scholarly journals When first line treatment of neonatal infection is not enough: blood culture and resistance patterns in neonates requiring second line antibiotic therapy in Bangui, Central African Republic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Andrea Nebbioso ◽  
Oluwakemi F. Ogundipe ◽  
Ernestina Carla Repetto ◽  
Calorine Mekiedje ◽  
Hugues Sanke-Waigana ◽  
...  
Keyword(s):  
Blood Culture ◽  
Klebsiella Oxytoca ◽  
Neonatal Infection ◽  
Sub Saharan Africa ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Sub Saharan ◽  
Third Generation Cephalosporins

Abstract Background Infectious diseases account for the third most common cause of neonatal deaths. Globally, antibiotic resistance (ABR) has been increasingly challenging neonatal sepsis treatment, with 26 to 84% of gram-negative bacteria resistant to third-generation cephalosporins. In sub-Saharan Africa, limited evidence is available regarding the neonatal microbiology and ABR. To our knowledge, no studies have assessed neonatal bacterial infections and ABR in Central-African Republic (CAR). Therefore, this study aimed to describe the pathogens isolated and their specific ABR among patients with suspected antibiotic-resistant neonatal infection admitted in a CAR neonatal unit. Methods This retrospective cohort study included neonates admitted in the neonatal unit in Bangui, CAR, from December 2018 to March 2020, with suspected antibiotic-resistant neonatal infection and subsequent blood culture. We described the frequency of pathogens isolated from blood cultures, their ABR prevalence, and factors associated with fatal outcome. Results Blood cultures were positive in 33 (26.6%) of 124 patients tested (17.9% for early-onset and 46.3% for late-onset infection; p = 0.002). Gram-negative bacteria were isolated in 87.9% of positive samples; with most frequently isolated bacteria being Klebsiella pneumoniae (39.4%), Escherichia coli (21.2%) and Klebsiella oxytoca (18.2%). All tested bacteria were resistant to ampicillin. Resistance to third-generation cephalosporins was observed in 100% of tested Klebsiella pneumoniae, 83.3% of isolated Klebsiella oxytoca and 50.0% of tested Escherichia coli. None of the tested bacteria were resistant to carbapenems. Approximately 85.7 and 77.8% of gram-negative tested bacteria were resistant to first-line (ampicillin-gentamicin) and second-line (third-generation cephalosporins) treatments, respectively. In hospital mortality, adjusted for blood culture result, presence of asphyxia, birth weight and sex was higher among neonates with positive blood culture (adjusted relative risk [aRR] = 2.32; 95% confidence interval [CI] = 1.17–4.60), male sex (aRR = 2.07; 95% CI = 1.01–4.26), asphyxia (aRR = 2.42; 95% CI = 1.07–5.47) and very low birth weight (1000–1499 g) (aRR = 2.74; 95% CI = 1.3–5.79). Conclusion Overall, 77.8% of confirmed gram-negative neonatal infections could no longer effectively be treated without broad-spectrum antibiotics that are not routinely used in sub-Saharan Africa referral hospitals. Carbapenems should be considered an option in hospitals with surveillance and antibiotic stewardship.

scholarly journals Opening Pandora’s box: high level resistance to antibiotics of last resort in Gram negative bacteria from Nigeria

2018 ◽  
Author(s):  
David O Ogbolu ◽  
Laura J V Piddock ◽  
Mark A Webber
Keyword(s):  
Resistance Mechanisms ◽  
Sub Saharan Africa ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
E Coli ◽  
First Line Therapy ◽  
Sub Saharan ◽  
High Level ◽  
Third Generation Cephalosporins ◽  
Level Resistance

ABSTRACTAntimicrobial resistance (AMR) is a global problem but information about the prevalence and mechanisms of resistance in sub-Saharan Africa are lacking. We determined the percentage of drug resistant isolates and resistance mechanisms in 307 Gram negative isolates randomly collected from south western Nigeria. Susceptibility testing revealed 78.1%, 92.2% and 52.6% of all isolates were resistant to fluoroquinolones, third generation cephalosporins and carbapenems respectively. There were more resistant isolates from the stools of uninfected patients than from specimens of patients with symptoms of infections. Only a small proportion of E. coli (10%) and Klebsiella (7%) isolates produced a carbapenemase. Whole genome sequencing of selected isolates identified the presence of globally disseminated clones. This depicts a crisis for the use of first line therapy in Nigerian patients, it is likely that Nigeria is playing a significant role in the spread of AMR due to her high population and mobility across the globe.

Norfloxacin: A Quinoline Antibiotic

1986 ◽  
Vol 20 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Dwight A. Marble ◽  
John A. Bosso
Keyword(s):  
Side Effects ◽  
Nalidixic Acid ◽  
Antimicrobial Agents ◽  
Bitter Taste ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Gram Negative ◽  
Intravenous Antibiotics ◽  
Third Generation Cephalosporins ◽  
Quinolinecarboxylic Acid

Norfloxacin is a quinoline (quinolinecarboxylic acid) that should prove successful in treating infections that currently require hospitalization and intravenous antibiotics. Although a nalidixic acid derivative, it possesses greater antibacterial activity against gram-positive and gram-negative bacteria. Compared with other antimicrobial agents, norfloxacin is more potent than the aminoglycosides, first-, second-, and third-generation cephalosporins, tetracycline, trimethoprim-sulfamethoxazole, carbenicillin, piperacillin, nalidixic acid, oxolinic acid, cinoxacin, and enoxacin. In the clinical studies to date, the side effects of norfloxacin have been minimal, but include nausea, vomiting, anorexia, dizziness, headache, drowsiness, depression, and a bitter taste in the mouth. In studies with more than 4000 patients, the incidence of side effects ranged from 3.9 to 4.7 percent, with most appearing by the second day of therapy.

scholarly journals Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase–associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa

2019 ◽  
Vol 69 (Supplement_6) ◽  
pp. S449-S458 ◽  
Author(s):  
Trevor Toy ◽  
Gi Deok Pak ◽  
Trung Pham Duc ◽  
James I Campbell ◽  
Muna Ahmed El Tayeb ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Sub Saharan Africa ◽  
Health Concern ◽  
Reference Laboratory ◽  
Gram Negative Bacteria ◽  
Esbl Production ◽  
African Countries ◽  
Gram Negative ◽  
Extended Spectrum ◽  
Sub Saharan

Abstract Background Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. Methods Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. Results Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. Conclusions Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.

scholarly journals 1107. Third Generation Cephalosporins Monotherapy Experience in Pediatric Patients with High-Risk Febrile Neutropenia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S584-S584
Author(s):  
Valentina Gutierrez ◽  
Ximena Claverie
Keyword(s):  
Pseudomonas Aeruginosa ◽  
High Risk ◽  
Febrile Neutropenia ◽  
Pediatric Patients ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Gram Negative ◽  
Third Line ◽  
Third Generation Cephalosporins ◽  
Clinical Worsening

Abstract Background Fever during neutropenia is common in children with cancer. The updated guidelines recommend empirical antibiotic monotherapy using an antipseudomonal ß-lactam, a fourth generation cephalosporin or a carbapenem for high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. In our hospital there are not Pseudomonas aeruginosa isolates in oncology pediatric patients, therefore, we use ceftriaxone as monotherapy in high risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third generation cephalosporins in these patients. Methods Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until December 2019. Results We found 140 episodes in 53 patients, 42 (79%) were leukemia and 11 (21%) solid tumor patients. Of the 140 episodes, 97 (69%) had clinical signs at admission, mostly respiratory in 48 (49%) of the cases. Ninety one (65%) cases started ceftriaxone at admission, 27 (30%) maintained ceftriaxone for 7 days of treatment. Sixty four (70%) cases changed treatment: 38/64 (42%) started second line antibiotics for clinical worsening, 19/64 (20%) required second and third line antibiotics for persistent fever and clinical worsening, and 7/64 (8%) received third line antibiotics from the start for past microbiological history. Eighteen (13%) cases evolved with sepsis requiring intensive care unit management.We had 32 (23%) episodes with positive blood culture, 13 (41%) due to gram positive bacteria, 16 (50%) gram negative bacteria, and 3 (9%) cases of fungal infections. Of the gram negative bacteria, 7 (44%) were ESBL producers, without Pseudomonas aeruginosa isolates.One case died (0.7%) for refractory sepsis due to gram negative bacteria. Conclusion Monotherapy with ceftriaxone is not a good option as initial therapy for high risk febrile neutropenia patients due to the spread of ESBL strains. The empiric therapy has to be evaluated regularly and should always be based in local epidemiology. Disclosures All Authors: No reported disclosures

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

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.

scholarly journals CTX-M-type ESBL-mediated resistance to third-generation cephalosporins and conjugative transfer of resistance in Gram-negative bacteria isolated from hospitals in Tamil Nadu, India

2020 ◽  
Author(s):  
Ramesh Nachimuthu ◽  
Velu Rajesh Kannan ◽  
Bulent Bozdogan ◽  
Vaithilingam Krishnakumar ◽  
Karutha Pandian S ◽  
...  
Keyword(s):  
Type Species ◽  
Tamil Nadu ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Gram Negative ◽  
Content Type ◽  
E Coli ◽  
Link Type ◽  
Third Generation Cephalosporins ◽  
Group 1

Clinical pathogens, especially Gram-negative bacteria developing resistance to third-generation cephalosporins, are making clinical outcomes more complicated and serious. This study was undertaken to evaluate the distribution of CTX-M-type extended-spectrum β-lactamases (ESBLs) in Tamil Nadu, India. For this study, clinical samples were collected from five different hospitals located in Tamil Nadu and the ESBL-producing Gram-negative isolates were characterized. MIC was performed using cefotaxime and ceftazidime. The bla ESBL-producing genes were screened using multiplex PCR for the genes, CTX-M group-1, -2, -8, -9, -26. The conjugation studies were performed using Escherichia coli AB1157 as a recipient for the isolates harbouring plasmid-borne resistance following broth-mating experiment. In total, 1500 samples were collected and 599 Gram-negative bacteria were isolated that included E. coli (n=233), Klebsiella pneumoniae (n=182), Pseudomonas aeruginosa (n=79), Citrobacter spp. (n=30), Proteus mirabilis (n=28), Salmonella spp. (n=21), Acinetobacter baumannii (n=12), Serratia spp. (n=6), Shigella spp. (n=4), Morganella morganii (n=3) and Providencia spp. (n=1). MIC results showed that 358 isolates were resistant to cefotaxime and ceftazidime. Further, ESBL gene-amplification results showed that 19 isolates had CTX-M group-1 gene including E. coli (n=16), K. pneumoniae (n=2) and P. aeruginosa (n=1) whereas one M. morganii isolate had CTX-M group-9, which was plasmid-borne. Through conjugation studies, 12/20 isolates were found to be involved in the transformation of its plasmid-borne resistance gene. Our study highlighted the importance of horizontal gene transfer in the dissemination of plasmid-borne bla CTX-M-type resistance genes among the clinical isolates.

scholarly journals Extended Spectrum Beta-Lactamase (ESBL)-Mediated Resistance to Third Generation Cephalosporins and Conjugative Transfer of Resistance in Gram-Negative Bacteria Isolated from Hospitals in Tamil Nadu, India

2019 ◽  
Author(s):  
Nachimuthu Ramesh ◽  
Velu Rajesh Kannan ◽  
Bulent Bozdogan ◽  
Vaithilingam Krishnakumar ◽  
Prasanth Manohar
Keyword(s):  
Tamil Nadu ◽  
Clinical Samples ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Salmonella Spp ◽  
Gram Negative ◽  
E Coli ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins ◽  
Group 1

Clinical pathogens especially Gram-negative bacteria developing resistance to third-generation cephalosporins are making the clinical outcome more complicated and serious. This study was undertaken to evaluate the distribution of extended-spectrum beta-lactamases in Tamil Nadu regions in India. For this study, clinical samples were collected from five different hospitals located in Tamil Nadu and ESBL producing Gram-negative isolates were characterized. Minimal inhibitory concentration (MIC) was performed using cefotaxime and ceftazidime. The blaESBL producing genes were screened using multiplex PCR for the genes, CTX-M group-1,-2,-8,-9,-26. Conjugation studies were performed using E. coli AB1157 as a recipient for the isolates harbouring plasmid-borne resistance following broth-mating experiment. In total, 1500 samples were collected and 599 Gram-negative bacteria were isolated that included Escherichia coli (n=233), Klebsiella pneumoniae (n=182), Pseudomonas aeruginosa (n=79), Citrobacter spp. (n=30), Proteus mirabilis (n=28), Salmonella spp. (n=21), Acinetobacter baumannii (n=12), Serratia spp. (n=6), Shigella spp. (n=4), Morganella morganii (n=3) and Providencia spp. (n=1). MIC results showed that 358 isolates were resistant to cefotaxime and ceftazidime. Further, ESBL gene amplification results showed that 19 isolates had CTX-M group-1 gene including E. coli (n=16), K. pneumoniae (n=2) and P. aeruginosa (n=1) whereas one M. morganii isolate had CTX-M group-9 gene in their plasmid. Through conjugation studies, 12/20 isolates were found to be involved in the transformation of its plasmid-borne resistance gene. Our study highlighted the role of horizontal gene transfer in the dissemination of plasmid-borne blaCTX-M resistance genes among ESBL producing isolates.

scholarly journals Spontaneous Bacterial Peritonitis in Cirrhotic Patients: A Shift in the Microbial Pattern? A Retrospective Analysis

2021 ◽  
pp. 1-11
Author(s):  
Raquel Pimentel ◽  
Jorge Leitão ◽  
Carlos Gregório ◽  
Lélita Santos ◽  
Armando Carvalho ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Gram Positive Bacteria ◽  
Cirrhotic Patients ◽  
Empirical Antibiotics ◽  
Third Generation Cephalosporins

<b><i>Introduction:</i></b> Over the last decade, a shift in the spontaneous bacterial peritonitis (SBP) microbial pattern toward an increasing incidence of gram-positive and multidrug-resistant (MDR) bacteria has been reported. Systematic surveillance of the local microbiological scenario and antibiotic resistance is crucial to SBP treatment success. The main objective of this study was to evaluate the microbiological profile and bacterial resistance of SBP pathogens in a Portuguese cohort to allow selection of the most appropriate empirical antibiotics. <b><i>Methods:</i></b> This is a single-center retrospective study including 63 adult cirrhotic patients with culture-positive SBP. Patients were identified using a hospital general diagnostic database and searching for all SBP events (neutrophil count in ascitic fluid ≥250/mm<sup>3</sup>) from January 1, 2012, to December 31, 2017. Patients were excluded if they had culture-negative SBP, secondary peritonitis, peritoneal dialysis, a liver transplant, or immunodeficiency. The site of SBP acquisition was classified as nosocomial if it was diagnosed 48 h or longer after hospitalization or as nonnosocomial if it was diagnosed within the first 48 h. MDR bacteria were those with an acquired resistance to at least 1 agent in 3 or more antimicrobial categories. All statistical analyses were carried out using IBM SPSS Statistics software version 22 (IBM, New York, USA). <b><i>Results:</i></b> The study cohort comprised 53 (84.1%) men. The mean age of the patients was 60.6 ± 11.2 years. Alcohol was the most common etiology (88.9%) and most patients had advanced liver cirrhosis (87.1%, Child C). Gram-negative bacteria were slightly more frequent than gram-positive bacteria (56.9 vs. 43.1%). <i>Escherichia coli</i> was the most common pathogen (33.8%). Nineteen (31.7%) bacteria were classified as MDR. Resistance to third-generation cephalosporins, quinolones, piperacillin-tazobactam, and carbapenems was found in 31.7, 35, 26.7, and 18.3% of the cases, respectively. The rates of gram-positive bacteria were similar between nosocomial and nonnosocomial episodes (45 vs. 42.2%; <i>p</i> = 0.835). MDR bacteria were more common in the nosocomial group (50 vs. 23.8%; <i>p</i> = 0.046). Resistance to third-generation cephalosporins (50 vs. 23.8%; <i>p</i> = 0.046), piperacillin-tazobactam (44.4 vs. 19.1%; <i>p</i> = 0.041), and carbapenems (33.3 vs. 11.9%; <i>p</i> = 0.049) occurred more frequently in nosocomial episodes. Resistance to first-line antibiotic occurred in 29.3% of the patients, being more common in the nosocomial group (44.4 vs. 22.5%; <i>p</i> = 0.089). <b><i>Conclusion:</i></b> Although gram-negative bacteria remain the most common causative microorganisms, our results emphasize the shift in SBP microbiological etiology, as almost half of the isolated microorganisms were gram positive. The emergence of bacteria resistant to traditionally recommended empirical antibiotics underlines the importance of basing this choice on local flora and antibiotic susceptibility data, allowing a more rational and successful use of antibiotics.

scholarly journals A highly multiplexed melt-curve assay for detecting the most prevalent carbapenemase, ESBL and AmpC genes

2019 ◽  
Author(s):  
T. Edwards ◽  
C. Williams ◽  
Y. Teethaisong ◽  
J. Sealey ◽  
S. Sasaki ◽  
...  
Keyword(s):  
16S Rdna ◽  
Simultaneous Detection ◽  
Detection Methods ◽  
Gram Negative Bacteria ◽  
Third Generation ◽  
Molecular Surveillance ◽  
Gram Negative ◽  
Beta Lactamases ◽  
Resistance Patterns ◽  
Third Generation Cephalosporins

AbstractResistance to third generation cephalosporins and carbapenems in Gram-negative bacteria is chiefly mediated by beta-lactamases including ESBL, AmpC and carbapenemase enzymes. Routine phenotypic detection methods do not provide timely results, and there is a lack of comprehensive molecular panels covering all important markers.An ESBL/carbapenemase HRM assay (SHV, TEM, CTX-M ESBLs, and NDM, IMP, KPC, VIM and OXA-48-like carbapenemases) and an AmpC HRM assay (16S rDNA control, FOX, MOX, ACC, EBC, CIT and DHA) were designed, and evaluated on 111 Gram-negative isolates with mixed resistance patterns.The sensitivity for carbapenemase, ESBL and AmpC genes was 96.7% (95%CI:82.8-99.9%), 93.6% (95%CI:85.7-97.9%) and 93.8% (95%CI:82.8-98.7%), respectively with a specificity of 100% (95%CI:95.6-100%), 93.9% (95%CI:79.8-99.3%) and 93.7% (95%CI:84.5-98.2%).The HRM assays enable the simultaneous detection of the fourteen most important ESBL, carbapenemase and AmpC genes and could be used as a molecular surveillance tool or to hasten detection of AMR for treatment management.

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