scholarly journals Predominance of multi-resistant gram-negative bacteria colonizing chronic lower limb ulcers (CLLUs) at Bugando Medical Center

2014 ◽  
Vol 7 (1) ◽  
pp. 211 ◽  
Author(s):  
Nyambura Moremi ◽  
Martha F Mushi ◽  
Mbunda Fidelis ◽  
Phillipo Chalya ◽  
Mariam Mirambo ◽  
...  
Keyword(s):  
Lower Limb ◽  
Medical Center ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Bugando Medical ◽  
Chronic Lower Limb Ulcers

Pseudo-Outbreak ofMycobacterium chelonaeandMethtlobactertum mesophilicumCaused by Contamination of an Automated Endoscopy Washer

2001 ◽  
Vol 22 (7) ◽  
pp. 414-418 ◽  
Author(s):  
Amy Beth Kressel ◽  
Francine Kidd
Keyword(s):  
Dna Fingerprinting ◽  
Medical Center ◽  
Academic Medical Center ◽  
Gram Negative Bacteria ◽  
Source Water ◽  
Mycobacterium Chelonae ◽  
Gram Negative ◽  
Academic Medical ◽  
Control Department ◽  
Cleaning Cycle

AbstractObjective:To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified asMycobacterium chelonae,and pink bacteria, later identified asMethylo-bacterium mesophilicum,from fungal cultures obtained by bronchoscopy.Design:Outbreak investigation.Setting:An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.Patients:Patients undergoing bronchoscopy July 21 to October 2, 1998.Methods:The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sentM chelonaeisolates for DNA fingerprinting.Results:M chelonae, M mesophilicum,gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of theM chelonaerevealed that they were clonally related.Conclusions:The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

Emergence of Multidrug Resistance in Bacteria and Impact on Antibiotic Expenditure at a Major Army Medical Center Caring for Soldiers Wounded in Iraq and Afghanistan

2008 ◽  
Vol 29 (7) ◽  
pp. 661-663 ◽  
Author(s):  
Michael J. Zapor ◽  
Daniel Erwin ◽  
Goldina Erowele ◽  
Glenn Wortmann
Keyword(s):  
Medical Center ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Walter Reed Army Medical ◽  
Gram Negative Bacteria ◽  
Drug Resistant ◽  
Gram Negative ◽  
Army Medical ◽  
Resistant Strains ◽  
Drug Resistant Strains

Since the invasions of Iraq and Afghanistan, the epidemiologic traits of clinical isolates at Walter Reed Army Medical Center have shifted toward drug-resistant strains of microorganisms, particularly among the gram-negative bacteria. Moreover, antibiotic prescribing patterns during this period have changed remarkably and mirror the emergence of these organisms at our institution.

scholarly journals Genetic Analysis of mcr-1-Carrying Plasmids From Gram-Negative Bacteria in a Dutch Tertiary Care Hospital: Evidence for Intrapatient and Interspecies Transmission Events

2021 ◽  
Vol 12 ◽  
Author(s):  
Nikolaos Strepis ◽  
Anne F. Voor in ’t holt ◽  
Margreet C. Vos ◽  
Willemien H. A. Zandijk ◽  
Astrid P. Heikema ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Interspecies Transmission ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Genetic Composition ◽  
Gram Negative ◽  
Infection Control Measures ◽  
Depth Analysis

The role of plasmids in the complex pandemic of antimicrobial resistance is increasingly being recognized. In this respect, multiple mobile colistin resistance (mcr) gene-carrying plasmids have been described. However, the characteristics and epidemiology of these plasmids within local healthcare settings are largely unknown. We retrospectively characterized the genetic composition and epidemiology of plasmids from mcr-1-positive bacterial isolates identified from patients from a large academic hospital in the Netherlands. Clinical Gram-negative bacteria with an MIC > 2 μg/mL for colistin, obtained from patients hospitalized at the Erasmus MC University Medical Center Rotterdam during the years 2010–2018, were screened for presence of the mcr-1 gene. Extracted plasmids from mcr-1-positive isolates were sequenced using a combination of short- and long-read sequencing platforms, characterized by incompatibility type and genetic composition and compared to publicly available mcr-1-carrying plasmid sequences. In 21 isolates from 14 patients, mcr-1 was located on a plasmid. These plasmids were of diverse genetic background involving Inc types IncX4, IncI2(delta), IncHI2, as well as double Inc types IncHI2/IncN and IncHI2/IncQ. mcr-1-carrying plasmids were found in Escherichia coli, Klebsiella pneumoniae, and Kluyvera georgiana, and within the chromosome of an ST147 K. pneumoniae isolate. In depth analysis indicated intrapatient, interpatient, and interspecies transmission events of mcr-1-carrying plasmids. In addition, our results show that the mcr-1 gene resides in a rich environment full of other (mcr-1 negative) plasmids and of many different Inc types, enabling interplasmidal transfer events and facilitating widespread dissemination of the mcr-1 gene. Multiple mcr-1-carrying plasmid transmission events had likely occurred among isolates from hospitalized patients. Recognition and identification of plasmid transmission events within hospitals is necessary in order to design and implement effective infection control measures.

scholarly journals Risk of Acquiring Extended-Spectrumβ-Lactamase–ProducingKlebsiellaSpecies andEscherichia colifrom Prior Room Occupants in the Intensive Care Unit

2013 ◽  
Vol 34 (5) ◽  
pp. 453-458 ◽  
Author(s):  
Adebola O. Ajao ◽  
J. Kristie Johnson ◽  
Anthony D. Harris ◽  
Min Zhan ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Bacterial Species ◽  
Academic Medical Center ◽  
Gram Negative Bacteria ◽  
Icu Patients ◽  
Gram Negative ◽  
Colonization Pressure ◽  
Icu Length Of Stay

Objective.To quantify the association between admission to an intensive care unit (ICU) room most recently occupied by a patient positive for extended-spectrumβ-lactamase (EBSL)-producing gram-negative bacteria and acquisition of infection or colonization with that pathogen.Design.Retrospective cohort study.Setting and Patients.The study included patients admitted to medical and surgical ICUs of an academic medical center between September 1, 2001, and June 30, 2009.Methods.Perianal surveillance cultures were obtained at admission to the ICU, weekly, and at discharge from the ICU. Patients were included if they had culture results that were negative for ESBL-producing gram-negative bacteria at ICU admission and had an ICU length of stay longer than 48 hours. Pulsed-field gel electrophoresis (PFGE) was performed on ESBL-positive isolates from patients who acquired the same bacterial species (eg,Klebsiellaspecies orEscherichia coli) as the previous room occupant.Results.Among 9, 371 eligible admissions (7, 651 unique patients), 267 (3%) involved patients who acquired an ESBL-producing pathogen in the ICU; of these patients, 32 (12%) were hospitalized in a room in which the prior occupant had been positive for ESBL. Logistic regression results suggested that the prior occupant's ESBL status was not significantly associated with acquisition of an ESBL-producing pathogen (adjusted odds ratio, 1.39 [95% confidence interval, 0.94-2.08]) after adjusting for colonization pressure and antibiotic exposure in the ICU. PFGE results suggested that 6 (18%) of 32 patients acquired a bacterial strain that was the same as or closely related to the strain obtained from the prior occupant.Conclusions.These data suggest that environmental contamination may not play a substantial role in the transmission of ESBL-producing pathogens among ICU patients. Intensifying environmental decontamination may be less effective than other interventions in preventing transmission of ESBL-producing pathogens.

scholarly journals Impact of CLSI Break Point Changes Over the Past Decade on Antimicrobial Susceptibility in Gram-Negative Bacteria

2021 ◽  
Vol 1 (S1) ◽  
pp. s60-s60
Author(s):  
Wesley Johnson ◽  
David Burgess ◽  
Donna Burgess ◽  
Sarah Cotner ◽  
Jeremy VanHoose ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Break Point ◽  
Significant Decline ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
The Past ◽  
Academic Medical ◽  
Break Points ◽  
The Impact

Background: Over the past decade, the CLSI has updated susceptibility break points for several antimicrobial agents. The purpose of this study was to evaluate the impact of these changes against gram-negative bacteria at our academic medical center. Methods: In this retrospective, IRB-approved study, we collected consecutive, nonduplicate clinical isolates of Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, K. oxytoca, K. pneumoniae, and Pseudomonas aeruginosa for the past decade (2010–2019) at our academic medical center and 3 adult ICUs. Susceptibility testing was performed using the BD Phoenix automated system. For these isolates, susceptibilities for 7 β-lactams (aztreonam, ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, ertapenem, and meropenem) and 2 fluoroquinolones (levofloxacin, ciprofloxacin) were calculated based upon CLSI break points in 2010 and current CLSI break points in 2020. Any change >5% in susceptibility was deemed significant for this analysis. Results: In 17.5% of Enterobacteriales isolates tested, at least 1 antimicrobial demonstrated significant decline. Ertapenem was the most commonly affected antimicrobial (45% of the isolates) followed by ceftriaxone (35%) and cefepime (25%). Susceptibilities of aztreonam, ceftazidime, and meropenem were not affected for any of the Enterobacteriales. The most common organism demonstrating a significant impact on change in susceptibility among the Enterobacteriales was E. cloacae (41.7% of the time) followed by E. aerogenes (20.8%), K. oxytoca (12.5%), K. pneumoniae (8.3%) and E. coli (4.2%). Most of the impact was observed hospital-wide (33.3%), followed closely by the MICU (28.6%), the NSICU (23.8%) and the CVICU (14.3%). For P. aeruginosa, the impact of the antimicrobial break-point changes on susceptibility was more pronounced than the Enterobacteriales. Overall, 93.8% of the time there was a significant decline in antimicrobial susceptibility. Each antimicrobial (ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam) demonstrated a significant decline in susceptibility hospital-wide and in each ICU except for the susceptibility of meropenem in the NSICU. Conclusions: Changes in break points had a significant impact on the susceptibility of all antimicrobials for P. aeruginosa at our institution, both hospital-wide and in the adult ICUs. Although the impact was less for the Enterobacteriales, ertapenem, ceftriaxone, and cefepime demonstrated significant susceptibility changes, especially with E. cloacae. Understanding and evaluating the impact of the break-point changes may lead to changes in empiric therapy in other institutions.Funding: NoDisclosures: None

scholarly journals Antibiotic exposure and acquisition of antibiotic-resistant gram-negative bacteria among outpatients at a US Veterans Affairs medical center

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Ukwen C. Akpoji ◽  
Brigid M. Wilson ◽  
Janet M. Briggs ◽  
Sunah Song ◽  
Taissa A. Bej ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Outpatient Visit ◽  
Medical Center ◽  
Disease Diagnosis ◽  
Veterans Affairs ◽  
Administrative Databases ◽  
Gram Negative Bacteria ◽  
Antibiotic Exposure ◽  
Antibiotic Resistant ◽  
Gram Negative

Abstract Objectives: To assess the prevalence of antibiotic-resistant gram-negative bacteria (R-GNB) among patients without recent hospitalization and to examine the influence of outpatient antibiotic exposure on the risk of acquiring R-GNB in this population. Design: 2-year retrospective cohort study. Setting: Regional Veterans Affairs healthcare system. Patients: Outpatients at 13 community-based clinics. Methods: We examined the rate of acquisition of R-GNB within 90 days following an outpatient visit from 2018 to 2019. We used clinical and administrative databases to determine and summarize prescriptions for systemic antibiotics, associated infectious diagnoses, and subsequent R-GNB acquisition among patients without recent hospitalizations. We also calculated the odds ratio of R-GNB acquisition following antibiotic exposure. Results: During the 2-year study period, 7,215 patients had outpatient visits with microbiological cultures obtained within 90 days. Of these patients, 206 (2.9%) acquired an R-GNB. Among patients receiving antibiotics at the visit, 4.6% acquired a R-GNB compared to 2.7% among patients who did not receive antibiotics, yielding an unadjusted odds ratio of 1.75 (95% confidence interval, 1.18–2.52) for a R-GNB following an outpatient visit with versus without an antibiotic exposure. Regardless of R-GNB occurrence, >50% of antibiotic prescriptions were issued at visits without an infectious disease diagnosis or issued without documentation of an in-person or telehealth clinical encounter. Conclusions: Although the rate of R-GNBs was low (2.9%), the 1.75-fold increased odds of acquiring a R-GNB following an outpatient antibiotic highlights the importance of antimicrobial stewardship efforts in outpatient settings. Specific opportunities include reducing antibiotics prescribed without an infectious diagnosis or a clinical visit.

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