scholarly journals 1061. Decreased Utilization of Piperacillin–Tazobactam for Escherichia coli and Klebsiella Bacteremia due to Selective Susceptibility Reporting

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S375-S376
Author(s):  
Yorgo Zahlanie ◽  
Brenton Hall ◽  
Wenjing Wei ◽  
Norman Mang ◽  
Jessica Ortwine ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
The United States ◽  
Blood Cultures ◽  
Clinical Microbiology Laboratory ◽  
Prescribing Practices ◽  
Post Intervention ◽  
Weak Support ◽  
E Coli ◽  
Susceptibility Data ◽  
One Year

Abstract Background Over 2 million people in the United States are diagnosed with antibiotic-resistant infections annually. The Infectious Diseases Society of America (IDSA) recommends cascade reporting of antibiotic susceptibility data by the clinical microbiology laboratory as an intervention to decrease resistance, though this is based on low-quality evidence. Methods We conducted a retrospective study to assess the effect of cascade susceptibility reporting on prescribing practices and patient outcomes. A cascaded testing algorithm was executed wherein susceptibility data for piperacillin–tazobactam (PT) was suppressed from the susceptibility report if an organism was susceptible to ceftriaxone. Patients with positive monomicrobial blood cultures with non-ESBL Escherichia coli (E. coli) or Klebsiella isolates in blood cultures and receiving empiric PT were included. Data were collected one year prior and one year after cascading protocol implementation, and included patient demographics, length of stay (LOS), duration of antibiotics, time to de-escalation, and adverse events including acute kidney injury (AKI) and Clostridioides difficile infection (CDI). Results 212 patients (108 pre-intervention and 104 post-intervention) were included. 87% of patients were de-escalated from PT pre-intervention, while 90% were deescalated post-intervention. Mean time to deescalation decreased from 30 hours before to 17 hours after cascade implementation (P = 0.02) (Figure 1). Median LOS decreased from 15 to 10 days following the intervention (P = 0.12). While the rate of AKI increased from 14 to 19% post-intervention (P = 0.89), the rate of CDI (2 vs. 2 patients) was comparable among both cohorts (P = 0.97) (Figure 2). Conclusion While cascade susceptibility reporting is recommended by the IDSA as a tool for antimicrobial stewardship, this recommendation has weak support due to paucity of data. In this study, we found that selective susceptibility reporting has the potential to decrease the use of PT and to reduce LOS in patients with E. coli and Klebsiella bacteremia. Further research to better identify patient populations most impacted by a cascade algorithm and its overall effectiveness as a stewardship tool is needed. Disclosures All authors: No reported disclosures.

Introduction to the Food Safety Concerns of Verotoxin-Producing Escherichia coli

2003 ◽  
Vol 228 (4) ◽  
pp. 331-332 ◽  
Author(s):  
Hussein S. Hussein ◽  
Stanley T. Omaye
Keyword(s):  
Escherichia Coli ◽  
Food Safety ◽  
Safety Concern ◽  
Critical Evaluation ◽  
The United States ◽  
Global Perspective ◽  
E Coli ◽  
The Past ◽  
Food Borne Pathogens ◽  
Food Borne

Verotoxin-producing Escherichia coli (VTEC) have emerged in the past two decades as food-borne pathogens that can cause major outbreaks of human illnesses worldwide. The number of outbreaks has increased in recent years due to changes in food production and processing systems, eating habits, microbial adaptation, and methods of VTEC transmission. The human illnesses range from mild diarrhea to hemolytic uremic syndrome (HUS) that can lead to death. The VTEC outbreaks have been attributed to O157:H7 and non-O157:H7 serotypes of E. coli. These E. coli serotypes include motile (e.g., O26:H11 and O104:H21) and nonmotile (e.g., O111:H–,0145:H–, and O157:H–) strains. In the United States, E. coli O157:H7 has been the major cause of VTEC outbreaks. Worldwide, however, non-O157:H7 VTEC (e.g., members of the 026, O103, O111, O118, O145, and O166 serogroups) have caused approximately 30% of the HUS cases in the past decade. Because large numbers of the VTEC outbreaks have been attributed to consumption of ruminant products (e.g., ground beef), cattle and sheep are considered reservoirs of these food-borne pathogens. Because of the food safety concern of VTEC, a global perspective on this problem is addressed (Exp Biol Med Vol. 228, No. 4). The first objective was to evaluate the known non-O157:H7 VTEC strains and the limitations associated with their detection and characterization. The second objective was to identify the VTEC serotypes associated with outbreaks of human illnesses and to provide critical evaluation of their virulence. The third objective was to determine the rumen effect on survival of E. coli O157:H7 as a VTEC model. The fourth objective was to explore the role of intimins in promoting attaching and effacing lesions in humans. Finally, the ability of VTEC to cause persistent infections in cattle was evaluated.

Sequence of Colonization Determines the Composition of Mixed Biofilms by Escherichia coli O157:H7 and O111:H8 Strains†

2015 ◽  
Vol 78 (8) ◽  
pp. 1554-1559 ◽  
Author(s):  
RONG WANG ◽  
NORASAK KALCHAYANAND ◽  
JAMES L. BONO
Keyword(s):  
Escherichia Coli ◽  
Foodborne Pathogens ◽  
Early Stage ◽  
Critical Role ◽  
The United States ◽  
Food Samples ◽  
E Coli ◽  
Cell Percentage ◽  
Composition And Structure ◽  
Biofilm Development

Bacterial biofilms are one of the potential sources of cross-contamination in food processing environments. Shiga toxin–producing Escherichia coli (STEC) O157:H7 and O111:H8 are important foodborne pathogens capable of forming biofilms, and the coexistence of these two STEC serotypes has been detected in various food samples and in multiple commercial meat plants throughout the United States. Here, we investigated how the coexistence of these two STEC serotypes and their sequence of colonization could affect bacterial growth competition and mixed biofilm development. Our data showed that E. coli O157:H7 strains were able to maintain a higher cell percentage in mixed biofilms with the co-inoculated O111:H8 companion strains, even though the results of planktonic growth competition were strain dependent. On solid surfaces with preexisting biofilms, the sequence of colonization played a critical role in determining the composition of the mixed biofilms because early stage precolonization significantly affected the competition results between the E. coli O157:H7 and O111:H8 strains. The precolonizer of either serotype was able to outgrow the other serotype in both planktonic and biofilm phases. The competitive interactions among the various STEC serotypes would determine the composition and structure of the mixed biofilms as well as their potential risks to food safety and public health, which is largely influenced by the dominant strains in the mixtures. Thus, the analysis of mixed biofilms under various conditions would be of importance to determine the nature of mixed biofilms composed of multiple microorganisms and to help implement the most effective disinfection operations accordingly.

scholarly journals Simulated Pediatric Blood Cultures to Assess the Inactivation of Clinically Relevant Antimicrobial Drug Concentrations in Resin-Containing Bottles

2021 ◽  
Vol 11 ◽  
Author(s):  
Liliana Giordano ◽  
Flora Marzia Liotti ◽  
Giulia Menchinelli ◽  
Giulia De Angelis ◽  
Tiziana D’Inzeo ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Streptococcus Pneumoniae ◽  
Pediatric Patients ◽  
Blood Cultures ◽  
Blood Collection ◽  
E Coli ◽  
Drug Concentrations ◽  
The Common ◽  
Bactec Fx

The bacteremia level as well as the administration of antibiotics before blood collection may significantly affect the recovery of bacterial pathogens from pediatric blood cultures in BacT/Alert Virtuo or Bactec FX BC systems, which remain the common techniques to diagnose bacteremia in pediatric patients. We simulated pediatric blood cultures with low or intermediate bacteremia level to evaluate BacT/Alert PF Plus and Bactec Peds Plus blood culture bottles for resin-based inactivation of 16 antibiotic–bacterium combinations. Overall, 105/192 (54.7%) of BacT/Alert PF Plus bottles and 69/192 (36.0%) of Bactec Peds Plus bottles allowed organisms to grow when exposed to antibiotics. In particular, both BacT/Alert PF Plus and Bactec Peds Plus bottles proved to be effective with piperacillin/tazobactam and Pseudomonas aeruginosa or with oxacillin and methicillin-susceptible Staphylococcus aureus (100% growth), whereas no effectiveness was apparent with ceftriaxone and Escherichia coli, Streptococcus agalactiae, or Streptococcus pneumoniae or with cefepime and E. coli (0% growth). In some relevant instances (e.g., with vancomycin and methicillin-resistant S. aureus or Streptococcus pneumoniae), BacT/Alert PF Plus bottles were superior to Bactec Peds Plus bottles. Together, these findings underscore the potentiality of resin-containing bottles to enhance diagnosis of bacteremia in pediatric patients on antimicrobial therapy. This is particularly true with one of the evaluated BC systems and with simulated intermediate bacteremia level only.

Effect of Sampling Plans on the Risk of Escherichia coli O157 Illness

2015 ◽  
Vol 78 (7) ◽  
pp. 1370-1374
Author(s):  
ANDREAS KIERMEIER ◽  
JOHN SUMNER ◽  
IAN JENSON
Keyword(s):  
Public Health ◽  
Escherichia Coli ◽  
Sample Size ◽  
Health Effect ◽  
The United States ◽  
Escherichia Coli O157 ◽  
Sampling Protocol ◽  
Sampling Plans ◽  
E Coli ◽  
Sample Amount

Australia exports about 150,000 to 200,000 tons of manufacturing beef to the United States annually. Each lot is tested for Escherichia coli O157 using the N-60 sampling protocol, where 60 small pieces of surface meat from each lot of production are tested. A risk assessment of E. coli O157 illness from the consumption of hamburgers made from Australian manufacturing meat formed the basis to evaluate the effect of sample size and amount on the number of illnesses predicted. The sampling plans evaluated included no sampling (resulting in an estimated 55.2 illnesses per annum), the current N-60 plan (50.2 illnesses), N-90 (49.6 illnesses), N-120 (48.4 illnesses), and a more stringent N-60 sampling plan taking five 25-g samples from each of 12 cartons (47.4 illnesses per annum). While sampling may detect some highly contaminated lots, it does not guarantee that all such lots are removed from commerce. It is concluded that increasing the sample size or sample amount from the current N-60 plan would have a very small public health effect.

Simplified scheme for identification of prompt lactose-fermenting members of the Enterobacteriaceae

1976 ◽  
Vol 4 (6) ◽  
pp. 511-514
Author(s):  
M J Hicks ◽  
K J Ryan
Keyword(s):  
Escherichia Coli ◽  
Ornithine Decarboxylase ◽  
Clinical Microbiology ◽  
Clinical Microbiology Laboratory ◽  
Microbiology Laboratory ◽  
Biochemical Tests ◽  
Gram Negative ◽  
E Coli ◽  
Colonial Morphology ◽  
Level Identification

A brief, simplified scheme involving the spot indole test and colonial morphology was evaluated for genus level identification of prompt lactose-fermenting (PLF) members of the Enterobacteriaceae. One hundred and ninety-four consecutive, clinically important PLF gram-negative rods isolated in a clinical microbiology laboratory were identified by this simplified scheme, as well as by standard biochemical tests, and the API 20E (Analytab Products, Inc., Plainview, N.Y.) system. In the simplified scheme a flat, spot indole-positive colony was identified as Escherichia coli. Spot indole-negative organisms forming nucoid colonies were identified as Klebsiella sp. or Enterobacter sp. on the basis of semisolid motility and ornithine decarboxylase tests. Approximately 94% of the study isolates followed reactions typical for E. coli, Klebsiella sp., and Enterobacter sp. as defined by this simplified scheme. When compared with the standard and Analytab Products Inc. identifications, the overall accuracy was 97.4%. The accuracy of identification of E. coli, Klebsiella sp., and Enterobacter sp. was 98.1%, 95.6%, and 87.5%, respectively. This simplified scheme is recommended for identification of selected PLF isolates in the clinical microbiology laboratory.

Diarrhea Associated With Adherent Enteropathogenic Escherichia coli in an Infant and Toddler Center, Seattle, Washington

PEDIATRICS ◽  
1986 ◽  
Vol 77 (3) ◽  
pp. 296-300
Author(s):  
Leonard J. Paulozzi ◽  
Kathleen E. Johnson ◽  
Lawrence M. Kamahele ◽  
Carla R. Clausen ◽  
Lee W. Riley ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Day Care ◽  
Care Center ◽  
The United States ◽  
Enteropathogenic Escherichia Coli ◽  
Day Care Center ◽  
E Coli ◽  
Published Report ◽  
The Common ◽  
Stool Cultures

During November 1983, the Seattle-King County Department of Public Health investigated an outbreak of diarrhea associated with enteropathogenic Escherichia coli, serogroup 0111:K58, in an infant and toddler day-care center. Of the 25 children in the center, ranging in age from 4 to 30 months (median age 11 months), diarrhea occurred in 14 characterized by watery, greenish stools. The median duration of diarrhea was 12 days. Two of the ill children were hospitalized because of severe dehydration. Stool cultures from the children diagnosed initially did not yield the common bacterial pathogens, parasites, or rotavirus. Stool cultures from 11 of 14 ill children and two of 11 well children (P <.005), however, yielded an E coli serogroup, 0111: K58, which was not invasive or toxigenic by standard tests. The source of the organism was not identified. Although this organism has been recognized as a cause of diarrhea in newborn nurseries, this is the first published report of a documented outbreak of enteropathogenic E coli-induced diarrhea in a day-care center in the United States.

scholarly journals Comparison of the Reveal 20-Hour Method and the BAM Culture Method for the Detection of Escherichia coli O157:H7 in Selected Foods and Environmental Swabs: Collaborative Study

2001 ◽  
Vol 84 (3) ◽  
pp. 737-751 ◽  
Author(s):  
Charles B Bird ◽  
Rebecca J Hoerner ◽  
Lawrence Restaino ◽  
G Anderson ◽  
W Birbari ◽  
...  
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Collaborative Study ◽  
Culture Method ◽  
The United States ◽  
Escherichia Coli O157 ◽  
Private Industry ◽  
E Coli ◽  
Different Levels

Abstract Four different food types along with environmental swabs were analyzed by the Reveal for E. coli O157:H7 test (Reveal) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli O157:H7. Twenty-seven laboratories representing academia and private industry in the United States and Canada participated. Sample types were inoculated with E. coli O157:H7 at 2 different levels. Of the 1095 samples and controls analyzed and confirmed, 459 were positive and 557 were negative by both methods. No statistical differences (p <0.05) were observed between the Reveal and BAM methods.

Fecal Shedding of Escherichia coli O157:H7 in North Dakota Feedlot Cattle in the Fall and Spring

2006 ◽  
Vol 69 (5) ◽  
pp. 1154-1158 ◽  
Author(s):  
MARGARET L. KHAITSA ◽  
MARC L. BAUER ◽  
GREGORY P. LARDY ◽  
DAWN K. DOETKOTT ◽  
REDEMPTA B. KEGODE ◽  
...  
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
North Dakota ◽  
The United States ◽  
Extreme Weather ◽  
Early Spring ◽  
Feedlot Cattle ◽  
Escherichia Coli O157 ◽  
Fecal Shedding ◽  
E Coli

Cattle are an important reservoir of Escherichia coli O157:H7, which can lead to contamination of food and water, and subsequent human disease. E. coli O157:H7 shedding in cattle has been reported as seasonal, with more animals shedding during summer and early fall than during winter. North Dakota has relatively cold weather, especially in winter and early spring, compared with many other regions of the United States. The objective was to assess fecal shedding of E. coli O157: H7 in North Dakota feedlot cattle over the fall, winter, and early spring. One hundred forty-four steers were assigned randomly to 24 pens on arrival at the feedlot. Samples of rectal feces were obtained from each steer four times (October and November 2003, and March and April 2004) during finishing. On arrival (October 2003), 2 (1.4%) of 144 cattle were shedding E. coli O157:H7. The shedding increased significantly to 10 (6.9%) of 144 after 28 days (November 2003), to 76 (53%) of 143 at the third sampling (March 2004), and dropped significantly to 30 (21%) of 143 at the fourth (last) sampling (March 2004) before slaughter. Unfortunately, we were unable to sample the cattle during winter because of the extreme weather conditions. Sampling time significantly (P < 0.0001) influenced variability in E. coli O157:H7 shedding, whereas herd (P = 0.08) did not. The prevalence of E. coli O157:H7 shedding in North Dakota steers in fall and early spring was comparable to what has been reported in other parts of the United States with relatively warmer weather. Further research into E. coli O157:H7 shedding patterns during extreme weather such as North Dakota winters is warranted in order to fully assess the seasonal effect on the risk level of this organism.

scholarly journals Culture of Urine Specimens by Use of chromID CPS Elite Medium Can Expedite Escherichia coli Identification and Reduce Hands-On Time in the Clinical Laboratory

2016 ◽  
Vol 54 (11) ◽  
pp. 2767-2773 ◽  
Author(s):  
Melanie L. Yarbrough ◽  
Meghan A. Wallace ◽  
Cynthia Marshall ◽  
Erin Mathias ◽  
Carey-Ann D. Burnham
Keyword(s):  
Escherichia Coli ◽  
Clinical Laboratory ◽  
Time Interval ◽  
Clinical Microbiology Laboratory ◽  
Biochemical Tests ◽  
Content Type ◽  
E Coli ◽  
Hands On ◽  
Clinically Significant ◽  
Urine Specimens

Urine is one of the most common specimen types submitted to the clinical microbiology laboratory; the use of chromogenic agar is one method by which the laboratory might expedite culture results and reduce hands-on time and materials required for urine culture analysis. The objective of our study was to compare chromID CPS Elite (bioMérieux), a chromogenic medium, to conventional primary culture medium for evaluation of urine specimens. Remnant urine specimens (n= 200) were inoculated into conventional media and into chromID CPS Elite agar (chromID). The time to identification and consumables used were documented for both methods. Clinically significant pathogen(s) were recovered from 51 cultures using conventional media, withEscherichia colibeing the most frequently recovered organism (n= 22). The rate of exact uropathogen agreement between conventional and chromogenic media was 82%, while overall categorical agreement was 83.5% The time interval between plating and final organism identification was decreased with chromID agar versus conventional media forE. coli(mean of 24.4 h versus 27.1 h,P< 0.001). Using chromID, clinically significant cultures required less hands-on time per culture (mean of 1 min and 2 s [1:02 min]) compared to conventional media (mean of 1:31 min). In addition, fewer consumables (2.4 versus 3.3 sticks and swabs) and rapid biochemical tests (1.0 versus 1.9) were necessary using chromID versus conventional media. Notably, antimicrobial susceptibility testing demonstrated good overall agreement (97.4%) between the chromID and conventional media for all antibiotics tested. chromID CPS Elite is accurate for uropathogen identification, reduces consumable usage, and may expedite the identification ofE. coliin clinical specimens.

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