Characterization of Third-Generation Cephalosporin-ResistantEscherichia colifrom Bloodstream Infections in Denmark

2014 ◽  
Vol 20 (4) ◽  
pp. 316-324 ◽  
Author(s):  
Frank Hansen ◽  
Stefan S. Olsen ◽  
Ole Heltberg ◽  
Ulrik S. Justesen ◽  
David Fuglsang-Damgaard ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation

scholarly journals Characterization of Third-Generation-Cephalosporin-Resistant Shiga Toxin-Producing Strains of Escherichia coli O157:H7 in Japan

2015 ◽  
Vol 53 (9) ◽  
pp. 3035-3038 ◽  
Author(s):  
Ryuji Kawahara ◽  
Kazuko Seto ◽  
Masumi Taguchi ◽  
Chie Nakajima ◽  
Yuko Kumeda ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Generation Cephalosporin ◽  
Escherichia Coli O157 ◽  
Third Generation ◽  
Content Type ◽  
Resistant Strains ◽  
Third Generation Cephalosporins

We isolated Shiga toxin-producingEscherichia coliO157:H7 strains resistant to third-generation cephalosporins. The resistant strains harboredblaCMY-2, a plasmid-mediated AmpC β-lactamase. Genotyping of isolates revealed the possible spread of this problematic bacterium. Results suggested the importance of the investigation and surveillance of enterobacteria with plasmids harboringblaCMY-2.

scholarly journals Clinical Failure and Emergence of Resistance during Third Generation Cephalosporin Therapy for Enterobacter spp. Infection: Is the Risk Overestimated? A Prospective Multicentric Study

Hygiene ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 69-79
Author(s):  
Benoît Pilmis ◽  
Thibaud Delerue ◽  
Anna Belkacem ◽  
Pauline Caraux-Paz ◽  
Solen Kernéis ◽  
...  
Keyword(s):  
Rare Event ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Clinical Failure ◽  
First Line ◽  
Multicentric Study ◽  
First Line Therapy ◽  
Secondary Objective ◽  
Emergence Of Resistance

Background: Clinical and microbiological guidelines recommend treating infections caused by Enterobacter spp. with cefepime or carbapenems. The main objective of this study was to assess the risk of clinical failure with third generation cephalosporin (3GC) therapy compared to other β-lactams for infections caused by Enterobacter spp. Our secondary objective was to evaluate the risk of emergence of resistance during therapy. Methods: We conducted a prospective observational study in seven French hospitals over an 18-month period including all patients with a pulmonary and/or bloodstream infection due to Enterobacter spp. susceptible to 3GC. Results: Seventy-four patients were included in our study. Among them, 26 (35%) received a 3GC as a first-line treatment, and clinical improvements were observed for 13/21 (62%) of them. Four (5%) cases of emergence of 3GC resistance were observed during therapy including one in the 3GC group. 3GC therapy can be safely used as first-line therapy especially for non-severe patients suffering from pulmonary or bloodstream infections due to Enterobacter spp. Conclusions: Emergence of 3GC resistance remains a rare event, and there is a lack of evidence of the benefit of last-line antibiotics therapies.

scholarly journals Piperacillin–tazobactam versus meropenem for treatment of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacteriaceae: a study protocol for a non-inferiority open-label randomised controlled trial (PeterPen)

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040210 ◽  
Author(s):  
Roni Bitterman ◽  
Fidi Koppel ◽  
Cristina Mussini ◽  
Yuval Geffen ◽  
Michal Chowers ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Control Group ◽  
Third Generation ◽  
Beta Lactam ◽  
Open Label ◽  
Randomised Controlled

IntroductionThe optimal treatment for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae bloodstream infections has yet to be defined. Retrospective studies have shown conflicting results, with most data suggesting the non-inferiority of beta-lactam–beta-lactamase inhibitor combinations compared with carbapenems. However, the recently published MERINO trial failed to demonstrate the non-inferiority of piperacillin–tazobactam to meropenem. The potential implications of the MERINO trial are profound, as widespread adoption of carbapenem treatment will have detrimental effects on antimicrobial stewardship in areas endemic for ESBL and carbapenem-resistant bacteria. Therefore, we believe that it is justified to re-examine the comparison in a second randomised controlled trial prior to changing clinical practice.Methods and analysisPeterPen is a multicentre, investigator-initiated, open-label, randomised controlled non-inferiority trial, comparing piperacillin–tazobactam with meropenem for third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections. The study is currently being conducted in six centres in Israel and one in Canada with other centres from Israel, Italy and Canada expected to join. The two primary outcomes are all-cause mortality at day 30 from enrolment and treatment failure at day seven (death, fever above 38°C in the last 48 hours, continuous symptoms, increasing Sequential Organ Failure Assessment Score or persistent blood cultures with the index pathogen). A sample size of 1084 patients was calculated for the mortality endpoint assuming a 12.5% mortality rate in the control group with a 5% non-inferiority margin and assuming 100% follow-up for this outcome.Ethics and disseminationThe study is approved by local and national ethics committees as required. Results will be published, and trial data will be made available.Trial registration numbersClinicalTrials.gov Registry (NCT03671967); Israeli Ministry of Health Trials Registry (MOH_2018-12-25_004857).

WGS-based surveillance of third-generation cephalosporin-resistant Escherichia coli from bloodstream infections in Denmark

2017 ◽  
Vol 72 (7) ◽  
pp. 1922-1929 ◽  
Author(s):  
Louise Roer ◽  
Frank Hansen ◽  
Martin Christen Frølund Thomsen ◽  
Jenny Dahl Knudsen ◽  
Dennis Schrøder Hansen ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation

scholarly journals The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study

2016 ◽  
Vol 21 (33) ◽  
Author(s):  
Andrew J Stewardson ◽  
Arthur Allignol ◽  
Jan Beyersmann ◽  
Nicholas Graves ◽  
Martin Schumacher ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Antimicrobial Resistance ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Hospital Death ◽  
Third Generation ◽  
The Impact

We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

scholarly journals Characterization of a P1-like bacteriophage carrying CTX-M-27 in Salmonella spp. resistant to third generation cephalosporins isolated from pork in China

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Ling Yang ◽  
Wan Li ◽  
Gui-Ze Jiang ◽  
Wen-Hui Zhang ◽  
Huan-Zhong Ding ◽  
...  
Keyword(s):  
Potential Role ◽  
Generation Cephalosporin ◽  
Complete Sequence ◽  
Third Generation ◽  
Salmonella Spp ◽  
Incp Plasmids ◽  
Horizontal Spread ◽  
Third Generation Cephalosporins

Abstract The aim of this study was to elucidate the epidemiology of third generation cephalosporin resistant Samonella isolates from pork of a slaughterhouse in China and the features of transferable elements carrying bla CTX-M genes. One hundred and twenty-six (7.3%) Salmonella isolates were identified; S. Derby and S. Rissen were the most two prevalent serotypes. Among these isolates 20 (15.8%) were resistant to third generation cephalosporins and nine of them carried bla CTX-M-27. S1-PFGE and replicon typing of bla CTX-M-27-carrying plasmids showed that seven were untypeable plasmids of about 104 Kb and two were IncP plasmids of about 300 Kb. Complete sequence analysis of one PBRT-untypeable plasmid showed it was a P1-like bateriophage, named SJ46, which contained a non-phage-associated region with several mobile elements, including Tn1721, ISEcp1B and IS903D. The other six 104 Kb PBRT-untypeable bla CTX-M-27-carrying plasmids also harboured the same phage-insertion region of SJ46 suggesting that they were the same P1-like bacteriophage. PFGE profiles of the parental strains revealed both potential vertical and horizontal spread of this P1-like bla CTX-M-27-containing element. Additionally, the representative gene of the P1 family bacteriophage, repL, was detected in 19.0% (24/126) of the isolates. This study indicated a potential role of P1-family bacteriophage in capture and spread of antimicrobial resistance in pathogens.

scholarly journals Clinical Benefit of Appropriate Empirical Fluoroquinolone Therapy for Adults with Community-Onset Bacteremia in Comparison with Third-Generation-Cephalosporin Therapy

2016 ◽  
Vol 61 (2) ◽  
Author(s):  
Ching-Chi Lee ◽  
Jiun-Ling Wang ◽  
Chung-Hsun Lee ◽  
Chih-Chia Hsieh ◽  
Yuan-Pin Hung ◽  
...  
Keyword(s):  
Critical Illness ◽  
Propensity Scores ◽  
Fatal Outcome ◽  
Group Versus ◽  
Bloodstream Infections ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Crude Mortality ◽  
Group A ◽  
Community Onset

ABSTRACT Both fluoroquinolones (FQs) and third-generation cephalosporins (3rd-GCs) are commonly prescribed to treat bloodstream infections, but comparative efficacies between them were rarely studied. Demographics and clinical characteristics of 733 adults with polymicrobial or monomicrobial community-onset bacteremia empirically treated by an appropriate FQ (n = 87) or 3rd-GC (n = 646) were compared. A critical illness (respectively, 8.0% versus 19.0%; P = 0.01), an initial syndrome with severe sepsis (33.3% versus 50.3%; P = 0.003), or a fatal outcome at 28 days (4.6% versus 10.5%; P = 0.08) was less common in the FQ group. A total of 645 (88.0%) patients were febrile at initial presentation, and the FQ group with (FQ group versus 3rd-GC group, respectively, 7.6 days versus 12.0 days; P = 0.04) and without (3.8 days versus 5.4 days; P = 0.001) a critical illness had a shorter time to defervescence than the 3rd-GC group. By the propensity scores, 87 patients with appropriate FQ therapy were matched with 435 treated by 3rd-GC therapy at a ratio of 1:5, and there were no significant differences in terms of bacteremia severity, comorbidity severity, major comorbidities, causative microorganisms, and bacteremia sources between groups. Moreover, crude mortality rates at 28 days (FQ group versus 3rd-GC group, respectively, 4.6% versus 7.8%; P = 0.29) did not differ significantly. However, the time to defervescence was shorter in the FQ group (4.2 ± 3.6 versus 6.2 ± 7.6 days; P < 0.001). Conclusively in the adults with community-onset bacteremia, appropriate empirical FQ therapy was related to shorter time to defervescence than with 3rd-GC therapy, at least for those without a critical illness.

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