The characteristics of antimicrobial resistance and treatment of carbapenem-resistant Enterobacteriaceae infections in children from 2013 to 2018 in a chinese tertiary hospital

Abstract Background The aim of this study was to performe a retrospective analysis of prevalence and treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections in children in a tertiary hospital. Methods The non-repeat clinical isolates of CRE in children were collected in Liaocheng People's Hospital from January, 2013 to December, 2018. The bacterial identification and antibiotic susceptibility was performed according to the standard methods. The isolated strains will be detected carbapenemases genotypes and homology analysis. All data on the culture-positive strains and associated clinical infection from different pediatric wards were reviewed. Results A total of 20 CRE strains isolated from pediatric patients, which derived from different infection sites and present a classification of multiple species of Enterobacteriaceae. And the production of IMP-type carbapenemase in these strains is the main reason of antimicrobial resistance. Most of the infected patients have severe comorbidities and invasive procedures, and use insensitive drugs due to the high resistance rates and medication restrictions. Nevertheless, most infected children have been treated despite the resistance of pathogens to multiple antimicrobial agents. In our follow-up survey, most children received adjuvant therapy such as human intravenous immunoglobulin, which may be an important factor in helping patients defeat pathogenic bacteria. Conclusions This study demonstrates a high prevalence of IMP-mediated CRE infection in pediatric patients with severe comorbidities and invasive procedures. Most children have been cured, which may be related to application of adjuvant therapy and weaker pathogenicity of the IMP-type Enterobacteriaceae.

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Phenotypic and Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae from Clinical Bacterial Isolates: A Multicenter Retrospective Chart Review Study in western of Saudi Arabia

10.21203/rs.3.rs-58646/v1 ◽

2020 ◽

Author(s):

Rbab Taha ◽

Abdulfattah W Alamri ◽

Areej H Mufti ◽

Abdulhakim Al thaqafi ◽

Asif Jiman Fatani Fatani ◽

...

Keyword(s):

Saudi Arabia ◽

Antimicrobial Resistance ◽

Chart Review ◽

Antimicrobial Agents ◽

Retrospective Chart Review ◽

Clinical Isolates ◽

Major Health Problem ◽

E Coli ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background: Carbapenemase-producing bacteria are a major health problem because of its limited treatment options. Carbapenem-Resistant Enterobacteriaceae (CRE) are non-susceptible to carbapenem, which serves as the most potent class of antimicrobial agents available for multidrug-resistant bacterial infections. The aim of our study was to determine the prevalence of CRE and determine the type of carbapenemase genes present among patients in tertiary care hospitals in Jeddah, Saudi Arabia.Methods: We performed a retrospective chart review on 180 patients in two sites. Primarily, we evaluated the prevalence of KPC, NDM, VIM, OXA-48, and IMP genes of CRE from clinical isolates tested by Xpert® Carba-R. Secondly, we assessed the prevalence of CRE based on antibiogram reports and described the susceptibility of CRE and the aforementioned CRE genes to antimicrobial agents.Results: CRE clinical isolates showed no occurrence of KPC, VIM, and IMP genes. OXA-48 gene was predominantly prevalent, with 76.1%, followed by NDM 13.9%, and both genes co-existed in 6.1% of the isolates. The CRE percent prevalence in one site in 2017 was 3.8%, and increased to 6.03% in 2018, whereas in the second site, the percentage was much higher, reaching 22.9% in 2018 and 18.9% in 2019. The CRE prevalence was dominated by Klebsiella pneumoniae (K. pne), occurring in 92.8% of the isolates, followed by E. coli in 6.7%. K. pne showed a higher frequency of OXA-48 (79%) than NDM (11.7%) genes, with a p-value of 0.007, while E. coli showed an equal frequency of both genes (41.7%). K. pne and E. coli showed high antimicrobial resistance to imipenem, meropenem, tazocin, and ciprofloxacin. However, they showed less resistance to amikacin, gentamycin, and tigecycline. NDM and OXA-48 genes showed 100% resistance to imipenem, meropenem, tazocin, ciprofloxacin and amikacin and the lowest resistance to gentamycin, tigecycline, and colistin.Conclusion: Over the two year retrospective study period, the CRE percent prevalence in the evaluated clinical isolates has remarkably increased. K. pne and E. coli were the most prevalent CRE organisms with OXA-48 and NDM as the predominant genes. CRE organisms and genes showed high antimicrobial resistance to imipenem, meropenem and tazocin, and lower resistance to gentamycin and tigecycline.

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Detection of antimicrobial resistance genes of carbapenem-resistant Enterobacteriaceae in Escherichia coli isolated from the water supply of smallholder dairy farms in Saraburi and Maha Sarakham, Thailand

International Journal of One Health ◽

10.14202/ijoh.2020.1-5 ◽

2020 ◽

Vol 6 (1) ◽

pp. 1-5

Author(s):

Natapol Pumipuntu ◽

Sangkom Pumipuntu

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Resistance Genes ◽

Water Samples ◽

Dairy Farms ◽

Drug Resistant ◽

E Coli ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae ◽

Smallholder Dairy Farms

Background and Aim: The problem of antimicrobial resistance of bacteria in both humans and animals is an important public health concern globally, which is likely to increase, including in Thailand, where carbapenem-resistant Enterobacteriaceae (CRE), such as Escherichia coli, are of particular concern. They are pathogens found in the gastrointestinal tract of humans and other animals as well as in the environment. They may cause opportunistic infection and are often resistant to antibiotics in various fields especially in animal husbandry, such as pets or livestock farms. This study aimed to investigate the occurrence of carbapenem-resistant E. coli from water samples of smallholder dairy farms in Saraburi and Maha Sarakham, Thailand. Materials and Methods: Sixty-four water samples were collected from 32 dairy farms in Kaeng Khoi district, Muak Lek district, and Wang Muang district of Saraburi Province, and Kantharawichai district and Mueang district of Maha Sarakham Province, Thailand. All samples were cultured and isolated for E. coli by biochemical tests. All E. coli isolates were tested for drug susceptibility using imipenem, meropenem, and drug resistance genes of carbapenemases such as blaNDM, blaIMP, and blaOXA48 of drug-resistant E. coli isolates detected by polymerase chain reaction (PCR) technique. Results: A total of 182 E. coli isolates were found (140 and 42 isolates from Saraburi and Maha Sarakham, respectively). Drug sensitivity tests found that two isolates of E. coli from water in Kaeng Khoi were resistant to imipenem; therefore, the incidence of E. coli resistance to carbapenem was 1.43% of Saraburi Province. On the other hand, there was no incidence of drug-resistant E. coli in Maha Sarakham. In addition, the detection of the drug-resistant gene of E. coli in both isolates by PCR showed the expression of blaNDM. Conclusion: This study reports E. coli resistance to antimicrobial drugs on livestock farms. It can be considered to be the first report of E. coli CRE detection in a dairy farm at Saraburi, which should be the subject of further extended study.

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Antimicrobial Activities of Extracts of Camellia sinensis (L.) O. Kuntze and Profile of Antimicrobial Agents Resistance for Carbapenem-Resistant Enterobacteriaceae

Biomedical Science Letters ◽

10.15616/bsl.2019.25.3.288 ◽

2019 ◽

Vol 25 (3) ◽

pp. 288-292

Author(s):

Jong Hwa Yum

Keyword(s):

Camellia Sinensis ◽

Antimicrobial Agents ◽

Antimicrobial Activities ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

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Treatment of Carbapenem-Resistant Enterobacteriaceae Infections with Ceftazidime-Avibactam

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.644 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S286-S286

Author(s):

Elham Rahmati ◽

Emily Blodget ◽

Rosemary C She ◽

Jennifer Cupo Abbott ◽

Robert A Bonomo ◽

...

Keyword(s):

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

Carbapenem Resistant Enterobacteriaceae

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2418. Management of Carbapenem-Resistant Enterobacteriaceae Infections in a Long-term Acute Care Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.2071 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S723-S723

Author(s):

Patience Dogho ◽

Nancy Osadiaye ◽

Osamuyimen Igbinosa

Keyword(s):

Acute Care ◽

Acute Care Hospital ◽

Care Hospital ◽

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

Carbapenem Resistant Enterobacteriaceae

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662. Recurrence of Infection and Emergence of Drug Resistance After Treatment with Meropenem/Vaborbactam Compared with Ceftazidime/Avibactam in Carbapenem-Resistant Enterobacteriaceae Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.730 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S303-S303 ◽

Cited By ~ 1

Author(s):

Renee Ackley ◽

Danya Roshdy ◽

Jacqueline Isip ◽

Sarah B, Minor ◽

Amanda L Elchynski ◽

...

Keyword(s):

Drug Resistance ◽

Combination Therapy ◽

Clinical Success ◽

Recurrent Infection ◽

Signs And Symptoms ◽

Development Of Resistance ◽

Carbapenem Resistant ◽

Enterobacteriaceae Infections ◽

Post Hoc ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background Options for treatment of carbapenem-resistant Enterobacteriaceae (CRE) infections were historically limited to antibiotics with limited efficacy and significant toxicities. Ceftazidime/avibactam (CA) and meropenem/vaborbactam (MV) are superior to older regimens; however, a direct comparison of the agents is lacking. This study compared clinical outcomes including recurrence of infection and emergence of drug resistance in patients who received CA vs. MV for CRE infections. Methods This was a multicenter, retrospective cohort study of adults with CRE infections who received CA or MV for ≥72 hours from February 2015 to October 2018. Patients with localized urinary tract infection were excluded. The primary endpoint was clinical success (30-day survival, resolution of signs and symptoms of infection, sterilization of blood cultures within 7 days in patients with bacteremia, absence of recurrent infection). Secondary endpoints included 30- and 90-day mortality, adverse events (AE), recurrent CRE infection within 90 days, and development of resistance in patients with recurrent infection. We conducted a post hoc subgroup analysis in patients with recurrence to compare development of resistance in those who received CA monotherapy, CA combination therapy, and MV monotherapy. Results 131 patients were included (CA: 105 patients, MV: 26 patients), 40% had bacteremia. No statistical difference in clinical success was observed between groups (62% vs. 69%, respectively, P = 0.49). Patients in the CA arm received combination therapy more often than patients in the MV arm (61% vs. 15%, P < 0.01). No difference in 30- and 90-day mortality resulted among groups, but numerically higher rates of AE were observed in the CA group (38% vs. 23%, P = 0.17). In patients with recurrent infection, development of resistance occurred more often with CA monotherapy, though not statistically significant (Table 1). One case of MV resistance was observed in a patient who had received 4 prior courses of MV, but this episode was outside of the study period. Conclusion Clinical success was similar between the groups despite MV being used more often as monotherapy. Development of resistance and rates of AE were higher in the CA group compared with MV therapy. Disclosures All authors: No reported disclosures.

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Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

Pathogens ◽

10.3390/pathogens9080667 ◽

2020 ◽

Vol 9 (8) ◽

pp. 667

Author(s):

Claire Hayward ◽

Kirstin E. Ross ◽

Melissa H. Brown ◽

Harriet Whiley

Keyword(s):

Antimicrobial Resistance ◽

Hot Spot ◽

Developed Countries ◽

Healthcare Associated Infections ◽

Carbapenem Resistant ◽

The Us ◽

Waterborne Infection ◽

Healthcare Associated ◽

Carbapenem Resistant Enterobacteriaceae

Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.

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