Colistin Resistance in KPC-2- and SHV-5-Producing Klebsiella pneumoniae Clinical Isolates in Bulgaria

Chemotherapy ◽  
2017 ◽  
Vol 62 (6) ◽  
pp. 339-342 ◽  
Author(s):  
Encho Savov ◽  
Iva Todorova ◽  
Lida Politi ◽  
Angelina Trifonova ◽  
Maja Borisova ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Colistin Resistance ◽  
Klebsiella Species ◽  
Microbial Identification ◽  
Clonal Type ◽  
Intrinsic Mechanism ◽  
Vitek 2

Background/Aims: Colistin resistance is increasingly recognized among carbapenemase-producing Klebsiella pneumoniae isolates in several European regions. The current study documents the appearance of colistin resistance among KPC-2 and SHV-5-produning K. pneumoniae strains in Bulgaria. Methods: Four colistin-resistant K. pneumoniae isolates were recovered from 2 patients hospitalized in the anesthesiology and resuscitation clinic of a tertiary care university hospital in Sofia, Bulgaria. Microbial identification and antimicrobial susceptibility testing was performed by Vitek 2 (Biomerieux, France). β-Lactamase genes were amplified using a panel of primers for detection of all MBL-types, KPCs, plasmid-mediated AmpCs in single PCR reactions, OXA-type carbapenemases, extended-spectrum β-lactamases (ESBLs) and TEM enzymes. The colistin-resistant mcr-1 gene was also investigated using previously described primers and conditions. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used to investigate clonality. Results: The 4 K. pneumoniae isolates exhibited colistin MICs >16 mg/L and showed multidrug-resistant phenotypes, remaining intermediately susceptible only to gentamicin. They were clustered into a single PFGE clonal type and MLST assigned them to sequence type 258. All isolates possessed KPC-2 carbapenemase and SHV-5 ESBL. They were negative for the plasmid-mediated colistin-resistant mcr-1 gene, possibly implying an intrinsic mechanism of resistance. Conclusions: Although colistin use in Bulgaria only started moderately during 2014, the findings of the current study notify the appearance of colistin resistance among carbapenemase-producing Klebsiella species in another European region.

Detection of colistin resistance among multidrug-resistant Klebsiella pneumoniae and Escherichia coli clinical isolates in Turkey

2021 ◽  
Author(s):  
Nilgün Kansak ◽  
Sebahat Aksaray ◽  
Müge Aslan ◽  
Rıza Adaleti ◽  
Nevriye Gönüllü
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Pcr Amplification ◽  
Reference Method ◽  
High Sensitivity ◽  
Multidrug Resistant ◽  
Automated System ◽  
Colistin Resistance ◽  
E Coli ◽  
Vitek 2

AbstractIn this study investigation of plasmid-mediated mcr 1-5 resistance genes was performed among multidrug-resistant (MDR) colistin sensitive and resistant Klebsiella pneumoniae and Escherichia coli strains isolated in our laboratory. We aimed to evaluate automated system (Vitek-2), broth microdilution (BMD) reference method and chromogenic media performance. Totally 94 MDR K. pneumoniae and six E. coli isolates were included in the study. CHROMID® Colistin R agar (COLR) (bioMerieux, France) was used to determine the colistin resistance by chromogenic method. Standard PCR amplification was performed using specific primers to screen the plasmid-mediated mcr 1-5 genes. Sixty-one isolates were resistant to colistin and 39 were susceptible with reference BMD. The essential and categorical agreement of Vitek-2 was determined as 100 and 99%. The sensitivity of COLR medium was 100%, the specificity was 97.5%. In our study mcr-1 was detected in eight isolates, while other mcr genes were not detected. Due to the high sensitivity and specificity of the COLR medium, it can be used in routine diagnostics for the detection of colistin resistance. In our study we detected 8% prevalence of mcr-1 among MDR strains however, two mcr-1 positive isolates were found sensitive to colistin by BMD.

scholarly journals Implementation of an automated cluster alert system into the routine work of infection control and hospital epidemiology: experiences from a tertiary care university hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seven Johannes Sam Aghdassi ◽  
Britta Kohlmorgen ◽  
Christin Schröder ◽  
Luis Alberto Peña Diaz ◽  
Norbert Thoma ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Median Number ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Alert System ◽  
Related Data ◽  
Healthcare Settings ◽  
Care Systems ◽  
One Year

Abstract Background Early detection of clusters of pathogens is crucial for infection prevention and control (IPC) in hospitals. Conventional manual cluster detection is usually restricted to certain areas of the hospital and multidrug resistant organisms. Automation can increase the comprehensiveness of cluster surveillance without depleting human resources. We aimed to describe the application of an automated cluster alert system (CLAR) in the routine IPC work in a hospital. Additionally, we aimed to provide information on the clusters detected and their properties. Methods CLAR was continuously utilized during the year 2019 at Charité university hospital. CLAR analyzed microbiological and patient-related data to calculate a pathogen-baseline for every ward. Daily, this baseline was compared to data of the previous 14 days. If the baseline was exceeded, a cluster alert was generated and sent to the IPC team. From July 2019 onwards, alerts were systematically categorized as relevant or non-relevant at the discretion of the IPC physician in charge. Results In one year, CLAR detected 1,714 clusters. The median number of isolates per cluster was two. The most common cluster pathogens were Enterococcus faecium (n = 326, 19 %), Escherichia coli (n = 274, 16 %) and Enterococcus faecalis (n = 250, 15 %). The majority of clusters (n = 1,360, 79 %) comprised of susceptible organisms. For 906 alerts relevance assessment was performed, with 317 (35 %) alerts being classified as relevant. Conclusions CLAR demonstrated the capability of detecting small clusters and clusters of susceptible organisms. Future improvements must aim to reduce the number of non-relevant alerts without impeding detection of relevant clusters. Digital solutions to IPC represent a considerable potential for improved patient care. Systems such as CLAR could be adapted to other hospitals and healthcare settings, and thereby serve as a means to fulfill these potentials.

scholarly journals Prevalence of SUL(1,2), GYR(A, B) and OXA genes among multidrug resistance Klebsiella pneumoniae isolates recovered from women suffering urinary tract infection

2020 ◽  
Vol 11 (2) ◽  
pp. 2424-2432
Author(s):  
Nabil Salim Saaid Tuwaij ◽  
Huda Jameel Baker Al-khilkhali ◽  
Haneen Mohamed Mohsen
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Vitek 2 ◽  
Resistant Microorganism ◽  
Urine Specimens

Klebsiella pneumoniae is a significant concern multidrug-resistant microorganism and a one common gram negative bacteria associated with infections of women urinary tract. Therefore, this work aimed to the molecular screening of Sul(1and 2), Gyr(A and B) and OXA genes among K. pneumoniae isolates in Najaf City, Iraq. Out of 250 urine specimens were collected from women showing symptoms of urinary tract infection during five months January to of May 2019, bacterial growth was157 isolates, included 133 gram negative compared with  24 gram positive bacteria while 98 specimens were no growth. According to the Vitek-2 system, 30 K. pneumoniae isolates were obtained.Data on current work revealed that the 26-35 age group was the highest 14 K. pneumoniae isolates. Results of antimicrobial susceptible recorded all isolates were multi-drug resistant (MDR) and they have a different range of resistance. However, all 30 isolates(100%) resistant to ampicillin drugs, while the lowest rate was 1(3.33%) forImipenemdrug. PCR assay revealed exist of oxa, sul-1, sul-2, gyr-A and gyr-B genes among K. pneumoniae isolates with rates 20(66.66%), 11(36.66%), 22(73.33%), 3(10%) and 17(56.66%) respectively.

scholarly journals Prevalence and clonal relatedness of NDM and OXA-48-producing Klebsiella pneumoniae in a tertiary care hospital in South India

2019 ◽  
Vol 11 (04) ◽  
pp. 312-316
Author(s):  
Poothakuzhiyil Remya ◽  
Mariappan Shanthi ◽  
Uma Sekar
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Genomic Diversity ◽  
Major Type ◽  
Care Hospital ◽  
Clonal Relatedness ◽  
Genes Encoding ◽  
Clinically Significant ◽  
Pfge Profiles

Abstract BACKGROUND: Carbapenems are used for the treatment of serious infections caused by multidrug-resistant Klebsiella pneumoniae. Resistance to carbapenems in K. pneumoniae is mainly due to metallo-beta-lactamases (NDM, IMP, and VIM) and class D oxacillinase (OXA-48-like). AIM AND OBJECTIVE: This study was undertaken to detect the genes encoding for carbapenemase in K. pneumoniae and to determine the clonal relatedness of selected isolates of K. pneumoniae producing NDM and OXA-48 by pulsed-field gel electrophoresis method (PFGE). MATERIALS AND METHODS: The isolates were collected over a period of 1 year. A total of 370 clinically significant, nonduplicate isolates of K. pneumoniae were included in this study. Phenotypic tests for the detection of carbapenemases were performed for all the isolates. Polymerase chain reaction (PCR) was carried out for the detection of carbapenemase genes such as blaKPC, blaIMP, blaVIM,blaNDM, and blaOXA-48. PFGE was performed, and the PFGE profiles were analyzed and compared using BioNumerics version 7.6. RESULTS: Of the 370 isolates of K. pneumoniae, carbapenemase genes were detected in 13.78% (51/370). blaOXA-48was the prevalent gene detected followed by blaNDMand blaKPC. Thirty strains of K. pneumoniae selected by PFGE analysis were divided into five clusters (A, B, C, D, and E). Cluster C was the major type detected carrying blaNDMand blaOXA-48genes.CONCLUSION:blaOXA-48was the most prevalent gene detected in this study. PCR is useful in detecting carbapenemase genes, especially blaNDM, which may show false susceptibility to carbapenems. There was no direct correlation detected between PFGE profiles and antibiotic susceptibility pattern. PFGE has revealed the genomic diversity among isolates, thereby suggesting heterogeneity in strain circulation within intensive care unit and wards of the hospital. Monitoring and molecular typing is essential to curtail the spread of multidrug-resistant strains and control the outbreaks of infection.

scholarly journals Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use

2015 ◽  
Vol 9 (03) ◽  
pp. 309-312 ◽  
Author(s):  
Aysegul Ulu-Kilic ◽  
Emine Alp ◽  
Dilek Altun ◽  
Fatma Cevahir ◽  
Gamze Kalın ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Care Facility ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Icu Patients ◽  
Thoracic Drainage ◽  
Tertiary Care Facility

Introduction: The widespread use of tigecycline raises the question of increasing infection rates of Pseudomonas aeruginosa (PA) in ICUs which are not affected by this antibiotic. Objective:  The aim of this study was to determine if treatment with tigecycline is a risk factor for PA infection in ICU patients. Methodology: A retrospective and observational study was conducted at Erciyes University Hospital, Turkey, between 2008 and 2010. The Erciyes University Hospital is a 1300-bed tertiary care facility. The patients included in this study were hospitalized in four adult ICUs. Patients with PA infections (case group) were compared with patients with nosocomial infection other than PA (control group). Results: A total of 1,167 patients with any nosocomial infections were included in the study. Two hundred and seventy eight (23.8%) of the patients had PA infection during their ICU stay. Fifty nine patients (21.2%) in the case group received tigecycline before developing PA infections, which were found to be significantly more frequent than in the controls (p < 0.01). Multivariate analysis showed that risk factors for PA infection were previous tigecycline use (4 times), external ventricular shunt (4.2 times), thoracic drainage catheter (2.5 times) and tracheostomy (1.6 times). Conclusion: Our results contribute to the need for new studies to determine the safety of tigecycline use, especially for the treatment of critically ill patients. Since tigecycline seems to be an alternative for the treatment of multidrug resistant (MDR) microorganisms, rational use of this antibiotic in ICU patients is essential.

scholarly journals Screening for Multidrug-Resistant Organisms in a Tertiary-Care University Hospital in the North West Bank: A Descriptive Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s382-s383
Author(s):  
Souad Belkebir ◽  
Alaa Kanaan ◽  
Rawan Jeetawi
Keyword(s):  
Bacterial Colonization ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Diffusion Method ◽  
Infection Prevention And Control ◽  
Isolation And Identification ◽  
Active Screening ◽  
Multidrug Resistant Organisms ◽  
Positive Results

Background: The prevalence of multidrug-resistant organisms (MDROs) in acute healthcare settings is increasing worldwide. Active screening for MDROs carriers on admission permits the prompt implementation of the appropriate precautions to decrease the probability of cross transmission to other inpatients. Objective: To report the spectrum of bacterial nasal, axilla, and perianal colonization among in patients at Najah National University Hospital (NNUH) during 2018. Methods: A retrospective observational study was performed at NNUH, a tertiary-care referral university hospital in Nablus, north of Palestine, that includes medical and surgical ICUs for both adults and children from January to August 2018. Nasal, axilla, and perianal swabs were collected within the first 24 hours of admission according to hospital policy. Patients who were referred from another hospital, who were admitted to a hospital for at least 2 nights during the previous 8 months, and who are known to have an MDROs in the past were included. Swab samples were processed for isolation and identification of these multidrug-resistant strains. Transmission-based precautions were implemented if positive results were reported (ie, contact isolation) and decolonization regimens were applied according to the CDC recommendations (muporocin ointment for nasal MRSA, daily bathing with chlorhexidine 2% soap for the rest). A daily isolation list was circulated among bed managers and senior nurses and head of departments for appropriate management of beds and reallocation of patients. The antibiotic susceptibility pattern was assessed using the disc-diffusion method on Mueller–Hinton agar and a Vitek-2 system. Results: During the period of the study, 1,425 nasal swabs, 1,245 axilla swabs, and 300 perianal swabs were collected according to the inclusion criteria. Positive results were reportedin 7%, 4%, and 44% for nasal, axilla, and perianal specimens, respectively. Regarding the distribution of bacterial colonization in the nasal swab, 73% were MRSA; for the axial, 29% were Pseudomonas; and from the perianal swab, the most prevalent pathogen was ESBL (56%) (Figs. 1–3). A discrepancy between the number of nasal or axilla and perianal swabs was observed, which was mainly due to the refusal of many patients to have the sample collected by the nurse. Conclusions: Colonization of the skin and mucous membranes of inpatients with MDROs is considered a risk factor for developing future infections. Therefore, active screening for those pathogens is critical for infection prevention and control programs and patient safety in acute-care settings.Funding: NoneDisclosures: None

scholarly journals Comparison of Automated and Manual Methods for Antimicrobial Susceptibility Testing

2020 ◽  
pp. 43-48
Author(s):  
Asifa Bhat ◽  
Dekyong Angmo ◽  
Shaista Nazir
Keyword(s):  
Klebsiella Pneumoniae ◽  
Antimicrobial Susceptibility ◽  
Error Rate ◽  
Antimicrobial Agents ◽  
Reference Method ◽  
Multidrug Resistant ◽  
Dilution Method ◽  
Automated Method ◽  
Broth Microdilution Method ◽  
Vitek 2

Background: Carbapenems are considered the broadest-spectrum β-lactam agents and are often required for treatment of severe hospital-acquired infections caused by multidrug-resistant Gram-negative organisms. Minimum inhibitory concentrations (MICs) are important in diagnostic laboratories to confirm resistance of microorganisms to an antimicrobial agent and also to monitor the activity of new antimicrobial agents. Aims and Objectives: To compare the MIC obtained by Broth Microdilution method (BMD) with that of Vitek-2(automated method) for recovered isolates of Klebsiella pneumoniae. Materials and Methods: Prospective study conducted over a period of one year. It included all isolates of Klebsiella pneumoniae recovered from blood culture of the patients. The identification and antimicrobial susceptibility was done on Vitek-2.These Isolates were subjected to Microbroth dilution method for MIC determination. Results: Out of the 55 meropenem resistant  isolates by vitek-2, 20(36.3%) had MIC of ≥256 µg/ml followed by 18(32.7%) isolates with a MIC of 128 µg/ml, followed by 11(20%) isolates with MIC of 64 µg/ml and 6(10.9%) isolates with MIC of 32 µg/ml. Also among 15 meropenem sensitive isolates by Vitek-2, 13(86.7%) had MIC of ≤0.5 µg/ml, followed by two (13.3%) isolates with MIC of 2 µg/ml. Results obtained by vitek 2 were compared with those from BMD(the reference method), which showed a 13.3% minor error rate and no major or very major error rate. Conclusion: Overall, the Vitek 2 performance was comparable to that of BMD for testing a limited number of Klebsiella pneumoniae isolates.

Sign in / Sign up

Export Citation Format

Share Document