilli in Three Hospitals of Northern Lebanon.
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Rima M, Oueslati S, Dabos L, Daaboul D, Mallat H, Bou Raad E, Achkar M, Mawlawi O, Bernabeu S, Bonnin RA, Girlich D, Osman M, Hamze M, and Naas T
- Abstract
Carbapenem resistance (CR) is an emerging health issue. Epidemiological surveys on carbapenem-resistant Gram-negative bacilli (CR-GNB) in Lebanon remain scarce. In this study, we determined the prevalence of CR-GNB isolated between 2015 to 2019 in three hospitals in northern Lebanon: 311 CR- Enterobacterales (out of 11210; 2.8%), 155 CR- Pseudomonas (out of 1034; 15%) and 106 CR- Acinetobacter (out of 184; 57.6%) were identified. CR mechanisms were determined for 146 randomly chosen isolates: the Carba NP test revealed an enzymatic resistance to carbapenems in 109 isolates (out of 146, 74.7%). Produced carbapenemases were evaluated by the NG-Test Carba5, NG-Test OXA-23 immunochromatographic assays and PCR. Carbapenemase-producing (CP) Enterobacterales expressed bla
OXA-48 -like, blaNDM -like and blaVIM -like genes and CP- Pseudomonas expressed blaIMP -like and blaVIM -like genes, whereas CP- Acinetobacter expressed blaOXA-23 -like genes. The NG-Test Carba5 results were confirmed by PCR sequencing and revealed several variants, such as NDM-19, VIM-62 and OXA-162, never described so far in Lebanon. Isolates with discordant results were sequenced by WGS and highlighted novel variants of the natural oxacillinases of Pseudomonas aeruginosa : blaOXA-50 -like genes. Their role in carbapenem resistance should be further studied. Overall, our findings highlight an alarming situation and encourage health care centers to establish performant registration systems that could help in limiting resistance spread.- Published
- 2022
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326. Comparative In Vitro Study of Biofilm Formation and Antimicrobial Susceptibility in Gram-Negative Bacilli Isolated from Prosthetic Joint Infections.
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Macias-Valcayo A, Aguilera-Correa JJ, Broncano A, Parron R, Auñon A, Garcia-Cañete J, Blanco A, and Esteban J
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- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Escherichia coli, Humans, Microbial Sensitivity Tests, Biofilms, Gram-Negative Bacteria
- Abstract
Prosthetic joint infections (PJIs) are typically caused by microorganisms that grow in biofilms. Traditional antimicrobial susceptibility tests are based on the study of planktonic bacteria that might lead to missing the biofilm behavior and to a treatment failure. This study was designed to analyze the antimicrobial susceptibility of clinical Gram-negative bacilli (GNB) isolates from PJIs in planktonic and sessile states and the possible relationship between antimicrobial resistance and biofilm formation. A total of 46 clinical isolates from patients with PJIs (mainly hip and knee prostheses) plus three GNB ATCC isolates were studied. The Minimal Inhibitory Concentration (MIC), minimal bactericidal concentration (MBC), minimal biofilm inhibitory concentration (MBIC), and minimal biofilm eradication concentration (MBEC) were assessed using a previously published methodology. Almost all of the GNB clinical isolates tested were biofilm forming. Pseudomonas aeruginosa was the largest biofilm-forming species. A comparison of MBIC
90 versus MIC90 shows an increase higher than 1- to -2-fold dilutions in most antimicrobials studied, and MBEC90 was significantly higher than MIC90, becoming resistant to all the antimicrobial drugs tested. Higher biofilm production values were obtained in antibiotic-susceptible Escherichia coli in comparison to their resistant counterparts. However, regarding the relationships between antimicrobial resistance and biofilm formation, our analysis showed that each strain differed. A high antimicrobial resistance rate was found among the GNB studied. Moreover, almost all bacterial isolates were in vitro biofilm formers. Although there was no significant association between biofilm and antibiotic resistance, multidrug-resistant isolates were found to be greater biofilm formers than non-multidrug-resistant isolates. IMPORTANCE This study is the first one to analyze a high number of isolates of Gram-negative bacilli that are the cause of prosthetic joint infection. The analysis includes biofilm development and antimicrobial susceptibility testing of both planktonic and sessile bacteria. The obtained results support the clinical knowledge about the treatment of these bacteria when biofilms are involved.- Published
- 2022
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327. Risk of Cardiovascular Implantable Electronic Device Infection in Patients Presenting With Gram-Negative Bacteremia.
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Chesdachai S, Baddour LM, Sohail MR, Palraj BR, Madhavan M, Tabaja H, Fida M, Lahr BD, and DeSimone DC
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Background: Gram-negative bacteremia (GNB) as a manifestation of cardiovascular implantable electronic device (CIED) infection is uncommon. Moreover, echocardiography may be nonspecific in its ability to differentiate whether CIED lead masses are infected. We aimed to determine the rate of CIED infection in the setting of GNB., Methods: All patients with CIED who were hospitalized with GNB during 2012-2019 at Mayo Clinic were investigated. The definition of CIED infection was based on criteria recommended by the 2019 European Heart Rhythm Association document., Results: A total of 126 patients with CIED developed GNB. None of them had signs of pocket infection. Twenty (15.9%) patients underwent transesophageal echocardiography. Overall, 4 (3%) patients had definite CIED infection. None of them underwent CIED extraction; 3 died within 12 weeks and 1 received long-term antibiotic suppression. Ten (8%) patients had possible CIED infection; despite no CIED extraction, no patient had relapsing GNB. We observed a higher rate of CIED infection in patients with Serratia marcescens bacteremia as compared to that in patients with other GNB., Conclusions: The rate of CIED infection following GNB was relatively low. However, accurate classification of CIED infection among patients presenting with GNB remains challenging, in part, due to a case definition of CIED infection that is characterized by a low pretest probability in the setting of GNB. Prospective, multicenter studies are needed to determine accurate identification of CIED infection among GNB, so that only patients with true infection undergo device removal., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2022
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328. Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum β-lactamases among clinical isolates of gram-negative bacilli in Jimma, Ethiopia
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Zeynudin, Ahmed, Pritsch, Michael, Schubert, Sören, Messerer, Maxim, Liegl, Gabriele, Hoelscher, Michael, Belachew, Tefara, and Wieser, Andreas
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Gram-negative bacilli ,Genotype ,Enterobacteriaceae Infections ,Microbial Sensitivity Tests ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,Antimicrobial susceptibility ,beta-Lactamases ,Anti-Bacterial Agents ,Extended-spectrum beta-lactamase ,lcsh:Infectious and parasitic diseases ,Aminoglycosides ,Enterobacteriaceae ,Gene Frequency ,Gram-negative Bacilli ,Extended-spectrum Beta-lactamase ,Ctx-m ,Antimicrobial Susceptibility ,Ethiopia ,Prevalence ,polycyclic compounds ,Humans ,lcsh:RC109-216 ,CTX-M ,Research Article ,Fluoroquinolones - Abstract
Background The prevalence of extended-spectrum β-lactamases (ESBLs) have been reported in clinical isolates obtained from various hospitals in Ethiopia. However, there is no data on the prevalence and antibiotic susceptibility patterns of CTX-M type ESBL produced by Gram-negative bacilli. The aim of this study was to determine the frequency and distribution of the blaCTX-M genes and the susceptibility patterns in ESBL producing clinical isolates of Gram-negative bacilli in Jimma University Specialized Hospital (JUSH), southwest Ethiopia. Methods A total of 224 non-duplicate and pure isolates obtained from clinically apparent infections, were included in the study. Identification of the isolates was performed by MALDI-TOF mass spectrometry. Susceptibility testing and ESBL detection was performed using VITEK® 2, according to EUCAST v4.0 guidelines. Genotypic analysis was performed using Check-MDR CT103 Microarrays. Results Of the total 112 (50.0%) isolates screen positive for ESBLs, 63.4% (71/112) tested positive for ESBL encoding genes by Check-MDR array, which corresponds to 91.8% (67/73) of the total Enterobacteriaceae and 10.3% (4/39) of nonfermenting Gram-negative bacilli. Among the total ESBL gene positive isolates, 95.8% (68/71) carried blaCTX-M genes with CTX-M group 1 type15 being predominant (66/68; 97.1% of CTX-M genes). The blaCTX-M carrying Enterobacteriaceae (n = 64) isolates showed no resistance against imipenem and meropenem and a moderate resistance rate against tigecycline (14.1%), fosfomycin (10.9%) and amikacin (1.6%) suggesting the effectiveness of these antibiotics against most isolates. On the other hand, all the blaCTX-M positive Enterobacteriaceae showed a multidrug resistant (MDR) phenotype with remarkable co-resistances (non-susceptibility rates) to aminoglycosides (92.2%), fluoroquinolones (78.1%) and trimethoprim/sulfamethoxazol (92.2%). Conclusions This study demonstrates a remarkably high prevalence of blaCTX-M genes among ESBL-producing isolates. The high level of resistance to β-lactam and non-β-lactam antibiotics as well as the trend to a MDR profile associated with the blaCTX-M genes are alarming and emphasize the need for routine diagnostic antimicrobial susceptibility testing for appropriate choice of antimicrobial therapy. Electronic supplementary material The online version of this article (10.1186/s12879-018-3436-7) contains supplementary material, which is available to authorized users.
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- 2018
329. Evaluation of Gram-Negative Bacilli Isolated from Patients in Intensive Care Units
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Muhammet Emin Naldan, Ömer Karaşahin, Mehmet Veysel Coşkun, Onur Ünal, and Mete Koray Vural
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medicine.medical_specialty ,Gram-negative bacilli ,business.industry ,lcsh:R ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,lcsh:Medicine ,Gram negative bacilli ,lcsh:RC86-88.9 ,bacterial infections and mycoses ,Intensive care unit ,intensive care unit ,infection ,law.invention ,law ,Intensive care ,medicine ,Intensive care medicine ,business - Abstract
Objective: A significant proportion of nosocomial infections resulting in significant mortality and morbidity for hospitalized patients are due to the patients in intensive care units (ICU). For this reason, the identification and detection of antimicrobial resistance in the microorganisms that are isolated from ICU patients is of great importance for successful treatment. Therefore, in this study, it was aimed to evaluate Gram-negative bacilli (GNB) isolated from patients in ICU of Erzurum Regional Training and Research Hospital, Turkey. Materials and Methods: A total of 327 GNB isolated from the clinical specimens of patients in ICU between January 2015 and January 2016 were evaluated. The conventional methods and the Kirby Bauer disc diffusion method (if necessary assisted with Vitek 2 automated system) were used for the identification and detection of antimicrobial susceptibility of isolated microorganisms. Antibiotic susceptibility tests were interpreted according to EUCAST criteria. Results: Of the 327 GNB, 218 were nonfermentative and 109 were Enterobacteriaceae spp. The most frequently isolated microorganisms were Acinetobacter baumannii and Klebsiella pneumoniae, respectively. The microorganisms were mostly isolated from respiratory tract samples and blood cultures. All of A. baumannii and Pseudomonas aeruginosa strains were susceptible to colistin and trimethoprim-sulfamethoxazole resistance was not detected in Stenotrophomonas maltophilia. The lowest resistance in K. pneumoniae and Escherichia coli was found against amikacin while the highest resistance was found against ampicillin/sulbactam. These ratios were observed against imipenem-meropenem and cefuroxime for Enterobacter spp., respectively. Conclusion: These results indicate that resistant GNB infections continue to be a serious problem in the ICU and emphasize the need to update and monitor the empirical antibiotic selection to prevent these infections.
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- 2017
330. Different phenotypic and molecular mechanisms associated with multidrug resistance in Gram-negative clinical isolates from Egypt
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Omneya M. Helmy and Mona T. Kashef
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0301 basic medicine ,Imipenem ,Gram-negative bacilli ,Klebsiella pneumoniae ,030106 microbiology ,medicine.disease_cause ,RAPD typing ,Microbiology ,03 medical and health sciences ,multidrug resistance ,medicine ,Pharmacology (medical) ,Original Research ,Pharmacology ,biology ,Pseudomonas aeruginosa ,biology.organism_classification ,Acinetobacter baumannii ,Multiple drug resistance ,Infectious Diseases ,Infection and Drug Resistance ,efflux pump ,Gentamicin ,Egypt ,Efflux ,medicine.drug ,Piperacillin - Abstract
Omneya M Helmy,Mona T Kashef Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt Objectives: We set out to investigate the prevalence, different mechanisms, and clonal relatedness of multidrug resistance (MDR) among third-generation cephalosporin-resistant Gram-negative clinical isolates from Egypt.Materials and methods: A total of 118 third-generation cephalosporin-resistant Gram-negative clinical isolates were included in this study. Their antimicrobial susceptibility pattern was determined using Kirby–Bauer disk diffusion method. Efflux pump-mediated resistance was tested by the efflux-pump inhibitor-based microplate assay using chlorpromazine. Detection of different aminoglycoside-, β-lactam-, and quinolone-resistance genes was done using polymerase chain reaction. The genetic diversity of MDR isolates was investigated using random amplification of polymorphic DNA.Results: Most of the tested isolates exhibited MDR phenotypes (84.75%). The occurrence of efflux pump-mediated resistance in the different MDR species tested was 40%–66%. Acinetobacter baumannii isolates showed resistance to most of the tested antibiotics, including imipenem. The blaOXA-23-like gene was detected in 69% of the MDR A. baumannii isolates. The MDR phenotype was detected in 65% of Pseudomonas aeruginosa isolates, of which only 23% exhibited efflux pump-mediated resistance. On the contrary, efflux-mediated resistance to piperacillin and gentamicin was recorded in 47.5% of piperacillin-resistant and 25% of gentamicin-resistant MDR Enterobacteriaceae. Moreover, the plasmid-mediated quinolone-resistance genes (aac(6’)-Ib-cr, qnrB, and qnrS) were detected in 57.6% and 83.33% of quinolone-resistant MDR Escherichia coli and Klebsiella pneumoniae isolates, respectively. The β-lactamase-resistance gene blaSHV-31 was detected for the first time in one MDR K. pneumoniae isolate from an endotracheal tube specimen in Egypt, accompanied by blaTEM-1, blaCTX-M-15, blaCTX-M-14, aac(6’)-Ib-cr, qnrS, and multidrug efflux-mediated resistance.Conclusion: MDR phenotypes are predominant among third-generation cephalosporin-resistant Gram-negative bacteria in Egypt and mediated by different mechanisms, with an increased role of efflux pumps in Enterobacteriaceae. Keywords: multidrug resistance, efflux pump, Egypt, Gram-negative bacilli, RAPD typing
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- 2017
331. Bacterial Meningitis in Older Adults.
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Hofinger, Diedre and Davis, Larry
- Abstract
The burden of disease due to bacterial meningitis is shifting toward older adults. Clinicians should maintain a high level of suspicion of meningitis in older adults, since they may present without classic signs and symptoms. Clinicians should remember that more older patients are at risk of healthcare-associated meningitis and may be at risk of more resistant organisms. A lumbar puncture should be performed as quickly as possible. If a CT scan is required before the lumbar puncture, blood cultures should be drawn and appropriate empiric antibiotics should be started before sending the patient to the CT scanner. Empiric antibiotics should be chosen based on patient history, review of patient's known illnesses and risk factors, results of CSF Gram stain, and local institution antibiotic resistance patterns. Clinicians should remember that Streptococcus pneumoniae may be resistant to penicillin and cephalosporins, so vancomycin is usually also administered until the bacterial resistance pattern is known. Adjunctive dexamethasone may be started before or at the time of antibiotic therapy based on risk versus benefit analysis, and may be discontinued if patient is found to not have Streptococcus pneumoniae meningitis. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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332. In vitro activity of doripenem alone and in multi-agent combinations against extensively drug-resistant Acinetobacter baumannii and Klebsiella pneumoniae.
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Clock, Sarah A., Tabibi, Setareh, Alba, Luis, Kubin, Christine J., Whittier, Susan, and Saiman, Lisa
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CARBAPENEMS , *MULTIAGENT systems , *DRUG resistance in bacteria , *ACINETOBACTER baumannii , *KLEBSIELLA pneumoniae , *BACTERIAL diseases , *PHARMACODYNAMICS , *DIAGNOSTIC microbiology - Abstract
Abstract: Carbapenems are increasingly needed to treat infections caused by drug-resistant gram-negative bacilli (GNB), but carbapenem resistance is increasing. We evaluated the activity of doripenem by broth microdilution against 96 extensively drug-resistant (XDR) Acinetobacter baumannii and Klebsiella pneumoniae isolates from patients with hospital-associated infections. All isolates were non-susceptible to doripenem, but ≥1 doripenem combination demonstrated synergy (fractional inhibitory concentration index: ≤0.5 for 2 agents, ≤0.75 for 3 agents) against 7 (15%) A. baumannii and 23 (48%) K. pneumoniae isolates; doripenem with rifampin and/or polymyxin B were most active. As doripenem has unique potential for use in prolonged infusions, suggested pharmacodynamic (PD) breakpoints range from 2–8 μg/mL; synergistic activity was found for higher proportions of XDR-GNB at higher PD breakpoints with doripenem with amikacin or with rifampin. The clinical utility of these observations requires further study, as treatment options for XDR-GNB infections are limited. [Copyright &y& Elsevier]
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- 2013
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333. 10 × '20 Progress—Development of New Drugs Active Against Gram-Negative Bacilli: An Update From the Infectious Diseases Society of America.
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Boucher, Helen W., Talbot, George H., Benjamin, Daniel K., Bradley, John, Guidos, Robert J., Jones, Ronald N., Murray, Barbara E., Bonomo, Robert A., and Gilbert, David
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- *
DRUG resistance , *ANTIBIOTICS , *ANTI-infective agents , *GRAM-negative bacteria , *DRUG development , *BACILLUS (Bacteria) - Abstract
Infections caused by antibiotic-resistant bacteria, especially the “ESKAPE” pathogens, continue to increase in frequency and cause significant morbidity and mortality. New antimicrobial agents are greatly needed to treat infections caused by gram-negative bacilli (GNB) resistant to currently available agents. The Infectious Diseases Society of America (IDSA) continues to propose legislative, regulatory, and funding solutions to this continuing crisis. The current report updates the status of development and approval of systemic antibiotics in the United States as of early 2013. Only 2 new antibiotics have been approved since IDSA's 2009 pipeline status report, and the number of new antibiotics annually approved for marketing in the United States continues to decline. We identified 7 drugs in clinical development for treatment of infections caused by resistant GNB. None of these agents was included in our 2009 list of antibacterial compounds in phase 2 or later development, but unfortunately none addresses the entire spectrum of clinically relevant GNB resistance. Our survey demonstrates some progress in development of new antibacterial drugs that target infections caused by resistant GNB, but progress remains alarmingly elusive. IDSA stresses our conviction that the antibiotic pipeline problem can be solved by the collaboration of global leaders to develop creative incentives that will stimulate new antibacterial research and development. Our aim is the creation of a sustainable global antibacterial drug research and development enterprise with the power in the short term to develop 10 new, safe, and efficacious systemically administered antibiotics by 2020 as called for in IDSA's “10 × '20 Initiative.” [ABSTRACT FROM AUTHOR]
- Published
- 2013
334. Bacterial colonization of pressure ulcers: assessment of risk for bloodstream infection and impact on patient outcomes.
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Braga, I.A., Pirett, C.C.N.S., Ribas, R.M., Filho, P.P. Gontijo, and Filho, A. Diogo
- Abstract
Summary: Background: Pressure ulcers (PUs) represent a major problem for hospitalized patients, health professionals and society. Aim: To evaluate the impact of in-hospital PUs as a reservoir of multidrug-resistant organisms (MDROs), risk factor for bacteraemia and predictor of poor prognosis. Methods: A prospective cohort study of patients with stage II or greater PUs hospitalized in a tertiary acute care university teaching hospital for more than 48 h was performed to evaluate colonization/infection by potential and/or multi-resistant hospital pathogens from April to December 2005 and from August 2009 to April 2010. Findings: A total of 145 patients with stage II or greater PUs were included. Of these, 76.5% (111/145) had PUs colonized and/or infected with either S. aureus (20.7%), Gram-negative bacilli (32.5%), or both (46.8%) and most were MDROs (64.8%). Bacteraemia was detected in 50.5% (56/111) of the patients. The ulcers were considered to be the probable source of bacteraemia in 53.6% (30/56) of the episodes. Prior administration of antibiotics (P = 0.04) and infected wound (P < 0.001) were the variables independently associated with bloodstream infection as well as associated with a higher 30-day mortality rate; risk factors for the latter included hospitalization in ICU (P = 0.03) and mechanical ventilation use (P = 0.05). Conclusions: Our results suggest that besides being a major reservoir of MDROs, patients with PUs constitute a high-risk population for bacteraemia with a poor outcome. Broad-spectrum antibiotics and infected wound were independent factors predisposing patients to both bacteraemia and death. [ABSTRACT FROM AUTHOR]
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- 2013
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335. Treatment of Complicated Urinary Tract Infections With an Emphasis on Drug-Resistant Gram-Negative Uropathogens.
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Levison, Matthew and Kaye, Donald
- Abstract
Complicated urinary tract infection is a challenging infection, since cure is difficult and either persistence or recurrence is common. The challenge is frequently increased because complicated urinary tract infection is often caused by gram-negative bacilli resistant to multiple antimicrobial drugs. In this review, we approach the therapy of complicated urinary tract infection with an emphasis on those caused by antimicrobial drug-resistant gram-negative uropathogens. [ABSTRACT FROM AUTHOR]
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- 2013
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336. There should be no ESKAPE for febrile neutropenic cancer patients: the dearth of effective antibacterial drugs threatens anticancer efficacy.
- Author
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Bow, E. J.
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- *
MULTIDRUG resistance , *BETA lactamases , *GRAM-negative bacteria , *GRAM-negative bacterial diseases , *METHICILLIN-resistant staphylococcus aureus , *ANTINEOPLASTIC agents - Abstract
The success of modern anticancer treatment is a composite function of enhanced efficacy of surgical, radiation and systemic treatment strategies and of our collective clinical abilities in supporting patients through the perils of their cancer journeys. Despite the widespread availability of antibacterial therapies, the threat of community- or healthcare facility-acquired bacterial infection remains a constant risk to patients during this journey. The rising prevalence of colonization by multidrug-resistant (MDR) bacteria in the population, acquired through exposure from endemic environments, antimicrobial stewardship and infection prevention and control strategies notwithstanding, increases the likelihood that such organisms may be the cause of cancer treatment-related infection and the likelihood of antibacterial treatment failure. The high mortality associated with invasive MDR bacterial infection increases the likelihood that many patients may not survive long enough to reap the benefits of enhanced anticancer treatments, thus threatening the societal investment in the cancer journey. Since cancer care providers arguably no longer have, and are unlikely to have in the foreseeable future, the antibacterial tools to reliably rescue patients from harm's way, the difficult ethical debate over the risks and benefits of anticancer treatments must now be reopened. [ABSTRACT FROM PUBLISHER]
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- 2013
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337. Treatment of Prosthetic Joint Infections: Validation of a Surgical Algorithm and Proposal of a Simplified Alternative.
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Martel-Laferrière, Valérie, Laflamme, Pierre, Ghannoum, Marc, Fernandes, Julio, Di Iorio, Daniela, and Lavergne, Valéry
- Abstract
Abstract: The Del Pozo and Patel (DPP) algorithm permits to identify suitable candidates for debridement and implant retention (DR) in prosthetic joint infections (PJI), but does not include gram-negative bacilli (GNB) as a risk factor of worst outcome. We conducted a retrospective study to validate the DPP algorithm and propose a simplified algorithm including GNB PJI. From 2002 to 2009, 73 PJI underwent surgery; 55% were chosen according to PDD algorithm. Non-adherence increased the risk of treatment failure (HR = 4.2). Performing DR in the presence of GNB PJI and performing DR in a joint prosthesis implanted for >3 months without hematogenous infection were independent risk factors. Our simplified algorithm, based on these 2 criteria, showed comparable performance to the DPP algorithm but increased eligibility for DR by a 2.4 fold. [Copyright &y& Elsevier]
- Published
- 2013
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338. De-escalation of antimicrobial therapy for bacteraemia due to difficult-to-treat Gram-negative bacilli.
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Shime, N., Kosaka, T., and Fujita, N.
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ACADEMIC medical centers ,ANTI-infective agents ,BLOOD testing ,CHI-squared test ,CONFIDENCE intervals ,DRUG resistance ,EPIDEMIOLOGY ,GRAM-negative bacterial diseases ,MICROBIAL sensitivity tests ,RESEARCH funding ,SEPSIS ,U-statistics ,DATA analysis ,RETROSPECTIVE studies ,SEVERITY of illness index ,DESCRIPTIVE statistics ,PHARMACODYNAMICS - Abstract
Purpose: To examine the status and clinical outcome of de-escalating antimicrobial therapy for bacteraemia due to hospital-acquired, Gram-negative bacilli that are difficult to treat. Methods: Among 1,610 patients presenting with positive blood cultures collected at our medical centre over a 6-year period, 133 were infected with Serratia, Pseudomonas, Acinetobacter, Citrobacter or Enterobacter sp. (SPACES). We examined the appropriateness of an empiric initial administration of antimicrobials based on in vitro sensitivity, and the success and outcomes of a pathogen-directed de-escalation of therapy. The treatment was considered to be successfully de-escalated when the antimicrobial spectrum was narrowed according to a spectrum ranking or when ≥2 antimicrobials prescribed initially were lowered to one agent. Outcome measures included persistent, recurrent and metastatic infections, infection-related deaths and cost of antimicrobials. Results: The treatment was initially appropriate in 79 of 133 patients (59 %), of whom 49 (62 %) were candidates for and 28 (57 %) underwent treatment de-escalation. No treatment failure was observed among these 28 patients, while 2 of 11 patients (18 %) whose treatment was not de-escalated died ( p = 0.13). The median cost of antimicrobials was €250/patient lower in the de-escalated than in the non-de-escalated group ( p < 0.001). Conclusions: Antimicrobial therapy for bacteraemia due to hard-to-treat SPACES was de-escalated in 57 % of candidates, based on the in vitro sensitivity, with no deaths and significantly lower costs of antimicrobial therapy. [ABSTRACT FROM AUTHOR]
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- 2013
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339. Prevalence and Molecular Characterization of Metallo β-Lactamase Producing Gram-Negative Pathogens Causing Eye Infections.
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Rameshkumar G, Dhandapani R, Lalitha P, Rajapandian SGK, Palanivel V, Thangavelu S, Alyousef AA, Albalawi T, Alam P, Zubair M, Saleh FM, Alatawi FA, and Husain FM
- Subjects
- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Escherichia coli, Gram-Negative Bacteria genetics, Humans, Microbial Sensitivity Tests, Prevalence, Pseudomonas aeruginosa genetics, beta-Lactamases genetics, Endophthalmitis drug therapy, Endophthalmitis epidemiology, Eye Infections drug therapy
- Abstract
Purpose: Metallo β-lactamases (MβL) production is a worldwide problem, particularly in gram-negative bacteria. As scanty data is available on the prevalence of MBL, the present study is being undertaken to determine the prevalence, antibacterial sensitivity patterns, and molecular characterization of MβL associated resistant genes in gram-negative bacteria isolated from ocular infections., Material and Methods: At a tertiary eye care center in south India, 359 gram-negative pathogens, 200 isolates from eye infections, and 159 isolates from normal flora of the eye were studied. A gold standard microbiology method was used to identify the isolates. An antibiotic double disc synergy test and a combination disc test were used to detect MβL production. Multiplex PCR was used to investigate the molecular characteristics of the MβL encoding genes bla
VIM , blaIMP , and blaNDM ., Results: Of the 359 gram-negative bacterial pathogens, Pseudomonas aeruginosa 108 (30.1%) and Enterobacter agglomerans 46 (12.8%) were commonly isolated. High prevalence of P. aeruginosa 81% (17 strains) was detected as an MβL producer and it shows 100% resistance to 2nd and 3rd generation cephalosporins and meropenem. Multiplex PCR detected only the blaVIM gene in 56 (28%) of various eye infections and 27 (17%) of normal flora of the gram-negative bacteria (GNB). The blaVIM gene is detected predominantly in 51.8% of keratitis and 21.4% of postoperative endophthalmitis. High prevalence of the gene was detected in P. aeruginosa 42.9% (24 of 56) and Alcaligens denitrificans 10.7% (6 of 56) from eye infections. Whereas, in the control group, P. aeruginosa and E. coli each had 14.8% (4 of 27) that were shown positive., Conclusion: The emerging MβLs mediated resistance among P. aeruginosa is a challenging task for ophthalmologists, especially in patients with endophthalmitis and bacterial keratitis. This local knowledge will aid in advising appropriate antibiotic use and avoiding unnecessary antibiotic prescriptions, which are highly warranted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Rameshkumar, Dhandapani, Lalitha, Rajapandian, Palanivel, Thangavelu, Alyousef, Albalawi, Alam, Zubair, Saleh, Alatawi and Husain.)- Published
- 2022
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340. Bedside risk prediction for positive follow-up blood culture in Gram-negative bacilli bacteremia: for whom is follow-up blood culture useful?
- Author
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Kim H, Seo H, Chung H, Park S, Sung H, Kim MN, Bae S, Jung J, Kim MJ, Kim SH, Lee SO, Choi SH, Kim YS, and Chong YP
- Subjects
- Adult, Blood Culture methods, Fever, Follow-Up Studies, Gram-Negative Bacteria, Gram-Positive Bacteria, Humans, Retrospective Studies, Bacteremia diagnosis, Bacteremia drug therapy, Bacteremia microbiology, Gram-Negative Bacterial Infections diagnosis, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections microbiology
- Abstract
Purpose: The value of follow-up blood culture (FUBC) in Gram-negative bacteremia (GNB) management is controversial. We evaluated bedside risk predictors and their probabilities of yielding positive FUBCs in GNB., Methods: All adult patients with GNB in a 2700-bed tertiary center were retrospectively enrolled between January 2019 and December 2019. Only one initial GNB episode was included per patient. Positive FUBC was defined as isolation of the same organism in blood culture 48-72 h after the initial blood culture., Results: A total of 2216 patients with GNB were identified, of whom 34.4% underwent FUBC. Of the 645 patients with FUBCs analyzed in the study, 89 (13.8%) had positive FUBCs. In multivariate analysis, hemodialysis [adjusted odds ratio (aOR), 2.6], fever on the day of FUBCs (aOR 3.6), intravascular device (aOR 2.4), no use of in vitro active antibiotic within 24 h (aOR 2.5), non-fermenting bacteria (aOR 4.7), and multidrug resistance (aOR 5.4) were independent risk factors for positive FUBCs. If microbiological results were excluded in multivariate analysis, hemodialysis, immunosuppressive treatment, fever on the day of FUBCs, and intravascular device were independent bedside risk predictors for positive FUBCs. The yield of FUBCs increased from 3.0% (95% CI 1.0-7.0) to 63.6% (95% CI 25.6-100) as the number of bedside risk predictors increased from 0 to 4. In addition, positive FUBCs were significantly associated with 30 day mortality., Conclusions: FUBCs may not need to be routinely used for patients with GNB bacteremia, and bedside risk predictors could be helpful in identifying patients for whom FUBC is likely to be useful., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2022
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341. The problem of multi-resistance in gram-negative bacilli in intensive care units: Treatment and prevention strategies.
- Author
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Garnacho-Montero J and Amaya-Villar R
- Subjects
- Anti-Bacterial Agents therapeutic use, Gram-Negative Bacteria, Humans, Intensive Care Units, Gram-Negative Bacterial Infections drug therapy, Gram-Negative Bacterial Infections prevention & control
- Abstract
The rise of infections caused by multi-resistant gram-negative bacilli (MR-GNB), which includes carbapenems, represents one of the major current challenges worldwide. These MR-GNB include extended spectrum β-lactamase-producing Enterobacterales, derepressed AmpC-producing or carbapenemase-producing Enterobacterales as well as non-fermenting Gram-negative bacilli such as Pseudomonas aeruginosa or Acinetobacter baumannii. P. aeruginosa predominantly exhibits other resistance mechanisms different to β-lactamases such as expulsion pumps or loss of porins. A. baumannii frequently presents several of these resistance mechanisms. Mortality is high especially if empirical treatment is inadequate. In this review, treatment strategies are revised, describing the tools available to identify patients in whom empirical antibiotic treatment would be justified to cover MR-GNB, the importance of optimizing the administration of these antibiotics, as well as prevention strategies to avoid its spread from patients colonized or infected by a MR-GNB., (Copyright © 2022. Published by Elsevier España, S.L.U.)
- Published
- 2022
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342. In vitro activity of ceftolozane/tazobactam against Gram-negative isolates collected from ICU patients with lower respiratory tract infections in seven Asian countries-SMART 2017-2019.
- Author
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Lob SH, Kazmierczak KM, Chen WT, Siddiqui F, DeRyke CA, Young K, Motyl MR, and Sahm DF
- Subjects
- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Cephalosporins, Drug Resistance, Multiple, Bacterial, Humans, Intensive Care Units, Meropenem pharmacology, Piperacillin, Tazobactam Drug Combination pharmacology, Piperacillin, Tazobactam Drug Combination therapeutic use, Pseudomonas aeruginosa, Tazobactam pharmacology, Tazobactam therapeutic use, Thailand, Pseudomonas Infections drug therapy, Respiratory Tract Infections drug therapy
- Abstract
Objectives: Antimicrobial resistance is one of the top 10 global public-health threats. Especially high rates of resistance have been reported for isolates from ICU patients, requiring expanded treatment options in this setting. We evaluated the activity of ceftolozane/tazobactam and comparators against Gram-negative isolates collected from patients with lower respiratory tract infections (LRTIs) in ICUs in seven Asian countries., Methods: In 2017-2019, up to 100 consecutive, aerobic Gram-negative LRTI isolates were collected per year at each of 37 hospitals. MICs were determined using the Clinical and Laboratory Standards Institute reference broth microdilution method., Results: Overall, ceftolozane/tazobactam was active against 72% of 1408 Enterobacterales and 86% of 761 Pseudomonas aeruginosa isolates. Susceptibility to the non-carbapenem β-lactam comparators, including piperacillin/tazobactam, was 52-67% among Enterobacterales isolates, and the activity of all β-lactam comparators, including meropenem, was 57-70% among P. aeruginosa. Ceftolozane/tazobactam maintained activity against 61% of meropenem-nonsusceptible and 64% of piperacillin/tazobactam-nonsusceptible P. aeruginosa. At the country-level, ceftolozane/tazobactam activity ranged from >90% against Enterobacterales from Hong Kong and South Korea to <64% in Thailand and Vietnam, and from >90% against P. aeruginosa from South Korea, Malaysia, Philippines and Taiwan to <75% in Thailand and Vietnam. Correspondingly, the proportions of carbapenemase-positive isolates among Enterobacterales and P. aeruginosa isolates were highest in Thailand and Vietnam., Conclusion: Ceftolozane/tazobactam provides a potential treatment option for ICU patients in Asia, which is especially important considering the reduced activity of commonly used β-lactams against the studied ICU isolates. Knowledge of local resistance patterns should inform empirical therapy decision-making., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2022
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343. Evaluation of NG-Test CARBA 5 for the detection of carbapenemase-producing Gram-negative bacilli.
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Saito K, Mizuno S, Nakano R, Tanouchi A, Mizuno T, Nakano A, Suzuki Y, Kakuta N, and Yano H
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- Humans, Bacterial Proteins analysis, Bacterial Proteins genetics, beta-Lactamases analysis, beta-Lactamases genetics, Carbapenems pharmacology, Gram-Negative Bacteria genetics, Microbial Sensitivity Tests, Sensitivity and Specificity, Anti-Infective Agents, Gammaproteobacteria
- Abstract
Carbapenemase-producing Enterobacterales (CPE) pose one of the most serious antimicrobial resistance threats to public health worldwide. The outcome of CPE infection differs depending on the resistance mechanism. Therefore, rapid detection of CPE infection is essential for optimizing patient management. The carbapenem inactivation method (CIM) and modified CIM (mCIM) are standard methods for detecting CPE, but they usually require 24 h to generate results. Recently, an immunochromatographic assay, NG-Test CARBA 5, has become commercially available. It detects the five most common carbapenemase producers (KPC, IMP, NDM, VIM, and OXA-48) rapidly and accurately. We aimed to evaluate the diagnostic accuracy of NG-Test CARBA 5 for detecting carbapenemase-producing Gram-negative bacilli (CPGNB). We used 116 carbapenemase-producing strains and 48 non-carbapenemase-producing strains. Of the 116 carbapenemase-producing strains, 107 harboured genes for at least one of the five most common carbapenemases, KPC, IMP, NDM, VIM, and OXA-48-like. Forty-eight non-carbapenemase-producing strains, including carbapenem-resistant Enterobacterales , harboured genes for extended-spectrum β-lactamases (CTX-M groups [ n =25] and SHV groups [ n =2]) or plasmid-mediated AmpC β-lactamases (DHA [ n =3], CMY-2 [ n =2], and CFE-1 [ n =1]). Antimicrobial susceptibility was tested using the agar dilution method, according to the Clinical and Laboratory Standards Institute guidelines. Of the 116 carbapenemase-producing strains, 79 were resistant to at least meropenem or imipenem. The sensitivity and specificity of the NG-Test CARBA 5 for the strains were 99.1 % (106 strains positive for 107 strains of the five most common carbapenemase producers) and 100 % (60 strains negative for other types of CPGNB [ n =10] and non-CPGNB strains [ n =48]), respectively. The carbapenemase-producing strain with a false-negative result produced IMP-66. The NG-Test CARBA 5 had high sensitivity and specificity for detecting carbapenemase-producing strains.
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- 2022
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344. Salvaging lives in carbapenem-resistant Gram-negative osteoarticular and soft tissue infections: early compromises save lives.
- Author
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Agashe VM, Soman R, Rodrigues C, Shetty A, Sunavala A, Raghuvanshi S, and Menon A
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- Anti-Bacterial Agents therapeutic use, Gram-Negative Bacteria, Humans, Retrospective Studies, Carbapenems pharmacology, Carbapenems therapeutic use, Soft Tissue Infections drug therapy, Soft Tissue Infections epidemiology
- Abstract
Purpose: Incidence of carbapenem-resistant Gram-negative infections has risen alarmingly all across the globe, both in developed and developing countries alike. The purpose of this study was to assess whether challenges of life-threatening infections with very high resistance pattern can be successfully addressed by a modified approach., Methods: This is a retrospective study of 26 patients with osteoarticular and soft tissue infections with carbapenem-resistant Gram-negative bacilli treated between 2001 and 2017 with at least two year follow-up after stopping antibiotics. All were treated by a multispecialty team approach with primary aim of "source control at the earliest and avoiding recurrence at all cost". The protocol involved opting for early compromises especially in at "risk individuals", such as resorting to early amputations, especially if salvage meant multiple bony and soft tissue reconstructive procedures, explanation of prosthesis than staged revision, avoiding internal fixations, opting for shortest possible time in external fixators with reshaping and telescoping bone ends to get bony stability and increase surface area even if it meant compromising length., Results: There were five amputations, two excision arthroplasty of hip, many minor but acceptable malunions and shortening. However, lives of 24/26 patients could be salvaged, much better than most of the published data. The two patients who died had peri-prosthetic joint infection after total hip arthroplasty and presented very late in sepsis and died within days of explantation. Infection remission could be achieved in remaining patients., Conclusion: These "risk to life" cases can be successfully treated by lowering the aims and expectations from "excellent function to salvage of life and infection remission". Therein lies the "success" in these complex high-risk cases., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)
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- 2022
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345. Emerging quinolones resistant transfer genes among gram-negative bacteria, isolated from faeces of HIV/AIDS patients attending some Clinics and Hospitals in the City of Benin, Edo State, Nigeria
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Enabulele IO, Yah SC, Yusuf EO, and Eghafona NO
- Subjects
Resistance Gene Transfer ,HIV/AIDS ,Gram-negative bacilli ,Medicine - Abstract
A survey of 1431 gram-negative bacilli from June 2001 to September 2005 were obtained from the faeces of 920 HIV/AIDS patients attending some Clinics and Hospitals in Benin City, Nigeria, were screened for quinolones resistance gene. The HIV/AIDS patients CD4 cells range was ≤14/mm3 ≥800/mm3 of blood. Out of the 1431 isolates, 343 (23.9%) were resistance to quinolones with a MIC ≥4μg/ml for norfloxacin, ciprofloxacin and pefloxacin while a MIC of ≥32 µg/ml for nalidixic acid. The screened isolates include Pseudomonas aeruginosa 64(18.7%), E coli 92(26.8%), Klebsiella pneumoniae 53(15.4%), Salmonella typhi 39(11.4%), Shigella dysenteriae 36(10.5%), Proteus mirabilis 34(9.9%) and Serratia marcescens 25(7.3%). The average resistance of the isolates to the various quinolones ranged from 42.7% to 66.7%. Klebsiella were the most resistant isolates with a mean resistance of 66.7% while Proteus were the less resistant isolates with a mean resistance of 42.7%. Most isolates were resistant to Nalidixic acid followed by norfloxacin while the less resistant were to the pefloxacin. The frequency of qnr genes transfer to EJRifr as recipient ranged from 2 x 10-2 to 6 x 10-6 with an average of 2 plasmids per cell. The molecular weight of the plasmids ranged from
- Published
- 2006
346. Prosthetic valve endocarditis caused by Pseudomonas aeruginosa with variable antibacterial resistance profiles: a diagnostic challenge
- Author
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Gürtler, Nicolas, Osthoff, Michael, Rueter, Florian, Wüthrich, Daniel, Zimmerli, Lukas, Egli, Adrian, and Bassetti, Stefano
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- 2019
- Full Text
- View/download PDF
347. Prevalence of Ciprofloxacin Resistance Among Gram-Negative Bacilli at a Specialist Hospital in Saudi Arabia.
- Author
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Ahmad, Shamweel
- Subjects
- *
CIPROFLOXACIN , *MEDICAL sciences , *GRAM-negative bacteria , *QUINOLONE antibacterial agents - Abstract
Background: Resistance to antimicrobials of different structural classes including fluoroquinolones has arisen in a multitude of bacterial species both in the community and the hospitals. This may complicate the therapeutic management of infections. Decreased susceptibility to fluoroquinolones arises mainly by singlestep mutations in the gyrA and parC genes, which encode the fluoroquinolones targets, the topoisomerase enzymes, conferring cross resistance to all fluoroquinolones. Accumulation of multiple mutations in several genes confers increasing level of resistance associated with clinical failure. However, even low level resistance can generate therapeutic failure. In 1998, some mobile elements with a potential for the horizontal transfer of the quinolone resistance genes were described. The loci which are responsible for this plasmid- mediated quinolone resistance, which have been designated as qnrA, qnrB and qnrS, have been identified in the Enterobacteriaceae species. Aim: To evaluate the susceptibility pattern of the isolates to various antibiotics and to know the prevalence rate of ciprofloxacin resistance in our hospital. Materials & Methods: A total of 916 gram-negative bacilli (GNB) were isolated from different clinical specimens over a period of nine months, were subjected to antibiotic susceptibility testing. Isolates with resistance or with a decreased susceptibility to ciprofloxacin (£20 mm) were then screened for their minimum inhibitory concentration (MIC) by using the E-test. Results: Out of 916 GNB, 321 (35%) isolates were resistant to ciprofloxacin. The MIC of these isolates ranged from 4 to >32?g/ml. Conclusion: The resistance rate to ciprofloxacin was 35% in our study. Most of the ciprofloxacin resistant isolates were from urinary tract infections (UTI). The ciprofloxacin resistance was also closely associated with multi-drug resistance, thus limiting the treatment options. Ciprofloxacin resistance can be used as a general surrogate marker of multidrug resistance, thus limiting the already restricted treatment options. The considerably high MIC values for ciprofloxacin in this study reflected the extent of the treatment problems for these resistant isolates and a need for the continuous evaluation of the commonly used antibiotics. [ABSTRACT FROM AUTHOR]
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- 2012
- Full Text
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348. Long-term outcome of acute prosthetic joint infections due to gram-negative bacilli treated with retention of prosthesis.
- Author
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Jaén, Nieves, Martínez-Pastor, Juan C., Muñoz-Mahamud, Ernesto, García-Ramiro, Sebastián, Bosch, Jordi, Mensa, Josep, and Soriano, Alex
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HEALTH outcome assessment ,ARTIFICIAL joints ,GRAM-negative bacterial diseases ,PROSTHETICS ,FLUOROQUINOLONES ,UNIVARIATE analysis - Abstract
Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2012
349. Spread of carbapenemase NDM-1 producers: The situation in India and what may be proposed.
- Author
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Khan, Asad U. and Nordmann, Patrice
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CARRIER state (Communicable diseases) , *CROSS infection , *DRUG resistance in microorganisms , *DRUG prescribing , *NONPRESCRIPTION drugs , *HEALTH , *HYGIENE , *MEDICAL screening , *INFORMATION resources , *PHYSICIAN practice patterns , *CARBAPENEMS - Abstract
New Delhi metallo-β-lactamase 1 (NDM-1) producers, first identified from patients hospitalized in India, are now reported worldwide. The Indian subcontinent is clearly a main reservoir of NDM-1 producers. In order to slow down the spread of these NDM-1-positive Enterobacteriaceae, first in India and then worldwide, a series of measures must be implemented as soon as possible. These include discouraging the over-the-counter sale of antibiotics, improving basic and extended knowledge on hygiene, and the wide-scale detection of blaNDM-1, in both infecting agents and in the carrier state for at-risk patients. [ABSTRACT FROM AUTHOR]
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- 2012
- Full Text
- View/download PDF
350. Development of a multiplex polymerase chain reaction to detect five common Gram-negative bacteria of aquatic animals.
- Author
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Tsai, M-A, Ho, P-Y, Wang, P-C, E, Y-J, Liaw, L-L, and Chen, S-C
- Subjects
- *
POLYMERASE chain reaction , *GRAM-negative bacteria , *AQUATIC animals , *BACTERIAL genomes , *VIBRIO vulnificus , *AEROMONAS hydrophila , *DISEASES - Abstract
A multiplex polymerase chain reaction (m-PCR) technique was developed as a rapid and accurate diagnostic tool for identifying five major Gram-negative bacilli - Vibrio vulnificus, V. parahaemolyticus, Aeromonas hydrophila, Chryseobacterium meningosepticum and Edwardsiella tarda- that cause major diseases in cultured aquatic animals in Taiwan. The expected amplicons for V. vulnificus, V. parahaemolyticus, A. hydrophila, C. meningosepticum and E. tarda were 410, 368, 685, 180 and 230 bp, respectively. The assay was shown to be specific for the target pathogens. The sensitivities of detection were estimated to be 20.5 fg∼200 pg of genomic DNA or 102∼104 colony-forming units (cfu) of bacterial isolates when adopted as PCR templates. The m-PCR was capable of simultaneously amplifying target fragments from bacterial genome DNA mixed with the DNA extracted from viscera and tissues taken from fish without affecting the performance of the method. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
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