scholarly journals Bloodstream Infections Caused by S. aureus: Daptomycin Nonsusceptibility and Clinical Aspects

2020 ◽  
Vol 41 (S1) ◽  
pp. s143-s143
Author(s):  
Simone Nouer ◽  
Débora S. Fernandes ◽  
Rennan Les ◽  
Adriana Lucia Pires Ferreira ◽  
Kátia Regina Netto dos Santos
Keyword(s):  
Area Under The Curve ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Epidemiological Studies ◽  
Clinical Aspects ◽  
Disk Diffusion Test ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Vancomycin Mics ◽  
Stage Renal Disease

Background:Staphylococcus aureus is one of the leading pathogens isolated from bloodstream infections (BSIs), and vancomycin has been the main choice to treat MRSA (methicillin-resistant S. aureus) infections. Vancomycin-intermediate S. aureus (VISA) and heteroresistant-VISA (hVISA) have been described, limiting this antibiotic use. We evaluated aspects associated with the resistance and its clonality of the S. aureus isolated from BSIs, and we determined their association with clinical aspects of patients attended at Rio de Janeiro between 2016 and 2018. The detection of MRSA and trimethoprim-sulfamethoxazole resistant isolates was performed using the disk diffusion test, while the minimum inhibitory concentrations (MICs) were evaluated for 5 antimicrobials using the broth microdilution method. The MICs for ceftaroline and vancomycin of the MRSA isolates were determined using the E test. The presence of hVISA isolates was evaluated for isolates with vancomycin MICs of 1 and 2 μg/mL by screening on BHI agar added with vancomycin. The population profile was divided by the area under the curve (ie, PAP/AUC test). SCC mec was evaluated by PCR and the clonal profile by PFGE method. Among 123 S. aureus isolates from BSI, 31% were MRSA. MIC50 and MIC90 were daptomycin 2 and 2 μg/mL; linezolid, 1 and 1 μg/mL; oxacillin 1 and 256 μg mL; teicoplanin, 0.5 and 0.5 μg/mL and vancomycin 1 and 1 μg/ml. MIC values for ceftaroline and vancomycin were 0.75 and 2 μg/mL. The frequency of isolates not susceptible to daptomycin was 75%. The clonal lineages and SCCmec types found were USA100/ST5-II (50%), USA800/ST5-IV (22%), USA300/ST8-IV (15.8%), USA1100/ST30-IV (5.3%), BEC/ST239-III (5.3%), and 1 isolate carrying SCCmecV/ST1. We found 1 VISA isolate, and the PAP/AUC analysis detected 3 hVISA isolates that were associated with the USA100 and USA300 lineages. Overall, 85% of patients had a vascular catheter. More advanced age was associated with MRSA infection as was higher mortality. Patients with end-stage renal disease were more affected by MSSA infection. Daptomycin nonsusceptibility and VISA and hVISA phenotypes associated with prevalent clonal lineages were described. In addition, MRSA infections presented higher mortality, which emphasizes the importance of epidemiological studies.Funding: NoneDisclosures: None

scholarly journals Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 76
Author(s):  
Matthaios Papadimitriou-Olivgeris ◽  
Christina Bartzavali ◽  
Alexandra Georgakopoulou ◽  
Fevronia Kolonitsiou ◽  
Chrisavgi Papamichail ◽  
...  
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Carbapenemase Gene ◽  
Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

scholarly journals Evaluation of Vancomycin and Daptomycin Potency Trends (MIC Creep) against Methicillin-Resistant Staphylococcus aureus Isolates Collected in Nine U.S. Medical Centers from 2002 to 2006

2009 ◽  
Vol 53 (10) ◽  
pp. 4127-4132 ◽  
Author(s):  
Helio S. Sader ◽  
Paul D. Fey ◽  
Douglas N. Fish ◽  
Ajit P. Limaye ◽  
George Pankey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Center ◽  
Geometric Mean ◽  
Yearly Variation ◽  
Microdilution Method ◽  
Medical Centers ◽  
Broth Microdilution Method ◽  
Vancomycin Mics ◽  
Type Population ◽  
Mrsa Strains

ABSTRACT Vancomycin MIC creep has been reported by some institutions but not confirmed in large surveillance studies. We evaluated the possible occurrence of MIC creep when testing vancomycin and daptomycin against methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) by using precise incremental reference MIC methods. Nine hospitals (one in each U.S. census region) randomly selected bloodstream MRSA strains (target, 40/year) from 2002 to 2006. MICs were determined by the reference broth microdilution method using incremental dilutions (eight for each log2 dilution step). Isolates for which vancomycin MICs were >1 μg/ml were typed by pulsed-field gel electrophoresis (PFGE). The vancomycin MIC mode was either 0.625 μg/ml (for eight hospitals) or 0.813 μg/ml (for one hospital), and vancomycin MIC results for 72.9% of strains were between 0.563 and 0.688 μg/ml. No yearly variation in the central tendency of vancomycin MICs for the wild-type population in any medical center was observed; however, when data were analyzed by the geometric mean statistic, vancomycin MIC increases (at three sites) and declines (at three sites) were observed. The daptomycin MIC mode varied from 0.156 μg/ml (2003 to 2005) to 0.219 μg/ml (2002 and 2006), and MIC results for 83.5% (80.3 to 89.2% in each of the centers) of isolates fell between these values. Among PFGE-typed strains, 43 of 55 (78%; from seven hospitals) showed a pattern consistent with that of the USA100 clone, which was represented by all strains from two hospitals and 64 to 88% of strains from five other medical centers; only one strain (2%) was USA300. In conclusion, the perception of MIC creep may vary according to the methods used to analyze the data. Geometric mean MIC data revealed a possible, very-low-level MIC creep at three of nine sites over the 5-year period, which was not evident using modal MICs or the data from all nine hospitals (+0.02 μg/ml). The occurrence of isolates for which the vancomycin MIC was >1 μg/ml was very unusual, with no increased trend, but these organisms were usually clonal (USA100).

scholarly journals Cefepime-Zidebactam (WCK 5222) Activity Tested against Gram-negative Organisms Causing Bloodstream Infections Worldwide

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S374-S375 ◽  
Author(s):  
Helio S Sader ◽  
Mariana Castanheira ◽  
Jennifer M Streit ◽  
Leonard R Duncan ◽  
Robert K Flamm
Keyword(s):  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Vitro Activity ◽  
Asia Pacific ◽  
In Vitro Activity ◽  
Gram Negative ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Research Grant

Abstract Background Zidebactam (ZID), a bicyclo-acyl hydrazide, is a β-lactam enhancer with a dual mechanism of action involving selective and high binding affinity to Gram-negative (GN) PBP2 and β-lactamase inhibition. We evaluated the in vitro activity of cefepime (FEP) combined with ZID against GN organisms causing bloodstream infections (BSI) in hospitals worldwide. Methods A total of 2,094 isolates from 105 medical centers were evaluated. Isolates were collected from Europe (1,050), USA (331), Latin America (LA; 200) and the Asia-Pacific region (AP; 393) in 2015, and China (120) in 2013 by the SENTRY Program. Susceptibility (S) testing was performed by reference broth microdilution method against FEP-ZID (1:1 ratio) and comparators. The collection included 1,809 Enterobacteriaceae (ENT), 170 P. aeruginosa (PSA) and 115 Acinetobacter spp. (ASP). Results FEP-ZID was very active against ENT (MIC50/90 of ≤0.03/0.12 μg/mL) with 99.9 and 100.0% of isolates inhibited at ≤4/4 and ≤8/8 μg/mL, respectively, and retained potent activity against carbapenem-resistant (CRE; n = 44; MIC50/90, 1/4 μg/mL), multidrug-resistant (MDR), and extensively drug-resistant (XDR) isolates (Table). Amikacin (AMK; MIC50/90, 2/4 μg/mL; 97.7% S) was also very active against ENT, and colistin (COL; MIC50/90, 0.12/>8 μg/mL) inhibited only 87.3% of isolates at ≤2 μg/mL. FEP-ZID was highly active against PSA, including isolates resistant to other antipseudomonal β-lactams, MDR (MIC50/90, 4/8 μg/mL) and XDR (MIC50/90, 4/8 μg/mL) isolates. Among the comparators, COL (MIC50/90 of ≤0.5/1 μg/mL; 100.0% S) and AMK (MIC50/90, 4/16 μg/mL; 91.2% S) were the most active agents against PSA. FEP-ZID (MIC50/90, 16/32 μg/mL) was 4-fold more active than FEP against ASP. Conclusion FEP-ZID (WCK 5222) exhibited potent in vitro activity against a large worldwide collection of GN isolates from BSI, including MDR and XDR isolates. These results support further clinical development of WCK 5222 for treating BSI. Disclosures H. S. Sader, Wockhardt Bio Ag: Research Contractor, Research grant; M. Castanheira, Wockhardt Bio Ag: Research Contractor, Research grant; J. M. Streit, Wockhardt Bio Ag: Research Contractor, Research grant; L. R. Duncan, Wockhardt Bio Ag: Research Contractor, Research grant; R. K. Flamm, Wock: Research Contractor, Research support

scholarly journals 1589. Ceftolozane–Tazobactam Activity Against Difficult-to-Treat Resistance in Pseudomonas aeruginosa from Bloodstream Infections in US Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S580-S580
Author(s):  
Dee Shortridge ◽  
S J Ryan Arends ◽  
Leonard R Duncan ◽  
Jennifer M Streit ◽  
Robert K Flamm
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infections ◽  
The United States ◽  
Multidrug Resistant ◽  
First Line ◽  
Microdilution Method ◽  
Drug Classes ◽  
Broth Microdilution Method ◽  
Tract Infections ◽  
Abdominal Infections

Abstract Background Infections caused by Pseudomonas aeruginosa (PSA) resistant to first-line agents are difficult to treat and require using more toxic antimicrobials, such as amikacin (AMK) and colistin (COL). Kadri et al. recently described the category of difficult-to-treat resistance (DTR) as intermediate or resistant to all tested first-line agents (fluoroquinolones, carbapenems, and extended-spectrum cephalosporins). Ceftolozane–tazobactam (C-T) is an antibacterial combination of an antipseudomonal cephalosporin and a β-lactamase inhibitor. C-T has been approved in >60 countries to treat complicated urinary tract infections, acute pyelonephritis, and complicated intra-abdominal infections. The filing is in progress for treatment of hospital-acquired pneumonia, including ventilator-associated pneumonia. The Program to Assess Ceftolozane–Tazobactam Susceptibility (PACTS) monitors gram-negative (GN) isolates resistant to C-T worldwide. In this study, the activity of C-T and comparators against PSA bloodstream isolates that are DTR, multidrug-resistant (MDR), or extensively drug-resistant (XDR) were analyzed. Methods A total of 922 PSA isolates from BSI were collected between 2011 and 2018 from 35 PACTS hospitals in the United States. Isolates were tested for C-T susceptibility (S) by the CLSI broth microdilution method. Other antibiotics tested included cefepime (FEP), ceftazidime (CAZ), ciprofloxacin, levofloxacin (LEV), doripenem, imipenem, meropenem (MEM), piperacillin–tazobactam (PIP-TAZ), AMK and COL. Antibiotic-resistant phenotypes analyzed using CLSI (2019) breakpoints included MDR (nonsusceptible to ≥ 1 agent in ≥ 3 drug classes), XDR (susceptible to ≤ 1 agent in ≤ 2 drug classes), or DTR. Results The percent of DTR isolates was 4.8% when compared with 15.2% MDR and 9.3% XDR. The %S for C-T and other first- and second-line agents are shown in the table for each phenotype. Conclusion C-T demonstrated 97.1%S overall for BSI isolates, similar to AMK (97.8%) and COL (99.5%). C-T had better coverage than first-line drugs against MDR (81.4%) and XDR (72.1%), and 50% for the DTR isolates, which represented only 4.8% of isolates. Only AMK and COL had > 75%S for DTR isolates. Disclosures All authors: No reported disclosures.

scholarly journals Epidemiology and Virulence Determinants including Biofilm Profile of Candida Infections in an ICU in a Tertiary Hospital in India

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ravinder Kaur ◽  
Ritu Goyal ◽  
Megh S. Dhakad ◽  
Preena Bhalla ◽  
Rakesh Kumar
Keyword(s):  
Antifungal Susceptibility ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Virulence Determinants ◽  
Predominant Species ◽  
Microdilution Method ◽  
Wide Range ◽  
Broth Microdilution Method ◽  
Candida Infections ◽  
Hospital Study

The purpose of this prospective study was to isolate, speciate, and determine antifungal susceptibility and virulence patterns of Candida species recovered from the intensive care units (ICUs) in an Indian hospital. Study included 125 medical/postoperative patients admitted to ICU. Identification and speciation of yeast isolates were done by the biochemical methods. Antifungal susceptibility was done by broth microdilution method. Virulence testing of Candida species was done by phospholipase, proteinase, and adherence assay. A total of 103 Candida isolates were isolated; C. tropicalis was the predominant species (40.7%), followed by C. albicans (38.83 %), C. glabrata (11.65%), C. parapsilosis (3.88%), and 1.94% each of C. krusei, C. kefyr, and C. sphaerica. 60 Candida isolates (58.25%) showed resistance to fluconazole, while 7 (6.7%) isolates showed resistance to amphotericin B. Phospholipase and proteinase activities were seen in 73.8% and 55.3% Candida isolates with different species showing a wide range of activities, while 68.9% Candida isolates showed {4+} adherence activity. The present study revealed that nonalbicans Candida species (NAC spp.) caused most of the cases of Candidemia in the ICU patients. The isolation of C. tropicalis from a large number of cases highlights the ability of this pathogen to cause bloodstream infections. The presence of azole resistance is a matter of concern.

scholarly journals 1598. Antimicrobial Activity of the Novel β-Lactam Enhancer Combination Cefepime–Zidebactam (WCK-5222) Tested Against Gram-Negative Bacteria Isolated in United States Medical Centers from Patients with Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S583-S583
Author(s):  
Mariana Castanheira ◽  
Michael D Huband ◽  
Robert K Flamm ◽  
Helio S Sader
Keyword(s):  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
High Dose ◽  
Gram Negative ◽  
Highly Active ◽  
Microdilution Method ◽  
Medical Centers ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Dual Mechanism

Abstract Background Zidebactam (ZID) is a β-lactam enhancer antibiotic with a dual mechanism of action: high binding affinity to gram-negative PBP2 and β-lactamase (BL) inhibition. We evaluated the activity of cefepime (FEP) combined with ZID against contemporary clinical isolates of gram-negative bacilli (GNB) causing bloodstream infections (BSIs) in the US hospitals. Methods 1,239 GNB were consecutively collected (1/patient) from 34 US medical centers in 2018. Susceptibility (S) testing against FEP-ZID (1:1 ratio) and comparators were performed by reference broth microdilution method in a central laboratory. The FEP S breakpoint of ≤ 8 mg/L (CLSI, high dose) was applied to FEP-ZID for comparison purposes. An FEP-ZID S breakpoint of ≤ 64 mg/L has been proposed for non-fermentative GNB based on pharmacokinetic/pharmacodynamic target attainment and was also applied. Selected Enterobacterales (ENT) isolates were evaluated by whole-genome sequencing. Results FEP-ZID was highly active against ENT (MIC50/MIC90, 0.03/0.12 mg/L; highest MIC, 4 mg/L; Table), including multidrug-resistant (MDR, MIC50/MIC90, 0.12/0.25 mg/L) and carbapenem-resistant isolates (n = 7; MIC50, 0.5 mg/L). The highest FEP-ZID MIC values among E. coli, K. pneumoniae, and E. cloacae were 1, 2, and 0.25 mg/L, respectively. The most active comparators tested against MDR ENT were ceftazidime–avibactam (CAZ-AVI; MIC50/MIC90, 0.25/1 mg/L; 98.0%S), meropenem (MEM; MIC50/MIC90, 0.03/0.12 mg/L; 93.1%S) and amikacin (AMK; MIC50/MIC90, 4/16 mg/L; 92.1%S). The most active agents tested against P. aeruginosa were FEP-ZID (MIC50/MIC90, 1/4 mg/L; highest MIC, 8 mg/L), colistin (MIC50/MIC90, 0.5/1 mg/L; 100.0%S), and AMK (MIC50/MIC90, 4/8 mg/L; 99.2%S); whereas CAZ-AVI and ceftolozane–tazobactam were active against 96.5–96.7% of isolates. FEP-ZID exhibited good activity against Acinetobacter spp. (MIC50/MIC90, 2/8 mg/L) and S. maltophilia (MIC50/MIC90, 4/32 mg/L). S. maltophilia displayed low S rates to most comparators. Conclusion FEP-ZID demonstrated potent activity against a large collection GNB from BSI, including isolates resistant to other BL inhibitor combinations and/or carbapenems. These results support further clinical development of FEP-ZID. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Tigecycline’s MIC in the Outcome of Critically Ill Patients with Carbapenemase-Producing Klebsiella pneumoniae Bacteraemia Treated with Tigecycline Monotherapy—Validation of 2019′s EUCAST Proposed Breakpoint Changes

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 828
Author(s):  
Matthaios Papadimitriou-Olivgeris ◽  
Christina Bartzavali ◽  
Alexandra Nikolopoulou ◽  
Fevronia Kolonitsiou ◽  
Virginia Mplani ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Primary Outcome ◽  
Inhibitory Concentration ◽  
Therapeutic Option ◽  
Bloodstream Infections ◽  
Microdilution Method ◽  
Appropriate Treatment ◽  
Broth Microdilution Method ◽  
The Impact ◽  
Treatment Mortality

Background: Tigecycline is a therapeutic option for carbapenemase-producing Klebsiella pneumoniae (CP-Kp). Our aim was to evaluate the impact of the tigecycline’s minimum inhibitory concentration (MIC) in the outcome of patients with CP-Kp bacteraemia treated with tigecycline monotherapy. Methods: Patients with monomicrobial bacteraemia due to CP-Kp that received appropriate targeted monotherapy or no appropriate treatment were included. Primary outcome was 30-day mortality. MICs of meropenem, tigecycline, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. PCR for blaKPC, blaVIM, blaNDM, and blaOXA genes was applied. Results: Among 302 CP-Kp bacteraemias, 32 isolates (10.6%) showed MICs of tigecycline ≤ 0.5 mg/L, whereas 177 (58.6%) showed MICs that were 0.75–2 mg/L. Colistin and aminoglycoside susceptibility was observed in 43.0% and 23.8% of isolates, respectively. The majority of isolates carried blaKPC (249; 82.5%), followed by blaVIM (26; 8.6%), both blaKPC and blaVIM (16; 5.3%), and blaNDM (11; 3.6%). Fifteen patients with tigecycline MIC ≤ 0.5 mg/L and 55 with MIC 0.75–2 mg/L were treated with tigecycline monotherapy; 30-day mortality was 20.0% and 50.9%, respectively (p = 0.042). Mortality of 150 patients that received other antimicrobials was 24.7%; among 82 patients that received no appropriate treatment, mortality was 39.0%. No difference in 30-day mortality was observed between patients that received tigecycline (MIC ≤ 0.5 mg/L) or other antimicrobials. Conclusion: Tigecycline monotherapy was as efficacious as other antimicrobials in the treatment of bloodstream infections due to CP-Kp isolates with a tigecycline’s MIC ≤ 0.5 mg/L.

scholarly journals Ceftobiprole Activity When Tested Against Contemporary Bacteria Causing Bloodstream Infections in the US (2016)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S368-S368 ◽  
Author(s):  
Robert K Flamm ◽  
Leonard R Duncan ◽  
Dee Shortridge ◽  
Jennifer I Smart ◽  
Kamal Hamed ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Community Acquired Pneumonia ◽  
Surveillance Program ◽  
Coagulase Negative Staphylococci ◽  
Two Phase ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
The Us ◽  
Research Grant

Abstract Background Ceftobiprole medocaril (prodrug of ceftobiprole) is an advanced cephalosporin, approved for adults in multiple European countries for the treatment of hospital-acquired pneumonia (excluding ventilator-associated pneumonia) or community-acquired pneumonia. It is not approved in the US; however, it has achieved qualified infectious disease product status and two phase 3 studies supported by BARDA are planned to begin in the US in 2017. Methods A total of 2,787 Gram-positive (GP) and -negative (GN) isolates from bloodstream infections (BSI) from 30 medical centers in the SENTRY Antimicrobial Surveillance Program were evaluated. Isolates were collected in the US during 2016. Susceptibility (S) testing was performed by reference broth microdilution method against ceftobiprole and comparators. Isolates included 693 Staphylococcus aureus (SA), 216 coagulase-negative staphylococci (CoNS), 244 enterococci, 63 Streptococcus pneumoniae (SPN), 74 viridans group streptococci (VGS), 138 β-haemolytic streptococci (BHS), 1,105 Enterobacteriaceae (ENT), 129 Pseudomonas aeruginosa (PSA), 41 Acinetobacter spp. (ASP), 30 Stenotrophomonas maltophila, 19 Haemophilus spp. and 35 miscellaneous bacteria. Results Methicillin-resistant S. aureus (MRSA) S rates were lower than for methicillin-susceptible S. aureus (MSSA) for most agents. For levofloxacin (LEV) and erythromycin (ERY), the S rates were LEV: MRSA, 23.2%; MSSA, 86.1%; ERY: MRSA, 9.0%; MSSA, 69.3%. All MSSA and 99.0% of MRSA were S to ceftobiprole, while all MSSA and 96.5% of MRSA were S to ceftaroline (CPT). For CoNS, 98.1% of ceftobiprole MIC values were ≤2mg/L. Ceftobiprole was active against Enterococcus faecalis (96.1% ≤2mg/L) and not against E. faecium (18.9% ≤2mg/L). Against ENT, ceftobiprole (85.0%S) was similar in activity to ceftazidime (CAZ, 87.2%S) and cefepime (FEP, 88.9%S). The MIC50/90 values for ceftobiprole, FEP, and CAZ against PSA were identical at 2/16 mg/L. Conclusion Ceftobiprole exhibited potent in vitro activity against GP and GN isolates from contemporary BSI in the US. These results support further clinical evaluation of ceftobiprole for the treatment of BSI. Disclosures R. K. Flamm, Basilea Pharmaceutica International Ltd.: Research Contractor, Research grant; L. R. Duncan, Basilea Pharmaceutica International Ltd.: Research Contractor, Research grant; D. Shortridge, Basilea Pharmaceutica International Ltd.: Research Contractor, Research grant; J. I. Smart, Basilea Pharmaceutica International Ltd.: Employee, Salary; K. Hamed, Basilea Pharmaceutica International Ltd.: Employee, Salary; R. E. Mendes, Basilea Pharmaceutica International Ltd.: Research Contractor, Research grant; H. S. Sader, Basilea Pharmaceutica International Ltd.: Research Contractor, Research grant

scholarly journals Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuzhen Xiao ◽  
Tianchi Chen ◽  
Hairu Wang ◽  
Qian Zeng ◽  
Qing Chen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Bloodstream Infections ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Icu Patients ◽  
Microdilution Method ◽  
Antimicrobial Resistance Genes ◽  
Broth Microdilution Method ◽  
Almost All

Background: Bloodstream infections (BSIs) are recognized as important nosocomial infections. Klebsiella pneumoniae is one of the major causes of bacteremia. This retrospective study focused on drug susceptibility and molecular epidemiology of K. pneumoniae isolated from intensive care unit (ICU) patients with BSI in Shanghai, China.Methods: Consecutive K. pneumoniae isolates were collected from ICU patients. Antibiotic susceptibility testing was conducted by the broth microdilution method. PCR was performed to detect antimicrobial resistance genes. We also completed multilocus sequence typing (MLST) and GoeBURST was used to analyze the result of MLST.Results: A total of 78 K. pneumoniae isolates were enrolled. K. pneumoniae from ICU-BSIs were highly resistant to almost all common antibiotics. The most frequent resistance determinants responsible for extended-spectrum β-lactamase (ESBL) producers were blaCTX−M−14, blaCTX−M−15, and blaCTX−M−55. KPC was the only enzyme, which was detected by the carbapenemase producers. The most principal sequence types (STs) were ST11, ST15, and ST23.Conclusion: This study presents for the first time the antibiotic resistance phenotype and molecular epidemiology of K. pneumoniae isolated from ICU patients with BSIs in Shanghai. ICU-BSI K. pneumoniae is characteristic of a high resistance rate. The occurrence of the KPC-2 enzyme may result from nosocomial clonal dissemination of ST11 K. pneumoniae.

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