Enterokokken mit speziellen Resistenzen – Epidemiologie, Hygiene und Therapie

2019 ◽  
Vol 144 (08) ◽  
pp. 553-560 ◽  
Author(s):  
Alexander Mischnik ◽  
Guido Werner ◽  
Jennifer Bender ◽  
Nico Mutters
Keyword(s):  
Scientific Evidence ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Resistance Patterns ◽  
Single Intervention ◽  
Vancomycin Resistant ◽  
Meta Analyses ◽  
Resistance Rates ◽  
Insight Into

AbstractEnterococci with special resistance patterns (mainly vancomycin-resistant enterococci) play an important role in everyday clinical practice. Rising resistance rates to linezolid, daptomycin or tigecycline are also increasingly reported. Therapeutically, linezolid and daptomycin are the most important substances mainly in infections due to vancomycin-resistant enterococci. Several systematic meta-analyses of bloodstream infections showed discrepant results in the comparison of mortality of linezolid and daptomycin-treated bacteraemias. The containment of enterococci with special resistance patterns is currently receiving great attention. The key hygienic issue in all recommendations for dealing with multidrug-resistant enterococci can be summarized very simply: current scientific evidence is often inconsistent and studies that have clearly tested a single intervention for efficacy are lacking. The present work gives an insight into the current epidemiology and therapeutic strategies. Furthermore, the recently published German KRINKO recommendations are presented.

scholarly journals High Colonization Rate and Heterogeneity of ESBL- and Carbapenemase-Producing Enterobacteriaceae Isolated from Gull Feces in Lisbon, Portugal

2020 ◽  
Vol 8 (10) ◽  
pp. 1487
Author(s):  
Marta Aires-de-Sousa ◽  
Claudine Fournier ◽  
Elizeth Lopes ◽  
Hermínia de Lencastre ◽  
Patrice Nordmann ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Encoding Genes

In order to evaluate whether seagulls living on the Lisbon coastline, Portugal, might be colonized and consequently represent potential spreaders of multidrug-resistant bacteria, a total of 88 gull fecal samples were screened for detection of extended-spectrum β-lactamase (ESBL)- or carbapenemase-producing Enterobacteriaceae for methicillin-resistant Staphylococcus aureus (MRSA) and for vancomycin-resistant Enterococci (VRE). A large proportion of samples yielded carbapenemase- or ESBL-producing Enterobacteriaceae (16% and 55%, respectively), while only two MRSA and two VRE were detected. Mating-out assays followed by PCR and whole-plasmid sequencing allowed to identify carbapenemase and ESBL encoding genes. Among 24 carbapenemase-producing isolates, there were mainly Klebsiella pneumoniae (50%) and Escherichia coli (33%). OXA-181 was the most common carbapenemase identified (54%), followed by OXA-48 (25%) and KPC-2 (17%). Ten different ESBLs were found among 62 ESBL-producing isolates, mainly being CTX-M-type enzymes (87%). Co-occurrence in single samples of multiple ESBL- and carbapenemase producers belonging to different bacterial species was observed in some cases. Seagulls constitute an important source for spreading multidrug-resistant bacteria in the environment and their gut microbiota a formidable microenvironment for transfer of resistance genes within bacterial species.

scholarly journals Differences in Hospital-Associated Multidrug-Resistant Organisms and Clostridium difficile Rates Using 2-Day versus 3-Day Definitions

2014 ◽  
Vol 35 (11) ◽  
pp. 1417-1420 ◽  
Author(s):  
Adrijana Gombosev ◽  
Salah E. Fouad ◽  
Eric Cui ◽  
Chenghua Cao ◽  
Leah Terpstra ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clostridium Difficile ◽  
Infection Prevention ◽  
Prevention Programs ◽  
Multidrug Resistant ◽  
Infect Control Hosp ◽  
Methicillin Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Multidrug Resistant Organisms ◽  
Vancomycin Resistant

We surveyed infection prevention programs in 16 hospitals for hospital-associated methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, extended-spectrum β-lactamase, and multidrug-resistant Acinetobacter acquisition, as well as hospital-associated MRSA bacteremia and Clostridium difficile infection based on defining events as occurring >2 days versus >3 days after admission. The former resulted in significantly higher median rates, ranging from 6.76% to 45.07% higherInfect Control Hosp Epidemiol 2014;35(11):1417–1420

scholarly journals Distribution of vancomycin resistant enterococci and their resistance patterns determined by surveillance

2014 ◽  
Vol 8 (7) ◽  
pp. 680-684
Author(s):  
Efe Iris Nur ◽  
Sezgin Sayıner Hakan ◽  
Yıldırmak Taner ◽  
Şimşek Funda ◽  
Ersz Arat Muret
Keyword(s):  
Vancomycin Resistant Enterococci ◽  
Resistance Patterns ◽  
Vancomycin Resistant

scholarly journals Molecular epidemiology of vancomycin-resistant Enterococcus faecium strains isolated from haematological malignancy patients in a research hospital in Turkey

2010 ◽  
Vol 59 (6) ◽  
pp. 660-664 ◽  
Author(s):  
S. Kirdar ◽  
A. G. Sener ◽  
U. Arslan ◽  
S. G. Yurtsever
Keyword(s):  
Enterococcus Faecium ◽  
Haematological Malignancy ◽  
Research Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Time Period ◽  
Genes Encoding ◽  
Resistance Patterns ◽  
Training And Research ◽  
Vancomycin Resistant ◽  
Short Time

Infections and outbreaks of vancomycin-resistant enterococci (VRE) still appear to be rare in Turkey. In the present study, VRE strains isolated during an outbreak in a haematology unit of a training and research hospital in Turkey were typed and their antimicrobial-resistance patterns were characterized by molecular methods. Twelve vancomycin-resistant Enterococcus faecium strains isolated from patients with haematological malignancies were investigated by PCR for the presence of genes encoding resistance to vancomycin, tetracycline, chloramphenicol, gentamicin and erythromycin. Their clonal relationship was evaluated by PFGE and multilocus sequence typing. All strains were resistant to vancomycin and erythromycin, and had the vanA and ermB genes, respectively. PFGE was used to determine the presence of two pulsotypes and determine their subtypes. Pulsotype A belonged to sequence type (ST) 17 and pulsotype B belonged to ST 78. All strains with the vanA gene were not the same clone, indicating multiple acquisitions of resistant isolates, even over such a short time period.

scholarly journals Molecular Characterization of invasive Enterobacteriaceae from Pediatric Patients in Central and Northwestern Nigeria

2020 ◽  
Author(s):  
Carissa Duru ◽  
Grace M Olanipekun ◽  
Vivian Odili ◽  
Nicholas J Kocmich ◽  
Amy Rezac ◽  
...  
Keyword(s):  
Resistance Genes ◽  
Treatment Options ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Esbl Production ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
High Prevalence ◽  
Resistance Rates

AbstractBackgroundBacteremia is a leading cause of death in developing countries but etiologic evaluation is infrequent and empiric antibiotics are not evidence-based. Very little is known about the types of extended-spectrum β-lactamases (ESBL) in pediatric bacteremia patients in Nigeria. We evaluated the patterns of ESBL resistance in children enrolled into surveillance for community acquired bacteremic syndromes across health facilities in Central and Northwestern Nigeria.MethodBlood culture from suspected cases of sepsis from children age less than 5 years were processed using automated Bactec® incubator System from Sept 2008-Dec 2016. Enterobacteriacea were identified to the species level using Analytical Profile Index (API20E®) identification strip and antibiotic susceptibility profile was determined by the disc diffusion method. The multidrug resistant strains were then screened and confirmed for extended spectrum beta lactamase (ESBL) production by the combination disc method as recommended by Clinical and Laboratory Standard Institute (CLSI). Real time PCR was used to elucidate the genes responsible for ESBL production characterize the resistance genesResultOf 21,000 children screened from Sept 2008-Dec 2016, 2,625(12.5%) were culture-positive. A total of 413 Enterobacteriaceae available for analysis were screened for ESBL. ESBL production was detected in 160/413(38.7%), comprising Klebsiella pneumoniae 105/160(65.6%), Enterobacter cloacae 21/160(13.1%), Escherichia coli 22/160(13.8%), Serratia species 4/160(2.5%), Pantoea species 7/160(4.4%) and Citrobacter species 1/160(0.6%). Of the 160 ESBL-producing isolates, high resistance rates were observed among ESBL-positive isolates for Ceftriaxone (92.3%), Aztreonam (96.8%), Cefpodoxime (96.25%), Cefotaxime (98.75%) and sulphamethoxazole-trimethoprim (90%), while 87.5 %, 90.63%, and 91.87% of the isolates were susceptible to Imipenem, Amikacin and Meropenem respectively. Frequently detected resistance genes were blaTEM 83.75%) (134/160), and, blaCTX-M 83.12% (133/160) followed by blaSHV genes 66.25% (106/160). Co-existence of blaCTX-M, blaTEM and blaSHV was seen in 94/160 (58.8%), blaCTX-M and blaTEM in 118/160 (73.8%), blaTEM and blaSHV in 97/160 (60.6%) and blaCTX-M and blaSHV in 100/160 (62.5%) of isolates tested.ConclusionOur results indicate a high prevalence of ESBL resistance to commonly used antibiotics in Enterobacteriaceae isolates from bloodstream infections in children in this study. Careful choice of antibiotic treatment options and further studies to evaluate transmission dynamics of resistance genes could help in the reduction of ESBL resistance in these settings.

scholarly journals Increasing proportion of vancomycin resistance among enterococcal bacteraemias in Switzerland: a 6-year nation-wide surveillance, 2013 to 2018

2020 ◽  
Vol 25 (35) ◽  
Author(s):  
Vanja Piezzi ◽  
Michael Gasser ◽  
Andrew Atkinson ◽  
Andreas Kronenberg ◽  
Danielle Vuichard-Gysin ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Vancomycin Resistance ◽  
Targeted Prevention ◽  
Prevention Strategies ◽  
Confidential Interval ◽  
Blood Isolate ◽  
Epidemiological Factors ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Using Data

Background Vancomycin-resistant enterococci (VRE), mostly Enterococcus faecium, are multidrug-resistant microorganisms that can cause nosocomial infections. VRE has increased throughout many European countries, but data from Switzerland are scarce. Aim The aim of this work was to characterise the epidemiology of enterococcal bacteraemias in Switzerland with a focus on VRE. Methods In this observational study, we retrospectively investigated bacteraemias from 81 healthcare institutions from January 2013 to December 2018 using data from the Swiss Centre for Antibiotic Resistance. Only the first blood isolate with E. faecalis or E. faecium from an individual patient was considered. We analysed the annual incidences of enterococcal bacteraemias and determined the proportion of VRE over time. We also assessed epidemiological factors potentially associated with VRE bacteraemia. Results We identified 5,369 enterococcal bacteraemias, of which 3,196 (59.5%) were due to E. faecalis and 2,173 (40.5%) to E. faecium. The incidence of enterococcal bacteraemias increased by 3.2% per year (95% confidential interval (CI): 1.6–4.8%), predominantly due to a substantial increase in E. faecalis bacteraemic episodes. Vancomycin resistance affected 30 (1.4%) E. faecium and one E. faecalis bacteraemic episodes. Among all E. faecium bacteraemias, the proportion of vancomycin-resistant isolates increased steadily from 2013 to 2018 (2% per year; 95% CI: 1.5–2.9%). No independent epidemiological factor for higher prevalence of vancomycin-resistant E. faecium bacteraemias was identified. Conclusions Vancomycin-resistant E. faecium bacteraemias remain infrequent in Switzerland. However, an important increase was observed between 2013 and 2018, highlighting the need for implementing active surveillance and targeted prevention strategies in the country.

scholarly journals Survey of Antibiotic Resistance among Enterococci in North Rhine-Westphalia, Germany

1999 ◽  
Vol 37 (5) ◽  
pp. 1638-1641 ◽  
Author(s):  
R. R. Reinert ◽  
G. Conrads ◽  
J. J. Schlaeger ◽  
G. Werner ◽  
W. Witte ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Surveillance Study ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
High Level ◽  
Resistance Rates

A surveillance study on antibiotic resistance of enterococcal isolates (n = 730) was carried out in North Rhine-Westphalia, Germany, in 1997. Resistance rates to ampicillin (7.4%), high-level gentamicin (15.0%), high-level streptomycin (27.9%), ciprofloxacin (37.9%), vancomycin (1.5%), and teicoplanin (1.5%) were determined. All vancomycin-resistant enterococci (VRE) carried the vanA gene. SmaI andApaI macrorestriction patterns indicated an intra- and interhospital spread of VRE.

scholarly journals Antibiotic Resistance Patterns of Enterococci and Occurrence of Vancomycin-Resistant Enterococci in Raw Minced Beef and Pork in Germany

1998 ◽  
Vol 64 (5) ◽  
pp. 1825-1830 ◽  
Author(s):  
G�nter Klein ◽  
Alexander Pack ◽  
Gerhard Reuter
Keyword(s):  
Nosocomial Infections ◽  
Direct Method ◽  
Processed Meat ◽  
Processing Plant ◽  
Vancomycin Resistant Enterococci ◽  
Minced Beef ◽  
Selective Agar ◽  
Resistance Patterns ◽  
Vancomycin Resistant ◽  
Minced Meat

ABSTRACT The food chain, especially raw minced meat, is thought to be responsible for an increase in the incidence of vancomycin-resistant enterococci (VRE) in human nosocomial infections. Therefore, 555 samples from 115 batches of minced beef and pork from a European Union-licensed meat-processing plant were screened for the occurrence of VRE. The processed meat came from 45 different slaughterhouses in Germany. Enterococci were isolated directly from Enterococcosel selective agar plates and also from Enterococcosel selective agar plates supplemented with 32 mg of vancomycin per liter. In addition, peptone broth was used in a preenrichment procedure, and samples were subsequently plated onto Enterococcosel agar containing vancomycin. To determine resistance, 209 isolates from 275 samples were tested with the glycopeptides vancomycin, teicoplanin, and avoparcin and 19 other antimicrobial substances by using a broth microdilution test. When the direct method was used, VRE were found in 3 of 555 samples (0.5%) at a concentration of 1.0 log CFU/g of minced meat. When the preenrichment procedure was used, 8% of the samples were VRE positive. Our findings indicate that there is a low incidence of VRE in minced meat in Germany. In addition, the resistance patterns of the VRE isolates obtained were different from the resistance patterns of clinical isolates. A connection between the occurrence of VRE in minced meat and nosocomial infections could not be demonstrated on the basis of our findings.

Run-off Patterns of Vancomycin Resistant Enterococci (VRE clones) in Cows Raw Milk and Imported Milk Powders at Baghdad Markets

2019 ◽  
Vol 43 (2) ◽  
pp. 61-66 ◽  
Author(s):  
Ali Hassan Ahmed Al-Shammary
Keyword(s):  
Enterococcus Faecalis ◽  
Raw Milk ◽  
Multidrug Resistant ◽  
Normal Flora ◽  
Milk Samples ◽  
Vancomycin Resistant Enterococci ◽  
Run Off ◽  
Vancomycin Resistant ◽  
Antibiotics Sensitivity ◽  
Contamination Events

Codebook shifting of some clones of Enterococci from normal flora to genotypically and phenotypically foodborne opportunistic and multidrug resistant pathogens in our ecosystem represent dangerous hygienic problem. Seventy-fivepooled milk samples were collectedfrom differentdistricts in Baghdad ecosystem from January until May (2019). Fiftyraw milk samples pooled directly from Cows and milk containers (twenty-five each) and twenty-five imported milk powders pooled from Baghdad markets in which, fifteen samples inspected monthly(five from each brand). Certifiedand modified traitsprofits for isolation and confirmation policy. Frequency and distribution of verified data in Baghdad environment reveled variable results. Seven Enterococcus faecalis phenotypes (9.33 %) recovered from raw milk samples in which, four isolates (5.33 %) recovered from Cows raw milk and three isolates (4 %) recovered from milk containers. None recovered clones founds in imported milk powders. All isolates were biofilm-producers and vancomycin resistant verifiedvia modified Christensen biofilm assay and antibiotics sensitivity test. Monitoring these contamination events with vancomycin resistant Enterococcus faecalis needs sophisticated hygienic efforts in Baghdad ecosystem

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