1377. Perinatal Transmission Dynamics of Antimicrobial Resistance

Abstract Background Antimicrobial resistance (AMR) is a global health threat that disproportionately affects low- and middle-income countries. An ongoing study of childhood mortality in Bangladesh revealed a common cause of death among neonates is sepsis from Gram-negative multi-drug-resistant organisms. Methods To ascertain factors leading to neonatal exposure, we enrolled 100 women presenting for delivery to Faridpur Hospital during February-March 2020. We collected vaginal and rectal swabs from mothers on presentation and at least 24 hours after delivery as well as rectal swabs from newborns. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase-(ESBL) producing organisms and carbapenem-resistant Enterobacteriaceae (CRE). Results Eight-five percent of women underwent C-section. Prior to delivery, ESBL organisms were isolated from 15% of vaginal and 63% of rectal swabs. CRE was detected in 2% of vaginal and 8% of rectal swabs. Following delivery, colonization exceeded 90% (ESBL) and 70% (CRE) in both swab sets. Similarly, among newborns, 85% were colonized with ESBL and 67% with CRE. Maternal AMR colonization on admission did not correlate with income, education, parity, prenatal care, or prior antibiotic use, but was associated with hospitalization during pregnancy (rectal CRE OR 11.9, p< 0.01). Maternal colonization at discharge was positively associated with membrane stripping (vaginal ESBL OR 9.0, p< 0.01; rectal CRE OR 5.0, p=0.03), C-section (OR 4.0-15.4, p< 0.05), and administration of third-generation cephalosporins (OR 5.0-10.1, p< 0.05). Newborn colonization correlated with maternal colonization on discharge (p< 0.005) but not on admission. Among newborns delivered by C-section, there was an 8-9-fold increased risk of ESBL and CRE colonization (p< 0.01). Conclusion These results demonstrate that AMR is driven by nosocomial factors in the perinatal setting, and invasive procedures and perinatal antibiotic use increase risk of AMR colonization. These findings emphasize the urgent need for enhanced antibiotic stewardship and infection prevention and control practices to preserve the benefits of hospital-based deliveries. Disclosures All Authors: No reported disclosures

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Clinical and microbiological characterization of sepsis and evaluation of sepsis scores

PLoS ONE ◽

10.1371/journal.pone.0247646 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0247646

Author(s):

Andre Fuchs ◽

Tafese Beyene Tufa ◽

Johannes Hörner ◽

Zewdu Hurissa ◽

Tamara Nordmann ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Sensitivity And Specificity ◽

Early Recognition ◽

Recognition Rate ◽

Tertiary Hospital ◽

Middle Income ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

Increased Risk ◽

Qsofa Score

Background Despite the necessity of early recognition for an optimal outcome, sepsis often remains unrecognized. Available tools for early recognition are rarely evaluated in low- and middle-income countries. In this study, we analyzed the spectrum, treatment and outcome of sepsis at an Ethiopian tertiary hospital and evaluated recommended sepsis scores. Methods Patients with an infection and ≥2 SIRS criteria were screened for sepsis by SOFA scoring. From septic patients, socioeconomic and clinical data as well as blood cultures were collected and they were followed until discharge or death; 28-day mortality was determined. Results In 170 patients with sepsis, the overall mortality rate was 29.4%. The recognition rate by treating physicians after initial clinical assessment was low (12.4%). Increased risk of mortality was significantly associated with level of SOFA and qSOFA score, Gram-negative bacteremia (in comparison to Gram-positive bacteremia; 42.9 versus 16.7%), and antimicrobial regimen including ceftriaxone (35.7% versus 19.2%) or metronidazole (43.8% versus 25.0%), but not with an increased respiratory rate (≥22/min) or decreased systolic blood pressure (≤100mmHg). In Gram-negative isolates, extended antimicrobial resistance with expression of extended-spectrum beta-lactamase and carbapenemase genes was common. Among adult patients, sensitivity and specificity of qSOFA score for detection of sepsis were 54.3% and 66.7%, respectively. Conclusion Sepsis is commonly unrecognized and associated with high mortality, showing the need for reliable and easy-applicable tools to support early recognition. The established sepsis scores were either of limited applicability (SOFA) or, as in the case of qSOFA, were significantly impaired in their sensitivity and specificity, demonstrating the need for further evaluation and adaptation to local settings. Regional factors like malaria endemicity and HIV prevalence might influence the performance of different scores. Ineffective empirical treatment due to antimicrobial resistance is common and associated with mortality. Local antimicrobial resistance statistics are needed for guidance of calculated antimicrobial therapy to support reduction of sepsis mortality.

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Detection of extended spectrum beta-lactamase genes in Pseudomonas aeruginosa isolated from patients in rural Eastern Cape Province, South Africa

Scientific Reports ◽

10.1038/s41598-021-86570-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mojisola C. Hosu ◽

Sandeep D. Vasaikar ◽

Grace E. Okuthe ◽

Teke Apalata

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

High Rate ◽

Infection Prevention And Control ◽

Beta Lactamase ◽

Eastern Cape ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Resistance Patterns

AbstractThe proliferation of extended spectrum beta-lactamase (ESBL) producing Pseudomonas aeruginosa represent a major public health threat. In this study, we evaluated the antimicrobial resistance patterns of P. aeruginosa strains and characterized the ESBLs and Metallo- β-lactamases (MBL) produced. Strains of P. aeruginosa cultured from patients who attended Nelson Mandela Academic Hospital and other clinics in the four district municipalities of the Eastern Cape between August 2017 and May 2019 were identified; antimicrobial susceptibility testing was carried out against thirteen clinically relevant antibiotics using the BioMérieux VITEK 2 and confirmed by Beckman autoSCAN-4 System. Real-time PCR was done using Roche Light Cycler 2.0 to detect the presence of ESBLs; blaSHV, blaTEM and blaCTX-M genes; and MBLs; blaIMP, blaVIM. Strains of P. aeruginosa demonstrated resistance to wide-ranging clinically relevant antibiotics including piperacillin (64.2%), followed by aztreonam (57.8%), cefepime (51.5%), ceftazidime (51.0%), piperacillin/tazobactam (50.5%), and imipenem (46.6%). A total of 75 (36.8%) multidrug-resistant (MDR) strains were observed of the total pool of isolates. The blaTEM, blaSHV and blaCTX-M was detected in 79.3%, 69.5% and 31.7% isolates (n = 82), respectively. The blaIMP was detected in 1.25% while no blaVIM was detected in any of the strains tested. The study showed a high rate of MDR P. aeruginosa in our setting. The vast majority of these resistant strains carried blaTEM and blaSHV genes. Continuous monitoring of antimicrobial resistance and strict compliance towards infection prevention and control practices are the best defence against spread of MDR P. aeruginosa.

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Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics ◽

10.3390/antibiotics9080497 ◽

2020 ◽

Vol 9 (8) ◽

pp. 497

Author(s):

Massimo Sartelli ◽

Timothy C. Hardcastle ◽

Fausto Catena ◽

Alain Chichom-Mefire ◽

Federico Coccolini ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Middle Income ◽

Middle Income Countries ◽

And Control ◽

Low And Middle Income

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

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Impact of the COVID-19 Pandemic on Antimicrobial Resistance (AMR) Surveillance, Prevention and Control: A Global Survey

10.1101/2021.03.24.21253807 ◽

2021 ◽

Author(s):

Sara Tomczyk ◽

Angelina Taylor ◽

Allison Brown ◽

Marlieke de Kraker ◽

Tim Eckmanns ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Prevention And Control ◽

Chronically Ill ◽

Infection Prevention And Control ◽

Health Staff ◽

Antibiotic Prescribing ◽

Free Text ◽

Middle Income ◽

Substantial Impact ◽

And Control

Objectives The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. Methods From October-December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire including Likert-scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed, and free-text questions were thematically analysed. Results Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; p<0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (p<0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased intensive care unit admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antibiotic prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. Conclusions This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses revealed universal patterns but also captured country variability. Although focus is understandably on COVID-19, gains in detecting and controlling AMR, a global health priority, cannot afford to be lost.

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Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae as a Proxy Composite Indicator of Antimicrobial Resistance in a Community in Thailand

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz425 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 2

Author(s):

Visanu Thamlikitkul ◽

Teerawit Tangkoskul ◽

Chakkraphong Seenama

Keyword(s):

Antimicrobial Resistance ◽

Antibiotic Use ◽

Composite Indicator ◽

Beta Lactamase ◽

Carriage Rate ◽

Extended Spectrum Beta Lactamase ◽

Household Level ◽

Fecal Carriage ◽

And Behavior ◽

Self Administered Questionnaire

Abstract Background Increasing awareness of and understanding about antimicrobial resistance (AMR), promoting changes in behavior, and monitoring of AMR in the community are challenging, as AMR is associated with many contributing factors that are difficult to assess individually. This study aimed to determine the effectiveness of a community-based AMR campaign for improving awareness, understanding, and behavior relating to antibiotic use and AMR in Thailand and to assess if fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae could be a proxy composite indicator of AMR in the community. Methods This study was conducted in 4 communities that are home to approximately 400 000 people. A self-administered questionnaire on awareness, understanding, and behavior relating to antibiotic use and AMR was responded to by 20 521 and 19 634 adults before and immediately after the AMR campaign, respectively, at the household level. Fecal samples were collected from 534 adults before the AMR campaign and from 709 adults at 18 months after the AMR campaign to determine presence of ESBL-producing Enterobacteriaceae. Results Awareness, understanding, and behavior relating to antibiotic use and AMR, as assessed by a self-administered questionnaire, were significantly improved after the AMR campaign. The fecal carriage rate of ESBL-producing Enterobacteriaceae decreased from 66.5% before to 44.6% after the AMR campaign (P < .01). Conclusions Our AMR campaign was effective for improving awareness, understanding, and behavior relating to antibiotic use and AMR among people in the community at the household level, and the prevalence of fecal carriage of ESBL-producing Enterobacteriaceae seemed to be decreased after the AMR campaign. Fecal carriage rate of ESBL-producing Enterobacteriaceae may be a proxy composite indicator of AMR in the community.

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Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey

BMJ Open ◽

10.1136/bmjopen-2018-023859 ◽

2019 ◽

Vol 9 (3) ◽

pp. e023859 ◽

Cited By ~ 7

Author(s):

Yin Mo ◽

Ivan Seah ◽

Pei Shi Priscillia Lye ◽

Xiang Lee Jamie Kee ◽

Kien Yee Michael Wong ◽

...

Keyword(s):

Antibiotic Use ◽

Community Dwelling ◽

Molecular Characteristics ◽

Beta Lactamase ◽

Cross Sectional ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Modifiable Factors ◽

Rectal Swabs ◽

Stool Samples

ObjectivesTo study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce prevalence of multidrug-resistant organism colonisation in the community.DesignCross-sectional questionnaire of KAP towards antibiotic use and collection of stool samples or rectal swabs. ESBL-PE isolates obtained underwent whole genome sequencing to identify resistance genes.SettingA densely populated community in Singapore.ParticipantsThere were 693 healthy community-dwelling questionnaire respondents. Out of which, 305 provided stool samples or rectal swabs.ResultsThe overall knowledge of antibiotic use was poor (mean score 4.6/10, IQR 3.0–6.0). 80 participants (80/305, 26.2%) carried at least one ESBL-PE isolate. The most common ESBL-PE was Escherichia coli sequence type 131 carrying CTX-M type beta-lactamases (11/71, 15.5%). Living overseas for >1 year (OR 3.3, 95% CI 1.6 to 6.9) but not short-term travel, recent hospitalisation or antibiotic intake was associated with ESBL-PE carriage. Interestingly, higher knowledge scores (OR 2.0, 95% CI 1.03 to 3.9) and having no leftover antibiotics (OR 2.4, 95% CI 1.2 to 4.9) were independent factors associated with ESBL-PE carriage in the multivariate logistic regression model.ConclusionsWhile the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.

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Risk of childhood mortality associated with death of a mother in low-and-middle-income countries: a systematic review and meta-analysis

BMC Public Health ◽

10.1186/s12889-019-7316-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Diep Thi Ngoc Nguyen ◽

Suzanne Hughes ◽

Sam Egger ◽

D. Scott LaMontagne ◽

Kate Simms ◽

...

Keyword(s):

Meta Analysis ◽

Child Death ◽

Population Based ◽

Childhood Mortality ◽

Child Rearing ◽

Case Control Studies ◽

Middle Income ◽

Middle Income Countries ◽

Increased Risk ◽

Low And Middle Income

Abstract Background Death of a mother at an early age of the child may result in an increased risk of childhood mortality, especially in low-and-middle-income countries. This study aims to synthesize estimates of the association between a mother’s death and the risk of childhood mortality at different age ranges from birth to 18 years in these settings. Methods Various MEDLINE databases, EMBASE, and Global Health databases were searched for population-based cohort and case-control studies published from 1980 to 2017. Studies were included if they reported the risk of childhood mortality for children whose mother had died relative to those whose mothers were alive. Random-effects meta-analyses were used to pool effect estimates, stratified by various exposures (child’s age when mother died, time since mother’s death) and outcomes (child’s age at risk of child death). Results A total of 62 stratified risk estimates were extracted from 12 original studies. Childhood mortality was associated with child’s age at time of death of a mother and time since a mother’s death. For children whose mother died when they were ≤ 42 days, the relative risk (RR) of dying within the first 1–6 months of the child’s life was 35.5(95%CI:9.7–130.5, p [het] = 0.05) compared to children whose mother did not die; by 6–12 months this risk dropped to 2.8(95%CI:0.7–10.7). For children whose mother died when they were ≤ 1 year, the subsequent RR of dying in that year was 15.9(95%CI:2.2–116.1,p [het] = 0.02), compared to children whose mother lived. For children whose mother died when they were ≤ 5 years of age, the RR of dying before aged 12 was 4.1(95%CI:3.0–5.7),p [het] = 0.83. Mortality was also elevated in specific analysis among children whose mother died when child was older than 42 days. Overall, for children whose mother died < 6 and 6+ months ago, RRs of dying before reaching adulthood (≤18 years) were 4.7(95%CI:2.6–8.7,p [het] = 0.2) and 2.1(95%CI:1.3–3.4,p [het] = 0.7), respectively, compared to children whose mother lived. Conclusions There is evidence of an association between the death of a mother and childhood mortality in lower resource settings. These findings emphasize the critical importance of women in family outcomes and the importance of health care for women during the intrapartum and postpartum periods and throughout their child rearing years.

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The Unexpected Syndemic HIV Increase Risk for Nutrition-Related Chronic Diseases (NRCDs) for Women in South Africa- A Scoping Review

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_036 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 831-831

Author(s):

Courtney George

Keyword(s):

South Africa ◽

Scoping Review ◽

People Living With Hiv ◽

Contributing Factors ◽

Middle Income ◽

Viral Loads ◽

Funding Sources ◽

Increased Risk ◽

Increase Risk ◽

Living With Hiv

Abstract Objectives A scoping review of the literature was conducted to ascertain why NRCDs are so high for women in South Africa who are positive for HIV. The hypothesis being tested is that the cause is an interrelated and complex syndemic between biomedical, social, and environmental factors. Methods Literature review was conducted and experts in nutrition, HIV, and global health were referred to assist in the scoping review. Results The main contributing factors of this syndemic found in this review were chronic inflammation, gut microbial translocation, ART-caused weight gain and metabolic changes, absence of breastfeeding, larger ideal body standards, and food insecurity. This review also found that most of the research is preliminary and limited, leaving many questions about this syndemic unanswered. Conclusions The scoping review reveals some novel connections between nutrition, infectious diseases, and the social determinants of health as well as critical gaps in the research and clinical practice in treating people living with HIV (PLHIV). There needs to be more funding, care, and interventions given after PLHIV are on treatment and at undetectable viral loads, due to this massive increased risk in NRCDs. Low- and middle-income countries are especially at risk for this syndemic and need special attention since this increased morbidity and mortality could be especially nefarious. Funding Sources None.

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Engaging patients in antimicrobial resistance and stewardship

International Journal of Health Governance ◽

10.1108/ijhg-02-2016-0008 ◽

2016 ◽

Vol 21 (3) ◽

pp. 180-193 ◽

Cited By ~ 5

Author(s):

Ioana Popescu ◽

Kim Neudorf ◽

Sandi N. Kossey

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Online Survey ◽

Antibiotic Use ◽

Infection Prevention And Control ◽

Care Providers ◽

Content Type ◽

Current State ◽

And Control ◽

Public Campaigns

Purpose – The purpose of this paper is to provide an overview of the perspectives of patient advisors (PAs) on the current state of antimicrobial resistance (AR) and stewardship in Canada and identifies next steps, with the goal of stimulating further collaboration for action between leaders and PAs as well as research. Design/methodology/approach – The perspectives of PAs were gathered using an electronic online survey of 72 respondents. A search of peer reviewed literature and publicly available reports informed the development of the survey and the articulation of a more comprehensive viewpoint in this paper. Findings – PAs view AR as a serious and growing public health threat. They believe sharing the responsibility for infection prevention and control and antimicrobial stewardship will help to control the problem. They see healthcare professionals as the most appropriate stakeholders to influence behaviors associated with appropriate antibiotic use, however, they also see value in public campaigns. Importantly, they identify several opportunities for PA contribution: education of care providers, patients, families, and the public; co-design and development of materials, policies, improvement initiatives, and research; and participation in and promotion of public campaigns. Practical implications – Engaging PAs as partners at all system levels is becoming common practice. PAs bring a unique and complementary perspective that could contribute to antimicrobial stewardship efforts. Originality/value – This paper begins to bridge a gap between literature and practice, and proposes that PAs can contribute to antimicrobial stewardship efforts.

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Surgical Site Infections in Breast Surgery: The Use of Preoperative Antibiotics for Elective, Nonreconstructive Procedures

International Journal of Breast Cancer ◽

10.1155/2016/1645192 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Christopher B. Crawford ◽

James A. Clay ◽

Anna S. Seydel ◽

Jessica A. Wernberg

Keyword(s):

Single Dose ◽

Breast Surgery ◽

Prophylactic Antibiotic ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Community Based ◽

Increased Risk ◽

Increase Risk ◽

Multivariable Analyses ◽

Univariate Analyses

Background. Antibiotic prophylaxis for surgical site infections (SSIs) for breast surgery is widespread, but the benefit in clean surgical cases is not well defined.Methods. A retrospective analysis of 855 patients undergoing elective, nonreconstructive breast operations was performed, with 401 patients receiving no antibiotics and 454 patients receiving a single dose of preoperative antibiotic.Results. Administration of a preoperative antibiotic did not decrease the SSI rate. In this community-based study, antibiotic use practices varied considerably by surgeon. In univariate analyses, SSI rates appeared to increase with prophylactic antibiotic use (12% SSI with antibiotics versus 4% without,p<0.0001), likely because the use of underdosed antibiotics was associated with higher rates of SSI (13.2% SSI with cefazolin 1 gram,p<0.0001, and 15.4% SSI with clindamycin 300 mg or less,p=0.0269). Methicillin-resistantStaphylococcus aureuswas the most common isolate from SSI cultures, 31.8% (7 of 22). In multivariable analyses, increased risk of SSI was associated with BMI > 25 kg/m2(OR: 1.08, 95% CI: 1.04–1.11,p<0.0001).Conclusion. The administration of a single dose of preoperative antibiotic did not decrease the rate of SSI in this large series of patients undergoing clean breast operations. BMI >25 kg/m2and the use of an inadequate dose of antibiotics for prophylaxis may increase risk of SSI.

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