scholarly journals A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009–2018 at Tygerberg Hospital, South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245089 ◽  
Author(s):  
Kessendri Reddy ◽  
Adrie Bekker ◽  
Andrew C. Whitelaw ◽  
Tonya M. Esterhuizen ◽  
Angela Dramowski
Keyword(s):  
South Africa ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Neonatal Unit ◽  
Attributable Mortality ◽  
Published Data ◽  
Period 2 ◽  
Empiric Antibiotic ◽  
Hospital Acquired

Background Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices. Methods A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital’s neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1). Results The neonatal unit’s HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009–2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001). Conclusion Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.

scholarly journals Change of the Frequency of Methicillin Resistance and Antibiogram Resistance Profile of Staphylococcus aureus within a Period of 15 Years

2021 ◽  
Author(s):  
Kamuran Şanlı ◽  
Selen Zeliha Mart Kömürcü ◽  
Nilgün Kansak ◽  
Rıza Adaleti
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Erythromycin Resistance ◽  
Resistance Profile ◽  
Antimicrobial Resistance Profile ◽  
Gentamicin Resistance ◽  
Successful Control ◽  
Mrsa Strains ◽  
Hospital Acquired

Objective: The aim of this retrospective study was to evaluate the rate and antimicrobial resistance profile of community-acquired (CA) and hospital-acquired (HA) methicillin-resistant and sensitive Staphylococcus aureus (MRSA, MSSA) strains between 2004 and 2019. Method: Within the scope of the research, the rate of MRSA and MSSA and the change in antimicrobial resistance profile over time were investigated using two research data of 210 Staphylococcus aureus strains isolated in 2004, and 401 in 2019. Results: While any significant change was not seen in the rates of CA-MRSA (32.4%) and CA-MSSA (67.6%) in 2004, and of CA-MRSA (31.6%) and CA-MSSA (68.4%) in 2019, the prevalence of HA-MRSA decreased by 56.1% in 2004 and 30.7% in 2019 and of HA-MSSA increased by 43.9% in 2004 and 69.3% in 2019. No resistance to vancomycin and teikoplanin was observed in MRSA strains. Resistance of CA-MRSA against ciprofloxacin, levofloxacin, clindamycin and gentamicin decreased. In CA-MSSA an increase of penicillin resistance as well as a decrease in gentamicin resistance was observed. In resistance of HA-MRSA against ciprofloxacin, levofloxacin, erythromycin, clindamycin, gentamicin decreased. HA-Resistance of MSSA against fusidic acid increased and against ciprofloxacin and trimethoprim/sulfamethoxazole and erythromycin resistance decreased. Conclusion: It was found that the rate of HA-MRSA decreased during the given period of 15 years. Vancomycin or teicoplanin resistance was not observed in MRSA and MSSA. While against ciprofloxacin, levofloxacin, clindamycin, gentamicin decreased in both CA-MRSA and HA-MRSA. A closer follow-up of the prevalence and antimicrobial resistance profiles of these strains is of utmost importance for the successful control of the infections caused by MRSA and MSSA.

Fluoroquinolone- and Methicillin-Resistant Staphylococcus Aureus: Insights from the Antimicrobial Resistance Management Program

2005 ◽  
Vol 21 (3) ◽  
pp. 123-128 ◽  
Author(s):  
John G Gums ◽  
Benjamin J Epstein
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Resistance Management ◽  
Multidrug Resistant ◽  
Management Program ◽  
Methicillin Resistant ◽  
The North ◽  
The Us ◽  
Northeast Us

Background: Staphylococcus aureus is a frequent cause of infections involving the bloodstream, skin and soft tissue, and lungs in hospitalized patients. These isolates are often multidrug resistant and represent a major therapeutic challenge. Objective: To explore the susceptibilities of S. aureus to nafcillin/oxacillin, a surrogate for methicillin resistance, and the fluoroquinolones and determine whether a relationship might exist between fluoroquinolone use and the prevalence of methicillin-resistant S. aureus (MRSA). Methods: To date, 353 institutions throughout the US and Puerto Rico have enrolled in the Antimicrobial Resistance Management (ARM) Program, and data have been submitted on nearly 5 million isolates of S. aureus. Isolates submitted from 1990 through 2002 were reviewed for sensitivity to nafcillin/oxacillin, clindamycin, erythromycin, and the fluoroquinolones ciprofloxacin and levofloxacin. Results: From 1990 through 2002 inclusive, susceptibility to nafcillin/oxacillin nationally was 64.9% (n = 360,460), ranging from 62.2% in the North Central and Northeast US to 72.8% in the Southwest. Nationally, S. aureus isolates were more resistant to levofloxacin (41.4%, n = 123,868) than ciprofloxacin (38.7%, n = 256,178). The greatest change in susceptibility of S. aureus to nafcillin/oxacillin and ciprofloxacin occurred concurrently from 1998 to 2002, which may implicate fluoroquinolone use with increasing rates of MRSA infection. Conclusions: Resistance to methicillin and the fluoroquinolones has increased in concert during the past 5 years. Collectively, data from the ARM Program, along with several other investigations, support a role of fluoroquinolone use in the emergence of MRSA. These observations, along with increasing resistance among gram-positive and gram-negative pathogens, underscore the need for judicious use of fluoroquinolones.

scholarly journals 1439. High Rates of Drug Resistance in Escherichia coli from a Pilot Antimicrobial Resistance Surveillance System in Cambodia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S723-S724
Author(s):  
Vandarith Nov ◽  
Darapheak Chau ◽  
Chhorvann Chhea
Keyword(s):  
Public Health ◽  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Klebsiella Pneumoniae ◽  
Surveillance System ◽  
Methicillin Resistance ◽  
Salmonella Typhi ◽  
Blood Samples

Abstract Background Antimicrobial resistance (AMR) is a major and growing global public health problem. The Cambodia Ministry of Health established a pilot laboratory-based AMR surveillance system for blood specimens in 2017. The objective of this study is to characterize AMR among pathogenic isolates from blood samples. Methods A retrospective analysis was performed using one year of data from a pilot AMR Surveillance system in Cambodia. Four blood culture isolate pathogens were included: Escherichia coli, Klebsiella pneumoniae, Salmonella Typhi /Salmonella Paratyphi A and Staphylococcus aureus. Blood culture isolates that were referred from eleven sentinel sites were analyzed at the National Public Health Laboratory for identification. Antibiotic susceptibility testing (AST) was done using disk diffusion, minimum inhibitory concentration method following Clinical Laboratory Standard Institute (CLSI) guidelines. Results Among 214 pathogenic isolates from blood samples, E.coli was the most common (56.1%), followed by Salmonella Typhi/Salmonella Paratyphi A (18.7%), Staphylococcus aureus (13.5%), and Klebsiella pneumoniae (11.7%). Methicillin Resistance Staphylococcus aureus (MRSA) was detected in half of the isolates. E.coli was resistant to ampicillin (94.4%), trimethoprim-sulfamethoxazole (84.5%), and ceftriaxone (79.2%). Salmonella Typhi was resistant to ampicillin (73.3%) and trimethoprim-sulfamethoxazole (60.0%) and Salmonella Paratyphi A were resistant to fluoroquinolones (91.7%). For last resort antibiotics, E.coli was resistant to carbapenem groups (3.2% for imipenem, 4.9% for meropenem, and 5.0% for ertapenem). Klebsiella pneumoniae was not resistant to any groups. Conclusion E.coli was found at high rates in blood samples and was resistant to common antibiotics used in Cambodia. These pilot data show the importance of establishing a national AMR surveillance system in Cambodia to monitor AMR trends following GLASS guidelines. Disclosures All Authors: No reported disclosures

scholarly journals Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110588
Author(s):  
Tomonori Aratani ◽  
Hitoshi Tsukamoto ◽  
Takashi Higashi ◽  
Takaaki Kodawara ◽  
Ryoichi Yano ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Regression Analysis ◽  
Cox Regression ◽  
Methicillin Resistance ◽  
Univariate Analysis ◽  
Cox Regression Analysis ◽  
Staphylococcus Aureus Bacteremia ◽  
Mortality Outcome ◽  
Delayed Initiation ◽  
Hospital Acquired

Objective Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB. Methods We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis. Results Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome. Conclusions Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.

EPISIOTOMY INFECTIONS IN THE PUERPERIUM AND ANTIMICROBIAL RESISTANCE OF RESPONSIBLE PATHOGENS IN UKRAINE

2020 ◽  
Vol 73 (11) ◽  
pp. 2325-2331
Author(s):  
Aidyn G. Salmanov ◽  
Taras G. Voitok ◽  
Igor V. Maidannyk ◽  
Serhiy Yu. Vdovychenko ◽  
Olena О. Chorna ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Vaginal Delivery ◽  
Prevalence Rate ◽  
Methicillin Resistance ◽  
Carbapenem Resistance ◽  
Resistant Bacteria ◽  
Esbl Production ◽  
Multicenter Cohort Study ◽  
Klebsiella Spp

1 2 ABSTRACT The aim: To obtain the first estimates of the current prevalence rate of episiotomy infections in the puerperium and antimicrobial resistance of responsible pathogens in Ukraine. Materials and methods: We performed a retrospective multicenter cohort study was based on surveillance data. The study population consisted of all women who had a vaginal delivery in 7 Regional Women’s Hospitals of Ukraine. Definitions of episiotomy infections were used from the Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC/NHSN). Results: Total 35.6% women after vaginal delivery had episiotomy done. The prevalence rate of episiotomy infections was 17.7%. The predominant pathogens were: Escherichia coli (49.2%), Enterobacter spp. (11.1%), Streptococcus spp. (9.1%), Enterococcus faecalis (6.5%), Klebsiella spp. (8.1%), followed by Pseudomonas aeruginosa (4.7%), Staphylococcus aureus (4.2%), Proteus spp.(2.9%) and Staphylococcus epidermidis (2.8%). The overall proportion of methicillin-resistance was observed in 17.3% of Staphylococcus aureus (MRSA). Vancomycin resistance was observed in 6.8% of isolated enterococci. Carbapenem resistance was identified in 8% of P.aeruginosa isolates. Resistance to third-generation cephalosporins was observed in 15.2% Klebsiella spp. and E.coli 16.4% isolates. The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 26.4%. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (31.4%, vs 12.5%). Conclusions: Episiotomy infections in the puerperium are common in Ukraine and most of these infections caused by antibiotic-resistant bacteria. Optimizing the management and empirical antimicrobial therapy may reduce the burden of episiotomy infections, but prevention is the key element.

scholarly journals Improved methods in the identification and screening for antimicrobial resistance: chromogenic screening for Staphylococcus aureus and methicillin resistance

2008 ◽  
Vol 29 (3) ◽  
pp. 150
Author(s):  
John Merlino
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Chromogenic Substrates ◽  
Methicillin Resistant ◽  
Microbial Identification ◽  
Laboratory Screening ◽  
Labour Costs ◽  
Improved Methods

New enzyme specific synthetic chromogenic substrates offer an advance in the laboratory screening and detection of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA), with increased efficiency, reduced labour costs and decreased turn around times, especially when incorporated into existing laboratory workflows, to support current methods of microbial identification and the detection of resistance.

scholarly journals Staphylococcus aureus PBP4 Is Essential for β-Lactam Resistance in Community-Acquired Methicillin-Resistant Strains

2008 ◽  
Vol 52 (11) ◽  
pp. 3955-3966 ◽  
Author(s):  
Guido Memmi ◽  
Sergio R. Filipe ◽  
Mariana G. Pinho ◽  
Zhibiao Fu ◽  
Ambrose Cheung
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Healthy Individuals ◽  
Penicillin Binding Protein ◽  
Methicillin Resistant ◽  
Fold Reduction ◽  
Resistant Strains ◽  
Mrsa Strains ◽  
Hospital Acquired ◽  
Major Target

ABSTRACT Recent cases of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) strains in healthy individuals have raised concerns worldwide. CA-MRSA strains differ from hospital-acquired MRSAs by virtue of their genomic background and increased virulence in animal models. Here, we show that in two common CA-MRSA isolates, USA300 and MW2 (USA400), a loss of penicillin binding protein 4 (PBP4) is sufficient to cause a 16-fold reduction in oxacillin and nafcillin resistance, thus demonstrating that mecA, encoding PBP2A, is not the sole determinant of methicillin resistance in CA-MRSA. The loss of PBP4 was also found to severely affect the transcription of PBP2 in cells after challenge with oxacillin, thus leading to a significant decrease in peptidoglycan cross-linking. Autolysis, which is commonly associated with the killing mechanism of penicillin and β-lactams, does not play a role in the reduced resistance phenotype associated with the loss of PBP4. We also showed that cefoxitin, a semisynthetic β-lactam that binds irreversibly to PBP4, is synergistic with oxacillin in killing CA-MRSA strains, including clinical CA-MRSA isolates. Thus, PBP4 represents a major target for drug rediscovery against CA-MRSA, and a combination of cefoxitin and synthetic penicillins may be an effective therapy for CA-MRSA infections.

scholarly journals Surveillance of antimicrobial resistance of maltose negative Staphylococcus aureus in South African dairy herds

2020 ◽  
Author(s):  
Joanne Karzis ◽  
Inge-Marié Petzer ◽  
Edward F. Donkin ◽  
Vinny Naidoo ◽  
Eric M. C. Etter
Keyword(s):  
South Africa ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Dairy Herds ◽  
Disk Diffusion Method ◽  
Milk Samples ◽  
Kwazulu Natal ◽  
Over Time

Abstract Background The discovery of antimicrobials in the 1930s was one of the greatest achievements in medicine. However, bacterial resistance to antimicrobials was already observed in the 1940s and has been reported since then in both human and veterinary medicine, including in dairy cows. Many years of monitoring milk samples in South Africa, has led to the identification of a new strain of Staphylococcus aureus (S. aureus), which is maltose negative and appears to be an emerging pathogen. In this study the differences in susceptibility to antimicrobials of this strain were evaluated over time, over different seasons, in different provinces, and according to somatic cell count (SCC) categories. Results A data set of 271 maltose negative S. aureus isolates, cultured from milk samples from 117 herds out of the estimated 2000 commercial dairy herds in South Africa between 2010 and 2017, was studied using the disk diffusion method. This analysis was done using the Clinical Laboratory Standards Institute (CLSI) breakpoints in order to compare using both the previous (Intermediate category grouped with Resistant) and current definitions, (Intermediate category grouped with Susceptible). The results of the analysis between the previous and the current definitions differed for tylosin, cefalonium, oxy-tetracycline and cloxacillin. Neither the analysis using the previous nor the current systems showed an effect of province for the maltose negative S. aureus. This was in contrast to the results for maltose positive S. aureus where differences between provinces were shown in a previous study, with the lowest prevalence of resistance shown in KwaZulu-Natal during spring. For the susceptibility testing of 57 maltose negative and 57 maltose positive S. aureus isolates from 38 farms, from KwaZulu Natal, Eastern Cape and Western Cape. The minimum inhibitory concentration (MIC) results for the maltose negative S. aureus isolates confirmed the results of the disk diffusion method. Conclusions The maltose negative strains of S. aureus differed in general, in their antimicrobial resistance patterns over time, in comparison to maltose-positive S. aureus strains. MIC testing also indicated that more multidrug -resistant isolates were seen with the maltose negative S. aureus than in the maltose positive strains.

scholarly journals Surveillance of antimicrobial resistance of maltose negative Staphylococcus aureus in South African dairy herds

2019 ◽  
Author(s):  
Joanne Karzis ◽  
Inge-Marié Petzer ◽  
Edward F. Donkin ◽  
Vinny Naidoo ◽  
Eric M. C. Etter
Keyword(s):  
South Africa ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Diffusion Method ◽  
Dairy Herds ◽  
Disc Diffusion ◽  
Disc Diffusion Method ◽  
Data Set ◽  
Milk Samples ◽  
Over Time

Abstract BackgroundThe discovery of antimicrobials in the 1930s was one of the greatest achievements in medicine. However, bacterial resistance to antimicrobials was already observed in the 1940s and has been reported since then in both human and veterinary medicine, including in dairy cows. Many years of monitoring milk samples in South Africa, has led to the identification of a new strain of Staphylococcus aureus (S. aureus), which is maltose negative and appears to be an emerging pathogen. In this study the differences in susceptibility to antimicrobials of this strain were evaluated over time, over different seasons, in different provinces, and according to somatic cell count (SCC) categories.Results A data set of 271 maltose negative S. aureus isolates, cultured from milk samples from 117 herds out of the estimated 2000 commercial dairy herds in South Africa between 2010 and 2017, was studied using the disc diffusion method. This analysis was done using the Clinical Laboratory Standards Institute (CLSI) breakpoints in order to compare using both the previously used system (intermediate category grouped with resistant) and more recent system, (intermediate category grouped with susceptible). The results between the previously used system and the more recent system analysis differed for tylosin, cefalonium, oxy-tetracycline and cloxacillin. Neither the analysis using the previous system nor the more recent system showed an effect of province for the maltose negative S. aureus. This was in contrast to the results for maltose positive S. aureus where differences between provinces were shown in a previous study. For the susceptibility testing of 57 maltose negative S. aureus and 57 maltose positive S. aureus the minimum inhibitory concentration (MIC) results for the maltose negative S. aureus confirmed the results of the disc diffusion method. ConclusionsThe maltose negative strains of S. aureus differed in general, in their antimicrobial resistance patterns over time, in comparison to maltose-positive S. aureus strains. MIC testing also indicated that more multi-resistant isolates were seen with the maltose negative S. aureus than in the maltose positive strains.

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