Molecular and Epidemiologic Study of Polyclonal Outbreaks of Multidrug-ResistantAcinetobacter baumanniiInfection in an Israeli Hospital

2007 ◽  
Vol 28 (8) ◽  
pp. 945-950 ◽  
Author(s):  
Dror Marchaim ◽  
Shiri Navon-Venezia ◽  
Azita Leavitt ◽  
Irina Chmelnitsky ◽  
Mitchell J. Schwaber ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Care Center ◽  
Tertiary Care ◽  
Epidemiologic Study ◽  
Multidrug Resistant ◽  
Pulsed Field Gel Electrophoresis ◽  
Clinical Samples ◽  
Tertiary Care Center ◽  
Pulsed Field ◽  
Incident Cases

Objectives.To perform a molecular and epidemiologic investigation of multidrug-resistant (MDR)Acinetobacter baumanniiin an institution were polyclonal outbreaks have been observed and determine whether these polyclonal outbreaks had an endogenous origin or were caused by in-hospital patient-to-patient transmission.Design.Retrospective analysis of prospectively collected data.Setting.An epidemiologic and genotypic investigation of incident cases of MDRA. baumanniiinfection in an Israeli university tertiary care center.Patients.Hospitalized patients with MDRA. baumanniiisolated from clinical samples during a 13-week period, from April 15, 2003, through July 15, 2003.Intervention.All patients with new MDRA. baumanniiinfections were recruited, and isolates were typed using pulsed-field gel electrophoresis. Data on in-hospital movements and consultations were extracted from computerized databases. Quantification of transmission opportunities (TOPs), defined as encounters between an established carrier and a future carrier of MDRA. baumannii, and analysis of ward clusters were performed.Results.We studied 96 MDRA. baumanniiisolates, which belonged to 18 different pulsed-field gel electrophoresis clones. In 65% of cases, TOPs involving patients with the same clone were demonstrated, which is significantly greater than the number of TOPs involving patients with different clones (P= .01).Conclusion.Although outbreaks of MDRA. baumanniiinfection may be polyclonal, we believe that patient-to-patient transmission explains most cases of transmission. Polyclonal local outbreaks reflect several clonal outbreaks occurring simultaneously. The cause of polyclonal outbreaks ofA. baumanniiinfections clustered by ward and time remains to be explained.

scholarly journals An outbreak inside an outbreak: rising incidence of carbapenem-resistant isolates during the COVID-19 pandemic. Report from a tertiary care center in Argentina.

2021 ◽  
Author(s):  
Maximiliano Gabriel Castro ◽  
Lucia Ines Ubiergo ◽  
Macarena Vicino ◽  
Gisel Cuevas ◽  
Fernanda Argarana
Keyword(s):  
Latin American ◽  
Care Center ◽  
Tertiary Care ◽  
Epidemiologic Study ◽  
Time Frame ◽  
Clinical Samples ◽  
Tertiary Care Center ◽  
Carbapenem Resistant ◽  
Time Period ◽  
Hospital Stays

Introduction: COVID-19 outbreaks have left us to deal with an aftermath on many fronts. In particular, disproportionate use of antibiotics, high ICU burden and longer in-hospital stays during the pandemic have been proposed to aggravate the emergency posed by carbapenem-resistant isolates (CRI), specially through carbapenemase production. However, there have been few reports worldwide regarding changes in CRI incidence and little latinamerican literature. Objective: We set out to determine whether the incidence of CRI rose in a tertiary care center in Santa Fe, Argentina during the time period with active cases of COVID-19. Methods: Analytic epidemiologic study retrospectively designed. Two time periods were defined: P1 (without active cases of COVID-19) from September, 2019 to August, 2020 and P2 (starting at the onset of the first wave of COVID-19 in this institution) from September, 2020 to June 2021. All clinically-relevant microbiological samples -those meant for diagnostic purposes- taken during the study period from patients in the Internal Medicine and Surgical wards as well as the Intensive Care Units were included. Incidence was calculated by dividing the number of CRI during each time frame by the count of patient-day during that same period, multiplied by a hundred. Results: 9,135 hospitalizations, 50,145 patient-days of analysis. A total of 7285 clinical samples were taken, with an overall positivity for CRI of 12.1% (n=883). Overall CRI incidence during P2 was 2.5 times higher than in P1 (2.52 vs 0.955/100 patient-days, p <0.001). ICU CRI incidence raised from 6.78 to 8.69/100 patient-days in P2 (p=0.006). Conclusion: We found alarming rates of CRI in our center, 2.5 times higher than previous to the first COVID-19 wave, similar to other reports worldwide. To our knowledge, this is one of the few Latin-American reports on the effect of the COVID-19 pandemic on CRI incidence.

Retrospective Analysis of Multidrug-ResistantAcinetobacter baumanniiStrains Isolated During a 4-Year Period in a University Hospital

2006 ◽  
Vol 27 (7) ◽  
pp. 647-653 ◽  
Author(s):  
Judith Fillaux ◽  
Anne Dubouix ◽  
Jean-Marie Conil ◽  
Jacky Laguerre ◽  
Nicole Marty
Keyword(s):  
Gel Electrophoresis ◽  
Clinical Characteristics ◽  
Epidemiologic Study ◽  
Multidrug Resistant ◽  
Pulsed Field Gel Electrophoresis ◽  
University Hospital ◽  
Clinical Samples ◽  
Relative Hazard ◽  
Burn Unit ◽  
Resistant Strains

Objective.To describe the epidemiology ofAcinetobacter baumanniiinfection during 2000-2003 and to determine whether the multidrug-resistant strains were already present in our Toulouse hospital before the 2003 French national outbreak.Design.Descriptive molecular and clinical epidemiologic study ofA. baumanniiisolates using a combination of antibiotyping and pulsed-field gel electrophoresis (PFGE).Setting.A 1,000-bed university hospital in Toulouse, France.Methods.All clinical samples that had tested positive forA. baumanniibetween January 1, 2000, and December 31, 2003, were collected. Multidrug-resistant isolates ofA. baumanniiwere then submitted to PFGE, and clinical characteristics of the source patients were noted.Results.A total of 1,277A. baumanniisamples were identified, 791 of which had not been previously identified; 148 were positive for multidrug-resistant strains. These strains were more likely to have been isolated in the intensive care unit (ICU) than were susceptible strains (P<.001; relative hazard, 3.77). The positive clinical samples were of various types (eg, nonprotected respiratory samples [43%] and blood [5%]), but no difference in type of source was seen between resistant and susceptible strains. A simultaneous analysis of pulsotypes and antibiotypes proved that the outbreak in the ICU in 2003 could be linked to an initially endemic clone that had been isolated in 2001. Furthermore, a second clone responsible for an extended-spectrum β-lactamase phenotype was sporadically present in our institution. Although the strains isolated in the burn unit were also genetically related one to another, the specific responsible clone only appeared in 2003.Conclusion.Several multidrug-resistant clones can coexist endemically for several years and can be detected during an outbreak by close survey of epidemic sources.

scholarly journals Detection of the Philadelphia chromosome in acute lymphoblastic leukemia by pulsed-field gel electrophoresis

Blood ◽  
1989 ◽  
Vol 74 (3) ◽  
pp. 1101-1107 ◽  
Author(s):  
AL Hooberman ◽  
CM Rubin ◽  
KP Barton ◽  
CA Westbrook
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Gel Electrophoresis ◽  
Chromosomal Abnormalities ◽  
Lymphoblastic Leukemia ◽  
Philadelphia Chromosome ◽  
Pulsed Field Gel Electrophoresis ◽  
Myelogenous Leukemia ◽  
Clinical Samples ◽  
Pulsed Field ◽  
Translocation Breakpoints

Abstract The Philadelphia (Ph1) chromosome is an acquired abnormality in the malignant cells of 10% to 25% of patients with acute lymphoblastic leukemia (ALL). Unlike chronic myelogenous leukemia (CML), where the molecular detection of the Ph1 chromosome is relatively straightforward using conventional Southern hybridization analysis, the detection of the Ph1 chromosome in ALL is complicated by the existence of several molecular subtypes, and the fact that translocation breakpoints are dispersed over a large genomic area. To circumvent these difficulties, we investigated pulsed-field gel electrophoresis (PFGE) to determine if this method could be used directly on clinical samples to detect the Ph1 chromosome in ALL. We report that, in a study of seven patients with Ph1-positive ALL, we could easily detect the Ph1 using only a single PFGE analysis, regardless of the Ph1 subtype, and we could confirm that the translocations occur either within or very near the BCR gene in all seven. We conclude that PFGE is a useful technique for the detection of the Ph1 in ALL, which ultimately may find wide applicability in the detection of other chromosomal abnormalities in other malignancies.

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