Letter To The Editor

PEDIATRICS ◽  
1970 ◽  
Vol 46 (2) ◽  
pp. 315-316
Author(s):  
Heinz F. Eichenwald
Keyword(s):  
United States ◽  
Antimicrobial Therapy ◽  
The United States ◽  
Resistant Bacteria ◽  
Gram Negative ◽  
E Coli ◽  
Continuous Review ◽  
Letter To The Editor ◽  
Emergence Of Resistance

Dr. Franciosi raises a point which deserves emphasis: antimicrobial therapy is not a static process; the widespread use of an antibiotic will often result in emergence of resistant bacteria necessitating continuous review of recommendations for therapy. The emergence of resistance of gram-negative enterobacteria to kanamycin, including not only E. coli but also klebsiella-aerobacter, has been reported to us from a number of areas in the United States and is recorded in scattered reports in the literature.

Prevalence of Extreme Heat-Resistant Gram-Negative Bacteria Carried by U.S. Cattle at Harvest

2020 ◽  
Vol 83 (8) ◽  
pp. 1438-1443
Author(s):  
MANITA GURAGAIN ◽  
GREGORY E. SMITH ◽  
DAVID A. KING ◽  
JOSEPH M. BOSILEVAC
Keyword(s):  
United States ◽  
Heat Resistance ◽  
The United States ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Fecal Samples ◽  
E Coli ◽  
Heat Resistant ◽  
Beef Processing

ABSTRACT Prevalence of heat-resistant bacteria in beef poses a potential problem as thermal interventions are routinely used in beef processing to control contamination. Despite extreme heat-resistant (XHR) Escherichia coli having been isolated from a ground beef processing plant, there has not been a study to assess the prevalence of XHR E. coli among types of cattle. Therefore, this study used a screening assay for XHR gram-negative bacteria and its molecular determinant, the locus of heat resistance (LHR), on feces collected from U.S. cattle. Fecal samples were collected from fed (n = 538), cull dairy (n = 425), and cull beef (n = 475) cattle at nine regional beef processing plants located across the United States. Among the 1,438 cattle sampled from northern (n = 288), southern (n = 288), eastern (n = 287), western (n = 287), and central (n = 288) regions of the United States, 91 (6.3%) cattle showed presence of XHR bacteria, as evident by growth in MacConkey broth following heat treatment of 80°C for 15 min, in their feces. Heat-resistant bacteria (n = 140) were isolated from the 91 fecal samples. Prevalence of XHR bacteria was highest (11%) in cattle from the northern region. Ninety percent of the XHR isolates were identified as E. coli. Multiplex PCR of all 1,438 fecal samples showed that the LHR was absent in 40.7% of samples and intact in 18.7% of samples. Despite the higher prevalence of intact LHR from PCR analysis, only 11 samples (0.8%) were confirmed to contain bacteria with an intact LHR. The LHR was absent in 91% of XHR bacteria, and only 7.9% of XHR bacteria had intact LHR, suggesting a novel mechanism of heat resistance. By developing and using the screening assays, we established the prevalence of XHR bacteria (6.3%) and LHR+ bacteria (0.8%) in U.S. beef cattle. HIGHLIGHTS

scholarly journals Detection of mcr-1-Carrying Escherichia coli Causing Bloodstream Infection in a New York City Hospital: Avian Origins, Human Concerns?

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Nenad Macesic ◽  
Daniel Green ◽  
Zheng Wang ◽  
Sean B. Sullivan ◽  
Kevin Shim ◽  
...  
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
New York ◽  
New York City ◽  
York City ◽  
The United States ◽  
Genomic Sequencing ◽  
City Hospital ◽  
Gram Negative ◽  
E Coli

Abstract The spread of mcr-1 in the United States remains poorly defined. mcr-1-producing Escherichia coli that also carried blaSHV-12 was detected in a hospitalized patient. No additional cases were identified during screening of 801 Gram-negative isolates. Genomic sequencing identified an IncX4 mcr-1- harboring plasmid and ST117 clonal background associated with avian pathogenic E coli.

scholarly journals Inhibition of MreB and ftsZ proteins to minimize E. coli biofilms formation

2019 ◽  
Author(s):  
Emile Charles
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Cell Division ◽  
Mortality Rate ◽  
Cell Shape ◽  
The United States ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Biofilm Development

AbstractIn the United States, more than two million individuals become infected by antibiotic-resistant bacteria, resulting in over 23,000 deaths annually. Bacterial biofilms, one of the major causes of this resistance, form a complex extracellular matrix that physically block antibiotic treatment. Within planktonic bacteria, two proteins, MreB and ftsZ, play a key role in bacterial cell growth and development. MreB regulates this development through maintaining the rod-like shape of gram-negative bacteria, while ftsZ regulates the timing and location of cell division. The present study compared the effects of two protein-inhibitors on biofilm formation of E. coli; the inhibitors, A22 Hydrochloride and PC190723, inhibit MreB (cell shape) and ftsZ (cell division), respectively. Efficacy was measured with a crystal violet staining assay. Four experiments were designed testing 1) the minimum inhibitory concentration of the inhibitors, 2) the synergistic effect of the inhibitors, 3) the microscopic effects of the inhibitors, and 4) the effect of the inhibitors on antibiotic susceptibility. A mid-level dosage of A22 significantly decreased biofilm density while there was no response to PC190732. The effect of A22 was verified microscopically, observing the change from bacilli cells to coccoid ones via the inhibition of MreB. In the second experiment, with conjunct inhibition, no interaction was found. Lastly, A22 was as effective as Amoxicillin in disrupting biofilms. The inhibition of MreB was found to have a key role in biofilm development. A model is proposed for biofilm density based on cell shape as affected by MreB.ImportanceEach year, more than 2 million Americans acquire antibiotic-resistant infection and 23,000 of them die (CDC, 2013). In a study done by Barsoumian et. al (2015), there was a 16% mortality rate pertaining to biofilm-related infections while non-biofilm infection caused a 5% mortality rate. These casualties aren’t limited to the United States. Abroad, antibiotic resistance is a huge issue: 25,000 deaths estimated in the EU; 38,000 deaths in Thailand; and 58,000 deaths in India, among infants alone (CDC, 2012). It is these statistics that inform us that antibiotic resistance must be addressed.

scholarly journals Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and bla NDM-5 , Causing a Complicated Urinary Tract Infection in a Patient from the United States: TABLE 1 

mBio ◽  
2016 ◽  
Vol 7 (4) ◽  
Author(s):  
José R. Mediavilla ◽  
Amee Patrawalla ◽  
Liang Chen ◽  
Kalyan D. Chavda ◽  
Barun Mathema ◽  
...  
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Urinary Tract ◽  
The United States ◽  
Clinical Samples ◽  
Isolation And Identification ◽  
Gram Negative ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Tract Infections

ABSTRACT Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene bla NDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1 - and bla NDM-5 -harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized. IMPORTANCE Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1 , was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin ( mcr-1 ) and carbapenem ( bla NDM-5 ) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections. To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.

scholarly journals Importance of Susceptibility Rate of ‘the First’ Isolate: Evidence of Real-World Data

Medicina ◽  
2020 ◽  
Vol 56 (10) ◽  
pp. 507
Author(s):  
Sollip Kim ◽  
Soo Jin Yoo ◽  
Jeonghyun Chang
Keyword(s):  
Antimicrobial Therapy ◽  
Real World ◽  
Antimicrobial Agents ◽  
The United States ◽  
Gram Negative Bacteria ◽  
Real World Data ◽  
Gram Negative ◽  
World Data ◽  
E Coli ◽  
Hospital Infection Control

Background and objectives: For proper antimicrobial therapy, cumulative antibiograms should be representative of geographic region and be accurate. Clinical and Laboratory Standards Institute (CLSI) guidelines recommend that only the first isolates (FI) of a species per patient are used when reporting cumulative antibiograms. However, >50% of hospitals in the United States report antibiograms of all isolates. We compared antibiograms from the FI with those from total isolates (TI). Materials and Methods: Antimicrobial data of all isolates identified in the Microbiology unit of Ilsan Paik Hospital in 2019 were retrospectively acquired from the hospital information system. The susceptibility rates to antimicrobials of Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were analyzed by FI and TI, respectively. Isolate counts and susceptibility rates of each species for the reported antimicrobials were compared. Results: The numbers of isolates by FI/TI were as follows: 1824/2692 E. coli, 480/1611 A. baumannii, and 662/1306 K. pneumoniae, and 407/953 P. aeruginosa for gram-negative bacteria and 649/1364 S. aureus, 211/313 E. faecium, and 323/394 E. faecalis for gram-positive bacteria. All antimicrobial agents showed higher susceptibility rates when calculated as FI than as TI in gram-negative bacteria except colistin: 3.7% for E. coli, 14.5% for A. baumannii, 8.3% for K. pneumoniae, and 7.9% for P. aeruginosa. In S. aureus, 8/11 antimicrobial agents revealed higher susceptibility rates for FI than for TI. E. faecalis and E. faecium showed lower susceptibility rates for 7/10 antimicrobial agents for FI than for TI. The oxacillin susceptibility rates of S. aureus were 36.6%/30.2% with FI/TI and vancomycin susceptibility rates for E. faecium were 54.1% and 49.5%, respectively. Conclusions: When comparing cumulative antibiograms by FI with TI using real-world data, there is a large gap for critical species requiring hospital infection control. Although FI calculation is difficult, antibiograms must be calculated as FI for proper preemptive antimicrobial therapy because FI provides proper antimicrobial susceptibility data.

scholarly journals Exploration of the Pharmacokinetic-Pharmacodynamic Relationships for Fosfomycin Efficacy Using anIn VitroInfection Model

2015 ◽  
Vol 59 (12) ◽  
pp. 7170-7177 ◽  
Author(s):  
Brian D. VanScoy ◽  
Jennifer McCauley ◽  
Evelyn J. Ellis-Grosse ◽  
Olanrewaju O. Okusanya ◽  
Sujata M. Bhavnani ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Multidrug Resistant ◽  
Dose Fractionation ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Content Type ◽  
E Coli ◽  
Drug Concentrations ◽  
Tract Infections

ABSTRACTFosfomycin, a phosphonic class antibiotic with a broad spectrum of antibacterial activity, has been used outside the United States since the early 1970s for the treatment of a variety of infections. In the United States, an oral (tromethamine salt) formulation is used for uncomplicated urinary tract infections. Recently, there has been interest in the use of an intravenous solution (ZTI-01) for the treatment of a broad range of infections associated with multidrug-resistant bacteria. In this era of multidrug-resistant bacteria with few treatment options, it is critical to understand the pharmacokinetic-pharmacodynamic (PK-PD) determinants for fosfomycin efficacy. Since such data are limited, a one-compartmentin vitroinfection model was used to determine the PK-PD index associated with efficacy and the magnitude of this measure necessary for various levels of effect. One challenge isolate (Escherichia coliATCC 25922, for which the fosfomycin agar MIC is 0.5 mg/liter and the broth microdilution MIC is 1 mg/liter) was evaluated in the dose fractionation studies, and two additional clinicalE. coliisolates were evaluated in the dose-ranging studies. Mutation frequency studies indicated the presence of an inherently fosfomycin resistantE. colisubpopulation (agar MIC = 32 to 64 mg/liter) within the standard starting inoculum of a susceptibility test. Due to the presence of this resistant subpopulation, we identified the percentage of the dosing interval that drug concentrations were above the inherent resistance inhibitory concentration found at baseline to be the PK-PD index associated with efficacy (r2= 0.777). The magnitudes of this PK-PD index associated with net bacterial stasis and 1- and 2-log10CFU/ml reductions from baseline at 24 h were 11.9, 20.9, and 32.8, respectively. These data provide useful information for modernizing and optimizing ZTI-01 dosing regimens for further study.

scholarly journals Prevalence of blaCTX-M Genes in Gram-Negative Bloodstream Isolates across 66 Hospitals in the United States

2021 ◽  
Author(s):  
Pranita D. Tamma ◽  
Tiffeny T. Smith ◽  
Ayomikun Adebayo ◽  
Sara M. Karaba ◽  
Emily Jacobs ◽  
...  
Keyword(s):  
United States ◽  
Blood Culture ◽  
Bacterial Species ◽  
Klebsiella Oxytoca ◽  
The United States ◽  
Molecular Diagnostic ◽  
Gram Negative ◽  
E Coli ◽  
Carbapenemase Gene ◽  
Species Specific

Objective: Understanding bacterial species at highest risk for harboring blaCTX-M genes is necessary to guide antibiotic treatment. We identified the species-specific prevalence of blaCTX-M genes in clinical isolates from the United States. Methods: 24 microbiology laboratories representing 66 hospitals using the GenMark Dx ePlex® Blood Culture Identification Gram-Negative (BCID-GN) Panel extracted blood culture results from April 2019 to July 2020. The BCID-GN Panel includes 21 Gram-negative targets. Along with identifying blaCTX-M genes, it detects major carbapenemase gene families. Results: 4,209 Gram-negative blood cultures were included. blaCTX-M genes were identified in 462 (11%) specimens. The species-specific prevalence of blaCTX-M genes were as follows: Escherichia coli (16%), Klebsiella pneumoniae (14%), Klebsiella oxytoca (6%), Salmonella spp. (6%), Acinetobacter baumannii (5%), Enterobacter species (3%), Proteus mirabilis (2%), Serratia marcenscens (0.6%), and Pseudomonas aeruginosa (0.5%). blaCTX-M prevalence was 26%, 24%, and 22% among participating hospitals in the District of Columbia, New York, and Florida, respectively. Carbapenemase genes were identified in 61 (2%) organisms with the following distribution: blaKPC (59%), blaVIM (16%), blaOXA (10%), blaNDM (8%), and blaIMP (7%). The species-specific prevalence of carbapenemase genes were as follows: A. baumannii (5%), K. pneumoniae (3%), P. mirabilis (3%), Enterobacter species (3%), Citrobacter spp. (3%), P. aeruginosa (2%), E. coli (<1%), K. oxytoca (<1%), and S. marcescens (<1%). Conclusion: Approximately 11% of Gram-negative organisms in our US cohort contain blaCTX-M genes. blaCTX-M genes remain uncommon in organisms beyond E. coli, K. pneumoniae, and K. oxytoca. Future molecular diagnostic panels would benefit from the inclusion of plasmid-mediated ampC and SHV and TEM ESBL targets.

scholarly journals 1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Kendra Foster ◽  
Linnea A Polgreen ◽  
Brett Faine ◽  
Philip M Polgreen
Keyword(s):  
United States ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Proteus Mirabilis ◽  
Antibiotic Use ◽  
The United States ◽  
Drug Resistant ◽  
E Coli ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

scholarly journals Epidemiologic and Microbiologic Characteristics of 28 Hospitalized Patients Cocolonized With Multiple Carbapenem-Resistant Enterobacteriaceae (CRE) in the United States

2020 ◽  
Vol 41 (S1) ◽  
pp. s62-s62
Author(s):  
Timileyin Adediran ◽  
Anthony Harris ◽  
J. Kristie Johnson ◽  
David Calfee ◽  
Loren Miller ◽  
...  
Keyword(s):  
United States ◽  
Secondary Analysis ◽  
Positive Culture ◽  
The United States ◽  
Healthcare Personnel ◽  
Surveillance Culture ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Multicenter Prospective Cohort Study ◽  
Epidemiological Significance

Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.Funding: NoneDisclosures: None

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