Frequency and antimicrobial susceptibility of bacteria causing bloodstream infections in pediatric patients from United States (US) medical centers (2014–2018): therapeutic options for multidrug-resistant bacteria

2020 ◽  
Vol 98 (2) ◽  
pp. 115108 ◽  
Author(s):  
Helio S. Sader ◽  
Mariana Castanheira ◽  
Jennifer M. Streit ◽  
Cecilia G. Carvalhaes ◽  
Rodrigo E. Mendes
Keyword(s):  
United States ◽  
Antimicrobial Susceptibility ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Therapeutic Options ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Medical Centers

scholarly journals 129. Antimicrobial Activity of Ceftazidime–avibactam and Comparator Agents Tested against Gram-Negative Organisms Isolated from Patients with Bloodstream Infections in United States Medical Centers (2017–2018)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S93-S94
Author(s):  
Cecilia G Carvalhaes ◽  
Mariana Castanheira ◽  
Rodrigo E Mendes ◽  
Helio S Sader
Keyword(s):  
United States ◽  
New York ◽  
Bloodstream Infections ◽  
The United States ◽  
Multidrug Resistant ◽  
Medical Centers ◽  
Carbapenem Resistant ◽  
Gram Negative Organisms ◽  
Esbl Producers

Abstract Background We evaluated the antimicrobial susceptibility of Enterobacterales (ENT) and P. aeruginosa (PSA) causing bloodstream infections (BSIs) in the United States (US) hospitals. Methods A total of 3,317 ENT and 331 PSA isolates were consecutively collected (1/patient) from patients with BSI in 68 US medical centers in 2017–2018 and tested for susceptibility (S) by reference broth microdilution methods in a central laboratory as part of the International Network for Optimal Resistance Monitoring (INFORM) Program. β-Lactamase screening was performed by whole-genome sequencing on ENT with decreased S to broad-spectrum cephalosporins (ESBL phenotype). Results The most common ENT species isolated from BSI were E. coli (EC; 41.9% of ENT), K. pneumoniae (KPN; 24.4%), and E. cloacae (ECL; 8.7%), and the most active agents against ENT were ceftazidime–avibactam (CAZ-AVI; 99.9%S), amikacin (AMK; 99.6%S) and meropenem (MEM; 99.3%S). CAZ-AVI was active against all EC and KPN isolates (100.0%S). Only 2 ENT isolates (0.06%) were CAZ-AVI resistant, 2 NDM-1-producing ECL isolated in the New York City area. Ceftolozane–tazobactam (C-T) and piperacillin–tazobactam (PIP-TAZ) showed good activity against EC and KPN (92.2–98.9%S; Table), with limited activity against ECL (81.9–83.7%S). The most common ESBLs were CTX-M-type, which was observed in 93% of ESBL producers (mainly CTX-M-15 [64% of ESBL producers] and CTX-M-27 [13%]), and OXA-1/OXA-30 (42%); 42% of ESBL producers (n = 333, excluding carbapenemase producers) displayed ≥2 ESBL genes, mainly CTX-M-15 and OXA-1/OXA-30 (40% of ESBL producers). The most active agents against ESBL producers were CAZ-AVI (100.0%S), imipenem (99.4%S), and colistin (COL; 99.1%S). Only CAZ-AVI (99.4%S), AMK (96.2%S) and MEM (92.8%S) were active against >90% of multidrug-resistant (MDR) ENT. Among 19 carbapenem-resistant ENT (CRE; 0.6% of ENT), 9 produced a KPC-like, 2 an NDM-1, and 2 an NMC-A; carbapenemase genes were not found in 6 CRE isolates. COL (100.0%S), CAZ-AVI (98.5%S), AMK (98.5%S), C-T (98.1%S), and tobramycin (97.0%S) were very active against PSA. Conclusion CAZ-AVI exhibited potent in vitro activity and great spectrum against ENT (99.9%S) and PSA (98.5%) isolated from patients with BSI from US hospitals. Disclosures All authors: No reported disclosures.

scholarly journals Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance

2017 ◽  
Vol 66 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Fevronia Kolonitsiou ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Anastasia Spiliopoulou ◽  
Vasiliki Stamouli ◽  
Vasileios Papakostas ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Carbapenem Resistant

The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.

scholarly journals The impact of nosocomial bloodstream infections on mortality: a retrospective propensity-matched cohort study

2021 ◽  
Author(s):  
Neta Petersiel ◽  
Assa Sherman ◽  
Mical Paul
Keyword(s):  
Cohort Study ◽  
Cox Regression ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Cognitive Change ◽  
Resistant Bacteria ◽  
Matched Cohort ◽  
Multidrug Resistant Bacteria ◽  
Matched Cohort Study ◽  
The Impact

Abstract Background The mortality toll of nosocomial infections drives infection control efforts. We aimed to assess the contemporary mortality associated with nosocomial bloodstream infections (BSIs). Methods Retrospective propensity-matched cohort study conducted in one hospital in Israel between 1/2010-12/2020. Adults &gt;18 years old with nosocomial BSI were matched to controls using nearest neighbor matching of the propensity score (PS) for nosocomial BSI. We assessed all-cause mortality at 30 days, 90 days and survival up to 1 year starting on the BSI day or matched hospital day among controls; and the functional and cognitive change between admission and discharge using the Norton score among patients discharged alive. Residual differences between matched groups were addressed through Cox regression for 1-year survival. Results A total of 1361 patients with nosocomial BSI were matched to 1361 patients without BSI. Matching achieved similar patient groups, with small differences remaining in the Charlson score, albumin and hemoglobin levels. At 90 days, mortality was higher among patients with BSI (odds ratio 3.36, 95% confidence intervals 2.77-4.07). Odds ratios were higher when the BSI was caused by multidrug-resistant bacteria (OR 5.22, 95% CI 3.3-8.26) and with inappropriate empirical antibiotics in the first 24 hours (OR 3.85, 2.99-4.94). Following full adjustment, the hazard ratio for 1-year mortality with nosocomial BSI was 2.28 (1.98-2.62). The Norton score declined more frequently among patients with BSI (OR 2.27, 1.81-2.86) Conclusions Nosocomial BSIs incur a highly significant mortality toll, particularly when caused by multidrug-resistant bacteria. Among hospital survivors, BSIs are associated with functional decline.

scholarly journals Carriage of multidrug-resistant bacteria among pediatric patients before and during their hospitalization in a tertiary pediatric unit in Tunisia

2017 ◽  
Vol 13 (1) ◽  
pp. 1419047 ◽  
Author(s):  
Miniar Tfifha ◽  
Asma Ferjani ◽  
Manel Mallouli ◽  
Nesrine Mlika ◽  
Saoussen Abroug ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria

scholarly journals Exploration of the Pharmacokinetic-Pharmacodynamic Relationships for Fosfomycin Efficacy Using anIn VitroInfection Model

2015 ◽  
Vol 59 (12) ◽  
pp. 7170-7177 ◽  
Author(s):  
Brian D. VanScoy ◽  
Jennifer McCauley ◽  
Evelyn J. Ellis-Grosse ◽  
Olanrewaju O. Okusanya ◽  
Sujata M. Bhavnani ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Multidrug Resistant ◽  
Dose Fractionation ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Content Type ◽  
E Coli ◽  
Drug Concentrations ◽  
Tract Infections

ABSTRACTFosfomycin, a phosphonic class antibiotic with a broad spectrum of antibacterial activity, has been used outside the United States since the early 1970s for the treatment of a variety of infections. In the United States, an oral (tromethamine salt) formulation is used for uncomplicated urinary tract infections. Recently, there has been interest in the use of an intravenous solution (ZTI-01) for the treatment of a broad range of infections associated with multidrug-resistant bacteria. In this era of multidrug-resistant bacteria with few treatment options, it is critical to understand the pharmacokinetic-pharmacodynamic (PK-PD) determinants for fosfomycin efficacy. Since such data are limited, a one-compartmentin vitroinfection model was used to determine the PK-PD index associated with efficacy and the magnitude of this measure necessary for various levels of effect. One challenge isolate (Escherichia coliATCC 25922, for which the fosfomycin agar MIC is 0.5 mg/liter and the broth microdilution MIC is 1 mg/liter) was evaluated in the dose fractionation studies, and two additional clinicalE. coliisolates were evaluated in the dose-ranging studies. Mutation frequency studies indicated the presence of an inherently fosfomycin resistantE. colisubpopulation (agar MIC = 32 to 64 mg/liter) within the standard starting inoculum of a susceptibility test. Due to the presence of this resistant subpopulation, we identified the percentage of the dosing interval that drug concentrations were above the inherent resistance inhibitory concentration found at baseline to be the PK-PD index associated with efficacy (r2= 0.777). The magnitudes of this PK-PD index associated with net bacterial stasis and 1- and 2-log10CFU/ml reductions from baseline at 24 h were 11.9, 20.9, and 32.8, respectively. These data provide useful information for modernizing and optimizing ZTI-01 dosing regimens for further study.

scholarly journals Multidrug Resistant Bacteria in Pediatric Patients: A Therapeutic Nightmare

2018 ◽  
Vol 7 (10) ◽  
pp. 2392-2396
Author(s):  
Archana Chintaman Choure ◽  
Vaishali B. Dohe ◽  
Swati S. Mudshingkar ◽  
Meghana S. Palewar ◽  
Renu R. Bhardwaj
Keyword(s):  
Pediatric Patients ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria
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