Reduced Use of Third-Generation Cephalosporins Decreases the Acquisition of Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae

2004 ◽  
Vol 25 (10) ◽  
pp. 832-837 ◽  
Author(s):  
Sang-Oh Lee ◽  
Eun Sun Lee ◽  
Shin Young Park ◽  
Sue-Yun Kim ◽  
Yiel-Hae Seo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Tertiary Care ◽  
Prior Exposure ◽  
Third Generation ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

AbstractObjectives:To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producingKlebsiella pneumoniaeamong patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.Design:Nested case-control and intervention study.Setting:A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.Methods:Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producingK. pneumoniaewas isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producingK. pneumoniae.After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producingK. pneumoniaebefore (October 2002 to February 2003) and after (April to August 2003) the intervention.Results:Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6;P= .002) was an independent risk factor of ESBL-producingK. pneumoniaeacquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producingK. pneumoniaeper 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 ± 5.0 vs 17.3 ± 2.6;P< .001) decreased significantly after the intervention.Conclusion:Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producingK. pneumoniae,and less use of TGCs was associated with a decrease in acquisition.

Risk Factors for Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit

2004 ◽  
Vol 25 (9) ◽  
pp. 781-783 ◽  
Author(s):  
Darren R. Linkin ◽  
Neil O. Fishman ◽  
Jean Baldus Patel ◽  
Jeffrey D. Merrill ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Clinical Epidemiology ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

AbstractRisk factors for colonization or infection with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during an outbreak in a neonatal intensive care unit (NICU) included low gestational age and exposure to third-generation cephalosporins. We also reviewed the existing medical literature regarding the clinical epidemiology of ESBLs in NICUs.

scholarly journals Risk factors for bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in a Turkish hospital

2013 ◽  
Vol 7 (07) ◽  
pp. 507-512 ◽  
Author(s):  
Onur Kaya ◽  
Fusun Zeynep Akcam ◽  
Ibak Gonen ◽  
Onur Unal ◽  
Tennure Ceylan
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Tertiary Care ◽  
Beta Lactamase ◽  
Tertiary Care Centre ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum ◽  
History Of ◽  
Independent Risk Factors

Introduction: Bloodstream infection caused by extended-spectrum beta-lactamase (ESBL)-producing pathogens has become a serious concern worldwide. The purpose of this study was to identify risk factors for bacteremia due to ESBL-producing Escherichia coli in a Turkish hospital. Methodology: We retrospectively reviewed the medical records of patients with E. coli bacteremia in a tertiary care centre from January 2007 to October 2011. Data from patients such as demographic features, underlying conditions, and antibiotic exposure were analysed. Results: A total of 113 patients with bacteremia due to E. coli were included and data from patients with ESBL-producing E. coli (case patients) were compared to those with non-ESBL-producing E. coli (control patients). The frequency of ESBL producers was 38.9% (44/113). Exposure to fluoroquinolones and cephalosporins, history of intra-abdominal surgery intervention, and presence of central venous catheteter and urinary catheteter were more frequently detected among case patients (P < 0.05). Independent risk factors for bacteremia due to ESBL-producing E. coli were exposure to fluoroquinolones (OR 13.39, 95% CI 1.28-140.03) and cephalosporins (OR 3.48, 95% CI 1.03-11.74). Conclusions: Previous use of fluoroquinolone and cephalosporin in patients with bacteremia caused by E. coli increased the risk for ESBL-producing strains.

scholarly journals Prevalence of bla CTX M Extended Spectrum Beta Lactamase Gene in Enterobacteriaceae from Critical Care Patients

2011 ◽  
Vol 3 (02) ◽  
pp. 080-083 ◽  
Author(s):  
R Indra Priyadharsini ◽  
A Kavitha ◽  
Reena Rajan ◽  
S Mathavi ◽  
K R Rajesh
Keyword(s):  
Critical Care ◽  
Intestinal Flora ◽  
Third Generation ◽  
Beta Lactamase ◽  
M Gene ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Group I ◽  
Third Generation Cephalosporins ◽  
Critical Care Patients

ABSTRACT Context: Critical care units provide a favourable environment for the antimicrobial resistant organisms to disseminate. There is recent increase in number of extended spectrum beta lactamase (ESBL) producers because of the emergence of CTX M Beta lactamases produced by Enterobacteriaceae. They colonize the intestinal flora and spread with greater intensity in the community and hospital. Usage of Carbapenems becomes mandatory as the ESBL inhibitor combination antibiotics (Amoxicillin/Clavulanate) are not effective especially against CTX M ESBLs. Aim: The aim of this study is to detect ESBL producing bla CTX M gene in Enterobacteriaceae from infections in Critical care patients and to stress on the intensity of the problem and to make interventions to curb the emergence and dissemination of CTX M ESBLs. Materials and Methods: A total of 118 Enterobacteriaceae isolates from Critical care unit patients were recovered from a variety of clinical specimens. Antimicrobial susceptibility test was done and isolates with resistance or with reduced susceptibility to any of the third generation Cephalosporins were selected for the study. Phenotypic confirmation of ESBL production was done by Double Disc Synergy Test and confirmed by minimum inhibitory concentration. Multiplex polymerase chain reaction was performed to screen the four groups of CTX-M ESBLs. Results: Among the 118 isolates of Enterobacteriaceae 54 isolates were positive for CTX-M group I ESBL which constitutes 45.7 %. Conclusions: Early detection of CTX M producing Enterobacteriaceae by continuous surveillance and thereby reducing their spread and restricted use of third generation Cephalosporins (3GC) antibiotics could be the possible routes to prevent the emergence and spread of CTX M ESBL producing organisms.

scholarly journals Ceftolozane-tazobactam versus meropenem for definitive treatment of bloodstream infection due to extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales (“MERINO-3”): study protocol for a multicentre, open-label randomised non-inferiority trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Adam G. Stewart ◽  
Patrick N. A. Harris ◽  
Mark D. Chatfield ◽  
Roberta Littleford ◽  
David L. Paterson
Keyword(s):  
Bloodstream Infection ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Definitive Treatment ◽  
Resistant Organism ◽  
Third Generation ◽  
Beta Lactamase ◽  
Open Label ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

Abstract Background Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales are common causes of bloodstream infection. ESBL-producing bacteria are typically resistant to third-generation cephalosporins and result in a sizeable economic and public health burden. AmpC-producing Enterobacterales may develop third-generation cephalosporin resistance through enzyme hyper-expression. In no observational study has the outcome of treatment of these infections been surpassed by carbapenems. Widespread use of carbapenems may drive the development of carbapenem-resistant Gram-negative bacilli. Methods This study will use a multicentre, parallel group open-label non-inferiority trial design comparing ceftolozane-tazobactam and meropenem in adult patients with bloodstream infection caused by ESBL or AmpC-producing Enterobacterales. Trial recruitment will occur in up to 40 sites in six countries (Australia, Singapore, Italy, Spain, Saudi Arabia and Lebanon). The sample size is determined by a predefined quantity of ceftolozane-tazobactam to be supplied by Merck, Sharpe and Dohme (MSD). We anticipate that a trial with 600 patients contributing to the primary outcome analysis would have 80% power to declare non-inferiority with a 5% non-inferiority margin, assuming a 30-day mortality of 5% in both randomised groups. Once randomised, definitive treatment will be for a minimum of 5 days and a maximum of 14 days with the total duration determined by treating clinicians. Data describing demographic information, risk factors, concomitant antibiotics, illness scores, microbiology, multidrug-resistant organism screening, discharge and mortality will be collected. Discussion Participants will have bloodstream infection due to third-generation cephalosporin non-susceptible E. coli and Klebsiella spp. or Enterobacter spp., Citrobacter freundii, Morganella morganii, Providencia spp. or Serratia marcescens. They will be randomised 1:1 to ceftolozane-tazobactam 3 g versus meropenem 1 g, both every 8 h. Secondary outcomes will be a comparison of 14-day all-cause mortality, clinical and microbiological success at day 5, functional bacteraemia score, microbiological relapse, new bloodstream infection, length of hospital stay, serious adverse events, C. difficile infection, multidrug-resistant organism colonisation. The estimated trial completion date is December 2024. Trial registration The MERINO-3 trial is registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT04238390. Registered on 23 January 2020.

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