scholarly journals Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study

2016 ◽  
Vol 10 (12) ◽  
pp. 1325-1331 ◽  
Author(s):  
Olivera Djuric ◽  
Snezana Jovanovic ◽  
Branka Stosovic ◽  
Tanja Tosic ◽  
Milica Jovanovic ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Aminoglycoside Resistance ◽  
Methicillin Resistant ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Clinically Relevant Bacteria

Introduction: We aimed to report the distribution and resistance patterns of eight invasive clinically relevant bacteria surveyed in the Clinical Center of Serbia (CCS) in Belgrade. Methodology: A total of 477 clinical blood stream isolates of Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. were collected in the period from January to December 2013. Antimicrobial susceptibility testing was performed using standard methods and interpreted using the Clinical and Laboratory Standards Institute (CLSI) breakpoint criteria. Results: Acinetobacter spp. was the most prevalent bacteria encountered (37%), followed by K. pneumoniae (25.7%). Multidrug resistance was observed in 92.5% of all isolates. Out of 177 strains of Acinetobacter spp., 97.7% were resistant to fluoroquinolones and carbapenems. Resistance to aminoglycosides, fluoroquinolones, and third-generation cephalosporins was 97.1%, 95.4%, and 95.8% among K. pneumoniae and 21.4%, 21.7%, and 31% among E. coli isolates, respectively. In total, 65.1% of K. pneumoniae and 12.1% of E. coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) positive. High-level aminoglycoside resistance of E. faecalis was 71.4%, and glycopeptide resistance of E. faecium was 95%. Out of 66 strains of S. aureus, 63.4% were methicillin resistant. Conclusions: The majority of bloodstream isolates of clinically relevant bacteria in CCS were multidrug resistant. The biggest concerns are carbapenem-resistant Acinetobacter spp., K. pneumoniae, and P. aeruginosa; third-generation cephalosporin-resistant E. coli; vancomycin-resistant E. faecium; and methicillin-resistant S. aureus. Stricter measures of infection control and antibiotic use are needed.

Emergence of Third generation Cephalosporin Resistant Escherichia coli in infants: Retrospective Study from a Tertiary Care Hospital in South India

2020 ◽  
Vol 18 ◽  
Author(s):  
Santhosh J. Thattil ◽  
Thekkuttuparambil A. Ajith
Keyword(s):  
Retrospective Study ◽  
Tertiary Care Hospital ◽  
Throat Swab ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Urine Samples ◽  
Care Hospital ◽  
Third Generation ◽  
E Coli ◽  
Sensitivity Pattern

Aim: This study was aimed to evaluate the emergence of third generation cephalosporin resistant Escherichiacoli isolated from the culture of various biological fluids of infants in a tertiary care hospital. Background: :Resistance to commonly used antibiotics is consistently increasing during the last decades and it was found varying with time and geographical location. Objectives: To determine the prevalence of third generation cephalosporin sensitivity pattern of E. coli isolated from urine, stool, and throat swab culture from laboratory records. Methods: Retrospective study included the laboratory report of antibiotic sensitivity conducted on infants specimens during the period of 2 years. Third generation cephalosporin sensitivity pattern of E. coli isolated from urine, stool, and throat swab culture were collected and data were statistically analyzed. Results: Reports of 351 samples with positive E. coli were included in the study. More samples were analyzed from infants above 6 months of age with female dominance (184/351). Among the specimens tested, urine samples were highest 128/351 (35.0%). Cephalosporin resistant strain was found in 243/351 samples (69.2%) (p=0.0463) with 218/243 (89.7%) isolated from infants above 6 months of age and 25/243 (10.2%) were from infants below 6 months of age (p=0.038). The frequency of cephalosporin resistant E.coli in urine specimens of male and female infants was significant (p=0.0001). Conclusion: Third generation cephalosporin resistant E. coli strain was found in 69.2% of isolates and more in urine samples from female infants above 6 months of age. The clinicians should consider the emergence of cephalosporin resistantE. coli while selecting antibiotics as the empirical treatment.

scholarly journals Impact of a Critical National Shortage of Cefazolin on Antimicrobial Practice at a Tertiary-Care Center in Japan

2020 ◽  
Vol 41 (S1) ◽  
pp. s256-s256
Author(s):  
Shutaro Murakami ◽  
Junko Hiroi ◽  
Yasuaki Tagashira ◽  
Akane Takamatsu ◽  
Shinya Hasegawa ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Antimicrobial Prophylaxis ◽  
Care Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Essential Medicines ◽  
Antimicrobial Use ◽  
Third Generation ◽  
Tertiary Care Center ◽  
Surgical Antimicrobial Prophylaxis

Background: Shortages of essential medicines, a long-standing issue in healthcare, apply equally to antimicrobial agents, a group of essential drugs necessary for sustainable healthcare. The WHO categorized essential medicines into the access, watch, and reserve groups. Older antimicrobials, in particular, were categorized into the access group, meaning that these drugs are in theory widely available at an affordable cost. The shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, which often has the undesirable consequence of defeating antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. In Japan, cefazolin has been in critically short supply since March 2019. Cefazolin is a first-line agent against common infectious diseases and in surgical antimicrobial prophylaxis, and its shortage has substantially impacted inpatient care. The aim of the present study was to investigate changes in antimicrobial practice at a tertiary-care center in Japan following the emergence of the national cefazolin shortage in March 2019. Methods: Data on each antimicrobial use are logged as days of therapy (DOT) per 1,000 patient days (PD) for antimicrobial stewardship purposes at the study institution. We extracted weekly data from September 2018 to September 2019 to evaluate the impact of the national cefazolin shortage on antimicrobial use at our tertiary-care center. Changes in weekly antimicrobial use and the weekly incidence of Clostridium difficile infections were analyzed by interrupted time series analysis. We also investigated changes in antimicrobial practice at selected situations. Results: As weekly cefazolin use significantly declined after the emergence of the national shortage, use of third-generation cephalosporin (+18.9 DOT per 1,000 PD for intercept [P < .001] and +0.65 DOT per 1,000 PD per week for trend [P = .037]) and clindamycin (18 DOT per 1,000 PD for intercept [P = .008] and 0.12 DOT per 1,000 PD per week for trend [P = .003]) significantly increased. Significant changes in antimicrobial practice were also observed in surgical antimicrobial prophylaxis: third-generation cephalosporin use increased from 1.0% (31 of 3,032) to 62.9% (2,237 of 3,554) (P < .001). However, no significant change in the incidence of Clostridium difficile infection was observed during the study period: +1.72 per 10,000 PD for intercept (P = .12) and 0.12 per 10,000 PD per week for the trend (P = .09). Conclusions: The national cefazolin shortage had a significantly negative impact on patient care and led to increased use of alternative, broader-spectrum antimicrobials, which are not ideal choices either for prophylaxis or treatment.Funding: NoneDisclosures: None

scholarly journals Detecting the dual presence of AmpC and ESBL enzymes

2009 ◽  
Vol 30 (5) ◽  
pp. 208
Author(s):  
John Sfakinos
Keyword(s):  
Generation Cephalosporin ◽  
Third Generation ◽  
Proteus Vulgaris ◽  
First Line ◽  
Morganella Morganii ◽  
Gram Negative ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Gram Negative Organisms ◽  
Third Generation Cephalosporins

Inducible-chromosomal AmpC cephalosporinase enzymes have been recognised for several years in the ESCAPPM (Enterobacter spp., Serratia spp., Citrobacter freundii, Acinetobacter spp., Proteus vulgaris, Providencia spp. and Morganella morganii) group of gram-negative organisms, which result in the potential resistance to third-generation cephalosporin drugs. More recently several non-ESCAPPM Enterobacteriaceae (particularly E coli, Klebsiella and Proteus mirabilis) have been found to harbour a non-inducible-plasmid form of AmpC. This is particularly important when found in bacteremic patients where third-generation cephalosporins are often the first line drugs of choice.

Microbiological and Antimicrobial Pattern of Diabetic Foot Ulcers at a Tertiary Care Center in East China

2021 ◽  
pp. 153473462110559
Author(s):  
Yaping Xie ◽  
Ying Xu ◽  
Kuang Chen ◽  
Can Chen ◽  
Jiao Huang ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Pathological State ◽  
E Coli ◽  
Diabetic Foot Infections ◽  
High Prevalence ◽  
Acinetobacter Spp ◽  
Gram Positive Cocci

Background Diabetic foot infections (DFIs) are the most complex and challenging pathological state, characterized by high complexity of management, morbidity, and mortality. Empirical antimicrobial administration is needed before the identification of the causative organisms. Microbiological profile of the diabetic foot patients is the basis of the antibiotic choice for clinicians. Methods 76 patients visiting the Diabetic Foot Center of our Hospital for having ulcers with Wagner 3 to 5 were retrospectively surveyed for the bacterium infected. Antimicrobial susceptibility testing (AST) was implemented and the results were interpreted on the basis of the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results A total of 92 isolates were obtained, of which 47 strains of gram-negative bacilli (GNB) accounted for 51.1%, 41 strains of gram-positive cocci (GPC) accounted for 44.6%, and 4 strains of fungi accounted for 4.3%. Species of Enterobacteriaceae and Staphylococcus are the two predominant strains. The top 4 most frequently isolated strains were Staphylococcus aureus (22.8%), enterococcus faecalis (9.8%), Pseudomonas aeruginosa (9.8%), Escherichia coli (5.4%). The rate of resistance to methicillin was 33.3% for S. aureus. The rate of extended-spectrum β-lactamases (ESBLs) production among E. coli was 60%. 50% of Klebsiella pneumoniae were resistant to carbapenems. P. aeruginosa showed high sensitivity to commonly used antibiotics. There was one isolate of Acinetobacter spp. resistant to most antimicrobials except tigecycline and aminoglycosides. Conclusion Enterobacteriaceae and Staphylococcus are the two predominant species. The resistance to antibiotics of S. aureus and P. aeruginosa showed optimistic results. However, the high prevalence of CRKP imposed a challenging issue for clinical physicians.

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.

scholarly journals Detection of Antimicrobial Activity of Cranberry Fruit Extract against Methicillin Resistant Staphylococcus aureus and Extended Spectrum Beta Lactamase Escherichia coli

2021 ◽  
pp. 44-52
Author(s):  
Ali Nawaz Bijarani ◽  
Muhammad Owais Ismail ◽  
Zahida Memon ◽  
Faisal Afridi ◽  
Shabana Qabulio ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bacterial Activity ◽  
Beta Lactamase ◽  
Fruit Extract ◽  
Methicillin Resistant ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Fruit Extracts ◽  
Extended Spectrum

Objective: Antibacterial effects of Cranberry fruit extract on Methicillin Resistant Staphylococcus aureus and Extended Spectrum beta lactamase producing E. coli and its comparison with Linezolid and Meropenem. Materials and Methods: It is a Pre Clinical (in-vitro) study conducted in Ziauddin University from January 2020 to October 2020. All samples were collected from Ziauddin University.  All clinical samples were collected inform of pus, urine, blood, tracheal aspirations, patients admitted in surgical and medical wards, intensive care units and outdoor patients who were attending clinics. All these samples were transported to Clinical Microbiology Laboratory, Ziauddin hospital, North Nazimabad campus and then culture and sensitivity test were performed there. Sample showing double growth and contamination on agar plates were excluded from study. Results: Out of 80 samples included in this study 46(57.5%) were female and 34(42.5%) samples were male; female to male samples ratio of 1.35:1.The mean age was 45.71±11.83 years. MRSA commonly found in pus swab 15(37.5%) and 21(52.5%) ESBL producing E. coli found in urine samples. 14(35%) samples were observed anti-bacterial activity of cranberry fruit extracts against Extended Spectrum Beta Lactamase Producing Escherichia coli at 50 mg/ml concentration, followed by 10(25%) and 9(22.5%) samples at  60 mg/ml, 40 mg/ml were respectively. While resistance of Extended Spectrum Beta Lactamase Producing Escherichia coliwere observed high at different concentration level of cranberry fruit extracts. Good anti-bacterial activity of cranberry fruit extracts observed  against Methicillin Resistant Staphylococcus aureus at different                      levels of concentration 20(50%), 23(57.5%), 21(52.5%), 26(65%), 29(72.5%) samples were 20 mg/ml,30mg/ml,40mg/ml, 50mg/ml, 60mg/ml respectively. Most superior and best dose of cranberry fruit extract against Staph Aureus in about 72.5% (29) at 60mg/ml and their Comparison with linezolid and meropenem against Methicillin Resistant Staphylococcus aureus and found best positive results as compared with Linezolid and found significant p value 0.005. Conclusions: Cranberry extract has a lot of potential to prove itself to be a good antimicrobial agent. The cranberry fruit extract has high antimicrobial activity against methicillin resistant S.aureus and resistant strains of E. coli in comparison to linezolid and meropenem.

COMPARATIVE STUDY OF E-STRIP AND VITEK 2 FOR VANCOMYCIN MIC FOR STAPHYLOCOCCUS AUREUS AT TERTIARY CARE CENTER

2021 ◽  
pp. 8-10
Author(s):  
Gauri Thakare ◽  
Sonal Chavan ◽  
Sharmila Raut ◽  
Rajani Tore ◽  
Ravindra Khadse
Keyword(s):  
Staphylococcus Aureus ◽  
Comparative Study ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Care Center ◽  
Tertiary Care ◽  
Test Material ◽  
Methicillin Resistant ◽  
Study Results ◽  
Vitek 2 ◽  
Strip Test

PURPOSE: Comparative Study done for Vancomycin susceptibility in Methicillin Resistant Staphylococcus aureus (MRSA) in two methods Vitek-2 and E-strip test. MATERIAL AND METHOD: Vancomycin susceptibility testing was performed on these Methicillin Resistant Staphylococcus aureus (MRSA) isolates by two methods viz. Vitek 2 & E- strip Test. RESULT: A total of 10680 various specimens were received and processed in laboratory. 210 samples were S. aureus amongst which 76 were MRSAs. Pus was the predominant sample followed by endotracheal secretions, blood, and sputum. All the strains of MRSA found susceptible to vancomycin (MIC≤ 2µg/ ml) by both the methods. Maximum specimens by both the methods had MICs of 1.0 µg/ ml. CONCLUSION: In the present study results of Vitek and E-strip were almost comparable. In the advanced era of automation and computerized technology with manpower compromised labs, Vitek could be a better option for vancomycin MIC.

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