scholarly journals Broader Distribution of Plasmid-Mediated Quinolone Resistance in the United States

2005 ◽  
Vol 49 (7) ◽  
pp. 3001-3003 ◽  
Author(s):  
A. Robicsek ◽  
D. F. Sahm ◽  
J. Strahilevitz ◽  
G. A. Jacoby ◽  
D. C. Hooper
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Resistance Gene ◽  
The United States ◽  
Quinolone Resistance ◽  
Low Level ◽  
Level Resistance ◽  
Selection Of

ABSTRACT The plasmid-encoded quinolone resistance gene qnrA confers low-level quinolone resistance, facilitating selection of higher-level resistance. Epidemiologic surveys for qnrA were extended to isolates of Enterobacter spp. and to quinolone-susceptible Enterobacteriaceae. Two (10%) of 20 ceftazidime-resistant quinolone-susceptible Klebsiella pneumoniae strains carried the gene, as did 12 (17%) of 71 ceftazidime-resistant Enterobacter strains from across the United States. One of these Enterobacter isolates was quinolone susceptible. Thus, qnrA is present in quinolone-resistant and quinolone-susceptible Enterobacter and Klebsiella strains in the United States.

scholarly journals Genetic Factors Associated with Elevated Carbapenem Resistance in KPC-Producing Klebsiella pneumoniae

2010 ◽  
Vol 54 (10) ◽  
pp. 4201-4207 ◽  
Author(s):  
Brandon Kitchel ◽  
J. Kamile Rasheed ◽  
Andrea Endimiani ◽  
Andrea M. Hujer ◽  
Karen F. Anderson ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Copy Number ◽  
Gene Copy Number ◽  
Carbapenem Resistance ◽  
The United States ◽  
Gene Copy ◽  
Sequencing Analysis ◽  
Low Level ◽  
High Level

ABSTRACT In the United States, the most prevalent mechanism of carbapenem resistance among Enterobacteriaceae is the production of a Klebsiella pneumoniae carbapenemase (KPC). KPC-producing isolates often exhibit a range of carbapenem MICs. To better understand the factors that contribute to overall carbapenem resistance, we analyzed 27 KPC-producing K. pneumoniae isolates with different levels of carbapenem resistance, 11 with low-level (i.e., meropenem or imipenem MIC ≤ 4 μg/ml), 2 with intermediate-level (i.e., meropenem and imipenem MIC = 8 μg/ml), and 14 with high-level (i.e., imipenem or meropenem MIC ≥ 16 μg/ml) carbapenem resistance, that were received from throughout the United States. Among 14 isolates that exhibited high-level carbapenem resistance, Western blot analysis indicated that 10 produced an elevated amount of KPC. These isolates either contained an increased bla KPC gene copy number (n = 3) or had deletions directly upstream of the bla KPC gene (n = 7). Four additional isolates lacked elevated KPC production but had high-level carbapenem resistance. Porin sequencing analysis identified 22 isolates potentially lacking a functional OmpK35 and three isolates potentially lacking a functional OmpK36. The highest carbapenem MICs were found in two isolates that lacked both functioning porins and produced elevated amounts of KPC. The 11 isolates with low-level carbapenem resistance contained neither an upstream deletion nor increased bla KPC copy number. These results suggest that both bla KPC copy number and deletions in the upstream genetic environment affect the level of KPC production and may contribute to high-level carbapenem resistance in KPC-producing K. pneumoniae, particularly when coupled with OmpK36 porin loss.

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 Presence of Plasmid-Mediated Quinolone Resistance in Klebsiella pneumoniae Isolates Possessing blaKPC in the United States

2008 ◽  
Vol 52 (7) ◽  
pp. 2680-2682 ◽  
Author(s):  
Andrea Endimiani ◽  
Lenore L. Carias ◽  
Andrea M. Hujer ◽  
Christopher R. Bethel ◽  
Kristine M. Hujer ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Resistance Genes ◽  
The United States ◽  
Quinolone Resistance ◽  
Conjugative Plasmid ◽  
Eastern United States

ABSTRACT The presence of plasmid-mediated quinolone resistance genes [i.e., qnrA, qnrB, qnrS, aac(6′)-Ib-cr, and qepA] was evaluated among 42 bla KPC-containing Klebsiella pneumoniae isolates collected in the eastern United States. One isolate carried the bla KPC-3 and qnrB19 genes on the same conjugative plasmid, whereas another carried the bla KPC-3 and qnrA1 genes on separate plasmids.

Researching American Muslims: A Case Study of Surveillance and Racialized State Control

2021 ◽  
pp. 1-16
Author(s):  
Hajer Al-Faham
Keyword(s):  
United States ◽  
Science Research ◽  
The United States ◽  
State Control ◽  
Limited Data ◽  
American Muslims ◽  
State Repression ◽  
Second Stage ◽  
Selection Of

How does surveillance shape political science research in the United States? In comparative and international politics, there is a rich literature concerning the conduct of research amid conditions of conflict and state repression. As this literature locates “the field” in distant contexts “over there,” the United States continues to be saturated with various forms of state control. What this portends for American politics research has thus far been examined by a limited selection of scholars. Expanding on their insights, I situate “the field” in the United States and examine surveillance of American Muslims, an understudied case of racialized state control. Drawing on qualitative data from a case study of sixty-nine interviews with Arab and Black American Muslims, I argue that surveillance operated as a two-stage political mechanism that mapped onto research methodologically and substantively. In the first stage, surveillance reconfigured the researcher-researchee dynamic, hindered recruitment and access, and limited data-collection. In the second stage, surveillance colored the self-perceptions, political attitudes, and civic engagement of respondents, thereby indicating a political socialization unfolding among Muslims. The implications of this study suggest that researchers can mitigate against some, but not all, of the challenges presented by surveillance and concomitant forms of state control.

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 Evaluation of pharmacists’ awareness of illegal online pharmacies and perceived impact on safe access to medicines

2021 ◽  
Vol 5 ◽  
pp. 239920262110056
Author(s):  
John B Hertig ◽  
Shannon M James ◽  
Connor J Hummel ◽  
Matthew J Rubin
Keyword(s):  
United States ◽  
Healthcare Providers ◽  
Access To Medicines ◽  
The United States ◽  
Pharmacy Education ◽  
Electronic Survey ◽  
Medication Therapy ◽  
Online Pharmacies ◽  
Effective Medication ◽  
Selection Of

Background: An estimated 95% of all online pharmacies operate unlawfully. Illegal online pharmacies distribute substandard and falsified medical products that may result in patient harm and suboptimal treatment, leading to an overall mistrust of medications, healthcare providers, and health systems. As medication experts, pharmacists are trusted to guide patients in selection of safe and effective medication therapy. Objective: The objective of this study was to determine gaps in knowledge and recognition of the negative clinical and safety impacts associated with illegal Internet pharmacies by licensed pharmacists. Methods: A 37-question electronic survey was developed and distributed to pharmacists across the United States by email via a database from the American Pharmacists Association. Descriptive statistics was utilized to analyze data. Results: A total of 347 pharmacists from across the United States responded to at least one question in the survey. In all, 58% of pharmacists reported a lack of confidence in their ability to counsel patients on the identification of illegal pharmacy websites. Fewer than 60% of pharmacists were able to accurately identify the legitimacy of a webpage based on visual characteristics. In addition, 75% of pharmacists reported being unfamiliar with resources available to help consumers identify safe and legitimate online pharmacies. Conclusion: Integration of the topic into pharmacy education curricula, training on available resources, and additional research into the prevalence and impact of illegal pharmacy websites are necessary to ensure that pharmacists and other healthcare professionals are adequately prepared to protect their communities from the threat of illegal online pharmacies.

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