Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis

Abstract Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.

Download Full-text

Distribution of Extended-Spectrum β-Lactamase (ESBL)-Encoding Genes among Multidrug-Resistant Gram-Negative Pathogens Collected from Three Different Countries

Antibiotics ◽

10.3390/antibiotics10030247 ◽

2021 ◽

Vol 10 (3) ◽

pp. 247

Author(s):

Khaled S. M. Azab ◽

Mohamed Ali Abdel-Rahman ◽

Hussien H. El-Sheikh ◽

Ehab Azab ◽

Adil A. Gobouri ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Saudi Arabia ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Gram Negative ◽

Extended Spectrum ◽

Resistant Strains ◽

Encoding Genes

The incidence of Extended-spectrum β-lactamase (ESBL)-encoding genes (blaCTX-M and blaTEM) among Gram-negative multidrug-resistant pathogens collected from three different countries was investigated. Two hundred and ninety-two clinical isolates were collected from Egypt (n = 90), Saudi Arabia (n = 162), and Sudan (n = 40). Based on the antimicrobial sensitivity against 20 antimicrobial agents from 11 antibiotic classes, the most resistant strains were selected and identified using the Vitek2 system and 16S rRNA gene sequence analysis. A total of 85.6% of the isolates were found to be resistant to more than three antibiotic classes. The ratios of the multidrug-resistant strains for Egypt, Saudi Arabia, and Sudan were 74.4%, 90.1%, and 97.5%, respectively. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa showed inconstant resistance levels to the different classes of antibiotics. Escherichia coli and Klebsiella pneumoniae had the highest levels of resistance against macrolides followed by penicillins and cephalosporin, while Pseudomonas aeruginosa was most resistant to penicillins followed by classes that varied among different countries. The isolates were positive for the presence of the blaCTX-M and blaTEM genes. The blaCTX-M gene was the predominant gene in all isolates (100%), while blaTEM was detected in 66.7% of the selected isolates. This work highlights the detection of multidrug-resistant bacteria and resistant genes among different countries. We suggest that the medical authorities urgently implement antimicrobial surveillance plans and infection control policies for early detection and effective prevention of the rapid spread of these pathogens.

Download Full-text

Occurrence of NDM-1 and VIM-2 Co-Producing Escherichia coli and OprD Alteration in Pseudomonas aeruginosa Isolated from Hospital Environment Samples in Northwestern Tunisia

Diagnostics ◽

10.3390/diagnostics11091617 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1617

Author(s):

Raouaa Maaroufi ◽

Olfa Dziri ◽

Linda Hadjadj ◽

Seydina M. Diene ◽

Jean-Marc Rolain ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Bacterial Resistance ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Hospital Environment ◽

Diffusion Method ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Disk Diffusion Method

Hospital environments constitute the main reservoir of multidrug-resistant bacteria. In this study we aimed to investigate the presence of Gram-negative bacteria in one Northwestern Tunisian hospital environment, and characterize the genes involved in bacterial resistance. A total of 152 environmental isolates were collected from various surfaces and isolated using MacConkey medium supplemented with cefotaxime or imipenem, with 81 fermenter bacteria (27 Escherichia coli, and 54 Enterobacter spp., including 46 Enterobacter cloacae), and 71 non-fermenting bacteria (69 Pseudomonas spp., including 54 Pseudomonas aeruginosa, and 2 Stenotrophomonas maltophilia) being identified by the MALDI-TOF-MS method. Antibiotic susceptibility testing was performed by disk diffusion method and E-Test was used to determine MICs for imipenem. Several genes implicated in beta-lactams resistance were characterized by PCR and sequencing. Carbapenem resistance was detected among 12 isolates; nine E. coli (blaNDM-1 (n = 8); blaNDM-1 + blaVIM-2 (n = 1)) and three P. aeruginosa were carbapenem-resistant by loss of OprD porin. The whole-genome sequencing of P. aeruginosa 97H was determined using Illumina MiSeq sequencer, typed ST285, and harbored blaOXA-494. Other genes were also detected, notably blaTEM (n = 23), blaCTX-M-1 (n = 10) and blaCTX-M-9 (n = 6). These new epidemiological data imposed new surveillance strategies and strict hygiene rules to decrease the spread of multidrug-resistant bacteria in this area.

Download Full-text

The Importance of Addressing Multidrug Resistance and Not Assuming Single-Drug Resistance in Case-Control Studies

Infection Control and Hospital Epidemiology ◽

10.1086/505917 ◽

2006 ◽

Vol 27 (7) ◽

pp. 670-674 ◽

Cited By ~ 14

Author(s):

Erika M. C. D'Agata ◽

Maria Adriana Cataldo ◽

Roberto Cauda ◽

Evelina Tacconelli

Keyword(s):

Risk Factors ◽

Drug Resistance ◽

Multidrug Resistant ◽

Case Control ◽

Resistant Bacteria ◽

Drug Resistant ◽

Case Control Studies ◽

Multidrug Resistant Bacteria ◽

Single Drug ◽

Independent Risk Factors

Background.Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug–resistant and multidrug-resistant bacteria.Objective.To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug–resistant or multidrug-resistant bacteria were evaluated.Design.Two retrospective case-control studies were performed with data on patients harboringPseudomonas aeruginosastrains resistant only to ciprofloxacin (CRPA) and patients harboringP. aeruginosastrains resistant to ciprofloxacin and other antibiotics (multidrug-resistantP. aeruginosa[MDR-PA]). These 2 groups were compared with patients not harboringP. aeruginosa.Setting.Two tertiary care hospitals.Results.A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23];P= .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21];P= .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0];P<.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0];P= .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1];P<.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1];P= .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1];P= .04).Conclusion.There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug–resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

Download Full-text

Rapid Detection of Carbapenemase Genes (Bla-Vim And Bla-Imp) By Multiplex Pcr in Gram-Negative Clinical Isolates

10.21203/rs.3.rs-111985/v1 ◽

2020 ◽

Author(s):

Mehraj Ansari ◽

Kulraj Rai ◽

Ganesh Rai ◽

Subhas Aryal ◽

Shiba Rai ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Multiplex Pcr ◽

Rapid Detection ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Clinical Samples ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Gram Negative ◽

Positive Results

Abstract BackgroundCarbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. However, during recent years, carbapenems resistant bacteria have emerged significantly. The main objective of this study was to determine the prevalence of carbapenemase (bla-VIM and bla-IMP) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii.ResultsOf the total 1,151 clinical samples, 253 (22.0%) showed growth positive. Of them, 226 (89.3%) were identified as members of Enterobacteriaceae, P. aeruginosa and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 isolates, 67 (69.1%) showed MHT positive results. bla-VIM and bla-IMP were detected in 40 and 38 isolates, respectively.ConclusionThis study determined the higher prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa and A. baumannii as detected by the presence of bla-VIM and bla-IMP genes.Keywords: Carbapenems, Carbapenemase, Modified Hodge Test, bla-VIM, bla-IMP

Download Full-text

Bacteriological Profile of Tracheal Aspirates of the Patients Attending Neuro-hospital Nepal

International Journal of Life Sciences ◽

10.3126/ijls.v4i0.3496 ◽

2010 ◽

Vol 4 ◽

Cited By ~ 3

Author(s):

Pratirodh Koirala ◽

Dwij Raj Bhatta ◽

Prakash Ghimire ◽

Bharat Mani Pokhrel ◽

Upendra Devkota

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Gram Negative Bacteria ◽

Viridans Streptococci ◽

Multidrug Resistant Bacteria ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Tracheal Aspirates

The tracheostomized patients are colonized mostly by gram negative bacteria which lead to either tracheobronchitis or bronchopneumonia. This study was conducted to isolate and identify the potential pathogen causing post tracheostomy infection. A cross-sectional study was conducted during April 2008 to February 2009 based at Neuro Center, Kathmandu. Tracheal aspirates of 50 patients having fever more than 38°C were collected and analyzed for bacterial content. Out of the 50 cases, 45(90%) cases showed bacterial growth. Sixty-seven isolates were identified; with 20(44.4%) poly-microbial cases. Pseudomonas aeruginosa and enteric gram negative bacteria were predominant bacteria (n=27, 40.3%) followed by Staphylococcus aureus (n=7, 10.4%), other Gram negative bacteria (n=4, 5.9%) and Viridans Streptococci (n=2, 2.9%). Pseudomonas aeruginosa were most sensitive to the Amikacin (n=22, 81.4%) and Ciprofloxacin (n=19, 70.3%). All Pseudomonal isolates were resistant to the Cefotaxime. Enteric Gram Negative bacteria (EGNB) were most sensitive to Amikacin and Chloramphenicol (20, 74.0%) and all were resistant to Ampicillin and Cephalexin. All the gram positive bacteria isolated were sensitive to Vancomycin. Among the total isolates, 24 (88.8%) of Pseudomonas aeruginosa, 21 (66.6%) of enteric gram negative bacteria, and 5 (55.5%) of Gram positive bacteria were multidrug resistant (MDR). The study reported alarming condition of MDR in tracheal aspirates. So surveillance for source of multidrug resistant bacteria would be beneficial for intervention of infection related to it. Key words: Tracheal aspirates, polymicrobial growth, Multidrug resistant bacteria (MDR)10.3126/ijls.v4i0.3496International Journal of Life Sciences Vol.4 2010 pp.60-65

Download Full-text

Cefepime/tazobactam as a new treatment option for multidrug resistant gram negative bacilli

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20192512 ◽

2019 ◽

Vol 7 (6) ◽

pp. 2278

Author(s):

Roshni Agarwal ◽

Vaibhav Agarwal ◽

Anjali Tewari ◽

Parwati Upadhyay

Keyword(s):

Pseudomonas Aeruginosa ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Diffusion Method ◽

Resistant Bacteria ◽

In Vitro Susceptibility ◽

Gram Negative ◽

E Coli ◽

New Treatment

Background: Every time an antibiotic is used, whether appropriately or not, the probability of the development and spread of antibiotic resistant bacteria is increased. Thus, multidrug resistant bacteria particularly ESBL (Extended spectrum βlactamase), Amp C and carbapenemases producing gram negative bacilli have emerged as a major health problem all over the world. Considering new treatment options as a carbapenems sparing and resistance prevention modality, this study was aimed to know the in vitro susceptibility pattern of Cefepime/Tazobactam (CPM/TZ) in comparison to other β-Lactam/ β-Lactamase inhibitors (BL/BLI) and carbapenems against GNB.Methods: A prospective study was conducted on all clinical samples received for a period of about 1 year. Identification and susceptibility of all isolates was done by Vitek 2 Compact system. Susceptibility of CPM/ TZ was done by disc diffusion method on the basis of CLSI guidelines. Both fermenters (E. coli and Klebsiella pneumoniae) and non-fermenters (Acintobacter baumanii and Pseudomonas aeruginosa) were included in the study.Results: Out of 550 GNB isolates the most common was E. coli (61.8%), Acintobacter baumanii (16%), Klebsiella pneumoniae (14.9%) and Pseudomonas aeruginosa (7.3%). Cefepime/tazobactam had a much higher susceptibility of 68% compared to cefepime (28%). Among the BL/BLI combinations tested cefepime/tazobactam (68%) showed the maximum percentage of susceptibility followed by cefoperazone/sulbactam (61.5%) and piperacillin/tazobactam (57.6%). Amongst all GNB isolates cefepime/tazobactam (68%) sensitivity was very much comparable to imipenem (71.8%) and meropenem (69.6%).Conclusions: CPM/TZ exhibited the best in vitro activity in comparison to the other BL/BLI. This new combination of cefepime/tazobactam appears to be a promising alternative therapeutic option to carbapenems. Clinical studies are needed to confirm this in vitro study result.

Download Full-text

Activity of Imipenem with Relebactam against Gram-Negative Pathogens from New York City

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00830-15 ◽

2015 ◽

Vol 59 (8) ◽

pp. 5029-5031 ◽

Cited By ~ 97

Author(s):

Amabel Lapuebla ◽

Marie Abdallah ◽

Olawole Olafisoye ◽

Christopher Cortes ◽

Carl Urban ◽

...

Keyword(s):

Escherichia Coli ◽

New York ◽

Pseudomonas Aeruginosa ◽

New York City ◽

Klebsiella Pneumoniae ◽

York City ◽

Multidrug Resistant ◽

Gram Negative ◽

Content Type ◽

Added Benefit

ABSTRACTImipenem with relebactam was active againstEscherichia coli,Klebsiella pneumoniae, andEnterobacterspp., includingK. pneumoniaecarbapenemase (KPC)-producing isolates. Loss of OmpK36 in KPC-producingK. pneumoniaeisolates affected the susceptibility of this combination. Enhanced activity was evident againstPseudomonas aeruginosa, including isolates with depressedoprDand increasedampCexpression. However, the addition of relebactam to imipenem did not provide added benefit againstAcinetobacter baumannii. The combination of imipenem with relebactam demonstrated activity against KPC-producingEnterobacteriaceaeand multidrug-resistantP. aeruginosa.

Download Full-text

Tamoxifen repurposing to combat infections by multidrug-resistant Gram-negative bacilli

10.1101/2020.03.30.017475 ◽

2020 ◽

Cited By ~ 1

Author(s):

Andrea Miró-Canturri ◽

Rafael Ayerbe-Algaba ◽

Raquel del Toro ◽

Jerónimo Pachón ◽

Younes Smani

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Immune System ◽

Acinetobacter Baumannii ◽

Therapeutic Efficacy ◽

Multidrug Resistant ◽

Tamoxifen Treatment ◽

Resistant Bacteria ◽

Gram Negative ◽

E Coli

AbstractThe development of new strategic therapies for multidrug-resistant bacteria, like the use of non-antimicrobial approaches and/or drugs repurposing to be used as monotherapies or in combination with clinically relevant antibiotics, has become an urgent need. A therapeutic alternative for infections by multidrug-resistant Gram-negative bacilli (MDR-GNB) is immune system modulation to improve the infection clearance. We showed that immunocompetent mice infected by Acinetobacter baumannii, Pseudomonas aeruginosa or Escherichia coli in peritoneal sepsis models and treated with tamoxifen at 80 mg/kg/d for three days reduced the release of MCP-1 and its signalling pathway IL-18 and phosphorylated ERK1/2. This reduction of MCP-1 induced the reduction of migration of inflammatory monocytes and neutrophils from bone marrow to blood. Indeed, the treatment with tamoxifen in murine peritoneal sepsis models reduced the bacterial load in tissues and blood; and increased the mice survival from 0% to 60-100%. Tamoxifen treatment of neutropenic mice infected by these pathogens increased mice survival up to 20-60%. Furthermore, susceptibility and time-kill assays showed that the metabolites of tamoxifen, N-desmethyltamoxifen, hydroxytamoxifen and endoxifen, the three together exhibited MIC90 values of 16 mg/L and were bactericidal against clinical isolates of A. baumannii and E. coli. This antimicrobial activity of tamoxifen metabolites parallels’ an increased membrane permeability of A. baumannii and E. coli without affecting their outer membrane proteins profiles. Together, these data showed that tamoxifen present a therapeutic efficacy against MDR A. baumannii, P. aeruginosa and E. coli in experimental models of infections and can be repurposed as new treatment for GNB infections.ImportanceAntimicrobial resistance in Gram-negative bacilli (GNB) is a global health treat. Drug repurposing, a novel approach involving the search of new indications for FDA approved drugs is gaining interest. Among them, we found the anti-cancer drug tamoxifen, which presents very promising therapeutic efficacy. The current study showed that tamoxifen presents activity in animal models of infection with MDR Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli by modulating the traffic of innate immune system cells and the antibacterial activity presented by its three major metabolites produced in vivo against these GNB. Our results offer a new candidate to be repurposed to treat severe infections caused by these pathogens.

Download Full-text

Survival capability of healthcare-associated, multidrug-resistant bacteria on untreated and on antimicrobial textiles

Journal of Industrial Textiles ◽

10.1177/1528083718754901 ◽

2018 ◽

Vol 48 (7) ◽

pp. 1113-1135 ◽

Cited By ~ 5

Author(s):

Adrienn Hanczvikkel ◽

András Víg ◽

Ákos Tóth

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Cotton Textile ◽

Multidrug Resistant Bacteria ◽

Gram Negative ◽

Untreated Cotton ◽

Antimicrobial Efficiency ◽

Healthcare Associated

Healthcare-associated infections are of global concern, and textiles can contribute to the transmission of pathogens. In this study, we examined quantitatively the survival capability of 60 multidrug-resistant bacterial strains from four species ( Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus and Enterococcus faecium) on untreated cotton textile in clinically relevant incubation periods. We determined the antibacterial efficiency of textiles treated either with quaternary ammonium compound (QAC)-containing Sanitized T99-19 liquid (50 m/m% Dimethyltetradecyl (3-(trimethoxysilyl)propyl) ammonium-chloride) or with silver salt-containing Sanitized T27-22 Silver liquid (2 m/m% AgCl and 8 m/m% TiO2) as well. Finally, we compared the results of the healthcare-associated, multidrug-resistant strains and antibiotic-sensitive, quality control standard strains (ATCC 25922, ATCC 11105 Escherichia coli, and ATCC 25923, ATCC 6538 Staphylococcus aureus) often used in antimicrobial efficiency tests. The results revealed that all investigated multidrug-resistant bacteria are able to survive on untreated cotton textile and pose health risk in hospitals. During one day the T27-22-Silver-treated textile was able to eliminate most of the Gram-positive pathogens, reducing the risk of cross-contamination, but none of the examined agents destroyed the multidrug-resistant, Gram-negative isolates. The antibiotic-susceptible and the multidrug-resistant Staphylococcus aureus strains had similar survival capability and biocide-tolerance, while the risk of infections caused by multidrug-resistant, Gram-negative pathogens could be extremely underestimated using only ATCC Escherichia coli standard strains. Our results also draw attention to the careful evaluation of antimicrobial efficiency tests and indicate that a significant reduction of bacterial count does not necessarily mean significant antibacterial efficiency that would be suitable to avoid infections.

Download Full-text