Osteomyelitis Due to Multiple Carbapenemase-Producing Gram-Negative Bacteria: The First Case Report of a GES-13-ProducingPseudomonas aeruginosaIsolate in Canada

A case of osteomyelitis in an infant following a burn injury sustained in Pakistan caused by a GES-13-producingPseudomonas aeruginosa(the first reported in Canada) and an OXA-48 producingKlebsiella pneumoniaeis described. The present case serves to highlight the importance of international travel as a risk factor for infection with carbapenemase-producing bacteria and the challenges in the laboratory detection of these organisms.

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National Surveillance of Antimicrobial Susceptibility of Bacteremic Gram-Negative Bacteria with Emphasis on Community-Acquired Resistant Isolates: Report from the 2019 Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART)

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01089-20 ◽

2020 ◽

Vol 64 (10) ◽

Author(s):

Po-Yu Liu ◽

Yu-Lin Lee ◽

Min-Chi Lu ◽

Pei-Lan Shao ◽

Po-Liang Lu ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Gram Negative Bacteria ◽

National Surveillance ◽

Gram Negative ◽

Content Type ◽

E Coli ◽

Carbapenem Resistant

ABSTRACT A multicenter collection of bacteremic isolates of Escherichia coli (n = 423), Klebsiella pneumoniae (n = 372), Pseudomonas aeruginosa (n = 300), and Acinetobacter baumannii complex (n = 199) was analyzed for susceptibility. Xpert Carba-R assay and sequencing for mcr genes were performed for carbapenem- or colistin-resistant isolates. Nineteen (67.8%) carbapenem-resistant K. pneumoniae (n = 28) and one (20%) carbapenem-resistant E. coli (n = 5) isolate harbored blaKPC (n = 17), blaOXA-48 (n = 2), and blaVIM (n = 1) genes.

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Susceptibility of Multiresistant Gram-Negative Bacteria to Fosfomycin and Performance of Different Susceptibility Testing Methods

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02048-13 ◽

2013 ◽

Vol 58 (3) ◽

pp. 1763-1767 ◽

Cited By ~ 31

Author(s):

L. V. Perdigão-Neto ◽

M. S. Oliveira ◽

C. F. Rizek ◽

C. M. D. M. Carrilho ◽

S. F. Costa ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Susceptibility Testing ◽

Gram Negative Bacteria ◽

Testing Methods ◽

Gram Negative ◽

Content Type ◽

Agar Dilution ◽

And Performance ◽

Systemic Infections

ABSTRACTFosfomycin may be a treatment option for multiresistant Gram-negative bacteria. This study compared susceptibility methods using 94 multiresistant clinical isolates. With agar dilution (AD), susceptibilities were 81%, 7%, 96%, and 100% (CLSI) and 0%, 0%, 96%, and 30% (EUCAST), respectively, forAcinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, andEnterobacterspp. Categorical agreement between Etest and AD forEnterobacteriaceaeandA. baumanniiwas ≥80%. Disk diffusion was adequate only forEnterobacter. CLSI criteria for urine may be adequate for systemic infections.

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Prosthetic Joint Infection from Carbapenemase-Resistant Klebsiella pneumoniae Successfully Treated with Ceftazidime-Avibactam

Case Reports in Infectious Diseases ◽

10.1155/2018/1854805 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

A. Schimmenti ◽

E. Brunetti ◽

E. Seminari ◽

B. Mariani ◽

P. Cambieri ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Significant Proportion ◽

Health Concern ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Extended Spectrum Beta Lactamase ◽

First Case ◽

Prosthetic Joint

Antimicrobial resistance in Gram-negative bacteria, particularly Enterobacteriaceae, has become a leading cause of morbidity and mortality and a serious public health concern. Gram-negative bacteria carrying extended-spectrum beta-lactamase (ESBL) enzymes now represent a significant proportion of all bacteria isolated from different countries worldwide. Furthermore, the increasing number of isolates carrying carbapenemases in recent years includes multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria. Here, we describe what, to our knowledge, is the first case of a patient with a prosthetic joint infection from carbapenemase-resistant Klebsiella pneumoniae (CRKP) successfully treated with ceftazidime-avibactam in Italy.

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In VitroActivity of Ceftazidime-Avibactam against 338 Molecularly Characterized Gentamicin-Nonsusceptible Gram-Negative Clinical Isolates Obtained from Patients in Canadian Hospitals

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00364-15 ◽

2015 ◽

Vol 59 (6) ◽

pp. 3623-3626 ◽

Cited By ~ 6

Author(s):

Andrew J. Denisuik ◽

James A. Karlowsky ◽

Tyler Denisuik ◽

Wright W. Nichols ◽

Thomas A. Keating ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

16S Rrna ◽

Klebsiella Pneumoniae ◽

Gram Negative Bacteria ◽

Aminoglycoside Resistance ◽

Single Strain ◽

Gram Negative ◽

Content Type ◽

16S Rrna Methylase

ABSTRACTThe mechanism of aminoglycoside resistance among 338 gentamicin-nonsusceptible Gram-negative bacteria (207Enterobacteriaceaeand 131Pseudomonas aeruginosa) was assessed, and thein vitroactivity of ceftazidime-avibactam against these isolates was determined. Aminoglycoside-modifying enzymes were detected in 91.8% ofEnterobacteriaceaeand 13.7% ofP. aeruginosaisolates. A single strain ofKlebsiella pneumoniaeharbored a 16S rRNA methylase (ArmA). The ceftazidime-avibactam MIC90values were 0.5 μg/ml (MIC, ≤8 μg/ml for 100% of isolates) and 16 μg/ml (MIC, ≤8 μg/ml for 87.8% of isolates) against gentamicin-nonsusceptibleEnterobacteriaceaeandP. aeruginosaisolates, respectively.

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Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital

Russian Journal of Woman and Child Health ◽

10.32364/2618-8430-2020-3-4-295-301 ◽

2020 ◽

Vol 3 (4) ◽

pp. 295-301

Author(s):

L.G. Boronina ◽

◽

E.V. Samatova ◽

S.M. Blinova ◽

M.P. Kukushkina ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Diffusion Method ◽

Gram Negative Bacteria ◽

Pediatric Hospital ◽

Mechanisms Of Resistance ◽

Gram Negative ◽

Carbapenem Resistant ◽

Phenotypic Methods ◽

Carbapenem Resistant Enterobacteriaceae

Aim: to define the incidence of carbapenem-resistant Enterobacteriaceae in the bioassay of hospitalized children. Patients and Methods: From January to December 2019, 940 strains of gram-negative bacteria were isolated from clinical material of 900 patients. Antibiotic susceptibility testing was conducted using the disk diffusion method; SENSITITRE and Phoenix M50 analyzers used «CHROMagarTM KPC» medium. Also, Carbapenem Inactivation Method was used to detect the carbapenemase activity. Results: the species composition of carbapenem-resistant Enterobacteriaceae included: Pseudomonas aeruginosa (n=55), Acinnetobacter baumannii (n=22), Escherichia coli (n=2), Klebsiella pneumoniae (n=40), Klebsiella oxytoca (n=1), Enterobacter cloacae (n=7), Serratia marcescens (n=2), Proteus mirabilis (n=2), Pseudomonas putida (n=1). 12.1% of all Enterobacterales isolates and 29.4% Klebsiella pneumoniae strains were resistant to ertapenem; 17.2% of Enterobacteriaceae and 20% of K. pneumoniae strains were resistant to imipenem and meropenem. 50.9% of Pseudomonas aeruginosa strains were resistant to meropenem and imipenem, and 45% — to doripenem. Acinetobacter baumannii strains resistant to meropenem — 66.6%, imipenem — 63.6%, doripenem — 83.3%. In 30.4% of P. aeruginosa and A. baumannii strains, carbapenemase activity was not detected, which indicated other mechanisms of resistance to carbapenem. Conclusion: in most cases, phenotypic methods only allow to suspect the presence of certain mechanisms of acquired resistance. However, since the main, most common mechanism is the production of hydrolytic enzymes, the identification of mechanisms of resistance to carbapenems should be precisely directed at this. At present, in addition to phenotypic methods, it is optimal to use molecular methods, in particular, realtime PCR, to effectively monitor the distribution of carbapenemase producers. KEYWORDS: Enterobacterales, non-fermenting gram-negative bacteria, carbapenemases, children, infection. FOR CITATION: Boronina L.G., Samatova E.V., Blinova S.M. et al. Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital. Russian Journal of Woman and Child Health. 2020;3(4):295–301. DOI: 10.32364/2618-8430-2020-3-4-295-301.

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Association between fluoroquinolone utilization rates and susceptibilities of gram-negative bacilli: Results from an 8-year intervention by an antibiotic stewardship program in an inner-city United States hospital

Science Progress ◽

10.1177/00368504211011876 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110118

Author(s):

Cosmina Zeana ◽

Frank E. Palmieri ◽

Vikas Gupta ◽

Gang Ye ◽

Peter Lao ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Proteus Mirabilis ◽

Community Hospital ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Stewardship Program ◽

Days Of Therapy ◽

Empiric Antibiotic

This study evaluated an antibiotic stewardship program (ASP) intervention aimed at reducing inpatient fluoroquinolone (FQ) use and examined its impact on ciprofloxacin susceptibilities of gram-negative bacteria in a large 611-bed community hospital. A two-step ASP intervention was implemented: an electronic medical record algorithm that prompted physicians to re-evaluate FQ use shortly after admission and changed institutional UTI/pneumonia guidelines that recommended options alternate to FQs for first-line empiric antibiotic therapy in 2010 and 2011 respectively. Between 2007 and 2017 FQ use and ciprofloxacin susceptibilities of all non-duplicate cultured isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa obtained ≥72 h after admission were reviewed. Ambulatory care isolates served as a comparison group. FQ utilization rates and relationships to ciprofloxacin susceptibility were evaluated using interrupted time series models. Over the 11-year period, FQ use decreased from 110.0 (2007) to 26.2 (2017) days of therapy/1000 days at risk ( p < 0.001). Compared to pre-intervention, the estimated (post-intervention) reduction in FQ utilization was 28.4 (95% CI: 10.9–46) days of therapy/1000 days at risk. Reduced FQ utilization was correlated with increase susceptibilities to ciprofloxacin of hospital onset isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis ( p < 0.02), and Pseudomonas aeruginosa ( p = 0.07). No significant susceptibility change was observed in the ambulatory care isolates. Persuasive interventions by an ASP successfully modified physicians’ inpatient empiric antibiotic use, produced a sustained reduction in FQ utilization rates and increased ciprofloxacin susceptibility to four commonly encountered gram-negative bacteria in a community hospital.

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The Analysis Of Antibiotic Consumption And Bacterial Resistance As An Indicator Of Their Proper Use At The Urology Department In The Health Centre “Studenica” Kraljevo

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2015-0018 ◽

2015 ◽

Vol 16 (2) ◽

pp. 135-141

Author(s):

Andriana Bukonjić ◽

Srđan Stefanović

Keyword(s):

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Bacterial Resistance ◽

Health Centre ◽

Antibiotic Consumption ◽

Resistance Rate ◽

Gram Negative Bacteria ◽

Financial Assets ◽

Bacterial Strains ◽

Gram Negative

Abstract The objective of the study was to analyze antibiotic consumption and determine bacterial resistance rates as an indicator of the rational utilization of this drug group at the urology department in the Health Centre “Studenica” Kraljevo. Over a two-year period, the average antibiotic consumption was 104.55 DDD/100BD. Of the total financial assets used for medical treatment, the antibiotic group JO1 had a share of 49.52% in 2011 and 47.53% in 2012. Antibacterial drugs from a group of β-lactamic antibiotics were consumed most commonly, at 54.02% (2011) and 43.44% (2012). First-generation cephalosporins, quinolones and aminoglycosides were the most frequently used drug groups, while cephalexin was the antibiotic with the highest individual consumption. E. coli was the most frequently isolated bacterium in 2011, while in 2012, Klebsiella pneumoniae was the most frequently isolated bacterium. The total bacterial resistance both in 2011 and 2012 was above 50%. Gram-negative bacteria showed a higher resistance rate (2011, 59.3%; 2012, 58.9%) than Gram-positive bacteria (2011, 44.4%; 2012, 40.6%). Klebsiella pneumoniae was the bacterium with the highest resistance (75.3%) in 2011, while in 2012, there was a resistance increase in Pseudomonas aeruginosa (71.4%), especially to carbapenems. A correlation was determined between the consumption of individual antibiotics and bacterial strain resistance in 2011 (r=0.433, p=0.044) and in 2012 (r=0.478, p=0.024). The high resistance rate shown in the bacterial strains, which was correlated with antibiotic consumption, as well as the great financial assets used for this group of drugs suggest the necessity for the rationalization of their utilization. Empirical therapy with Gram-negative bacteria should be based on carbapenems utilization, except with Pseudomonas aeruginosa, where piperacillin/tazobactam should be used.

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Extended-Spectrum β-Lactamases in the 21st Century: Characterization, Epidemiology, and Detection of This Important Resistance Threat

Clinical Microbiology Reviews ◽

10.1128/cmr.14.4.933-951.2001 ◽

2001 ◽

Vol 14 (4) ◽

pp. 933-951 ◽

Cited By ~ 1304

Author(s):

Patricia A. Bradford

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

21St Century ◽

Broad Spectrum ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Significant Percentage ◽

Extended Spectrum ◽

The World

SUMMARY β-Lactamases continue to be the leading cause of resistance to β-lactam antibiotics among gram-negative bacteria. In recent years there has been an increased incidence and prevalence of extended-spectrum β-lactamases (ESBLs), enzymes that hydrolyze and cause resistance to oxyimino-cephalosporins and aztreonam. The majority of ESBLs are derived from the widespread broad-spectrum β-lactamases TEM-1 and SHV-1. There are also new families of ESBLs, including the CTX-M and OXA-type enzymes as well as novel, unrelated β-lactamases. Several different methods for the detection of ESBLs in clinical isolates have been suggested. While each of the tests has merit, none of the tests is able to detect all of the ESBLs encountered. ESBLs have become widespread throughout the world and are now found in a significant percentage of Escherichia coli and Klebsiella pneumoniae strains in certain countries. They have also been found in other Enterobacteriaceae strains and Pseudomonas aeruginosa. Strains expressing these β-lactamases will present a host of therapeutic challenges as we head into the 21st century.

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Lower Respiratory Tract Pathogens and Their Antimicrobial Susceptibility Pattern: A 5-Year Study

Antibiotics ◽

10.3390/antibiotics10070851 ◽

2021 ◽

Vol 10 (7) ◽

pp. 851

Author(s):

Biagio Santella ◽

Enrica Serretiello ◽

Anna De Filippis ◽

Folliero Veronica ◽

Domenico Iervolino ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Respiratory Tract ◽

Antimicrobial Susceptibility ◽

Lower Respiratory Tract ◽

Susceptibility Testing ◽

Gram Negative Bacteria ◽

Susceptibility Pattern ◽

Gram Negative

Lower respiratory tract infections (LRTIs) are the most common infections in humans. It is estimated that 2.74 million deaths worldwide occur each year due to LRTIs. The aim of the study was to determine the frequency and antibiotic susceptibility pattern of microorganisms isolated from respiratory samples of patients with LRTIs. Between January 2015 and December 2019, a total of 7038 sputum and bronchoaspirate samples from suspected LRTI patients were collected. Among them, 2753 samples (39.1%) showed significant microbial growth on culture media. The LRTI rate was higher in patients with male gender (67.1%) and with age between 40–59 years (48.6%). The microorganism identification and antibiotic susceptibility testing were performed with Vitek 2. Out of 4278 isolates species, 3102 (72.5%) were Gram-negative bacteria, 1048 (24.5%) were Gram-positive bacteria, and 128 (3.0%) were Candida spp. Major microorganisms isolated were Acinetobacter baumannii (18.6%), Staphylococcus aureus (15.2%), Pseudomonas aeruginosa (14.2%), and Klebsiella pneumoniae (10.9%). In antimicrobial susceptibility testing, Staphylococcus aureus isolates were mostly resistant to Penicillin G (84.1%) and Oxacillin (48.1%), whereas they demonstrated maximum sensitivity to Tigecycline (100%) and Linezolid (99.5%). Among Gram-negative isolates, Acinetobacter baumannii showed maximum sensitivity to Colistin but was resistant to other antibiotics (95–99%). Klebsiella pneumoniae isolates were mostly resistant to Cefotaxime (72.7%) and sensitive to Gentamicin (54.3%), and Pseudomonas aeruginosa was resistant to Ciprofloxacin (40.3%) and sensitive to Amikacin (85.9%). Gram-negative bacteria represented the species most commonly isolated. A high rate of antimicrobial resistance was observed in this study. In conclusion, the correct identification of causative microorganisms and their susceptibility patterns to antibiotics is crucial for choosing targeted and effective antibiotic therapy in LRTIs, and to prevent the emergence of multidrug-resistant bacteria.

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Performance of the eazyplex® BloodScreen GN as a simple and rapid molecular test for identification of Gram-negative bacteria from positive blood cultures

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-021-04383-3 ◽

2021 ◽

Author(s):

Katharina Bach ◽

Birgit Edel ◽

Steffen Höring ◽

Lucie Bartoničkova ◽

Stefan Glöckner ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Blood Culture ◽

Klebsiella Pneumoniae ◽

Klebsiella Oxytoca ◽

Blood Cultures ◽

Gram Negative Bacteria ◽

Molecular Test ◽

Molecular Assay ◽

Gram Negative

AbstractThe LAMP-based eazyplex® BloodScreen GN was evaluated for the detection of frequent Gram-negatives directly from positive blood culture (BC) bottles. A total of 449 BCs were analyzed. Sensitivities and specificities were 100% and 100% for Escherichia coli, 95.7% and 100% for Klebsiella pneumoniae, 100% and 100% for blaCTX-M, 100% and 100% for Klebsiella oxytoca, 100% and 99% for Proteus mirabilis, and 100% and 99.8% for Pseudomonas aeruginosa, respectively. The time to result ranged from 8 to 16 min, plus about 6 min for sample preparation. The eazyplex® BloodScreen GN is a reliable molecular assay for rapid BC testing.

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