scholarly journals Carriage of ESBL-producing Gram-negative bacteria by flies captured in a hospital and its suburban surroundings in Ethiopia

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Tafese Beyene Tufa ◽  
Andre Fuchs ◽  
Tobias Wienemann ◽  
Yannik Eggers ◽  
Sileshi Abdissa ◽  
...  
Keyword(s):  
Waste Disposal ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Disposal Area ◽  
Route Of Transmission ◽  
The Town ◽  
Orthopedic Ward

Abstract Background Local data from the Asella Teaching and Referral Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria (GNB) in clinical isolates. To investigate a possible route of transmission, we determined the proportions ESBL-producing GNB in isolates from flies caught in the hospital and in the town of Asella. Methods Flies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 12 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The proportions of ESBL-producing bacteria among isolates obtained from flies collected in the hospital compound were significantly higher (82%, 90%, and 57% in NICU, orthopedic ward and waste disposal area, respectively) compared to flies collected outside of the hospital compound (2% (@1/45) in the butchery) (p ≤ 0.001). The proportion of ESBL was 67% (6/9) among Raoultella spp. 67% (4/6) among Kluyvera spp., 56% (5/9) among Enterobacter spp., 50% (5/10) among E. coli, and 44% (8/18) among Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion A high proportion of ESBL was identified in isolates from flies caught in the hospital compound compared with isolates of flies collected at a distance of 1.5 km from the hospital. Flies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in flies and possible impact of MDR for nosocomial infections.

scholarly journals Carriage of ESBL-producing Gram-negative bacteria by flies captured in a hospital and its suburban surroundings in Ethiopia

2020 ◽  
Author(s):  
Tafese B Tufa ◽  
Andre Fuchs ◽  
Tobias Wienemann ◽  
Yannik Eggers ◽  
Sileshi Abdissa ◽  
...  
Keyword(s):  
Waste Disposal ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Disposal Area ◽  
Route Of Transmission ◽  
The Town ◽  
Orthopedic Ward

Abstract Background: Local data from the Asella Teaching and Referral Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria (GNB) in clinical isolates. To investigate a possible route of transmission, we determined the proportions ESBL-producing GNB in isolates from flies caught in the hospital and in the town of Asella. Methods: Flies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results: In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 12 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The proportions of ESBL-producing bacteria among isolates obtained from flies collected in the hospital compound were significantly higher (82%, 90%, and 57% in NICU, orthopedic ward and waste disposal area, respectively) compared to flies collected outside of the hospital compound (2% (1/45) in the butchery) (p≤0.001). The proportion of ESBL was 67% (6/9) among Raoultella spp. 67% (4/6) among Kluyvera spp., 56% (5/9) among Enterobacter spp., 50% (5/10) among E. coli, and 44% (8/18) among Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion: A high proportion of ESBL was identified in isolates from flies caught in the hospital compound compared with isolates of flies collected at a distance of 1.5 km from the hospital. Flies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in flies and possible impact of MDR for nosocomial infections.

scholarly journals Carriage of ESBL-producing Gram-negative bacteria by houseflies captured in a hospital and its suburban surroundings in Ethiopia

2020 ◽  
Author(s):  
Tafese B Tufa ◽  
Andre Fuchs ◽  
Tobias Wienemann ◽  
Yannik Eggers ◽  
Sileshi Abdissa ◽  
...  
Keyword(s):  
Waste Disposal ◽  
Neonatal Intensive Care ◽  
High Rate ◽  
Gram Negative Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Disposal Area ◽  
Route Of Transmission ◽  
The Town ◽  
Orthopedic Ward

Abstract Background: Local data from the Asella Referral and Teaching Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria in clinical isolates. To investigate a possible route of transmission, we determined the colonization rate of houseflies with ESBL-producing Gram-negative bacteria in the hospital compound and in the town of Asella. Methods: Houseflies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results: In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 20 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The prevalence of ESBL-producing bacteria in collected flies was 82%, 90%, and 59% in NICU, orthopedic ward and the waste disposal area, respectively and 2% (1/45) in the butchery. The difference between flies trapped inside and outside the hospital compound was statistically significant (p≤0.001). The frequency of ESBL was 67% (6/9) in Raoultella spp. 67% (4/6) in Kluyvera spp., 56% (5/9) in Enterobacter spp., 50% (5/10) in E. coli and Citrobacter spp., and 44% (8/18) in Klebsiella spp.. Of the 41 ESBL-genes detected, 83% were CTX-M-like, 80% TEM-like, 22% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of antimicrobial resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion: A high proportion of the hospital’s housefly population were colonized with pathogenic ESBL-producing bacteria, but not houseflies collected at a distance of 1.5 km from the hospital. Houseflies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in houseflies and possible impact of the high rate of MDR for nosocomial infections.

scholarly journals Carriage of ESBL-producing Gram-negative bacteria by houseflies captured in a hospital and its suburban surroundings in Ethiopia

2020 ◽  
Author(s):  
Tafese B Tufa ◽  
Andre Fuchs ◽  
Tobias Wienemann ◽  
Yannik Eggers ◽  
Sileshi Abdissa ◽  
...  
Keyword(s):  
Waste Disposal ◽  
Neonatal Intensive Care ◽  
High Rate ◽  
Gram Negative Bacteria ◽  
Local Data ◽  
Gram Negative ◽  
Disposal Area ◽  
Route Of Transmission ◽  
The Town ◽  
Orthopedic Ward

Abstract Background: Local data from the Asella Referral and Teaching Hospital in the town of Asella, Ethiopia reveal a high prevalence of extended-spectrum β-lactamase- (ESBL) producing Gram-negative bacteria in clinical isolates. To investigate a possible route of transmission, we determined the colonization rate of houseflies with ESBL-producing Gram-negative bacteria in the hospital compound and in the town of Asella. Methods: Houseflies were collected in August 2019 from the neonatal intensive care unit (NICU), the orthopedic ward, the hospital’s waste disposal area, and from a butchery situated 1.5 km from the hospital. After trapping, the flies were macerated and suspended in sterile normal saline. The suspensions were inoculated on MacConkey agar and incubated overnight. Species identification and antimicrobial susceptibility testing were performed using Vitek®-MS and VITEK® 2. Results: In total, 103 bacterial isolates were obtained from 85 flies (NICU: 11 isolates from 20 flies, orthopedic ward: 10 isolates from 20 flies, waste disposal area: 37 isolates from 26 flies, butchery: 45 isolates from 27 flies). The prevalence of ESBL-producing bacteria in collected flies was 82%, 90%, and 57% in NICU, orthopedic ward and the waste disposal area, respectively and 2% (1/45) in the butchery. The difference between flies trapped inside and outside the hospital compound was statistically significant (p≤0.001). The frequency of ESBL was 67% (6/9) in Raoultella spp. 67% (4/6) in Kluyvera spp., 56% (5/9) in Enterobacter spp., 50% (5/10) in E. coli and Citrobacter spp., and 44% (8/18) in Klebsiella spp.. Of the 40 ESBL-genes detected, 85% were CTX-M-like, 83% TEM-like, 23% SHV-like, and 2% CTX-M-2-like. ESBL-producing bacteria showed higher rates of antimicrobial resistance against ciprofloxacin (66% vs. 5%), gentamicin (68% vs. 3%), piperacillin-tazobactam (78% vs. 5%), and trimethoprim-sulfamethoxazole (88% vs. 16%), compared to non-ESBL-producing bacteria. Conclusion: A high proportion of the hospital’s housefly population were colonized with pathogenic ESBL-producing bacteria, but not houseflies collected at a distance of 1.5 km from the hospital. Houseflies can be potential vectors for transmission of multidrug-resistant (MDR) bacteria within hospitals. Further studies are needed to determine the source of MDR colonization in houseflies and possible impact of the high rate of MDR for nosocomial infections.

scholarly journals Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

2020 ◽  
Author(s):  
Laura Saporito ◽  
Giorgio Graziano ◽  
Federica Mescolo ◽  
Emanuele Amodio ◽  
Vincenzo Insinga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Surveillance Program ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Active Surveillance Program

Abstract Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large use of antimicrobial treatment and invasive devices in fragile babies.Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage is in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU.Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy.Findings: During the strengthened microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns.Prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). MDR-GNB were not detected for three months and ESBL-KP for five months. Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR=0.21, 95% CI=0.076-0.629; p<0.001).Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of most dangerous ESBL-KP strains.

scholarly journals Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Laura Saporito ◽  
Giorgio Graziano ◽  
Federica Mescolo ◽  
Emanuele Amodio ◽  
Vincenzo Insinga ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Active Surveillance ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Surveillance Program ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Active Surveillance Program

Abstract Background Antimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP), was observed in “Civico” hospital NICU. Aim To assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU. Methods Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies. Findings During the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%; p < 0.001 and 11.1% vs 57.8%; p < 0.001). MDR-GNB were not detected at all for three months and ESBL-KP for five months. Multivariate analysis of the principal exposure variables showed that admission in the post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR = 0.21, 95% CI = 0.076–0.629; p < 0.001). Conclusions MDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.

scholarly journals High Carriage Rates of Multidrug-Resistant Gram-Negative Bacteria in Neonatal Intensive Care Units From Ghana

2020 ◽  
Vol 7 (4) ◽  
Author(s):  
Appiah-Korang Labi ◽  
Stephanie Bjerrum ◽  
Christabel C Enweronu-Laryea ◽  
Prosper K Ayibor ◽  
Karen L Nielsen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Multidrug Resistant ◽  
Neonatal Intensive Care Units ◽  
Snp Analysis ◽  
Gram Negative Bacteria ◽  
Cross Sectional ◽  
Gram Negative ◽  
Klebsiella Spp

Abstract Background Carriage of multidrug resistant (MDR) Gram-negative bacteria (GN) in hospitalized neonates may increase the risk of difficult-to-treat invasive infections at neonatal intensive care units (NICUs). Data on MDRGN carriage among hospitalized newborns in Africa are limited. Methods We conducted a cross-sectional study at the NICUs of 2 tertiary hospitals in Ghana. Swabs from the axilla, groin, perianal region, and the environment were cultured, GN were identified, and antibiotic susceptibility was tested. We obtained blood culture isolates from neonates with sepsis. Whole-genome sequencing was used to characterize carbapenemase-producing Klebsiella pneumoniae. Typing was done by multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis. Results A total of 276 GN were isolated from 228 screened neonates. Pathogenic GN were cultured in 76.8% (175 of 228) of neonates. Klebsiella spp (41.7%; 115 of 276) and Escherichia coli (26.4%; 73 of 276) were the commonest organisms. Carriage rates of MDRGN and third-generation cephalosporin resistant organisms were 49.6% (113 of 228) and 46.1% (105 of 228), respectively. Among Klebsiella spp, 75.6% (87 of 115) phenotypically expressed extended-spectrum β-lactamase activity, whereas 15.6% expressed carbapenemase and harbored bla-OXA-181 and bla-CTX-M-15. Overall, 7.0% (16 of 228) of neonates developed GN bloodstream infection. In 2 of 11 neonates, sequencing showed the same identity between carriage and the bloodstream isolate. Length of stay before specimen collection and antibiotic use were independently associated with carriage rates, which increased from 13% at admission to 42% by day 2 and reached a plateau at 91% by day 15. Conclusions High carriage rates of MDRGN, including carbapenemase-producing enterobacterales may be an emerging problem in NICUs in Africa.

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