scholarly journals Novel quinolone resistance determinant, qepA8, in Shigella flexneri isolated in the United States, 2016

2019 ◽  
Author(s):  
Hattie E. Webb ◽  
Kaitlin A. Tagg ◽  
Jessica C. Chen ◽  
Justin Kim ◽  
Rebecca Lindsey ◽  
...  
Keyword(s):  
United States ◽  
East Asia ◽  
Shigella Flexneri ◽  
The United States ◽  
Quinolone Resistance ◽  
Resistance Determinant ◽  
E Coli ◽  
Clinical Resistance ◽  
Base Insertion

AbstractA qepA8+ Shigella flexneri was cultured from the stool of a traveler returning from India and East Asia. This chromosomally encoded qepA variant, has a six-base insertion, and may have been mobilized as part of a complex IS1-mediated composite transposon including catA1, aadA1, and blaOXA-1. In laboratory E. coli, qepA8 alone only conferred decreased ciprofloxacin susceptibility; however, it may work in combination with additional mechanisms to confer clinical resistance.

scholarly journals Novel Quinolone Resistance Determinant, qepA8, in Shigella flexneri Isolated in the United States in 2016

2019 ◽  
Vol 63 (12) ◽  
Author(s):  
Hattie E. Webb ◽  
Kaitlin A. Tagg ◽  
Jessica C. Chen ◽  
Justin Kim ◽  
Rebecca Lindsey ◽  
...  
Keyword(s):  
United States ◽  
Shigella Flexneri ◽  
The United States ◽  
Quinolone Resistance ◽  
Resistance Determinant

scholarly journals Emerging Plasmid-Mediated Quinolone Resistance Associated with the qnr Gene in Klebsiella pneumoniae Clinical Isolates in the United States

2004 ◽  
Vol 48 (4) ◽  
pp. 1295-1299 ◽  
Author(s):  
Minggui Wang ◽  
Daniel F. Sahm ◽  
George A. Jacoby ◽  
David C. Hooper
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Plasmid Dna ◽  
Southern Hybridization ◽  
The United States ◽  
Quinolone Resistance ◽  
Clinical Isolates ◽  
E Coli ◽  
Agarose Gels

ABSTRACT Although quinolone resistance commonly results from chromosomal mutation, recent studies indicate that such resistance can also be transferred on plasmids carrying the gene responsible, qnr. One hundred ten ciprofloxacin-resistant clinical isolates of Klebsiella pneumoniae and Escherichia coli from the United States were screened for the qnr gene by PCR and Southern hybridization of plasmid DNA. Conjugation experiments were done with azide-resistant E. coli J53 as the recipient and selection with azide and sulfonamide, a resistance frequently linked to qnr. EcoRI and BamHI digests of qnr-hybridizing plasmids were subjected to electrophoresis on agarose gels and probed with qnr by Southern hybridization. qnr was detected in 8 (11.1%) of 72 K. pneumoniae strains. These eight positive strains were from six states in the United States. qnr was not found in any of the 38 E. coli strains tested. Quinolone resistance was transferred from seven of the eight probe-positive strains. Transconjugants with qnr-hybridizing plasmids had 32-fold increases in ciprofloxacin MICs relative to E. coli J53. For all eight strains, the sequence of qnr was identical to that originally reported. By size and restriction digests, four plasmids were related to the first-reported plasmid, pMG252, and three were different. Five new qnr plasmids encoded FOX-5 β-lactamase, as did pMG252, but two others produced SHV-7 extended-spectrum β-lactamase. Transferable plasmid-mediated quinolone resistance associated with qnr is now widely distributed in quinolone-resistant clinical strains of K. pneumoniae in the United States. Plasmid-determined quinolone resistance contributes to the increasing quinolone resistance of K. pneumoniae isolates and to the linkage previously observed between resistance to quinolones and the latest β-lactam antibiotics.

scholarly journals 1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Kendra Foster ◽  
Linnea A Polgreen ◽  
Brett Faine ◽  
Philip M Polgreen
Keyword(s):  
United States ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Proteus Mirabilis ◽  
Antibiotic Use ◽  
The United States ◽  
Drug Resistant ◽  
E Coli ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

scholarly journals Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s62-s62
Author(s):  
Timileyin Adediran ◽  
Anthony Harris ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
Loren Miller ◽  
...  
Keyword(s):  
United States ◽  
Secondary Analysis ◽  
Positive Culture ◽  
The United States ◽  
Healthcare Personnel ◽  
Surveillance Culture ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Multicenter Prospective Cohort Study ◽  
Epidemiological Significance

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.Funding: NoneDisclosures: None

The United States, China, and the Politics of Hegemonic Ordering in East Asia

2021 ◽  
Author(s):  
Beverley Loke
Keyword(s):  
United States ◽  
East Asia ◽  
The United States ◽  
English School ◽  
Post Cold War ◽  
Regional Dynamics ◽  
Regional Order ◽  
Us Hegemony ◽  
Power Position ◽  
Hybrid Forms

Abstract China's rise has raised important questions about the durability of US hegemony in East Asia. Much of the debate, however, has generally been cast in fairly simplistic terms, suggesting the durability or end of US regional hegemony. Such framings nevertheless fail to fully capture regional dynamics and complexity. Advancing an English School conception of hegemony, this paper examines the politics, contestation, and renegotiation of the post–Cold War US hegemonic order in East Asia. It maps out four logics of hegemonic ordering in the existing literature, outlines their shortfalls and advances a twofold argument. First, although regional order will not disintegrate into binary “order versus disorder” or “US versus Chinese hegemony” scenarios, the politics of hegemonic ordering—the interactive discourses, processes, relations, and practices that underpin hegemony—will intensify as the United States and China continue to both cooperate and compete for power, position, and influence in East Asia. Second, I argue that the East Asian regional order will evolve in ways that resemble hybrid forms of hegemony in a complex hierarchy. Specifically, I develop a new logic—“coalitional and collaborative hegemonies in a complex hierarchy”—that is anchored in assertiveness, fluidity, and compartmentalization. It demonstrates that Washington and Beijing will not only form coalitional hegemonies, seeking legitimation from multiple and often overlapping constituencies, but also engage in a collaborative hegemony on shared interests. This better reflects evolving regional dynamics and yields theoretical insights into examining hegemonic transitions less as clearly delineated transitions from one distinct hegemonic order to the next, and more as partial and hybrid ones.

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