Oral Antibiotics for Uncomplicated Acute Appendicitis: The Role of Extended-Spectrum Beta-Lactamase Risk Factor Stratification

Abstract Background Omadacycline (OMC) is a novel tetracycline (TET) derivative antibiotic with activity against TET-resistant Enterobacterales. OMC is available in both oral and intravenous formulations and is has been studied as a treatment of uncomplicated urinary tract infection (UTI) and acute pyelonephritis. The purpose of this study was to evaluate OMC activity against extended-spectrum beta-lactamase (ESBL) positive and negative Enterobacterales strains recovered from urine specimens. Methods Urine samples from patients with suspected UTI were quantitatively plated onto blood agar and MacConkey agar plates in the microbiology lab of Wake Forest Baptist Medical Center. After overnight incubation, colonies were identified to the species level by MALDI-TOF system. Susceptibility testing was performed for isolates of E. coli and K. pneumoniae. OMC and TET susceptibility testing was performed by disk diffusion and gradient strip methodologies. Results were interpreted in accordance with the Clinical and Laboratory Standards Institute (CLSI) or Food and Drug Administration breakpoints. Isolates were tested in triplicate. ESBL screening and susceptibility testing to oral antibiotics commonly prescribed for UTI were performed by the MicroScan WalkAway System. Susceptibility rates and MIC50/90 were calculated and subsets of isolates were analyzed using descriptive statistics. Results A total of 204 isolates, including 102 E. coli and 102 K. pneumoniae, were tested. All but 1 isolate (99.5%) exhibited categorical agreement in results generated by the strip (Table 1) and disk (data not shown) methods and this was considered a minor error involving an intermediate result. OMC MIC90 for E. coli and K. pneumoniae were 6 µg/mL and >32 µg/mL, respectively. OMC displayed increased susceptibility rates compared to TET regardless of isolate species or ESBL positivity (Table 2). Table 1. Omadacycline Minimum Inhibitory Concentrations (MICs, µg/mL) Table 2. Susceptibilities of Oral Antibiotics Used to Treat UTI (% S) Conclusion OMC exhibits promising antimicrobial activity against TET-resistant and ESBL-positive E. coli and K. pneumoniae. OMC displays superior activity to ESBL positive E. coli when compared to ESBL positive K. pneumoniae. These data support the development of OMC as a much needed option in the treatment of UTI caused by resistant Enterobacterales. Disclosures Tyler J. Stone, PharmD, Paratek (Research Grant or Support) Abdullah Kilic, MD, Paratek (Grant/Research Support) John Williamson, PharmD, Paratek (Research Grant or Support) Elizabeth Palavecino, MD, Paratek (Grant/Research Support)Paratek (Grant/Research Support)

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Can Oral Antibiotics Be an Alternative to Carbapenems in The Treatment of Non-Complicated Urinary Tract Infections Caused by Extended Spectrum Beta-lactamase Positive Escherichia coli?

ANKEM Dergisi ◽

10.5222/ankem.2017.085 ◽

2017 ◽

Author(s):

Yeşim ALPAY ◽

Mehmet Tevfik YAVUZ ◽

Turan ASLAN ◽

Batıhan BÜYÜKZENGİN

Keyword(s):

Escherichia Coli ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Beta Lactamase ◽

Oral Antibiotics ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Tract Infections

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High Carrying Rate of Extended-Spectrum Beta-Lactamase (ESBL) Producing Enterobacteriaceae by Slaughterhouse Workers in Lomé, Togo in 2019

Microbiology Research Journal International ◽

10.9734/mrji/2020/v30i1130281 ◽

2020 ◽

pp. 30-41

Author(s):

Amivi Mawussi Godonou ◽

Fifonsi Adjidossi Gbeasor-Komlanvi ◽

Novissi Tsogbale ◽

Fiali Lack ◽

Sika Dossim ◽

...

Keyword(s):

Clavulanic Acid ◽

Health Concern ◽

Diffusion Method ◽

Food Chains ◽

Beta Lactamase ◽

Bacterial Strains ◽

Carriage Rate ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

Introduction: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL) represent a real public health concern because of their spread. The role of agri-food chains in transmitting of digestive ESBL-producing bacterial strains in the community, was demonstrated but little work was done in our settings (Togo, west Africa). The aim of this study was to estimate the rate of digestive carrying ESBL producing enterobacteriacae in slaughterhouse workers in Lomé, Togo. Material and Methods: This was a cross-sectional study carried out in three slaughterhouses in Lomé. Fresh stools of 60 slaughterhouse workers and socio-demographic data were collected during the period of September to October 2019 after obtaining the consent of each participant. The bacterial strains of interest were isolated on the selective medium Purple Bromocresol + Ceftazidime at 6µg/l. UriselectÒ and API 20E media were used for identification. Antibiotic susceptibility test was performed in Mueller-Hinton agar plate diffusion method (Kirby Bauer technic) and according to CASFM-EUCAST recommendations. Results: The digestive carriage rate of ESBL producing enterobacteriacae among professionals of three slaughterhouses of Lomé was 80% (n=48/60). Escherichia coli was the main bacteria 78.2% (n = 43/55) followed by Klebsiella pneumoniae 16.4% (n = 9/55) and Enterobacter cloacae 5.4% (n = 3/55). The antibiotic profile of ESBL producing enterobacteriacae showed resistance to Amoxycillin + Clavulanic Acid (26%), Ticarcillin + Clavulanic Acid (86%), Piperacillin + Tazobactam (14%), Cefoxitin (7%) Ciprofloxacin (63%), Levofloxacin (49%), Nalidixic Acid (42%), Chloramphenicol (33%), Gentamicin (21%), Sulfamethoxazole-Trimetoprim (93%). These bacteria were 100% sensitive to Imipenem, Ertapenem, Amikacin and Fosfomycin. Conclusion: This study revealed a very high carriage rate of ESBL producing Enterobacteriacae among Slaughterhouse Workers in Lomé. It confirmed the major potential role of the agri-food chains in the spread of ESBL producing bacteria in the Community.

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Invasive disease due to extended spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal unit: the possible role of cockroaches

Journal of Hospital Infection ◽

10.1053/jhin.1999.0650 ◽

2000 ◽

Vol 44 (1) ◽

pp. 13-17 ◽

Cited By ~ 51

Author(s):

M.F Cotton ◽

E Wasserman ◽

C.H Pieper ◽

D.C Theron ◽

D.van Tubbergh ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Invasive Disease ◽

Neonatal Unit ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Reduced Use of Third-Generation Cephalosporins Decreases the Acquisition of Extended-Spectrum Beta-Lactamase-ProducingKlebsiella pneumoniae

Infection Control and Hospital Epidemiology ◽

10.1086/502304 ◽

2004 ◽

Vol 25 (10) ◽

pp. 832-837 ◽

Cited By ~ 48

Author(s):

Sang-Oh Lee ◽

Eun Sun Lee ◽

Shin Young Park ◽

Sue-Yun Kim ◽

Yiel-Hae Seo ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Independent Risk Factor ◽

Tertiary Care ◽

Prior Exposure ◽

Third Generation ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Third Generation Cephalosporins

AbstractObjectives:To identify risk factors for the respiratory acquisition of extended-spectrum beta-lactamase (ESBL)-producingKlebsiella pneumoniaeamong patients admitted to a neurosurgical intensive care unit (NSICU) and to modify them without changing general infection control measures.Design:Nested case-control and intervention study.Setting:A 1,200-bed, tertiary-care teaching hospital with a 17-bed NSICU.Methods:Sputa of all patients admitted to the NSICU were cultured weekly during the study. From October 2002 through February 2003, 29 case-patients from whose sputum ESBL-producingK. pneumoniaewas isolated were detected and 59 controls-patients were randomly selected among patients without any positive isolate of ESBL-producingK. pneumoniae.After analyzing the risk factors, we intervened to modify them and compared the acquisition rate of ESBL-producingK. pneumoniaebefore (October 2002 to February 2003) and after (April to August 2003) the intervention.Results:Multivariate analysis showed that prior exposure to third-generation cephalosporins (TGCs) (OR, 6.0; CI95, 1.9 to 18.6;P= .002) was an independent risk factor of ESBL-producingK. pneumoniaeacquisition. The neurosurgical team was notified of the result, and the infectious diseases specialist visited the NSICU three times a week to regulate TGC use during the intervention period. Patients admitted before the intervention were older than patients admitted after. The respiratory acquisition of ESBL-producingK. pneumoniaeper 1,000 patient-days (13.5 [CI95, 8.9 to 18.1] vs 2.7 [CI95, 0.9 to 4.6]) and the antimicrobial use density of TGCs (38.2 ± 5.0 vs 17.3 ± 2.6;P< .001) decreased significantly after the intervention.Conclusion:Prior exposure to TGCs was an independent risk factor for the respiratory acquisition of ESBL-producingK. pneumoniae,and less use of TGCs was associated with a decrease in acquisition.

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