scholarly journals Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins

2010 ◽  
Vol 66 (2) ◽  
pp. 398-407 ◽  
Author(s):  
M. E. A. de Kraker ◽  
M. Wolkewitz ◽  
P. G. Davey ◽  
W. Koller ◽  
J. Berger ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Hospital Stay ◽  
Excess Mortality ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Third Generation ◽  
Third Generation Cephalosporins

scholarly journals Clinical Impact of Antimicrobial Resistance in European Hospitals: Excess Mortality and Length of Hospital Stay Related to Methicillin-ResistantStaphylococcus aureusBloodstream Infections

2011 ◽  
Vol 55 (4) ◽  
pp. 1598-1605 ◽  
Author(s):  
Marlieke E. A. de Kraker ◽  
Martin Wolkewitz ◽  
Peter G. Davey ◽  
Hajo Grundmann
Keyword(s):  
Antimicrobial Resistance ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Excess Mortality ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Fatal Outcome ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Clinical Impact

ABSTRACTAntimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistantStaphylococcus aureus(MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptibleS. aureus(MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8;P= 0.04), but not for hospital mortality (HR = 1.1;P= 0.63) or LOS (difference = 0.6 days;P= 0.96). Irrespective of methicillin susceptibility,S. aureusBSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptibleS. aureus.

scholarly journals Population Snapshot of the Extended-spectrum β-lactamase-producing Escherichia Coli Invasive Strains Isolated From a Hungarian Hospital

2021 ◽  
Author(s):  
Kinga Tóth ◽  
Ákos Tóth ◽  
Katalin Kamotsay ◽  
Viktória Németh ◽  
Dóra Szabó
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Full Genome Sequence ◽  
Care Hospital ◽  
Third Generation ◽  
E Coli ◽  
Extended Spectrum ◽  
Antimicrobial Resistance Genes ◽  
Antimicrobial Resistance Gene ◽  
Third Generation Cephalosporins

Abstract Background:This study was carried out to determine the prevalence and the genetic background of extended-spectrum β-lactamase-producing Escherichia coli invasive isolates obtained from a tertiary-care hospital in Budapest, Hungary. MethodsBetween October-November 2018, all invasive ESBL-producing E. coli isolates were collected from Central Hospital of Southern Pest. The antimicrobial susceptibility testing was performed according to the EUCAST guidelines. The possible clonal relationships were investigated by core genome (cg)MLST (SeqSphere+) using whole-genome sequencing (WGS) data of isolates obtained from Illumina 251-bp paired-end sequencing. From WGS data acquired antimicrobial resistance genes and replicon types were retrieved using ResFinder3.1, PlasmidFinder2.1, and pMLST-2.0 online tools.ResultsOverall, 25 E. coli isolates were detected and six proved to be resistant to third-generation cephalosporins. Full genome sequence analysis showed that five E. coli isolates belonged to the ST131 clone: two to C1-M27 subclade with blaCTX-M-27 and three to C2/H30Rx subclade with blaCTX-M-15. One isolate belonged to ST1193 with blaCTX-M-27. According to cgMLST, all C2/H30Rx isolates formed a cluster (≤6 allele differences), while the blaCTX-M-27-producing C1-M27 isolates differed at least 35 alleles from each other. Both C2/H30Rx and C1-M27 ST131 isolates harbored similar antimicrobial resistance gene sets. However, only C2/H30Rx isolates had the qnrB and aac(3)-IIa. All isolates showed resistance against ceftriaxone, cefotaxime, and ciprofloxacin, and the C2/H30Rx isolates were also resistant to gentamicin, tobramycin, and ceftazidime.ConclusionsOut of six third-generation cephalosporins-resistant, invasive E. coli, five belonged to the S131clone. This study indicates, that the C2/H30Rx and C1-M27 subclades of the ST131 appear to be the dominant clones collected in a Hungarian hospital.

scholarly journals Antibiotic resistance among Escherichia coli and Salmonella isolated from dairy cattle feces in Texas

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0242390
Author(s):  
Rosine Manishimwe ◽  
Paola M. Moncada ◽  
Marie Bugarel ◽  
H. Morgan Scott ◽  
Guy H. Loneragan
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Dairy Cattle ◽  
Third Generation ◽  
Bacterial Isolates ◽  
Macconkey Agar ◽  
Selective Media ◽  
Cattle Feces ◽  
Third Generation Cephalosporins

In several developing countries, studies on antimicrobial resistance among bacteria from food animals are rare mostly because of under-resourced laboratories. The objective of this study was to develop and field-test a low cost protocol to estimate the isolate- and sample-level prevalence of resistance to critically important antibiotics among Escherichia coli and Salmonella isolated from dairy cattle feces. Using a predesigned protocol, fecal samples were collected to isolate non-type-specific E. coli and Salmonella using selective media without antibiotic supplements. Besides, samples were screened for E. coli and Salmonella isolates not susceptible to third-generation cephalosporins and quinolones using selective media supplemented with cefotaxime (1.0 μg/mL) and ciprofloxacine (0.5 μg/mL), respectively. All bacterial isolates were further tested for antibiotic susceptibility using disk diffusion. Bacterial isolates not susceptible to third-generation cephalosporins were tested for extended spectrum beta-lactamase (ESBL) phenotype using the combination disk test. Molecular methods were performed on selected bacterial isolates to identify and distinguish genetic determinants associated with the observed phenotypes. Among 85 non-type-specific E. coli isolated from MacConkey agar without antibiotics, the isolate-level prevalence of resistance to tetracycline was the highest (8.2%). Among 37 E. coli recovered from MacConkey agar with cefotaxime, 56.8% were resistant ceftriaxone. Among 22 E. coli isolates recovered from MacConkey agar with ciprofloxacin, 77.3% and 54.5% were resistant to nalidixic acid and ciprofloxacin, respectively. Sixteen Salmonella were isolated and only one demonstrated any resistance (i.e., single resistance to streptomycin). Among E. coli isolates not susceptible to ceftriaxone, an AmpC phenotype was more common than an ESBL phenotype (29 versus 10 isolates, respectively). Whole genome sequencing showed that phenotypic profiles of antibiotic resistance detected were generally substantiated by genotypic profiles. The tested protocol is suited to detecting and estimating prevalence of antimicrobial resistance in bacteria isolated from food animal feces in resource-limited laboratories in the developing world.

Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

1999 ◽  
Vol 20 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Murray A. Abramson ◽  
Daniel J. Sexton
Keyword(s):  
Hospital Stay ◽  
Medical Center ◽  
A Priori ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Tertiary Care Medical Center ◽  
Matching Criteria ◽  
Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

scholarly journals Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

2020 ◽  
Vol 148 ◽  
Author(s):  
T. Kimura ◽  
S. Stanhope ◽  
T. Sugitani
Keyword(s):  
Hospital Stay ◽  
Excess Mortality ◽  
Length Of Hospital Stay ◽  
Administrative Database ◽  
Matched Cohort ◽  
Limited Evidence ◽  
Immortal Time Bias ◽  
Hospitalised Patients ◽  
Substantial Economic Burden ◽  
Support Decision Making

Abstract Clostridioides (Clostridium) difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients, representing a substantial economic burden driven mainly by increased length of hospital stay (LoS). Currently in Japan, limited evidence on CDI-associated excess LoS is available. We conducted a retrospective, matched-cohort study using a large, Japanese, hospital-based administrative database. CDI was defined as CDI treatment plus either CDI diagnosis or positive enzyme immunoassay result. Propensity score matching at the time of CDI or recurrent CDI (rCDI) onset was applied to adjust baseline confounding and immortal time bias. The analysis included 5 994 054 hospitalisation records during 2008–2017, of which 11 823 were identified as CDI and 1359 as rCDI. The median excess LoS attributable to CDI and rCDI was 3 days and 6.5 days, respectively. The excess mortality attributable to CDI was 6.9%; there was no excess mortality attributable to rCDI (−1.9%). The median difference in costs attributable to CDI and rCDI during the residual stay was JPY 130 296 (USD 1185) and JPY 81 054 (USD 737) per hospitalisation, respectively. By adjusting the biases, the burden of CDI in Japan was evaluated. The findings could support decision making and resource allocation for CDI management in Japanese hospitals.

scholarly journals Extraintestinal pathogenic Escherichia coli in Saudi Arabia: A review of antimicrobial resistance and molecular epidemiology

2020 ◽  
Vol 19 (2) ◽  
pp. 447-453
Author(s):  
Abdulaziz Alqasim
Keyword(s):  
Escherichia Coli ◽  
Saudi Arabia ◽  
Antimicrobial Resistance ◽  
Molecular Epidemiology ◽  
Bloodstream Infections ◽  
Epidemiological Studies ◽  
Colistin Resistance ◽  
E Coli ◽  
Extended Spectrum ◽  
Pathogenic Escherichia Coli

Extra-intestinal pathogenic Escherichia coli (ExPEC) is commonly associated with causing urinary tract and bloodstream infections. Over the past two decades, the antimicrobial resistance of ExPEC has increasingly been reported [1]. Given that Saudi Arabia annually hosts mass religious events, such as Hajj, this review investigated several aspects of antimicrobial resistance of ExPEC in this country including the current prevalence of resistance and molecular epidemiology of ExPEC isolates. Generally, the overall prevalence of antibiotic resistance of ExPEC in Saudi Arabia is on increase. The current emergence of colistin resistance in ExPEC represents a major challenge to public health. Local molecular epidemiological studies have shown the dominance of E. coli sequence type 131 (E. coli ST131) over other major ExPEC STs. This is an important observation given that this clone has been associated with high multidrug resistance and extended-spectrum β-lactamases carriage. To reduce the burden of this resistance in the future, it would be crucial to avoid uncontrolled use of antibiotics in either clinical settings or animal food industry. Keywords: Extra-intestinal pathogenic Escherichia coli, Antimicrobial resistance, ST131, Saudi Arabia, Colistin resistance, Extended-spectrum β-lactamases

scholarly journals 2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S784-S784
Author(s):  
Shweta Kamat ◽  
Pankaj Gupta ◽  
Akshata Mane
Keyword(s):  
Clinical Experience ◽  
Online Survey ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Nationwide Survey ◽  
Third Generation ◽  
Tract Infections ◽  
Abdominal Infections ◽  
Tertiary Care Hospitals ◽  
Third Generation Cephalosporins

Abstract Background Broad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments. Methods An online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools. Results One-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively). Conclusion CS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms. Disclosures All authors: No reported disclosures.

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