scholarly journals 187. Regional Distribution of Antimicrobial Resistance Among Outpatient Urine e. Coli Isolates in US Females ≥12 Years of age: a Multicenter Evaluation in 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S222-S222
Author(s):  
Keith S Kaye ◽  
Vikas Gupta ◽  
Aruni Mulgirigama ◽  
Ashish V Joshi ◽  
Nicole Scangarella-Oman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Geographic Distribution ◽  
Central Region ◽  
Uncomplicated Urinary Tract Infection ◽  
Becton Dickinson ◽  
Material Support ◽  
E Coli ◽  
South Central ◽  
The Us ◽  
Us Census

Abstract Background The 2019 CDC Threats Report lists extended spectrum β-lactamase (ESBL) producing Enterobacterales as a serious health threat. While the clinical epidemiology of uncomplicated urinary tract infection (uUTI) has remained stable, there has been a notable increase in antimicrobial resistance (AMR) among community-acquired uUTIs. Urine cultures are seldom ordered for uUTI as treatment is often empiric; local surveillance data may therefore be lacking. The study objective was to determine the prevalence and geographic distribution of AMR in urine E. coli isolates from females in the US outpatient setting. Methods A retrospective cross-sectional study of E. coli ambulatory urine isolates identified from females (≥ 12 years of age) at 296 facilities, with ≥ 1 quarter of data in 2019 (BD Insights Research Database, Franklin Lakes, NJ). Initial isolates representing each distinct susceptibility pattern within 30 days of index urine were included. E. coli isolates were identified as not-susceptible (NS) if intermediate/resistant to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolone (FQ), nitrofurantoin (NFT), ESBL+ (by commercial panels or intermediate/resistant to ceftriaxone, cefotaxime, ceftazidime or cefepime), and multi-drug resistant, defined as NS to ≥ 2 or ≥ 3 of FQ, TMP-SMX, NFT or ESBL+. Logistic regression models were used to evaluate resistance prevalence and variation across US census regions. Results Of 267,524 non-duplicate E. coli isolates evaluated, 25.1% (67,189) were TMP-SMX NS, 20.3% (54,359) were FQ NS, 7.3% (19,576) were ESBL+, 3.5% (9,453) were NFT NS, 14.0% (37,328) were NS to ≥ 2 drugs and 4.0% (10,814) were NS to ≥ 3 drugs. For all phenotypes, there was significant variation in resistance across census regions (all P< 0.001) with the highest in the East South Central region and lowest in the New England region of the US (Table). The figure shows regional prevalence of ESBL+ E. coli in 2019. Table. Antimicrobial resistance data from 30-day non-duplicate urine E. coli isolates in females ≥12 years old in 2019, by US census region. Figure. Heat map of the overall US geographic distribution of ESBL+ E. coli (30-day non-duplicate urine isolates) from females across 296 acute care facilities in 2019. Conclusion The 2019 prevalence of AMR in non-duplicate ambulatory E. coli urine isolates was notable: TMP-SMX NS and FQ NS were > 20%. In addition, there were significant regional differences in resistance, with the highest in the East South Central region of the US, for all NS phenotypes. These analyses inform, and may optimize, empiric treatment of uUTI and patient outcomes. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Aruni Mulgirigama, MBBS, GlaxoSmithKline plc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Nicole Scangarella-Oman, MS, GlaxoSmithKline plc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Anthony Boyles, MSc, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals 1699. Variation of antimicrobial resistance by age groups for outpatient UTI isolates in US females: A multicenter evaluation from 2011 to 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S832-S832
Author(s):  
Keith S Kaye ◽  
Vikas Gupta ◽  
Aruni Mulgirigama ◽  
Ashish V Joshi ◽  
Nicole Scangarella-Oman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Age Groups ◽  
Outpatient Setting ◽  
Research Database ◽  
Age Group ◽  
Becton Dickinson ◽  
Gram Positive ◽  
Multicenter Cohort Study ◽  
Material Support ◽  
E Coli

Abstract Background An estimated 12% of women experience ≥ 1 episode of urinary tract infection (UTI) annually. Incidence is bimodal, with peaks occurring in young, sexually active women (18–24 years) and in post-menopausal women. Previous studies suggest the prevalence of antimicrobial resistance (AMR) in UTI is rising; however recent AMR data for community-acquired UTI are lacking. We estimated the prevalence of AMR among US females with outpatient UTI in 2011–2019, stratified by age. Methods A retrospective, multicenter, cohort study of AMR among non-duplicate urine isolates in US females (≥ 12 years of age) from 296 institutions from 2011–2019 (BD Insights Research Database, Franklin Lakes, NJ). Phenotypes examined for Enterobacterales (ENT) were: extended spectrum β-lactamase positive (ESBL+; determined by commercial panels or intermediate/resistant to ceftriaxone, cefotaxime, ceftazidime or cefepime); nitrofurantoin (NFT) not-susceptible (NS); fluoroquinolone (FQ) NS; trimethoprim-sulfamethoxazole (TMP-SMX) NS; and NS to ≥ 2 or ≥ 3 drug classes (including ESBL+). Gram-positive phenotypes were, methicillin resistant S. aureus and S. saprophyticus and vancomycin-resistant Enterococcus. Isolates were stratified by patient age (≥ 12 to < 18, ≥ 18 to < 55, ≥ 55 to < 65, ≥ 65 to < 75, ≥ 75 years). Chi-square tests were used to evaluate AMR difference between groups. Results In total, urine isolates were collected from 106 to 296 (2011–2019) US sites. Overall, the prevalence of antimicrobial NS increased with age for all E. coli phenotypes (all P< 0.001; Table 1), and for non-E. coli ENT (all P< 0.001), except NFT NS, which decreased from 70.6% to 59.7% (P=0.002; Table 2). The greatest difference between age groups in prevalence of resistance was observed for FQ NS E.coli: 5.8% (≥ 12 to < 18 years) vs 34.5% (≥ 75 years). For the multi-drug resistant E. coli phenotypes, resistance increased with age, ranging from 4.8–22.4% and 0.9–6.5% for ≥ 2 and ≥ 3 drug NS, respectively. Overall, the prevalence of resistance for Gram-positive phenotypes increased with age (all P< 0.001; Table 3). Table 1. Prevalence of antimicrobial resistance among E. coli isolates in US females with outpatient UTI by age group. Table 2. Prevalence of antimicrobial resistance among non-E. coli ENT isolates in US females with outpatient UTI by age group. Table 3. Prevalence of antimicrobial resistance among Gram-positive isolates in US females with outpatient UTI by age group. Conclusion The prevalence of AMR in E. coli and non-E. coli ENT increased with age among US females presenting for care in the outpatient setting overall. A similar trend increase by age is also seen in Gram-positive isolates. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Aruni Mulgirigama, MBBS, GlaxoSmithKline plc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Nicole Scangarella-Oman, MS, GlaxoSmithKline plc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Gang Ye, PhD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals 1698. Trends in antimicrobial resistance among outpatient urine E. coli isolates in US females ≥12 years of age: A multicenter evaluation from 2011 to 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S831-S832
Author(s):  
Keith S Kaye ◽  
Vikas Gupta ◽  
Aruni Mulgirigama ◽  
Ashish V Joshi ◽  
Nicole Scangarella-Oman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Outpatient Setting ◽  
Research Database ◽  
Becton Dickinson ◽  
Multicenter Cohort Study ◽  
Material Support ◽  
E Coli ◽  
Using Data ◽  
Tract Infections ◽  
Over Time

Abstract Background E. coli is the predominant uropathogen isolated in uncomplicated urinary tract infections (UTI). Surveillance data suggest increasing antimicrobial resistance (AMR), although recent data from the outpatient setting are limited. Treatment is typically empiric and should be guided by local resistance rates; however, this is challenging in the absence of routine culture and assessment of regional AMR. We characterized AMR trends for E. coli isolated from females with outpatient UTI in the US, from 2011 to 2019. Methods A retrospective multicenter cohort study of antimicrobial susceptibility using data from the BD Insights Research Database (Franklin Lakes, NJ) was conducted. The first E. coli urine culture isolates representing each distinct susceptibility pattern within 30 days of index urine from 2011–2019 were included from females ≥ 12 years old. E. coli isolates were identified as not-susceptible (NS) if intermediate or resistant to trimethoprim-sulfamethoxazole (TMP-SMX NS), fluoroquinolone (FQ NS), nitrofurantoin (NFT NS), ESBL+ (by commercial panels or intermediate/resistant to ceftriaxone, cefotaxime, ceftazidime or cefepime), and multi-drug resistant (MDR), defined as NS to ≥ 2 or ≥ 3 of FQ, TMP-SMX, NFT or ESBL+. Descriptive analyses characterized AMR (%) over time and generalized estimating equations were used to statistically assess AMR trends over time. Results A total of 1,513,882 E. coli isolates were tested at 106 to 295 US centers between 2011 and 2019. Over the study period, AMR remained persistently high (> 20%) for FQ and TMP-SMX and increased for the MDR (≥ 3 drugs) phenotype (from 3.1% to 4.0%) (Table). Prevalence of the ESBL+ phenotype increased year-on-year (from 4.1% to 7.3%). Modeling confirmed a significant increasing trend for the ESBL+ (7.7%/year) and MDR (≥ 3 drugs) phenotypes (2.7%/year) (P< 0.001), with decreasing or no trend change for NFT NS and other AMR phenotypes (Table). Table. Descriptive Statistics and Model-estimated Annual Change of AMR (count and % not-susceptible out of isolates tested) in E. coli among US Females (≥12 years of age) with Outpatient UTI Conclusion Characterization of AMR trends for E. coli over the last decade, in outpatient E. coli isolates in US females, shows persistently high AMR to FQ and TMP-SMX, and increasing AMR trends for the ESBL+ and MDR (≥ 3 drugs) phenotypes. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Aruni Mulgirigama, MBBS, GlaxoSmithKline plc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Nicole Scangarella-Oman, MS, GlaxoSmithKline plc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Gang Ye, PhD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals Antimicrobial Resistance Trends in Urine Escherichia coli Isolates From Adult and Adolescent Females in the United States From 2011–2019: Rising ESBL Strains and Impact on Patient Management

2021 ◽  
Author(s):  
Keith S Kaye ◽  
Vikas Gupta ◽  
Aruni Mulgirigama ◽  
Ashish V Joshi ◽  
Nicole E Scangarella-Oman ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Significant Variation ◽  
The United States ◽  
Uncomplicated Urinary Tract Infection ◽  
Research Database ◽  
Period Prevalence ◽  
The Us ◽  
Us Census

Abstract Background Uncomplicated urinary tract infection (uUTI) is predominantly caused by Escherichia coli, which has increasing antimicrobial resistance (AMR) at the US-community level. As uUTI is often treated empirically, assessing AMR is challenging and there are limited contemporary data characterizing period prevalence in the US. Methods This was a retrospective study of AMR using Becton, Dickinson and Company Insights Research Database (Franklin Lakes, NJ) data collected 2011–2019. Thirty-day, non-duplicate Escherichia coli urine isolates from US female outpatients (aged ≥12 years) were included. Isolates were evaluated for not-susceptibility (intermediate/resistant) to trimethoprim-sulfamethoxazole, fluoroquinolones, or nitrofurantoin, and assessed for extended-spectrum β-lactamase production (ESBL+) and for ≥2 or ≥3 drug-resistance phenotypes. Generalized estimating equations were used to model AMR trends over time and by US census region. Results Among 1,513,882 Escherichia coli isolates, the overall prevalence of isolates not-susceptible to trimethoprim-sulfamethoxazole, fluoroquinolones, and nitrofurantoin was 25.4%, 21.1%, and 3.8%, respectively. Among the isolates, 6.4% were ESBL+, 14.4% had ≥2 drug-resistance phenotypes, and 3.8% had ≥3. Modelling demonstrated a relative average yearly increase of 7.7% (95% confidence interval [CI], 7.2–8.2%) for ESBL+ isolates and 2.7% (95% CI, 2.2–3.2%) for ≥3 drug-phenotypes (both p<0.0001). Modelling also demonstrated significant variation in AMR prevalence between US census regions (p<0.001). Conclusions Period prevalence of AMR among US outpatient urine-isolated Escherichia coli was high, and for multi-drug-resistance phenotypes increased during the study period with significant variation between census regions. Knowledge of regional AMR rates helps inform empiric treatment of community-onset uUTI and highlights the AMR burden to physicians.

scholarly journals Comparison of Antimicrobial Resistance Detected in Environmental and Clinical Isolates from Historical Data for the US

2020 ◽  
Vol 2020 ◽  
pp. 1-11 ◽  
Author(s):  
Megan Hua ◽  
William Huang ◽  
Albert Chen ◽  
Michael Rehmet ◽  
Cade Jin ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Pathogen Detection ◽  
Historical Data ◽  
Clinical Isolates ◽  
Public Health Issue ◽  
Environmental Isolates ◽  
Multivariate Statistical ◽  
E Coli ◽  
Environmental Setting ◽  
The Us

Antimicrobial resistance (AMR) has become an urgent public health issue, as pathogens are becoming increasingly resistant to commonly used antimicrobials. While AMR isolate data are available in the NCBI Pathogen Detection Isolates Browser (NPDIB) database, few researches have been performed to compare antimicrobial resistance detected in environmental and clinical isolates. To address this, this work conducted the first multivariate statistical analysis of antimicrobial-resistance pathogens detected in NPDIB clinical and environmental isolates for the US from 2013 to 2018. The highly occurring AMR genes and pathogens were identified for both clinical and environmental settings, and the historical profiles of those genes and pathogens were then compared for the two settings. It was found that Salmonella enterica and E. coli and Shigella were the highly occurring AMR pathogens for both settings. Additionally, the genes fosA, oqxB, ble, floR, fosA7, mcr-9.1, aadA1, aadA2, ant(2”)-Ia, aph(3”)-Ib, aph(3’)-Ia, aph(6)-Id, blaTEM-1, qacEdelta1, sul1, sul2, tet(A), and tet(B) were mostly detected for both clinical and environmental settings. Ampicillin, ceftriaxone, gentamicin, tetracycline, and cefoxitin were the antimicrobials which got the most resistance in both settings. The historical profiles of these genes, pathogens, and antimicrobials indicated that higher occurrence frequencies generally took place earlier in the environmental setting than in the clinical setting.

scholarly journals Antimicrobial Resistance in Escherichia coli and Enterococcal Isolates From Irrigation Return Flows in a High-Desert Watershed

2021 ◽  
Vol 12 ◽  
Author(s):  
Robert S. Dungan ◽  
David L. Bjorneberg
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Most Probable Number ◽  
Probable Number ◽  
E Coli ◽  
South Central ◽  
Drug Classes ◽  
Return Flows ◽  
Irrigation Return Flows

Irrigation return flows (IRFs) collect surface runoff and subsurface drainage, causing them to have elevated contaminant and bacterial levels, and making them a potential source of pollutants. The purpose of this study was to determine antimicrobial susceptibility among Escherichia coli and enterococcal isolates that were collected from IRFs in a south-central Idaho watershed. Environmental isolates can be a potentially important source of antimicrobial resistance (AMR) and IRFs may be one way resistance genes are transported out of agroecosystems. Water samples were collected from nine IRFs and one background site (canal water from Snake River) on a biweekly basis during 2018. Escherichia coli and enterococci were enumerated via a most probable number (MPN) technique, then subsamples were plated on selective media to obtain isolates. Isolates of E. coli (187) or enterococci (185) were tested for antimicrobial susceptibility using Sensititre broth microdilution plates. For E. coli, 13% (25/187) of isolates were resistant to tetracycline, with fewer numbers being resistant to 13 other antimicrobials, with none resistant to gentamicin. While 75% (141/187) of the E. coli isolates were pan-susceptible, 12 multidrug resistance (MDR) patterns with 17 isolates exhibiting resistance to up to seven drug classes (10 antimicrobials). For the enterococcal species, only 9% (16/185) of isolates were pan-susceptible and the single highest resistance was to lincomycin (138/185; 75%) followed by nitrofurantoin (56/185; 30%) and quinupristin/dalfopristin (34/185; 18%). In addition, 13 enterococcal isolates belonging to Enterococcus faecalis, Enterococcus faecium, Enterococcus casseliflavus, and Enterococcus thailandicus, were determined to be MDR to up to six different antimicrobial drug classes. None of the enterococcal isolates were resistant to gentamycin, linezolid, tigecycline, and vancomycin.

scholarly journals 1428. Increased Consumption of Pivmecillinam in Primary Care for Uncomplicated Urinary Tract Infection (uUTI) Is Not Associated With Increased Resistance Rates

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S796-S796
Author(s):  
Anders Rhod Larsen ◽  
Anne Santerre Henriksen ◽  
Niels Frimodt-Møller
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Care Setting ◽  
Primary Care Setting ◽  
Active Form ◽  
Resistance Rate ◽  
Uncomplicated Urinary Tract Infection ◽  
E Coli ◽  
The Past ◽  
Development Of Resistance

Abstract Background The evolution of antibiotic resistance in Escherichia coli (E. coli) hampers the treatment of UTIs, mirroring the global public health concerns around antimicrobial resistance. Pivmecillinam, an oral prodrug of mecillinam (a β-lactam antibiotic), is used as first-line treatment for uUTIs in Denmark. Here, we examine the use of, and the prevalence of resistance to, mecillinam in Denmark in the primary care setting. Methods Nationwide data on the use of and resistance to pivmecillinam (reported as its active form, mecillinam) was extracted and examined from the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) 2019 report (www.danmap.org). Prevalence estimates of resistance reported by DANMAP 2019 were obtained from the Danish Microbiology Database (MiBA). Results In 2019, pivmecillinam accounted for about 27% of penicillins and 75% of penicillins with extended spectrum consumed in primary healthcare in Denmark. Pivmecillinam usage has increased primarily due to changes in recommendations for the treatment of uUTIs. Between 2010 and 2019, pivmecillinam usage in Denmark increased by 45% from 1.67 to 2.43, defined as daily doses per 1,000 inhabitants per day. In 2019, analysis of 83,850 urinary isolates from patients in the primary care setting with E. coli revealed a 5.3% resistance rate to mecillinam. Time-trend analysis using data from a 10-year period showed a small but significant decrease from the 5.5% resistance rate recorded in 2010 (p=0.001). In general, in spite of increasing use in Denmark, the development of resistance to pivmecillinam has remained low. In fact, a slight decline in pivmecillinam resistance was observed over the past decade. Conclusion Despite the rising number of UTIs and the increasing use of pivmecillinam for uUTI in Denmark, over the past decade, the development of resistance to pivmecillinam remains low. Disclosures Anne Santerre Henriksen, MS, Advanz (Consultant)Shionogi BV (Consultant)UTILITY Therapeutics (Consultant)

scholarly journals An Analysis of Antimicrobial Resistance of Clinical Pathogens from Historical Samples for Six Countries

Processes ◽  
2019 ◽  
Vol 7 (12) ◽  
pp. 964 ◽  
Author(s):  
Karen Li ◽  
Joanna Zheng ◽  
Thomas Deng ◽  
James Peng ◽  
Dagmar Daniel ◽  
...  
Keyword(s):  
South Africa ◽  
Antimicrobial Resistance ◽  
Pathogen Detection ◽  
Clinical Settings ◽  
Multivariate Statistical ◽  
E Coli ◽  
Time Profiles ◽  
Antimicrobial Resistance Gene ◽  
The Us ◽  
The Uk

The spread of antimicrobial resistance pathogens in humans has increasingly become an issue that threatens public health. While the NCBI Pathogen Detection Isolates Browser (NPDIB) database has been collecting clinical isolate samples over time for various countries, few studies have been done to identify genes and pathogens responsible for the antimicrobial resistance in clinical settings. This study conducted the first multivariate statistical analysis of the high-dimensional historical data from the NPDIB database for six different countries from majorly inhabited landmasses, including Australia, Brazil, China, South Africa, the UK, and the US. The similarities among different countries in terms of genes and pathogens were investigated to understand the potential avenues for antimicrobial-resistance gene spreading. The genes and pathogens that were closely involved in antimicrobial resistance were further studied temporally by plotting time profiles of their frequency to evaluate the trend of antimicrobial resistance. It was found that several of these significant genes (i.e., aph(3″)-Ib, aph(6)-Id, blaTEM-1, and qacEdelta1) are shared among all six countries studied. Based on the time profiles, a large number of genes and pathogens showed an increasing occurrence. The most shared pathogens responsible for carrying the most important genes in the six countries in the clinical setting were Acinetobacter baumannii, E. coli and Shigella, Klebsiella pneumoniae and Salmonella enterica. South Africa carried the least similar antimicrobial genes to the other countries in clinical isolates.

scholarly journals Investigation of Virulence Genes Detected in Antimicrobial-Resistance Pathogens Isolates for Five Countries across the World

Processes ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. 1589
Author(s):  
Kevin Cui ◽  
Iris Gong ◽  
Alvin Dong ◽  
Jacob Yan ◽  
Max Wang ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Salmonella Enterica ◽  
Pathogen Detection ◽  
Virulence Genes ◽  
Principal Component ◽  
Multivariate Statistical ◽  
E Coli ◽  
The Us ◽  
The World ◽  
The Uk

A large portion of annual deaths worldwide are due to infections caused by disease-causing pathogens. These pathogens contain virulence genes, which encode mechanisms that facilitate infection and microbial survival in hosts. More recently, antimicrobial resistance (AMR) genes, also found in these pathogens, have become an increasingly large issue. While the National Center for Biotechnology Information (NCBI) Pathogen Detection Isolates Browser (NPDIB) database has been compiling genes involved in microbial virulence and antimicrobial resistance through isolate samples, few studies have identified the genes primarily responsible for virulence and compared them to those responsible for AMR. This study performed the first multivariate statistical analysis of the multidimensional NPDIB data to identify the major virulence genes from historical pathogen isolates for Australia, China, South Africa, UK, and US—the largely populated countries from five of the six major continents. The important virulence genes were then compared with the AMR genes to study whether there is correlation between their occurrences. Among the significant genes and pathogens associated with virulence, it was found that the genes fdeC, iha, iss, iutA, lpfA, sslE, ybtP, and ybtQ are shared amongst all five countries. The pathogens E. coli and Shigella, Salmonella enterica, and Klebsiella pneumoniae mostly contained these genes and were common among four of the five studied countries. Additionally, the trend of virulence was investigated by plotting historical occurrences of gene and pathogen frequency in the annual samples. These plots showed that the trends of E. coli and Shigella and Salmonella enterica were similar to the trends of certain virulence genes, confirming the two pathogens do indeed carry important virulence genes. While the virulence genes in the five countries are not significantly different, the US and the UK share the largest amount of important virulence genes. The plots from principal component analysis and hierarchical clustering show that the important virulence and AMR genes were not significantly correlated, with only few genes from both types of genes clustered into the same groups.

scholarly journals Multidrug-Resistant Urinary Tract Isolates ofEscherichia coli: Prevalence and Patient Demographics in the United States in 2000

2001 ◽  
Vol 45 (5) ◽  
pp. 1402-1406 ◽  
Author(s):  
Daniel F. Sahm ◽  
Clyde Thornsberry ◽  
David C. Mayfield ◽  
Mark E. Jones ◽  
James A. Karlowsky
Keyword(s):  
United States ◽  
Multidrug Resistance ◽  
Urinary Tract ◽  
Central Region ◽  
The United States ◽  
Multidrug Resistant ◽  
The West ◽  
E Coli ◽  
South Central ◽  
Urinary Isolates

ABSTRACT Concurrent resistance to antimicrobials of different structural classes has arisen in a multitude of bacterial species and may complicate the therapeutic management of infections, including those of the urinary tract. To assess the current breadth of multidrug resistance among urinary isolates of Escherichia coli, the most prevalent pathogen contributing to these infections, all pertinent results in The Surveillance Network Database—USA from 1 January to 30 September 2000 were analyzed. Results were available for 38,835 urinary isolates of E. coli that had been tested against ampicillin, cephalothin, ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole. Of these isolates, 7.1% (2,763 of 38,835) were resistant to three or more agents and considered multidrug resistant. Among the multidrug-resistant isolates, 97.8% were resistant to ampicillin, 92.8% were resistant to trimethoprim-sulfamethoxazole, 86.6% were resistant to cephalothin, 38.8% were resistant to ciprofloxacin, and 7.7% were resistant to nitrofurantoin. The predominant phenotype among multidrug-resistant isolates (57.9%; 1,600 of 2,793) included resistance to ampicillin, cephalothin, and trimethoprim-sulfamethoxazole. This was the most common phenotype regardless of patient age, gender, or inpatient-outpatient status and in eight of the nine U.S. Bureau of the Census regions. Rates of multidrug resistance were demonstrated to be higher among males (10.4%) than females (6.6%), among patients >65 years of age (8.7%) than patients ≤17 (6.8%) and 18 to 65 (6.1%) years of age, and among inpatients (7.6%) than outpatients (6.9%). Regionally, the rates ranged from 4.3% in the West North Central region to 9.2% in the West South Central region. Given the current prevalence of multidrug resistance among urinary tract isolates ofE. coli in the United States (7.1%), continued local, regional, and national surveillance is warranted.

scholarly journals 408. Impact of the COVID-19 Pandemic on Antimicrobial Use and Resistance in the United States and the Dominican Republic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S305-S306
Author(s):  
Alfredo J Mena Lora ◽  
Rita Alexandra Rojas-Fermin ◽  
Stephanie L Echeverria ◽  
Katia Castro ◽  
Anel E Guzman ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Dominican Republic ◽  
The United States ◽  
Antimicrobial Use ◽  
E Coli ◽  
The Us ◽  
Tract Infections ◽  
The Impact

Abstract Background The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. Lower respiratory tract infections (LRTIs) caused by COVID-19 has led to an increase in hospitalizations. Disease severity and concerns for bacterial co-infections can increase antimicrobial pressure. Our aim is to define and compare the impact of COVID-19 on antimicrobial use (AU) and antimicrobial resistance (AMR) in the Dominican Republic (DR) and the United States (US). Methods We performed a retrospective review of AU and antimicrobial susceptibility patterns from 2019-20 at a hospital in the US (H-US) and the DR (H-DR). Our sites are community teaching hospitals with 151 beds in H-US and 295 beds in H-DR. After AU was tabulated, percent changes between 2019-20 were calculated. Resistance patterns for extended-spectrum beta-lactamase producing (ESBL) E coli, ESBL Klebsiella pneumoniae (ESBL-Kp), carbapenem resistant Pseudomonas aeruginosa (CR-PSAR) and Klebsiella pneumoniae (CR-Kp) were tabulated and percent changes between 2019-20 were calculated. Results AU increased by 10% in H-US and 25% in H-DR, with carbapenem use increasing by 268% and 144% respectively. Ceftriaxone use increased by 30% in H-US and 33% in H-DR. Azithromycin increased 54% in H-US and 338% in the H-DR. Resistance increased from 10% to 28% for ESBL-Kp and from 10% to 12% for ESBL E coli at H-US. CR-PSAR decreased from 20% to 12%, while cefepime and piperacillin resistance increased from 5% to 20% and 3% to 16% respectively (Figure 1). At H-DR, ESBL-Kp resistance decreased from 68% to 64% and increased from 58% to 59% for ESBL E coli. CR-PSAR and cefepime resistance increased from 5% to 19% and from 9% to 29% respectively (Figure 2). Figure 1. Antimicrobial resistance (%) for select organisms at H-US in 2019 and 2020 Figure 2. Antimicrobial resistance (%) for select organisms at H-DR in 2019 and 2020 Conclusion COVID-19 had a major impact on antimicrobial consumption and resistance in the US and DR. A greater impact was seen on ESBL rates in the US whilst a greater impact on carbapenem resistance was seen in the DR. The rise in carbapenem use in H-US reflected a rise in ESBL rates. In the DR, ESBL producing organisms were common prior to COVID-19 and carbapenem use was more widespread. The impact of the COVID-19 pandemic on AU may accelerate AMR worldwide. The scale up of antimicrobial stewardship across the globe is urgently needed to curb AMR. Disclosures All Authors: No reported disclosures

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