Suboptimal therapy and clinical management of gonorrhoea in an area with high-level antimicrobial resistance

Introduction Care coordination is a priority concern for healthcare systems. In Colombia, there is a lack of information on the topic. This study analysed how doctors of two Bogotá’s public healthcare networks perceived coordination between healthcare levels and what factors are associated with their perception. Methods A cross-sectional study using the COORDENA-CO questionnaire to a sample of 363 doctors (network-1 = 181; network-2 = 182) in 2015. The questionnaire asks about types and dimensions of care coordination: information and clinical management, with items in a Likert scale, as well as conditions regarding health system, organisational and doctors’ conditions. Descriptive statistics and logistic regression analysis were performed. Results The doctors’ perception of a high level of coordination did not exceed 25.4%. On coordination of information, limited transfer of clinical information was found. Concerning clinical management, there were limited care coherence, deficits in patient follow-up and lengthy waiting times for specialised care. A high perception of coordination were associated with being female, being over 50 years old, being a specialist, having less than one year’s working experience, working less than 20 h per week at the centre, forming part of network-1, having time available for performing coordination tasks, having job satisfaction and not identifying limitations imposed by healthcare insurers. Discussion There was limited perception of coordination, in its different dimensions and types with some differences between networks. The results support the importance of guaranteeing job satisfaction, ensuring sufficient time to coordination-related activities and intervening in the restrictions imposed by healthcare insurers to improve care coordination.

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Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.4.891 ◽

1996 ◽

Vol 40 (4) ◽

pp. 891-894 ◽

Cited By ~ 184

Author(s):

G V Doern ◽

M J Ferraro ◽

A B Brueggemann ◽

K L Ruoff

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Blood Culture ◽

Rank Order ◽

The United States ◽

Medical Centers ◽

Streptococcus Milleri ◽

Intermediate Resistance ◽

High Level ◽

Viridans Group Streptococci

Three hundred fifty-two blood culture isolates of viridans group streptococci obtained from 43 U.S. medical centers during 1993 and 1994 were characterized. Included were 48 isolates of "Streptococcus milleri," 219 S. mitis isolates, 29 S. salivarius isolates, and 56 S. sanguis isolates. High-level penicillin resistance (MIC, > or = 4.0 micrograms/ml) was noted among 13.4% of the strains; for 42.9% of the strains, penicillin MICs were 0.25 to 2.0 micrograms/ml (i.e., intermediate resistance). In general, amoxicillin was slightly more active than penicillin. The rank order of activity for five cephalosporins versus viridans group streptococci was cefpodoxime = ceftriaxone > cefprozil = cefuroxime > cephalexin. The percentages of isolates resistant (MIC, > or = 2 micrograms/ml) to these agents were 15, 17, 18, 20, and 96, respectively. The rates of resistance to erythromycin, tetracycline, and trimethoprim-sulfamethoxazole were 12 to 38%. Resistance to either chloramphenicol or ofloxacin was uncommon (i.e., < 1%). In general, among the four species, S. mitis was the most resistant and "S. milleri" was the most susceptible.

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Australian Group on Antimicrobial Resistance (AGAR) Australian Enterococcal Sepsis Outcome Programme (AESOP) Annual Report 2018

Communicable Diseases Intelligence ◽

10.33321/cdi.2020.44.19 ◽

2020 ◽

Vol 44 ◽

Cited By ~ 3

Author(s):

Geoffrey W Coombs ◽

Denise A Daley ◽

Shakeel Mowlaboccus ◽

Yung Thin Lee ◽

Stanley Pang ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Molecular Epidemiology ◽

Annual Report ◽

Treatment Options ◽

Northern Territory ◽

Australian Capital Territory ◽

Ampicillin Resistance ◽

High Level ◽

Sequence Types ◽

Outcome Programme

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2018 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,248 unique episodes of bacteraemia investigated, 93.5% were caused by either E. faecalis (54.2%) or E. faecium (39.3%). Ampicillin resistance was not detected in E. faecalis but was detected in 89.4% of E. faecium. Vancomycin non-susceptibility was not detected in E. faecalis but was reported in 45.0% of E. faecium. Overall 49.3% of E. faecium isolates harboured vanA or vanB genes. Of the vanA/vanB positive E. faecium isolates, 52.9% harboured vanA genes and 46.2% vanB genes; 0.8% harboured both vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is substantially higher than that seen in most European countries. E. faecium consisted of 59 multilocus sequence types (STs) of which 74.4% of isolates were classified into six major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The predominant STs (ST17, ST1424, ST796, ST80, ST1421, and ST262) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory and the Northern Territory. Overall, 55.8% of isolates belonging to the six predominant STs harboured vanA or vanB genes. The AESOP 2018 study has shown that enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin-resistant vanA- or vanB-harbouring E. faecium which have limited treatment options.

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Prevalence and Antimicrobial Resistance of Enterococcus Species Isolated from Retail Meats

Applied and Environmental Microbiology ◽

10.1128/aem.69.12.7153-7160.2003 ◽

2003 ◽

Vol 69 (12) ◽

pp. 7153-7160 ◽

Cited By ~ 136

Author(s):

Joshua R. Hayes ◽

Linda L. English ◽

Peggy J. Carter ◽

Terry Proescholdt ◽

Kyung Y. Lee ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Ground Beef ◽

Chicken Breast ◽

Grocery Stores ◽

Predominant Species ◽

Retail Meats ◽

Resistance Patterns ◽

Meat Samples ◽

High Level

ABSTRACT From March 2001 to June 2002, a total of 981 samples of retail raw meats (chicken, turkey, pork, and beef) were randomly obtained from 263 grocery stores in Iowa and cultured for the presence of Enterococcus spp. A total of 1,357 enterococcal isolates were recovered from the samples, with contamination rates ranging from 97% of pork samples to 100% of ground beef samples. Enterococcus faecium was the predominant species recovered (61%), followed by E. faecalis (29%), and E. hirae (5.7%). E. faecium was the predominant species recovered from ground turkey (60%), ground beef (65%), and chicken breast (79%), while E. faecalis was the predominant species recovered from pork chops (54%). The incidence of resistance to many production and therapeutic antimicrobials differed among enterococci recovered from retail meat samples. Resistance to quinupristin-dalfopristin, a human analogue of the production drug virginiamycin, was observed in 54, 27, 9, and 18% of E. faecium isolates from turkey, chicken, pork, and beef samples, respectively. No resistance to linezolid or vancomycin was observed, but high-level gentamicin resistance was observed in 4% of enterococci, the majority of which were recovered from poultry retail meats. Results indicate that Enterococcus spp. commonly contaminate retail meats and that dissimilarities in antimicrobial resistance patterns among enterococci recovered from different meat types may reflect the use of approved antimicrobial agents in each food animal production class.

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Antimicrobial Resistance of Campylobacter jejuni Isolated from Chicken Carcasses in the Federal District, Brazil

Journal of Food Protection ◽

10.4315/0362-028x.jfp-12-485 ◽

2013 ◽

Vol 76 (4) ◽

pp. 691-693 ◽

Cited By ~ 19

Author(s):

HELENIRA MELO de MOURA ◽

PATRÍCIA RENAULT SILVA ◽

PATRÍCIA HELENA CALDEIRA da SILVA ◽

NARA RÚBIA SOUZA ◽

ALINE MONDINI C. RACANICCI ◽

...

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Nalidixic Acid ◽

Campylobacter Jejuni ◽

Health Problem ◽

Food Processing ◽

Public Health Problem ◽

Federal District ◽

Antimicrobial Drugs ◽

High Level

The aim of the present study was to perform microbiological isolation of Campylobacter jejuni from chilled chicken carcasses marketed in the Federal District of Brazil and to subject the strains to an antibiogram. A total of 92 samples from chilled chicken carcasses were acquired, 18 of which (19.56%) tested positive for C. jejuni. A total of 16 strains were tested for susceptibility to eight antimicrobial drugs. All 16 strains were resistant to ciprofloxacin, 15 strains to nalidixic acid, streptomycin, tetracycline, and gentamycin, 14 strains to amoxicillin, 11 strains to erythromycin, and 6 strains to chloramphenicol. The present study is the first to report on the presence of C. jejuni in chilled chicken carcasses marketed in the Federal District region of Brazil. These results may indicate flaws in certain steps of this food processing and highlight a possible public health problem due to the high level of resistance exhibited by the isolated strains.

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Emergence and dissemination of three mild outbreaks of Neisseria gonorrhoeae with high-level resistance to azithromycin in Barcelona, 2016–18

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa536 ◽

2020 ◽

Author(s):

P Salmerón ◽

A Moreno-Mingorance ◽

J Trejo ◽

R Amado ◽

B Viñado ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Neisseria Gonorrhoeae ◽

23S Rrna ◽

Phylogenomic Analysis ◽

Rrna Gene ◽

Snp Analysis ◽

Enhanced Resolution ◽

23S Rrna Gene ◽

High Level ◽

Level Resistance

Abstract Background Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy. Objectives This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018. Methods WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records. Results Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour. Conclusions Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.

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Hyper-Aerotolerant Campylobacter coli from Duck Sources and Its Potential Threat to Public Health: Virulence, Antimicrobial Resistance, and Genetic Relatedness

Microorganisms ◽

10.3390/microorganisms7110579 ◽

2019 ◽

Vol 7 (11) ◽

pp. 579 ◽

Cited By ~ 2

Author(s):

Jae-Ho Guk ◽

Junhyung Kim ◽

Hyokeun Song ◽

Jinshil Kim ◽

Jae-Uk An ◽

...

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Inhibitory Concentration ◽

Genetic Relatedness ◽

Control Strategies ◽

Campylobacter Coli ◽

Potential Threat ◽

High Level ◽

Sequence Types ◽

Level Resistance

Campylobacter, a common foodborne human pathogen, is considered sensitive to oxygen. Recently, aerotolerant (AT) Campylobacter jejuni with the ability to survive under aerobic stress has been reported. Here, we investigated the prevalence of hyper-aerotolerant (HAT) Campylobacter coli from duck sources (118 carcasses and meat) and its characteristics to assess potential impacts on public health. Half of 56 C. coli isolates were HAT and most harbored various virulence genes including flaA, cadF, cdtA, ceuB, and wlaN. Moreover, 98.2% of C. coli isolates showed resistance to quinolones, including ciprofloxacin (CIP), and nine (16.1%) showed high-level resistance to ciprofloxacin (Minimum Inhibitory Concentration, MIC ≥ 32 μg/mL) and most of these were HAT. Based on genetic relatedness between C. coli from duck sources and those from human sources (PubMLST and NCBI), HAT isolates sharing the same MLST sequence types were significantly more prevalent than those not sharing the same sequence types as those from human sources. Therefore, HAT C. coli is prevalent in duck sources, and is most likely transmitted to humans through the food chain given its aerotolerance. This being so, it might pose a threat to public health given its virulence and antimicrobial resistance (AMR). This study will assist in improving control strategies to reduce farm-to-table HAT C. coli transmission to humans.

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Antimicrobial Resistance of Listeria monocytogenes Strains Isolated from Humans in France

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01557-09 ◽

2010 ◽

Vol 54 (6) ◽

pp. 2728-2731 ◽

Cited By ~ 119

Author(s):

A. Morvan ◽

C. Moubareck ◽

A. Leclercq ◽

M. Hervé-Bazin ◽

S. Bremont ◽

...

Keyword(s):

Listeria Monocytogenes ◽

Antimicrobial Resistance ◽

Resistant Strain ◽

Temporal Evolution ◽

Acquired Resistance ◽

Mechanisms Of Resistance ◽

Resistant Strains ◽

High Level ◽

Level Resistance ◽

Microbiological Surveillance

ABSTRACT Susceptibility to antibiotics of 4,816 clinical L. monocytogenes strains isolated since 1926 was studied, and the temporal evolution of susceptibility to antibiotics was analyzed through several decades. The mechanisms of resistance in each resistant strain were studied. The prevalence of resistant strains was estimated at 1.27% among isolates from humans. Resistance to tetracyclines+ and fluoroquinolones was more common and has recently emerged. Although acquired resistance in clinical L. monocytogenes did not implicate clinically relevant antibiotics, the possibility of resistance gene transfers, the description of the first clinical isolate with high-level resistance to trimethoprim, and the recent increase in penicillin MICs up to 2 μg/ml reinforce the need for microbiological surveillance.

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Multiple-Antibiotic Resistance of Enterococcus faecalis and Enterococcus faecium from Cecal Contents in Broiler Chicken and Turkey Flocks Slaughtered in Canada and Plasmid Colocalization of tetO and ermB Genes

Journal of Food Protection ◽

10.4315/0362-028x.jfp-10-451 ◽

2011 ◽

Vol 74 (10) ◽

pp. 1639-1648 ◽

Cited By ~ 33

Author(s):

CINDY-LOVE TREMBLAY ◽

ANN LETELLIER ◽

SYLVAIN QUESSY ◽

MARTINE BOULIANNE ◽

DANIELLE DAIGNAULT ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Enterococcus Faecalis ◽

Resistance Genes ◽

Enterococcus Faecium ◽

Broiler Chicken ◽

Multidrug Resistant ◽

Poultry Meat ◽

Antimicrobial Resistance Genes ◽

High Level ◽

Level Resistance

This study was conducted to characterize the antimicrobial resistance determinants and investigate plasmid colocalization of tetracycline and macrolide genes in Enterococcus faecalis and Enterococcus faecium from broiler chicken and turkey flocks in Canada. A total of 387 E. faecalis and E. faecium isolates were recovered from poultry cecal contents from five processing plants. The percentages of resistant E. faecalis and E. faecium isolates, respectively, were 88.1 and 94% to bacitracin, 0 and 0.9% to chloramphenicol, 0.7 and 14.5% to ciprofloxacin, 72.6 and 80.3% to erythromycin, 3.7 and 41% to flavomycin, 9.6 and 4.3% (high-level resistance) to gentamicin, 25.2 and 17.1% (high-level resistance) to kanamycin, 100 and 94% to lincomycin, 0 and 0% to linezolid, 2.6 and 20.5% to nitrofurantoin, 3 and 27.4% to penicillin, 98.5 and 89.7% to quinupristin-dalfopristin, 7 and 12.8% to salinomycin, 46.7 and 38.5% (high-level resistance) to streptomycin, 95.6 and 89.7% to tetracycline, 73 and 75.2% to tylosin, and 0 and 0% to vancomycin. One predominant multidrug-resistant phenotypic pattern was identified in both E. faecalis and E. faecium (bacitracin, erythromycin, lincomycin, quinupristin-dalfopristin, tetracycline, and tylosin). These isolates were further examined by PCR and sequencing for the genes encoding their antimicrobial resistance. Various combinations of vatD, vatE, bcrR, bcrA, bcrB, bcrD, ermB, msrC, linB, tetM, and tetO genes were detected, and ermB, tetM, and bcrB were the most common antimicrobial resistance genes identified. For the first time, plasmid extraction and hybridization revealed colocalization of tetO and ermB genes on a ca. 11-kb plasmid in E. faecalis isolates, and filter mating experiments demonstrated its transferability. Results indicate that the intestinal enterococci of healthy poultry, which can contaminate poultry meat at slaughter, could be a reservoir for quinupristin-dalfopristin, bacitracin, tetracycline, and macrolide resistance genes.

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