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.

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.

scholarly journals Robust detection of point mutations involved in multidrug-resistant Mycobacterium tuberculosis in the presence of co-occurrent resistance markers

2020 ◽  
Vol 16 (12) ◽  
pp. e1008518
Author(s):  
Julian Libiseller-Egger ◽  
Jody Phelan ◽  
Susana Campino ◽  
Fady Mohareb ◽  
Taane G. Clark
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Genome Wide Association Study ◽  
Point Mutations ◽  
Treatment Decision ◽  
Multidrug Resistant ◽  
Machine Learning Techniques ◽  
Health Concern ◽  
Global Public Health ◽  
Phenotypic Resistance ◽  
Robust Detection

Tuberculosis disease is a major global public health concern and the growing prevalence of drug-resistant Mycobacterium tuberculosis is making disease control more difficult. However, the increasing application of whole-genome sequencing as a diagnostic tool is leading to the profiling of drug resistance to inform clinical practice and treatment decision making. Computational approaches for identifying established and novel resistance-conferring mutations in genomic data include genome-wide association study (GWAS) methodologies, tests for convergent evolution and machine learning techniques. These methods may be confounded by extensive co-occurrent resistance, where statistical models for a drug include unrelated mutations known to be causing resistance to other drugs. Here, we introduce a novel ‘cannibalistic’ elimination algorithm (“Hungry, Hungry SNPos”) that attempts to remove these co-occurrent resistant variants. Using an M. tuberculosis genomic dataset for the virulent Beijing strain-type (n = 3,574) with phenotypic resistance data across five drugs (isoniazid, rifampicin, ethambutol, pyrazinamide, and streptomycin), we demonstrate that this new approach is considerably more robust than traditional methods and detects resistance-associated variants too rare to be likely picked up by correlation-based techniques like GWAS.

scholarly journals Case Report: Multidrug Resistant Raoultella ornithinolytica in a Septicemic Calf

2021 ◽  
Vol 8 ◽  
Author(s):  
Mathilde L. Pas ◽  
Kevin Vanneste ◽  
Jade Bokma ◽  
Laura Van Driessche ◽  
Sigrid C. J. De Keersmaecker ◽  
...  
Keyword(s):  
Susceptibility Testing ◽  
Multidrug Resistant ◽  
Beta Lactam ◽  
Emerging Pathogen ◽  
Suspected Sepsis ◽  
Phenotypic Resistance ◽  
Beta Lactam Antibiotics ◽  
Antimicrobial Resistance Genes ◽  
Threatening Condition ◽  
Life Threatening

Sepsis is a frequent life-threatening condition in young calves, requiring rapid broad spectrum and bactericidal therapy to maximize survival chances. Few studies have identified and characterized bacteria involved in sepsis in calves. This report demonstrates the involvement of a multidrug resistant Raoultella ornithinolytica, an emerging pathogen in human medicine, in a calf with suspected sepsis. R. ornithinolytica was identified by MALDI-TOF MS from blood cultures of a critically ill calf. Susceptibility testing showed phenotypic resistance against ampicillin, gentamicin, potentiated sulphonamides, streptomycin, tetracyclines and intermediate susceptibility for enrofloxacin. Whole genome sequencing confirmed identification as R. ornithinolytica and the multidrug resistant character of the isolate. Antimicrobial resistance genes acting against aminoglycosides, beta-lactam antibiotics, fosfomycin, quinolones, sulphonamides, trimethoprim and tetracyclines were found. The calf recovered after empirical parenteral therapy with enrofloxacin and sodium penicillin for seven days. Ancillary therapy consisted of fluid therapy, ketoprofen and doxapram hydrochloride. To the authors' knowledge, this is the first report characterizing a multidrug resistant R. ornithinolytica isolate from blood culture in cattle. It is currently unknown whether animals and farms may act as reservoirs for multidrug resistant R. ornithinolytica strains.

scholarly journals Verification of an Automated, Digital Dispensing Platform for At-Will Broth Microdilution-Based Antimicrobial Susceptibility Testing

2016 ◽  
Vol 54 (9) ◽  
pp. 2288-2293 ◽  
Author(s):  
Kenneth P. Smith ◽  
James E. Kirby
Keyword(s):  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Reference Laboratory ◽  
Broth Microdilution ◽  
Content Type ◽  
Susceptibility Data ◽  
Stock Solutions ◽  
At Will

With rapid emergence of multidrug-resistant bacteria, there is often a need to perform susceptibility testing for less commonly used or newer antimicrobial agents. Such testing can often be performed only by using labor-intensive, manual dilution methods and lies outside the capacity of most clinical labs, necessitating reference laboratory testing and thereby delaying the availability of susceptibility data. To address the compelling clinical need for microbiology laboratories to perform such testing in-house, we explored a novel, automated, at-will broth microdilution-based susceptibility testing platform. Specifically, we used the modified inkjet printer technology in the HP D300 digital dispensing system to dispense, directly from stock solutions into a 384-well plate, the 2-fold serial dilution series required for broth microdilution testing. This technology was combined with automated absorbance readings and data analysis to determine MICs. Performance was verified by testing members of theEnterobacteriaceaefor susceptibility to ampicillin, cefazolin, ciprofloxacin, colistin, gentamicin, meropenem, and tetracycline in comparison to the results obtained with a broth microdilution reference standard. In precision studies, essential and categorical agreement levels were 96.8% and 98.3%, respectively. Furthermore, significantly fewer D300-based measurements were outside ±1 dilution from the modal MIC, suggesting enhanced reproducibility. In accuracy studies performed using a panel of 80 curated clinical isolates, rates of essential and categorical agreement and very major, major, and minor errors were 94%, 96.6%, 0%, 0%, and 3.4%, respectively. Based on these promising initial results, it is anticipated that the D300-based methodology will enable hospital-based clinical microbiology laboratories to perform at-will broth microdilution testing of antimicrobials and to address a critical testing gap.

Status of the Prevention of Multidrug-Resistant Organisms in International Settings: A Survey of the Society for Healthcare Epidemiology of America Research Network

2016 ◽  
Vol 38 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Nasia Safdar ◽  
Sharmila Sengupta ◽  
Jackson S. Musuuza ◽  
Manisha Juthani-Mehta ◽  
Marci Drees ◽  
...  
Keyword(s):  
United States ◽  
Low Income ◽  
The United States ◽  
Multidrug Resistant ◽  
High Income ◽  
Research Network ◽  
Middle Income ◽  
Stewardship Program ◽  
Multidrug Resistant Organisms ◽  
Healthcare Epidemiology

OBJECTIVETo examine self-reported practices and policies to reduce infection and transmission of multidrug-resistant organisms (MDRO) in healthcare settings outside the United States.DESIGNCross-sectional survey.PARTICIPANTSInternational members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.METHODSElectronic survey of infection control and prevention practices, capabilities, and barriers outside the United States and Canada. Participants were stratified according to their country’s economic development status as defined by the World Bank as low-income, lower-middle-income, upper-middle-income, and high-income.RESULTSA total of 76 respondents (33%) of 229 SHEA members outside the United States and Canada completed the survey questionnaire, representing 30 countries. Forty (53%) were high-, 33 (43%) were middle-, and 1 (1%) was a low-income country. Country data were missing for 2 respondents (3%). Of the 76 respondents, 64 (84%) reported having a formal or informal antibiotic stewardship program at their institution. High-income countries were more likely than middle-income countries to have existing MDRO policies (39/64 [61%] vs 25/64 [39%],P=.003) and to place patients with MDRO in contact precautions (40/72 [56%] vs 31/72 [44%],P=.05). Major barriers to preventing MDRO transmission included constrained resources (infrastructure, supplies, and trained staff) and challenges in changing provider behavior.CONCLUSIONSIn this survey, a substantial proportion of institutions reported encountering barriers to implementing key MDRO prevention strategies. Interventions to address capacity building internationally are urgently needed. Data on the infection prevention practices of low income countries are needed.Infect Control Hosp Epidemiol.2016:1–8

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.

Modulation of the drug resistance by Platonia insignis Mart. extract, ethyl acetate fraction and Morelloflavone/Volkensiflavone (biflavonoids) in Staphylococcus aureus strains overexpressing efflux pump genes

2020 ◽  
Vol 21 ◽  
Author(s):  
Andressa Kelly Ferreira e Silva ◽  
Antonielly Campinho dos Reis ◽  
Emanuelly Elanny Andrade Pinheiroc ◽  
Jonas Nascimento de Sousa ◽  
Felipe Araújo de Alcântara Oliveira ◽  
...  
Keyword(s):  
Natural Products ◽  
Ethyl Acetate ◽  
Native Species ◽  
Efflux Pump ◽  
Public Health Problem ◽  
Ethyl Acetate Fraction ◽  
Multidrug Resistant ◽  
Global Public Health ◽  
Minimal Inhibitory Concentrations ◽  
Subinhibitory Concentrations

Background: Microbial resistance to antibiotics is a global public health problem, which requires urgent attention. Platonia insignis is a native species from the eastern Brazilian Amazon, used in the treatment of burns and wounds. Objectives: To evaluate the antimicrobial activity of the hydroalcoholic extract of P. insignis (PIHA), the ethyl acetate fraction (PIAE), and its subfraction containing a mixture of biflavonoids (BF). Moreover, the effect of these natural products on the antibiotic activity against S. aureus strains overexpressing efflux pump genes was also evaluated. Methods: Minimal inhibitory concentrations were determined against different species of microorganisms. To evaluate the modulatory effect on the Norfloxacin-resistance, the MIC of this antibiotic was determined in the absence and presence of the natural products at subinhibitory concentrations. Inhibition of the EtBr efflux assays were conducted in the absence or presence of the natural products. Results: PIHA showed a microbicidal effect against S. aureus and C. albicans, while PIAE was bacteriosctatic for S. aureus. PIAE and BF at subinhibitory concentrations were able to reduce the MIC of Norfloxacin acting as modulating agents. BF was able to inhibit the efflux of EtBr efflux in S. aureus strains overexpressing specific efflux pump genes. Conclusion: P. inignisis a source of efflux pump inhibitors, including volkensiflavone and morelloflavone which were able to potentiate the Norfloxacin activity by NorA inhibition, being also able to inhibit QacA/B, TetK and MsrA. Volkensiflavone and morelloflavone could be used as adjuvant in the antibiotic therapy of multidrug resistant S. aureus strains overexpressing efflux pumps.

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