scholarly journals Characterization of a clinical Enterobacter hormaechei strain belonging to epidemic clone ST418 co-carrying blaNDM-1, blaIMP-4 and mcr-9.1

2020 ◽  
Author(s):  
Wei Chen ◽  
Zhiliang Hu ◽  
Shiwei Wang ◽  
Doudou Huang ◽  
Weixiao Wang ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Control Measures ◽  
High Rate ◽  
Clinical Settings ◽  
Evolutionary Trajectory ◽  
Epidemic Clone ◽  
Single Strain ◽  
Disastrous Consequence ◽  
Infection Control Measures ◽  
Enterobacter Hormaechei

AbstractAn Enterobacter hormaechei isolate (ECL-90) simultaneously harboring blaNDM-1, blaIMP-4 and mcr-9.1 was recovered from the secretion specimen of a 24-year-old male patient in a tertiary hospital in China. The whole genome sequencing of this isolate was complete, and 4 circular plasmids with variable sizes were detected. MLST analysis assigned the isolate to ST418, known as a carbapenemase-producing epidemic clone in China. blaIMP-4 and mcr-9.1 genes were co-carried on an IncHI2/2A plasmid (pECL-90-2) and blaNDM-1 was harbored by an IncX3 plasmid (pECL-90-3). The genetic context of mcr-9.1 was identified as a prevalent structure, “rcnR-rcnA-pcoE-pcoS-IS903-mcr-9-wbuC”, which is a relatively unitary model involved in the mobilization of mcr-9. Meanwhile, blaNDM-1 gene was detected within a globally widespread structure known as NDM-GE-U.S (“ISAba125– blaNDM-1–blaMBL”). Our study warrants that the convergence of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, thus representing a potential challenge to clinical treatment and public health.ImportanceCarbapenemase-producing Enterobacteriaceae (CPE) spread at a high rate and colistin is the last-resort therapeutic for the infection caused by CPE. However, the emergence of plasmid-borne mcr genes highly facilitates the wide dissemination of colistin resistance, thus largely threatens the clinical use of colistin. Here, we for the first time characterized a clinical Enterobacter hormaechei strain co-producing blaNDM-1, blaIMP-4 and mcr-9.1 belonging to an epidemic clone (ST418). The accumulation of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, which may cause disastrous consequence with respect to antimicrobial resistance. Understanding how resistance genes were accumulated in a single strain could help us to track the evolutionary trajectory of drug resistance. Our finding highlights the importance of surveillance on the epidemic potential of colistin-resistant CPE, and effective infection control measures to prevent the resistance dissemination.

scholarly journals Characterization of a Clinical Enterobacter hormaechei Strain Belonging to Epidemic Clone ST418 Co-carrying blaNDM-1, blaIMP-4 and mcr-9.1

2020 ◽  
Author(s):  
Wei Chen ◽  
Zhiliang Hu ◽  
Shiwei Wang ◽  
Doudou Huang ◽  
Weixiao Wang ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Clinical Settings ◽  
Whole Genome ◽  
Epidemic Clone ◽  
Mlst Analysis ◽  
Unitary Model ◽  
Enterobacter Hormaechei ◽  
Potential Challenge ◽  
Genetic Context

Abstract An Enterobacter hormaechei isolate (ECL-90) simultaneously harboring blaNDM-1, blaIMP-4 and mcr-9.1 was recovered from the secretion specimen of a 24-year-old male patient in a tertiary hospital in China. The whole genome sequencing of this isolate was complete, and 4 circular plasmids with variable sizes were detected. Multi-locus sequence typing (MLST) analysis assigned the isolate to ST418, known as a carbapenemase-producing epidemic clone in China. blaIMP-4 and mcr-9.1 genes were co-carried on an IncHI2/2A plasmid (pECL-90-2) and blaNDM-1 was harbored by an IncX3 plasmid (pECL-90-3). The genetic context of mcr-9.1 was identified as a prevalent structure, “rcnR-rcnA-pcoE-pcoS-IS903-mcr-9-wbuC”, which is a relatively unitary model involved in the mobilization of mcr-9. Meanwhile, blaNDM-1 gene was detected within a globally widespread structure known as NDM-GE-U.S (“ISAba125–blaNDM-1–blaMBL”). Our study warrants that the convergence of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, thus representing a potential challenge to clinical treatment and public health.

scholarly journals Coronavirus Disease-19 and Dentistry: A Review

2020 ◽  
Vol 8 (T1) ◽  
pp. 618-621
Author(s):  
Fareedi Mukram Ali ◽  
Kishor Patil ◽  
Elnur Ibrahim Albashir ◽  
Abdulhamid Aidarous Alamir
Keyword(s):  
Infection Control ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Control Measures ◽  
Clinical Settings ◽  
Related Information ◽  
Infection Control Measures ◽  
Dental Practitioners ◽  
Clinical Signs And Symptoms ◽  
Novel Coronavirus

Novel coronavirus (nCoV) is a novel form of virus with a new strain identified recently in humans. Common clinical signs and symptoms primarily consist of fever, cough, and breathing difficulties. In severe cases, it can results in pneumonia, severe acute respiratory syndrome, kidney failure, and even death. It is important to follow all infection control measures in prevention of the nCoV from spreading and controlling the epidemic situation. The risk of cross infection can be high between dental practitioners and patients due to the features of dental clinical settings. Here, we are summarizing the nCoV related information and infection control measures to be followed in dental practice.

scholarly journals Vancomycin-resistant enterococci colonization and bacteremia in patients with hematological malignancies

2014 ◽  
Vol 8 (09) ◽  
pp. 1113-1118 ◽  
Author(s):  
Habip Gedik ◽  
Taner Yıldırmak ◽  
Funda Şimşek ◽  
Arzu Kantürk ◽  
Deniz Arıca ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Study Results ◽  
Hematological Cancers ◽  
Training And Research ◽  
The Mean ◽  
Vancomycin Resistant

Introduction: We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. Methodology: All patients in the hematology department of the Ministry of Health Okmeydanı Training and Research Hospital, an 800-bed tertiary hospital in İstanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study. Results: A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 ± 14.4 years (range: 17–82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancer score of patients with hematological malignancies was 17.18 ± 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 ± 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin’s lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia. Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.

scholarly journals Endoscopic intervention in a case proven latterly to be a COVID-19

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Shaimaa Elkholy ◽  
Mohamed-Naguib Wifi ◽  
Karim K. Maurice ◽  
Kerolos Youssif ◽  
Karim Mashhour ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Control Measures ◽  
High Rate ◽  
Stent Insertion ◽  
Main Body ◽  
Infection Control Measures ◽  
Care Workers ◽  
Duodenal Stent ◽  
Risk Of Exposure

Abstract Background COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the newly developed worldwide outbreak of coronavirus disease with a high rate of mortality especially among elderly and multiple co-morbid personnel. Asymptomatic COVID-19-infected patients are a well-known source of transmission of infection. The risk of exposure to respiratory secretions and/or feces is hardly avoidable during the endoscopic procedure; also, the aerosol and droplets take up to an hour disperse, so they remain a risk to staff and other patients after they leave the room; therefore, strict infectious precautions should be taken by all health care workers to limit the virus spread. Main body We present an endoscopic trial of duodenal stent insertion in non-operable gastric carcinoma that is proven 2 days later to be a COVID-19-positive case. Fortunately, no one of the health care workers that came in contact with the case becomes infected owing to the proper infection control measures. Conclusion We recommended that the endoscopy examination and procedures should be strictly limited to urgent cases to minimize the risk of virus infection among health care workers.

scholarly journals Epidemiology and control measures of an OXA-48-producing Enterobacteriaceae hospital-wide oligoclonal outbreak

2018 ◽  
Vol 146 (5) ◽  
pp. 656-662 ◽  
Author(s):  
V. Pérez-Blanco ◽  
L. Redondo-Bravo ◽  
G. Ruíz-Carrascoso ◽  
J. R. Paño-Pardo ◽  
R. Gómez-Gil ◽  
...  
Keyword(s):  
Infection Control ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Clinical Samples ◽  
Significant Drop ◽  
Contact Precautions ◽  
Infection Control Measures ◽  
Electronic Alerts ◽  
Initial Control ◽  
Incident Cases

AbstractThe main objective of our study was to describe the epidemiological and microbiological features of an oligoclonal hospital-wide outbreak caused by OXA-48-producing Enterobacteriaceae (OXA-48-PE). OXA-48 is a carbapenemase belonging to Ambler class D beta-lactamases, identified frequently in the Mediterranean and Southern European countries, and associated with several Enterobacteriaceae species. An outbreak of OXA-48-PE with a complex epidemic pattern was detected in January 2011. Initial control measures included contact precautions and the reinforcement of infection control practices, but despite all efforts made, the epidemiological situation hardly changed and new measures were implemented during 2013. An observational retrospective study was performed to describe the main features of the outbreak and to analyse the cumulative incidence (CI) trends. Eight hundred and 16 patients colonised or infected by OXA-48-PE were identified during the 2-year period (January 2013–December 2014), female 46%, mean age (s.d.), 71.6 (15.2). The samples isolated in the incident cases were rectal swabs (80%), urine samples (10.7%), blood samples (2.8%) and other clinical samples (6.6%). The most frequent OXA-48-PE was Klebsiella pneumoniae. Eleven different clones were identified, but K. pneumoniae sequence types 11 and 405 were predominant: ST11 (64.2%) and ST405 (29.3%). OXA-48-PE CI trend suffered a statistically significant change in August 2013, which continued the following months. Though we could not eradicate the outbreak, we observed a statistically significant drop in CI after an intervention for OXA-48-PE control, based on patient cohort, active surveillance, electronic alerts and reinforcement of infection control measures in a tertiary hospital.

scholarly journals Successful Treatment of Severe Post-craniotomy Meningitis Caused by an Escherichia coli Sequence Type 410 Strain Coharboring blaNDM–5 and blaCTX–M–65

2021 ◽  
Vol 12 ◽  
Author(s):  
Qing Yang ◽  
Piao-piao Zhang ◽  
Yan Jiang ◽  
Xiu-jue Zheng ◽  
Min Zheng ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Successful Treatment ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Multidrug Resistant ◽  
Sequence Type ◽  
Control Measures ◽  
Clinical Settings ◽  
Infection Control Measures ◽  
Carbapenem Resistant

Intracranial infections caused by multidrug-resistant Gram-negative bacterium have led to considerable mortality due to extremely limited treatment options. Herein, we firstly reported a clinical carbapenem-resistant Escherichia coli isolate coharboring blaNDM–5 and blaCTX–M–65 from a patient with post-craniotomy meningitis. The carbapenem-resistant Escherichia coli strain CNEC001 belonging to Sequence Type 410 was only susceptible to amikacin and tigecycline, both of which have poor penetration through the blood-brain barrier (BBB). The blaCTX–M–65 gene was expressed on a 135,794 bp IncY plasmid. The blaNDM–5 gene was located on a genomic island region of an IncX3-type plasmid pNDM5-CNEC001. Based on the characteristics of the strain, we presented the successful treatment protocol of intravenous (IV) tigecycline and amikacin combined with intrathecal (ITH) amikacin in this study. Intracranial infection caused by Escherichia coli coharboring blaNDM–5 and blaCTX–M–65 is rare and fatal. Continuous surveillance and infection control measures for such strain need critical attention in clinical settings.

scholarly journals Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010

2012 ◽  
Vol 17 (7) ◽  
Author(s):  
A Zagorianou ◽  
E Sianou ◽  
E Iosifidis ◽  
V Dimou ◽  
E Protonotariou ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Antibiotic Use ◽  
The United States ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Molecular Characteristics ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Infection Control Measures

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.

scholarly journals Emergence and Clonal Spread of KPC-2 Producing Clinical Klebsiella Aerogenes Isolates From a Teaching Hospital in Tucuman, Argentina.

2020 ◽  
Author(s):  
Juan Martín Vargas ◽  
María Paula Moreno Mochi ◽  
Juan Manuel Nuñez ◽  
Silvana Mochi ◽  
Mariel Cáceres ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Antimicrobial Treatment ◽  
Control Measures ◽  
Molecular Characteristics ◽  
Klebsiella Aerogenes ◽  
Adult Intensive Care Unit ◽  
Infection Control Measures ◽  
Potential Risk Factors ◽  
Clonal Spread ◽  
Healthcare Associated

Abstract IntroductionKlebsiella aerogenes is a nosocomial pathogen associated with drug resistance and healthcare-associated infections. We pursued this study to investigate an outbreak of clinical carbapenem-resistant K. aerogenes(CRKA) in an argentinian tertiary hospital which persisted for 4 months despite aggressive infection control measures. The primary goals aimed to evaluate the molecular characteristics and the clonal relationships among the CRKA isolates.MethodsWe characterized CRKA isolates by multiplex PCR and PFGE. The information was integrated with clinical and epidemiologic data.ResultsThe 14 CRKA strains were disseminated in an adult intensive care unit (50%) and five different wards. In patients who received antimicrobial treatment, 8 staggered to directed treatment, mainly with amikacin(6/8) and/or carbapenemes(5/8). The overall mortality was 42.8%, and the attributed mortality to CRKA infection was 21.4%, strains showed high rates of resistance to most of the antimicrobials without resistance to Amikacin and Tigecycline, and carried the blaKPC-2, blaSHV-2 and blaCTXM-15 genes. The PFGE indicated 2 distinct groups; 12/14 CRKA isolatesassociated with the dominant subgroup A and likely to be primarily responsible for the first isolation and subsequent dissemination in the hospital.ConclusionThe outbreak characteristics data showed prolonged hospitalization and previous use of broad-spectrum antibiotics as potential risk factors for the acquisition of CRKA.

Sign in / Sign up

Export Citation Format

Share Document