A journey into the unknown: An ethnographic examination of drug-resistant epilepsy treatment and management in the United States

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

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Activity of Oritavancin Against Gram-positive Pathogens Causing Bloodstream Infections in the United States Over 10 Years: Focus on Drug-Resistant Enterococcal Subsets (2010-2019)

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01667-21 ◽

2021 ◽

Author(s):

Cecilia G. Carvalhaes ◽

Helio S. Sader ◽

Jennifer M. Streit ◽

Mariana Castanheira ◽

Rodrigo E. Mendes

Keyword(s):

United States ◽

Staphylococcus Aureus ◽

Enterococcus Faecium ◽

Bloodstream Infections ◽

The United States ◽

Drug Resistant ◽

Gram Positive ◽

Methicillin Resistant ◽

Vancomycin Resistant ◽

Over Time

Oritavancin displayed potent and stable activity (MIC 90 range, 0.06-0.5 mg/L) over time (2010-2019) against Gram-positive pathogens causing bloodstream infections, including methicillin-resistant Staphylococcus aureus and resistant subsets of Enterococcus spp. Daptomycin and linezolid were also active against methicillin-resistant S. aureus and vancomycin-resistant Enterococcus . Only oritavancin and linezolid remained active against Enterococcus faecium isolates displaying an elevated daptomycin MIC (i.e., 2-4 mg/L). Proportions of methicillin-resistant S. aureus and vancomycin-resistant Enterococcus within the respective S. aureus and enterococcal populations decreased over this period.

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Tuberculosis in the 1990s: From Bedside to Bench and Back

Canadian Respiratory Journal ◽

10.1155/1999/719832 ◽

1999 ◽

Vol 6 (4) ◽

pp. 341-344

Author(s):

Frances B Jamieson ◽

Pamela Chedore

Keyword(s):

United States ◽

New Technologies ◽

The United States ◽

Clinical Impact ◽

Downward Trend ◽

Drug Resistant ◽

Critical Part

Since the mid-1980s, the rate of new cases of tuberculosis (TB) diagnosed in Canada ceased to follow a downward trend, and has instead stabilized at approximately 7 cases/100,000 population. In the United States, a similar trend emerged, such that in the early 1990s there was an increase in new cases of TB. Outbreaks of drug-resistant TB also occurred with devastating clinical impact. These observations prompted laboratories to re-examine their role in halting the spread of TB. Laboratories play a critical part in the diagnosis of TB; procedures must be optimized to provide rapid and accurate results. This review discusses the role of the mycobacteriology laboratory in the diagnosis of TB, and how new technologies available today have enhanced the ability of the laboratory to provide timely, efficient and accurate results.

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Not unexpectedly, a new drug-resistant ‘superbug’ pops up in the United States

Science ◽

10.1126/science.aag0576 ◽

2016 ◽

Author(s):

Kelly Servick

Keyword(s):

United States ◽

The United States ◽

Drug Resistant ◽

New Drug

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In vitro susceptibility of ceftolozane/tazobactam against typhoidal, non-typhoidal and extended spectrum β-lactamase-producing Salmonella

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01224-21 ◽

2021 ◽

Author(s):

Jade L. L. Teng ◽

Elaine Chan ◽

Asher C. H. Dai ◽

Gillian Ng ◽

Tsz Tuen Li ◽

...

Keyword(s):

United States ◽

Antimicrobial Agents ◽

The United States ◽

Drug Resistant ◽

Broth Microdilution ◽

In Vitro Susceptibility ◽

Extended Spectrum ◽

Control And Prevention ◽

Esbl Producers

Both typhoidal and non-typhoidal salmonellae are included in the top 15 drug-resistant threats described by the Center for Disease Control and Prevention of the United States. There is an urgent need to look for alternative antibiotics for the treatment of Salmonella infections. We examined the in vitro susceptibilities of ceftolozane/tazobactam and six other antibiotics on typhoidal and non-typhoidal salmonellae, including isolates that are extended-spectrum β-lactamase (ESBL)-positive, using the broth microdilution test. Of the 313 (52 typhoidal and 261 non-typhoidal) Salmonella isolates tested, 98.7% were susceptible to ceftolozane/tazobactam. Based on the overall MIC 50/90 values, Salmonella isolates were more susceptible to ceftolozane/tazobactam (0.25/0.5 mg/L) compared to all other comparator agents: ampicillin (≥64/≥64 mg/L), levofloxacin (0.25/1 mg/L), azithromycin (4/16 mg/L), ceftriaxone (≤0.25/4 mg/L), chloramphenicol (8/≥64 mg/L) and trimethoprim/sulfamethoxazole (1/≥8 mg/L). When comparing the activity of the antimicrobial agents against non-typhoidal Salmonella isolates according to their serogroup, ceftolozane/tazobactam had the highest activity (100%) against Salmonella serogroups D, G, I and Q isolates, whereas the lowest activity (85.7%) was observed against serogroup E isolates. All the 10 ESBL-producing Salmonella (all non-typhoidal) isolates, of which 8 were CTX-M-55-producers and 2 were CTX-M-65-producers, were sensitive to ceftolozane/tazobactam albeit with a higher MIC 50/90 value (1/2 mg/L) than non-ESBL-producers (0.25/0.5 mg/L). In summary, our data indicate that ceftolozane/tazobactam is active against most strains of both typhoidal and non-typhoidal salmonellae and also active against ESBL-producing salmonellae.

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Drug-Resistant Salmonella typhi in Pakistan

Clinical Pediatrics ◽

10.1177/0009922819881203 ◽

2019 ◽

Vol 59 (1) ◽

pp. 31-33 ◽

Cited By ~ 1

Author(s):

Christine E. Petrin ◽

Russell W. Steele ◽

Elizabeth A. Margolis ◽

Justin M. Rabon ◽

Holly Martin ◽

...

Keyword(s):

United States ◽

Typhoid Fever ◽

Enteric Fever ◽

The United States ◽

Salmonella Typhi ◽

Antimicrobial Treatment ◽

Third Generation ◽

Drug Resistant ◽

Oral Transmission ◽

Third Generation Cephalosporins

Enteric fever (formerly typhoid fever) is a bacterial illness caused by fecal-oral transmission of Salmonella typhi or paratyphi. In early 2018, an outbreak of Salmonella typhi resistant to third-generation cephalosporins, ampicillin, ciprofloxacin, trimethroprim-sulfamethoxazole, and chloramphenicol was reported in Pakistan. This strain, termed “extensively resistant typhi,” has infected more than 5000 patients in endemic areas of South Asia, as well as travelers to and from these areas, including 5 cases in the United States. We present the case of one such child who developed extensively resistant enteric fever during a recent visit to Pakistan and required broader antimicrobial treatment than typically required. Clinicians should be aware that incoming cases of enteric fever may be nonsusceptible to commonly recommended antibiotics and that extensively resistant typhi requires treatment with carbapenems such as meropenem or azithromycin.

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Activity of Plazomicin Tested against Enterobacterales Isolates Collected from U.S. Hospitals in 2016–2017: Effect of Different Breakpoint Criteria on Susceptibility Rates among Aminoglycosides

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02418-19 ◽

2020 ◽

Vol 64 (5) ◽

Author(s):

Mariana Castanheira ◽

Helio S. Sader ◽

Rodrigo E. Mendes ◽

Ronald N. Jones

Keyword(s):

United States ◽

16S Rrna ◽

The United States ◽

Drug Resistant ◽

Carbapenem Resistant ◽

Extensively Drug Resistant

ABSTRACT Plazomicin was active against 97.0% of 8,783 Enterobacterales isolates collected in the United States (2016 and 2017), and only 6 isolates carried 16S rRNA methyltransferases conferring resistance to virtually all aminoglycosides. Plazomicin (89.2% to 95.9% susceptible) displayed greater activity than amikacin (72.5% to 78.6%), gentamicin (30.4% to 45.9%), and tobramycin (7.8% to 22.4%) against carbapenem-resistant and extensively drug-resistant isolates. The discrepancies among the susceptibility rates for these agents was greater when applying breakpoints generated using the same stringent contemporary methods applied to determine plazomicin breakpoints.

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Extensively Drug-Resistant Pseudomonas aeruginosa ST309 Harboring Tandem Guiana Extended Spectrum β-Lactamase Enzymes: A Newly Emerging Threat in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz273 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 12

Author(s):

Ayesha Khan ◽

Truc T Tran ◽

Rafael Rios ◽

Blake Hanson ◽

William C Shropshire ◽

...

Keyword(s):

United States ◽

Pseudomonas Aeruginosa ◽

Phylogenetic Analysis ◽

The United States ◽

Clinical Isolates ◽

Drug Resistant ◽

Class 1 Integron ◽

E Coli ◽

Extensively Drug Resistant ◽

Extended Spectrum

Abstract Background Treatment of serious infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa remains a challenge, despite the introduction of novel therapeutics. In this study, we report 2 extensively drug-resistant clinical isolates of sequence type (ST) 309 P aeruginosa resistant to all β-lactams, including the novel combinations ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam. Methods Isolates were sequenced using both short-read (Illumina) and long-read technology to identify resistance determinants, polymorphisms (compared with P aeruginosa PAO1), and reconstruct a phylogenetic tree. A pair of β-lactamases, Guiana extended spectrum β-lactamase (GES)-19 and GES-26, were cloned and expressed in a laboratory strain of Escherichia coli to examine their relative impact on resistance. Using cell lysates from E coli expressing the GES genes individually and in tandem, we determined relative rates of hydrolysis for nitrocefin and ceftazidime. Results Two ST309 P aeruginosa clinical isolates were found to harbor the extended spectrum β-lactamases GES-19 and GES-26 clustered in tandem on a chromosomal class 1 integron. The presence of both enzymes in E coli was associated with significantly elevated minimum inhibitory concentrations to aztreonam, cefepime, meropenem, ceftazidime/avibactam, and ceftolozane/tazobactam, compared with those expressed individually. The combination of ceftazidime/avibactam plus aztreonam was active in vitro and used to achieve cure in one patient. Phylogenetic analysis revealed ST309 P aeruginosa are closely related to MDR strains from Mexico also carrying tandem GES. Conclusions The presence of tandem GES-19 and GES-26 is associated with resistance to all β-lactams, including ceftolozane/tazobactam. Phylogenetic analysis suggests that ST309 P aeruginosa may be an emerging threat in the United States.

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