Control of multidrug-resistant microorganisms

2019 ◽  
pp. 305-337
Author(s):  
Nizam Damani
Keyword(s):  
Healthcare Facility ◽  
Multidrug Resistant ◽  
Antibiotic Prescribing ◽  
Beta Lactamases ◽  
Carbapenem Resistant ◽  
Antimicrobial Management ◽  
Extended Spectrum Beta Lactamases ◽  
Vancomycin Resistant ◽  
And Control ◽  
Antibiotic Stewardship Programme

This chapter discusses the burden and impact of antimicrobial resistant (AMR) bacteria on human health. It describes the types of antibiotic resistance, and the various factors which are responsible for promoting the emergence and spread of multidrug-resistant organisms (MDROs) in the healthcare facility. The chapter provides advice on how to successfully implement an antibiotic stewardship programme in hospital and strategies to promote prudent antibiotic prescribing. The role and responsibilities of the antimicrobial management team is also discussed. It provides a summary and characteristic of most commonly encountered MRDOs in a healthcare facility and provide practical advice on how to prevent and control the spread of methicillin-resistant Staph. aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii.

scholarly journals Carbapenem resistant Escherichia coli and Pseudomonas aeruginosa in captive blackbucks (Antilope cervicapra) and leopards (Panthera pardus) from India

2021 ◽  
Vol 91 (1) ◽  
pp. 73-80
Author(s):  
Obli R. Vinodh Kumar ◽  
◽  
Bhoj R. Singh ◽  
Mathesh Karikalan ◽  
Shikha Tamta ◽  
...  
Keyword(s):  
Efflux Pump ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Beta Lactamases ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Faecal Samples ◽  
Carbapenemase Gene ◽  
Extended Spectrum Beta Lactamases ◽  
Antilope Cervicapra

The study aimed to investigate the occurrence of carbapenem resistant E. coli and P. aeruginosa in apparently healthy, captive blackbucks and leopards of India. Faecal samples of blackbucks (n = 7) and leopards (n = 7) were processed to isolate carbapenem resistant E. coli (CRE) and P. aeruginosa (CRP). Forty (leopards n = 26; blackbuck n = 14) E. coli and two P. aeruginosa (blackbuck n = 2) samples were isolated from the faecal samples (n = 14). Eleven carbapenem resistant isolates were recovered, of which 10 were CRE and one was CRP. The minimum inhibitory concentration (MIC) was determined for meropenem for carbapenem resistant isolates and was between 8 and 64 μg/mL. All the CRE and CRP were phenotypically multidrug resistant, and six CRE were extended-spectrum beta-lactamases (ESBL) producers. On genotypic screening, seven CRE and one CRP were positive for the blaNDM carbapenemase gene. Efflux pump-mediated carbapenem resistance was noticed in four CRE isolates (36.4%, 4/11). Of the six ESBL producing CRE, four isolates carried blaCTX-M-1 genes. The CRE isolates also harbored blaTEM-1, blaAmpC, qnrA, qnrB, qnrS, tetA, tetB and sul1 resistance genes. On Shiga toxin virulence screening, Stx1, Stx2 genes were detected in two and one isolates, respectively. Plasmid typing of CRE revealed that the blaNDM genes were carried on an Incl1 plasmid. The plasmid multilocus sequence typing (pMLST) of the isolates showed the Sequence Type (ST) 297. The occurrence of carbapenem resistance bacteria in captive wildlife should be a major public health priority.

scholarly journals Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 447
Author(s):  
Barbara Kot ◽  
Agata Grużewska ◽  
Piotr Szweda ◽  
Jolanta Wicha ◽  
Urszula Parulska
Keyword(s):  
Antibiotic Resistance ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Beta Lactamases ◽  
E Coli ◽  
Central Poland ◽  
Resistance Patterns ◽  
Extended Spectrum Beta Lactamases ◽  
Tract Infections

The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January–June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0–18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40–60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-β-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.

Epidemiological characteristics of uropatogenic isolates of Escherichia coli in hospitals

2021 ◽  
Vol 66 (4) ◽  
pp. 248-256
Author(s):  
M. V. Kuznetsova ◽  
J. S. Gizatullina
Keyword(s):  
Intensive Care ◽  
Infection Process ◽  
Beta Lactamases ◽  
E Coli ◽  
Medical Facilities ◽  
Extended Spectrum Beta Lactamases ◽  
N 93 ◽  
Tract Infections ◽  
And Control ◽  
Epidemiological Characteristics

The aim of the study was to evaluate the genetic affinity of uropathogenic E. coli cultures (UPEC) and to identify the major types of extended spectrum beta-lactamases (ESBL) found among nosocomial isolates. A molecular typing of UPEC (n=93) isolated from patients with urinary tract infections (UTI) who were hospitalised in nine medical facilities (MO) in Perm was performed. It was found that 69.89% of the cultures had individual RAPD/ERIC profiles, the remaining 30.10% were distributed among 13 genome groups. Most frequently blaCTX-M-1 was detected individually or in combination with other beta-lactamase genes (n=23, 79.31% of ESBL phenotype-positive isolates), genes were detected in seventeen cases (58.62%) blaTEM and/or blaOXA, the blaCMY fragment was found in only three isolates (10.34%), blaSHV was missing in this isolates. It was shown that in two thirds of the cases the pathogens of the infection process are representatives of the endogenous intestinal microbiota of the patients, in other cases an exogenous infection occurs. The proportion of “circulating” (possibly hospital) isolates in the spectrum of UTI increased in the series: therapy departments - surgery departments - intensive care units. In addition, in multidisciplinary hospitals there are conditions for cross-infections of patients, but the epidemiological chains of episodes of UTI are short and concise. It has been shown that the probability of infection with E. coli producing CTX-M or OXA enzymes is significantly higher in the intensive care unit than in surgery or therapy departments. The data obtained complement the understanding of the epidemiology of UTI caused by E. coli and can be used as an aid in the planning and implementation of methods for the prevention and control of nosocomial UTI.

Determination of extended spectrum beta-lactamases, metallo-beta-lactamases and AmpC-beta-lactamases among carbapenem resistant Pseudomonas aeruginosa isolated from burn patients

Burns ◽  
2014 ◽  
Vol 40 (8) ◽  
pp. 1556-1561 ◽  
Author(s):  
Davood Kalantar Neyestanaki ◽  
Akbar Mirsalehian ◽  
Fereshteh Rezagholizadeh ◽  
Fereshteh Jabalameli ◽  
Morovat Taherikalani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Burn Patients ◽  
Beta Lactamases ◽  
Carbapenem Resistant ◽  
Extended Spectrum ◽  
Extended Spectrum Beta Lactamases

scholarly journals Predicting Antibiotic Resistance in Urinary Tract Infection Patients with Prior Urine Cultures

2016 ◽  
Vol 60 (8) ◽  
pp. 4717-4721 ◽  
Author(s):  
Yaakov Dickstein ◽  
Yuval Geffen ◽  
Steen Andreassen ◽  
Leonard Leibovici ◽  
Mical Paul
Keyword(s):  
Urinary Tract ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Antibiotic Prescribing ◽  
Content Type ◽  
Extended Spectrum Beta Lactamase ◽  
Carbapenem Resistant ◽  
Positive Urine ◽  
Tract Infections

ABSTRACTTo improve antibiotic prescribing, we sought to establish the probability of a resistant organism in urine culture given a previous resistant culture in a setting endemic for multidrug-resistant (MDR) organisms. We performed a retrospective analysis of inpatients with paired positive urine cultures. We focused on ciprofloxacin-resistant (cipror) Gram-negative bacteria, extended-spectrum-beta-lactamase (ESBL)-producingEnterobacteriaceae, carbapenem-resistantEnterobacteriaceae(CRE), and carbapenem-resistant nonfermenters (CRNF). Comparisons were made between the frequency of each resistance phenotype following a previous culture with the same phenotype and the overall frequency of that phenotype, and odds ratios (ORs) were calculated. We performed a regression to assess the effects of other variables on the likelihood of a repeat resistant culture. A total of 4,409 patients (52.5% women; median age, 70 years) with 19,546 paired positive urine cultures were analyzed. The frequencies of ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF among all cultures were 47.7%, 30.6%, 1.7%, and 2.6%, respectively. ORs for repeated resistance phenotypes were 1.87, 3.19, 48.25, and 19.02 for ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF, respectively (P< 0.001 for all). At 1 month, the frequencies of repeated resistance phenotypes were 77.4%, 66.4%, 57.1%, and 33.3% for ciprorbacteria, ESBL-producingEnterobacteriaceae, CRE, and CRNF, respectively. Increasing time between cultures and the presence of an intervening nonresistant culture significantly reduced the chances of a repeat resistant culture. Associations were statistically significant over the duration of follow-up (60 months) for CRE and for up to 6 months for all other pathogens. Knowledge of microbiology results in the six preceding months may assist with antibiotic stewardship and improve the appropriateness of empirical treatment for urinary tract infections (UTIs).

scholarly journals Genotypic Characterisation of Multi Drug Resistant Gram-Negative Bacteria with Special Reference to Carbapenem Resistance in a Teaching Hospital, Hyderabad, Telangana State

2021 ◽  
Vol 10 (14) ◽  
pp. 1039-1041
Author(s):  
Swathi Gurajala ◽  
Sandeep Kumar Tipparthi ◽  
Rajkumar H.R.V.
Keyword(s):  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Resistant Bacteria ◽  
Antimicrobial Drug Resistance ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Prevention And Control Measures ◽  
And Control

Bacteria develop antimicrobial drug resistance through several mechanisms, the common one being the production of enzymes. As the number of antibiotics discovered is in notable numbers in the past few years, it is important to preserve high-end antibiotics for the treatment of multidrug-resistant organisms (MDROs) infections, by appropriate use of antibiotics. A study was conducted to record prevalence, phenotypic and genotypic characters of MDROs in our hospital, with reference to carbapenem resistance. 200 multidrug-resistant clinical isolates were collected in 6 months. Carbapenem-resistant organisms were detected phenotypically confirmed for the production of carbapenemases by modified Hodge test (MHT) and genotypic detection was done by a multiplex polymerase chain reaction (PCR) assay for the five most predominant carbapenemases (bla NDM-1, bla OXA-48 , bla VIM, bla IMP, bla KPC). The isolates consisted of E. coli (53 %) followed by K. pneumoniae (30 %), P. aeruginosa (13 %), and acinetobacter spp (4 %). Among these, 40 (20 %) isolates were carbapenem-resistant. Of these 40, 27 (67.5 %) showed an increase in zone size by the MHT, suggestive of metallo-beta-lactamase (MBL) mediated carbapenem resistance and about 32 (80 %) isolates were found to contain at least one carbapenemase gene. bla NDM-1 accounted for 37.5 % (12 / 32) of the isolates and was the most predominant one followed by bla OXA-48 [28 % (9 / 32)]. 22 % (7 / 32) of the isolates had one or more carbapenemase genes. Identifying the mechanisms of resistance of pathogens is important to implement strict infection prevention and control measures in the hospital to prevent the transmission of the resistant pathogens. KEY WORDS Multidrug-Resistant Bacteria, Bla NDM-1 Gene, Bla OXA-48 Gene, Carbapenem Resistance, Carbapenem Resistant Organisms.

scholarly journals Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015

2016 ◽  
Vol 21 (2) ◽  
Author(s):  
Ursel Heudorf ◽  
Bernhard Krackhardt ◽  
Maria Karathana ◽  
Niels Kleinkauf ◽  
Christian Zinn
Keyword(s):  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
German Population ◽  
Unaccompanied Refugee Minors ◽  
Frankfurt Am Main ◽  
Beta Lactamases ◽  
Extended Spectrum Beta Lactamases ◽  
Additional Resistance ◽  
Gram Negative Organisms ◽  
Refugee Minors

Many refugees arriving in Germany originate or have travelled through countries with high prevalence of multidrug-resistant Gram-negative organisms. Therefore, all unaccompanied refugee minors (<18 years-old) arriving in Frankfurt am Main between 12 October and 6 November 2015, were screened for multidrug-resistant Enterobacteriaceae in stool samples. Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) were detected in 42 of 119 (35%) individuals, including nine with additional resistance to fluoroquinolones (8% of total screened), thus exceeding the prevalences in the German population by far.

scholarly journals Antimicrobial activity of ceftolozane-tazobactam against Enterobacterales and Pseudomonas aeruginosa recovered during the Study for Monitoring Antimicrobial Resistance Trends (SMART) program in Spain (2016-2018)

2021 ◽  
Author(s):  
Rafael Cantón ◽  
◽  
Elena Loza ◽  
Ricardo M. Arcay ◽  
Emilia Cercenado ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Resistance ◽  
Klebsiella Oxytoca ◽  
Broth Microdilution ◽  
Beta Lactams ◽  
Beta Lactamases ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Smart Study ◽  
Extended Spectrum Beta Lactamases

Objective. To analyse the susceptibility to ceftolozane-tazobactam and comparators in Enterobacterales and Pseudomonas aeruginosa isolates recovered from intraabdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream infection (BSI) in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study. Methods. The susceptibility of 5,351 isolates collected in 11 Spanish hospitals (2016-2018) were analysed (EUCAST-2020 criteria) by broth microdilution and were phenotypically studied for the presence of extended-spectrum beta-lactamases (ESBL). Ceftolozane-tazobactam and/or carbapenem resistant isolates were genetically characterized for ESBL and carbapenemases. Results. Escherichia coli was the most frequent pathogen (49.3% IAI, 54.9% UTI, 16.7% RTI and 50% BSI), followed by Klebsiella pneumoniae (11.9%, 19.1%, 13.1% and 15.4%, respectively). P. aeruginosa was isolated in 9.3%, 5.6%, 32% and 9%, respectively. The frequency of isolates with ESBLs (2016-2017) was: 30.5% K. pneumoniae, 8.6% E. coli, 2.3% Klebsiella oxytoca and 0.7% Proteus mirabilis. Ceftolozane-tazobactam was very active against non-ESBL-(99.3% susceptible) and ESBL-(95.2%) producing E. coli being less active against K. pneumoniae (98% and 43.1%, respectively) isolates. CTX-M-15 was the most prevalent ESBL in E. coli (27.5%) and K. pneumoniae (51.9%) frequently associated with OXA-48-like carbapenemase. Overall, 93% of P. aeruginosa isolates were susceptible to ceftolozane-tazobactam, preserving this activity (>75%) in isolates resistant to other beta-lactams except in those resistant to meropenen or ceftazidime-avibactam. GES-5, PER-1, VIM-1/2 were the most prevalent enzymes in isolates resistant to ceftolozane-tazobactam. Conclusions. Ceftolozane-tazobactam showed high activity rates against isolates recovered in the SMART study although it was affected in K. pneumoniae and P. aeruginosa isolates with ESBL and/or carbapenemases.

scholarly journals Antimicrobial Resistance Factors of Extended-Spectrum Beta-Lactamases Producing Escherichia coli and Klebsiella pneumoniae Isolated from Cattle Farms and Raw Beef in North-West Province, South Africa

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Kotsoana Peter Montso ◽  
Sicelo Beauty Dlamini ◽  
Ajay Kumar ◽  
Collins Njie Ateba
Keyword(s):  
Antimicrobial Susceptibility ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Beta Lactamases ◽  
North West ◽  
E Coli ◽  
Esbl Gene ◽  
Extended Spectrum ◽  
North West Province ◽  
Extended Spectrum Beta Lactamases

Background. Extended spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae cause severe infections in humans which leads to complicated diseases. There is increasing evidence that cattle contribute to the development and spread of multidrug resistant pathogens and this raises public health concern. Despite this, data on the concurrence of ESBL producing pathogens in cattle, especially in the North-West province are rare. Therefore, the aim of the present study was to isolate, identify and characterise ESBL producing E. coli and K. pneumoniae species from cattle faeces and raw beef samples. Results. A total of 151 samples comprising 55 faeces samples and 96 raw beef samples were collected and 259 nonreplicative potential isolates of Enterobacteriaceae were obtained. One hundred and ninety-six isolates were confirmed as E. coli (114; 44%) and K. pneumoniae (82; 32%) species through amplification of uspA and uidA and ntrA gene fragments, respectively. Antimicrobial susceptibility test revealed that large proportions (66.7–100%) of the isolates were resistant to Amoxicillin, Aztreonam, Ceftazidime, Cefotaxime, and Piperacillin and were multidrug resistant isolates. Cluster analysis of antibiotic inhibition zone diameter data revealed close similarities between isolates from different sources or species thus suggested a link in antibiotic exposures. The isolates showing phenotypic resistance against ESBL antimicrobial susceptibility tests were screened for the presence of ESBL gene determinants. It was observed that 53.1% of the isolates harboured ESBL gene determinants. The blaTEM, blaSHV and blaCTX-M genes were detected in E. coli isolates (85.5%, 69.6%, and 58%, respectively) while blaCTX-M and blaOXA were detected in K. pneumoniae (40% and 42.9%, respectively). All the genetically confirmed ESBL producing E. coli and K. pneumoniae isolates were subjected to Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR analysis. Fingerprinting data revealed great similarities between isolates from different areas and sources which indicates cross-contamination between cattle and beef. Conclusion. This study revealed that cattle and its associated food products, beef in particular, harbour ESBL producing pathogens. And this warrants a need to enforce hygiene measures and to develop other mitigation strategies to minimise the spread of antibiotic resistant pathogens from animals to human.

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