Multiresistente Bakterien: Antibiotikaverordnung und Reserveantibiotika

2018 ◽  
Vol 143 (09) ◽  
pp. 643-650 ◽  
Author(s):  
Winfried Kern
Keyword(s):  
Antibiotic Resistance ◽  
Food Production ◽  
One Health ◽  
Susceptibility Testing ◽  
Environmental Issues ◽  
Multidrug Resistant ◽  
Human Medicine ◽  
New Drugs ◽  
Adequate Treatment ◽  
Multidrug Resistant Organisms

AbstractAscertaining critical indications for antibiotics and rational prescribing can delay and minimize the spread of antibiotic resistance. Room for improvement lies in particular in a stricter indication, in shortening antibiotic treatment and in initiating more targeted therapies with narrow-spectrum drugs. Not all infections due to multidrug-resistant organisms require treatment with reserve drugs. Detailed susceptibility testing together with enhanced knowledge of pharmacokinetics and -dynamics are needed for adequate treatment decisions. There are some new drugs with interesting spectrum of activity in development. The problem of antimicrobial resistance in human medicine, however, must also be seen in the context of “One Health” interactions between various systems including environmental issues and food production.

Antibiotic Resistance Profile of Commensal Escherichia coli Isolated from Broiler Chickens in Qatar

2017 ◽  
Vol 81 (2) ◽  
pp. 302-307 ◽  
Author(s):  
Nahla O. Eltai ◽  
Elmoubasher A. Abdfarag ◽  
Hamad Al-Romaihi ◽  
Eman Wehedy ◽  
Mahmoud H. Mahmoud ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Resistance ◽  
Broiler Chickens ◽  
Susceptibility Testing ◽  
Multidrug Resistant ◽  
Test Method ◽  
Health Concern ◽  
E Coli ◽  
Extended Spectrum ◽  
Stewardship Program

ABSTRACT Antibiotic resistance (AR) is a growing public health concern worldwide, and it is a top health challenge in the 21st century. AR among Enterobacteriaceae is rapidly increasing, especially in third-generation cephalosporins and carbapenems. Further, strains carrying mobilized colistin resistance (mcr) genes 1 and 2 have been isolated from humans, food-producing animals, and the environment. The uncontrolled use of antibiotics in food-producing animals is a major factor in the generation and spread of AR. No studies have been done to evaluate AR in the veterinary sector of Qatar. This study aimed at establishing primary baseline data for the prevalence of AR among food-producing animals in Qatar. Fecal samples (172) were obtained from two broiler farms and one live bird market in Qatar, and 90 commensal Escherichia coli bacteria were isolated and subjected to susceptibility testing against 16 clinically relevant antibiotics by using the E-test method. The results found that 81 (90%) of 90 isolates were resistant to at least one antibiotic, 14 (15.5%) of 90 isolates were colistin resistant, 2 (2.2%) of 90 isolates were extended-spectrum β-lactamase producers, and 2 (2.2%) of 90 isolates were multidrug resistant to four antibiotic classes. Extended-spectrum β-lactamase–producing E. coli and colistin-resistant isolates were confirmed by using double-disc susceptibility testing and PCR, respectively. Such a high prevalence of antibiotic-resistant E. coli could be the result of a long application of antibiotic treatment, and it is an indicator of the antibiotic load in food-producing animals in Qatar. Pathogens carrying AR can be easily transmitted to humans through consumption of undercooked food or noncompliance with hygiene practices, mandating prompt development and implementation of a stewardship program to control and monitor the use of antibiotics in the community and agriculture.

Prevalence of Multidrug-Resistant Salmonella on Commercial Dairies Utilizing a Single Heifer Raising Facility†

2008 ◽  
Vol 71 (1) ◽  
pp. 27-34 ◽  
Author(s):  
TOM S. EDRINGTON ◽  
TODD R. CALLAWAY ◽  
ROBIN C. ANDERSON ◽  
DAVID J. NISBET
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Dairy Cattle ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Brilliant Green ◽  
Dairy Farm ◽  
Multidrug Resistant ◽  
Resistance Pattern ◽  
Lactating Cows

The objectives of the current research were twofold: (i) to determine the prevalence of multidrug-resistant (MDR) Salmonella in the various classes of dairy cattle and (ii) to determine if comingling of calves from multiple farms at a heifer feedlot serves as a transmission vector for Salmonella back to the dairy farm. Four large commercial dairies in the southwestern United States were sampled in October 2005 and again in March 2006. Fecal samples were collected from hutch calves, 12-and 24-month-old heifers, lactating cows, dry cows, and cattle in the sick-fresh pen and cultured with brilliant green agar supplemented with novobiocin (BGAnov) to estimate the overall Salmonella prevalence, or with tetracycline (BGAtet) to estimate MDR Salmonella. Antimicrobial susceptibility testing was conducted with the National Antibiotic Resistance Monitoring System (NARMS) testing panel, and a portion of the isolates were serotyped. Salmonella prevalence among groups ranged from 0 to 96% positive, with the highest incidence observed in the hutch calves and cattle in the sick-fresh pen. Twenty-eight different serotypes were identified with serotype Reading accounting for the majority of isolates cultured on BGAtet. Nearly all (100 of 103) isolates cultured on BGAnov and screened for antibiotic resistance were pan susceptible, whereas over one-half (64%) of the isolates cultured on BGAtet were MDR. Forty isolates displayed the ACSSuT resistance pattern, and 36 isolates displayed the MDR-AmpC pattern of the 72 isolates examined following culture on BGAtet. The incidence of Salmonella cultured on BGAtet was low (9%) in all heifers and only one MDR isolate was cultured (from a 12-month-old heifer), suggesting the risk of transmission of Salmonella from the heifer feedlot back to the dairy is low. Results of this research suggest the incidence of MDR Salmonella, found primarily in hutch calves and cattle in the sick-fresh pen, is low in comparison to the overall Salmonella prevalence.

scholarly journals 586. Multidrug-Resistant Organisms from Three Pedaitric Inpatient Units in the Domincan Republic

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S277-S277
Author(s):  
David De Luna ◽  
Alfredo J Mena Lora ◽  
Yori Roque ◽  
Micheilisse López Franceschini ◽  
Maria del Carmen Perez ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Susceptibility Testing ◽  
Central Line ◽  
Multidrug Resistant ◽  
Global Public Health ◽  
Middle Income ◽  
Phenotypic Resistance ◽  
Patients Âgés ◽  
Susceptibility Data ◽  
Multidrug Resistant Organisms

Abstract Background Multidrug-resistant organisms (MDRO) are a major global public health threat. Antimicorbial consumption and resistance in low- and middle-income countries (LMICs) are rising. This trend can be consequential for vulnerable populations such as children who have high rates of febrile illnesses. The aim of our study is to asses the burden of MDRO in hospitalized pediatric patients in the Dominican Republic (DR). Methods Retrospective review of all positive cultures in patients ages 0–17 at three tertiary referral centers in Santiago, DR. Culture-positive cases from January 2016 to December 2017 were reviewed. Repeat cultures from the same patient were excluded. Phenotypic susceptibility data were collected from automated susceptibility testing systems using WHOnet interface. Results A total of 1,584 cultures were reviewed, of which 1,041 (65%) were Gram-negative and 514 (32%) Gram-positive. The most common microorganisms were E. coli (23%)and S. aureus (11%). Sample were obtained from stool (26.9%), blood (23.5%), urine (16.2%), secretions (5.4%), and central line catheters (7.2%). Phenotypic resistance consistent with extended-spectrum β-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) was found in 524 (50.3%) and 179 (17.2%) of Gram-negatives, respectively. MDRO rates by organism are in Figure 2. A total of 72 (21.0%) S aureusisolates were methicillin resistant (MRSA) and 62 (18%) showed suspected inducible resistance to clindamycin (Figure 3). Conclusion Data from automated culture systems suggests a high prevalence of ESBL and CRE in this city-wide cohort from three pediatric facilities. Prospective confirmatory studies with manual susceptibility testing may help clarify the true prevalence of MDRO. Further studies are needed to understand the epidemiology and risk factors pediatric patients colonized or infected with MDROs in LMICs and in the DR. Exposure to antimicrobials may be an important risk factor. Understanding antimicrobial use in children and possible exposure to antimicrobials in the environment may help identify antimicrobial stewardship targets and help curb antimicrobial pressure and resistance. Disclosures All authors: No reported disclosures.

scholarly journals Bringing Antimicrobial Susceptibility Testing for New Drugs into the Clinical Laboratory: Removing Obstacles in Our Fight against Multidrug-Resistant Pathogens

2019 ◽  
Vol 57 (12) ◽  
Author(s):  
James E. Kirby ◽  
Thea Brennan-Krohn ◽  
Kenneth P. Smith
Keyword(s):  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Drug Approval ◽  
Multidrug Resistant ◽  
New Drugs ◽  
Testing Methods ◽  
Clinical Laboratories ◽  
New Antibiotics ◽  
Multidrug Resistant Pathogens ◽  
Patient Use

ABSTRACT There are now several new antibiotics available to treat multidrug-resistant pathogens, and susceptibility testing methods for these drugs are increasingly available at the time of drug approval. However, lack of clarity regarding verification requirements remains a formidable barrier to introducing such testing in clinical laboratories, making these drugs practically unavailable for patient use. We propose a change in the framework for bringing in testing for new antibiotics, focusing on quality control rather than underpowered verification studies.

scholarly journals Biofilm Formation and Antibiotic resistance of Enterobacteriaceae isolates from Surgical Site infections in Hôpital de Référence Saint Joseph, Kinshasa, Democratic Republic of Congo

2020 ◽  
Author(s):  
Jean-Marie Liesse Iyamba ◽  
Rodriguez Musomoni Mabankama ◽  
Cyprien Mbundu Lukukula ◽  
Joseph Welo Unya ◽  
Daniel Tassa Okombe ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Biofilm Formation ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Surgical Site Infections ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Republic Of Congo ◽  
E Coli ◽  
Multidrug Resistant Organisms

Abstract Background: Enterobacteriaceae are one of the most predominant pathogen in surgical site infections. In recent years we oberved increase in resistance among bacteria from surgical site infections. The aim of this study was to evaluate antimicrobial suceptibility pattern of Enterobacteriaceae isolates from surgical site infections, the biofilm formation and the production of OXA-48 carbapenemase.Methods: A total of 41 Enterobacteriaceae (19 Escherchia coli, 8 Enterobacter sp., 9 Citrobacter sp., and 5 Serratia sp. ) clinical isolates were collected from patients with SSI in Hôpital Saint Joseph (Kinshasa) for diagnostic purposes. The pus samples were cultured and the antibiotic susceptibility profile of the isolates were determined by disk-diffusion method following Clinical and Laboratory Standards Institute 2012 recommendations. OXA-48-producing Enterobacteriaceae were detected using ChromaticTM OXA-48 chromogenic medium. Crystal Violet Staining Method was used to assess the ability of bacteria strains to form a biofilm. Results: All Enterobacteriacea isolates studied were biofilm producers and highly resistant to the majority of antibiotics tested. E. coli, Enterobacter sp., Citrobacter sp., and Serratia sp. were 100 % resistant cefotaxime, imipenem, and amoxicillin-clavulanic acid, and ampicillin. Serratia sp. isolates were 100% and 80% sensitive to norfloxacine and amikacine respectively. There was relationship between antibiotic resistance and biofilm production. E. coli, Enterobacter sp., and Citrobacter sp. strains were all OXA-48 producers.Conclusion: The results of the present study demonstrate the emergence of multidrug resistant organisms, the correlation between antibiotic resistance- biofilm formation and OXA-48 production. These results suggest the implementation of antimicrobial resistance survey programm in order to prevent and combat the spread of multidrug resistant organisms in hospital and community in Democratic Republic of Congo.

scholarly journals Multidisciplinary Applied Antibiotic Sensitivity Testing Training in the One Health Approach: ANATOLIAN PROJECT

2021 ◽  
Author(s):  
Serap Süzük Yıldız ◽  
Bunu Kaskatepe ◽  
Özlem Ünaldı ◽  
Hüsniye Şimşek ◽  
Zeynep Ceren Karahan ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Training Program ◽  
Antibiotic Susceptibility ◽  
One Health ◽  
Susceptibility Testing ◽  
Antibiotic Susceptibility Testing ◽  
Sensitivity Testing ◽  
Human Animal ◽  
The One ◽  
Resistance Data

Objective: Antibiotic resistance is one of the most significant problems of human-animal and environmental ecosystems. It is crucial to establish integrated surveillance systems and monitor resistance for the management of antibiotic resistance. Standardization of antibiotic resistance data obtained from various disciplines is the critical point in enhancing the data quality. To realize this objective, a common antibiotic susceptibility testing training program was prepared and performed for professionals from various disciplines to standardize the resistance data to be obtained from the human, animal, and environmental sectors in our country. Method: A total of 48 individuals participated in a five-day training program in three terms. In each period, four small groups, each consisting of four people from a group of different professions, were generated. Participants were trained on quality control, phenotypic tests, genotypic tests, and the use of resistance data in antibiotic susceptibility testing. Pre-test and post-tests were applied to the participants. Results: Individuals with a postgraduate degree who studied antibiotic susceptibility testing in the fields of medicine, veterinary medicine, pharmacy, food, and environment participated in the training. The average number of correct answers in the pre-test and post-test increased from 4.8 to 10.5 in April, from 4 to 9 in June and from 3.4 to 8.5 in September. They studied phenotypic and genotypic tests in the supplied isolates under the supervision of the educators. Conclusion: We presume that dissemination of the training at graduate and postgraduate levels will also enable the One-Health approach to become widespread. In addition, worldwide application of similar trainings will help standardization of resistance data, as well as one health approach.

scholarly journals 201. Frequency of Pseudomonas aeruginosa (PA) Discrete Inner Colonies and Comparison of Minimal Inhibitory Concentration (MIC) Values between Parent and Inner Colony Isolates Following Fosfomycin Disk Diffusion (DD) Testing

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S123-S123
Author(s):  
Dina Zheng ◽  
Morgan L Bixby ◽  
Elizabeth C Smith ◽  
Jadyn C Anderson ◽  
Phillip J Bergen ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Antibiotic Resistance ◽  
High Frequency ◽  
Susceptibility Testing ◽  
Inhibitory Concentration ◽  
Multidrug Resistant ◽  
Broth Microdilution ◽  
Zone Of Inhibition ◽  
Bmd Testing

Abstract Background Fosfomycin combination therapy is a potential approach for treatment of multidrug-resistant (MDR) PA infections despite a lack of approved susceptibility breakpoints for this organism. While DD testing is commonly used for fosfomycin, growth of discrete inner colonies (IC) within the zone of inhibition has been observed for multiple organisms following DD. Criteria recommended by CLSI and EUCAST are contradictory for interpreting these inner colonies. We therefore sought to determine the frequency of inner colonies and MIC differences between PA parent-inner colony pairs from an international isolate collection. Methods A convenience collection of 198 clinical PA isolates from three U.S institutions (n = 82), two Australian institutions (n = 72), and the CDC & FDA Antibiotic Resistance Isolate Bank (n = 44) were included. Fosfomycin MIC values were determined in duplicate on separate days by DD and broth microdilution (BMD) testing. For parent isolates with discrete IC observed during DD, IC isolates were subcultured and MIC values were determined and then compared to their corresponding parent isolates. MIC values were interpreted using CLSI Escherichia coli (EC) breakpoints (susceptible: MIC ≤ 64 μg/mL, intermediate: MIC = 128, resistant: MIC ≥ 256 μg/mL). Results Parent isolate BMD MIC values ranged from < 4 to > 256 μg/mL while IC isolate BMD MIC values ranged from 128 to > 1024 μg/mL. MIC50/90 values were 128/256 μg/mL and > 1024/ > 1024 μg/mL for the parent and IC isolates, respectively. A high frequency of 45% (89/198) of parent isolates displayed discrete IC which also demonstrated a higher frequency of resistance (97.8%) compared to the parent isolates (23.7%). Conclusion IC MIC values were higher overall compared to parent MIC values, with an average fold difference of ~18 between the parent-inner colony pairs. The frequency of IC found in this study (45%) is considerably higher than previously observed in EC clinical isolates. These data highlight the need to further investigate the importance of these IC and warrant caution for extrapolation of EC breakpoints for fosfomycin susceptibility testing against PA. Disclosures All Authors: No reported disclosures

Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

2019 ◽  
pp. 19-25 ◽  
Author(s):  
Rathika Krishnasamy
Keyword(s):  
Quality Of Life ◽  
Qualitative Interviews ◽  
Social Function ◽  
Multidrug Resistant ◽  
Contact Precautions ◽  
Dialysis Vintage ◽  
Multidrug Resistant Organisms ◽  
And Gender ◽  
The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

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