scholarly journals Antimicrobial resistance and epidemiology of ESBLs-producing Escherichia coli and Enterobacter cloacae isolates from the intensive care unit in an affiliated hospital of University, China

2020 ◽  
Author(s):  
Kun Chen ◽  
Guoliang Yang ◽  
Wenping Li ◽  
Mingcheng Li

Abstract Background:Concerns are increasing over the importance of the hospital intensive care units (ICU) for the transmission of extended spectrum-β-lactamase (ESBLs) -producing Enterobacteriaceae. We reported the clinical characteristics and epidemiology of ESBLs isolates collected from a tertiary care hospital in China. Methods:Escherichia coli(E. coli)and Enterobacter cloacae (E. cloacae)isolates from ICU infection samples were isolated and identified. Antimicrobial susceptibility profiles and production of ESBLs were determined by using the disk diffusion method and the broth microdilution method. Clonality of isolates was determined by ERIC-PCR techniques. Results:From the included the 223 strains isolated from hospitalized patients with nosocomial infections in ICU during 2016 to 2018, the majority of isolates belonged to Gram-negative Enerobacteriaceae including E. coli (46.6% of all strains), and E. cloacae (46.2% of all strains). 63.25% of samples were separated from sputum or tracheal secretions. All of 207 isolates, ESBL-screen positive E. coli was 45.2% (47/104), and 44.7% (46/103) for E. cloacae. Resistance rates of ESBLs-producing E. coli and E. cloacae isolates were 95.5%-91.3% for ampicillin, 80.6%-76.1% for ampicillin/azobactam, 88.1%-28.3% for ciprofloxacin, 89.6%-15.2% for levofloxacin, 34.3%-45.7% for netilmicin, 82.1%-41.3% for compound sulfamethoxazole, 20.9%-43.5% for amikacin, 58.2%-37.0% for gentamicin, 20.9%-69.6% for piperacillin/tazobactam. All of ESBLs-producer isolates resistant to cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime in additon to aztreonam were 100%, whereas the susceptibilities of isolates to imipenem and meropenem were 100%. Results of ERIC-PCR in all of ESBLs-producing E. coli isolates exhibited 11 distinct patterns using a similarity coefficient of 0.8. And one distinct ERIC profiles were observed amongst 46 strains of ESBLs-producing E. cloacae. ERIC profiles demonstrated an outbreak of nosocomial infection and ESBLs-producing E. coli and E. cloacae prevalent in the ICU of this hospital.Conclusions:Our data indicate that the ESBLs-producing E. coli and E. cloacae clones are circulating in the ICU and constitute a major source for further disseminating in this hospital. It is necessary to increase surveillance and development of adequate prevention strategies.

2014 ◽  
Vol 8 (05) ◽  
pp. 597-604 ◽  
Author(s):  
Seniha Senbayrak Akcay ◽  
Asuman Inan ◽  
Simin Cevan ◽  
Ayse Nilufer Ozaydın ◽  
Naz Cobanoglu ◽  
...  

Introduction: This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients. Methodology: A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing. Results: The most frequently isolated organisms were A. baumannii (37.3%), P. aeruginosa (30.3%), Enterobacter spp. (10.4%), E. coli (10.4%), and Klebsiella spp. (8.9%). A. baumannii was the most frequently isolated organism from the respiratory tract (43.4%); the susceptibility rates for imipenem and meropenem decreased to 7% and 6% (p < 0.0001), respectively. The percentage of multidrug-resistant (MDR) A. baumannii isolates continuously increased from 18.7% in 2004 to 69% in 2011 (p < 0.0001), whereas MDR P. aeruginosa isolates increased from 1.5% to 22% (p < 0.0001). Carbapenem-resistant Klebsiella isolates emerged in 2010 and increased to 20% in the next year. The rates of ESBL-producing Enterobacteriaceae in the ICU was very high in 2011 – 50% for E. coli and 80% for Klebsiella strains. Conclusion: The most common isolated Gram-negative bacillus in our study was A. baumannii and that the prevalence of MDR isolates has increased markedly over. Accordingly, the comparison of antibiotic resistance of other pathogens in 2004 and 2011 displayed an increasing trend. These data imply the urgent need for new and effective strategies in our hospital and in the region.


2020 ◽  
Vol 75 (12) ◽  
pp. 3563-3567 ◽  
Author(s):  
Sachin S Bhagwat ◽  
Periasamy Hariharan ◽  
Prashant R Joshi ◽  
Snehal R Palwe ◽  
Rahul Shrivastava ◽  
...  

Abstract Background Recent reports reveal the emergence of Escherichia coli isolates harbouring a novel resistance mechanism based on four-amino-acid inserts in PBP3. These organisms concomitantly expressed ESBLs or/and serine-/metallo-carbapenemases and were phenotypically detected by elevated aztreonam/avibactam MICs. Objectives The in vitro activities of the investigational antibiotic cefepime/zidebactam and approved antibiotics (ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/relebactam and others) were determined against E. coli isolates harbouring four-amino-acid inserts in PBP3. Methods Whole-genome sequenced E. coli isolates (n = 89) collected from a large tertiary care hospital in Southern India (n = 64) and from 12 tertiary care hospitals located across India (n = 25) during 2016–18, showing aztreonam/avibactam MICs ≥1 mg/L (≥4 times the aztreonam epidemiological cut-off) were included in this study. The MICs of antibiotics were determined using the reference broth microdilution method. Results Four-amino-acid inserts [YRIK (n = 30) and YRIN (n = 53)] were found in 83/89 isolates. Among 83 isolates, 65 carried carbapenemase genes [blaNDM (n = 39), blaOXA-48-like (n = 11) and blaNDM + blaOXA-48-like (n = 15)] and 18 isolates produced ESBLs/class C β-lactamases only. At least 16 unique STs were noted. Cefepime/zidebactam demonstrated potent activity, with all isolates inhibited at ≤1 mg/L. Comparator antibiotics including ceftazidime/avibactam and imipenem/relebactam showed limited activities. Conclusions E. coli isolates concurrently harbouring four-amino-acid inserts in PBP3 and NDM are an emerging therapeutic challenge. Assisted by the PBP2-binding action of zidebactam, the cefepime/zidebactam combination overcomes both target modification (PBP3 insert)- and carbapenemase (NDM)-mediated resistance mechanisms in E. coli.


2020 ◽  
Vol 6 (2) ◽  
pp. 147-152
Author(s):  
Ebuka Elijah David ◽  
Muhammad Arfat Yameen ◽  
Ikechuku Okorie Igwenyi ◽  
Arthur Chinedu Okafor ◽  
Uket Nta Obeten ◽  
...  

Aim: This study was aimed to determine the virulent genes and antibiotic resistance patterns among circulating diarrheagenic Escherichia coli (DEC) pathotypes in a tertiary care health center in east of Nigeria. Materials and Methods: Diarrheal stool samples were obtained from 80 children under 5 years and E. coli was isolated and identified using standard biochemical and molecular methods. Multiplex polymerase chain reaction (PCR) was used to detect eight virulent genes of DEC. Disk diffusion method was used to determine the antibiotic susceptibility of DEC. Results: DEC infection was observed in 54 (68%) children among which ial gene for enteroinvasive E. coli (EIEC) (40% [n=22]) was commonly detected followed by eltA/eltB for enterotoxigenic E. coli (ETEC) (30% [n=16]), pCVD for enteroaggregative E. coli (EAEC) (20% [n=11]), and eaeA/bfpA for typical enteropathogenic E. coli (EPEC) (10% [n=5]). The DEC isolates phenotypically exhibited resistance for ampicillin (AMP) (44 [81%]), followed by ciprofloxacin (CIP)/ levofloxacin (LEV) (28 [52%]), cefoxitin (FOX) (11 [20%]), and amoxicillin-clavulanic acid (AMC) (6 [11%]). About 60% isolates of stable toxins-ETEC were resistant to AMC, CIP, and LEV while all the labile toxin-ETEC exhibited resistance to AMP. About 60% (n=6) resistance were seen in EAEC against ampicillin, AMC, FOX, CIP, and LEV. In EIEC, all the isolates (n=22) were resistant to AMP while 50% (n=11) were resistant to both CIP and LEV. All EPEC (n=5) were resistant to AMP, FOX, CIP, and LEV. Conclusion: High frequency of virulent ial and eltA/eltB genes for EIEC and ETEC, respectively, suggests that they are the primary etiological agents of diarrhea in children among DEC pathotypes. Resistance of DEC to more than two classes of antibiotics indicate possible emergence of multidrug resistance.


2010 ◽  
Vol 4 (08) ◽  
pp. 517-520 ◽  
Author(s):  
Juhi Taneja ◽  
Bibhabati Mishra ◽  
Archana Thakur ◽  
Vinita Dogra ◽  
Poonam Loomba

Background: Nosocomial septicemia due to extended spectrum beta-(β)-lactamase (ESBL) producing Klebsiella pneumoniae and Escherichia coli are a therapeutic challenge due to resistance. Knowledge of disease burden and resistance patterns is required for proper and timely management. We report the prevalence and antimicrobial susceptibility of ESBL producing E. coli and K .pneumoniae from septicemia at a tertiary care hospital. Methodology: A total of 2,870 blood samples of suspected cases of septicemia were studied between January and December 2009. Antimicrobial susceptibility was determined by Kirby Bauer's disc diffusion method and MICs for imipenem, meropenem, and ertapenem were determined using the E-test. All isolates of E. coli and K. pneumoniae were tested for ESBL production by E-test method. Results: Forty-one (70.7%) K. pneumoniae isolates and ten (41.7%)  E. coli isolates were ESBL producers. Two (5%) of ESBL producing K. pneumoniae isolates, but no E. coli isolates, were resistant to carbapenems. In vitro, all ESBL producers were sensitive to tigecycline. Conclusion: Our data indicated that the prevalence of ESBL-producing E. coli and K. pneumonia strains isolated from blood cultures from hospitalized patients is high. ESBL-producing organisms were found to be more susceptible to meropenem than to imipenem and ertapenem. Tigecycline is active against all the ESBL or multidrug resistant (MDR) E. coli and Klebsiella spp. isolates.


2019 ◽  
Vol 6 ◽  
pp. 76-81
Author(s):  
Manita Tumbahangphe ◽  
Bijay Kumar Shrestha ◽  
Jenish Shakya ◽  
Hemanta Khanal

Objectives: The main objective of this study was to determine the prevalence of Escherichia coli among urinary tract infection (UTI) suspected patients visiting tertiary care hospital and to assess the biofilm producing ability of E. coli isolates. Methods: A prospective cross-sectional study was carried out in Biratnagar Metropolitan city, Eastern Nepal from December 2018 to May 2019. During the study 400 urine samples were collected from UTI suspected patients visiting a tertiary care hospital of Biratnagar. Urine samples were cultured by using semi-quantitative culture technique and identified. Antibiotic susceptibility testing was done by Kirby-Bauer Disk Diffusion method according to CLSI (2011) guidelines. Biofilm assays were performed by microtitre plate method. Results: This study reported 15% prevalence of E. coli out of 400 urine samples. 100% of E. coli isolates showed resistance to both Ampicillin and Amoxicillin while 100% were sensitive to Chloramphenicol. 70% (42/60) isolates were Multi Drug Resistance (MDR)E. coli. The maximum isolates (86.66%) were found to be biofilm producers by microtitre plate method. Resistance to other antibiotics such as Nalidixic acid (71.11% vs 46.66%), Norfloxacin (53.33% vs 46.66%), Cotrimoxazole (42.22% vs 26.66%) was comparatively higher among biofilm producers than non-biofilm producers. There was a significance of association between biofilm and MDR (p<0.05). Conclusion: There is relation between the ability of biofilm formation and drug resistance in the bacterium resulting to the failure of antibacterial drugs.


2020 ◽  
Vol 20 (25) ◽  
pp. 2300-2307
Author(s):  
Felipe Lemos Esteves do Amaral ◽  
Ticiane Costa Farias ◽  
Raquel Carlos de Brito ◽  
Thamara Rodrigues de Melo ◽  
Paula Benvindo Ferreira ◽  
...  

Background: The increasing and inappropriate use of antibiotics has increased the number of multidrug-resistant microorganisms to these drugs, causing the emergence of infections that are difficult to control and manage by health professionals. As an alternative to combat these pathogens, some monoterpenes have harmful effects on the bacterial cell membrane, showing themselves as an alternative in combating microorganisms. Therefore, the positive enantiomer α -pinene becomes an alternative to fight bacteria, since it was able to inhibit the growth of the species Escherichia coli ATCC 25922, demonstrating the possibility of its use as an isolated antimicrobial or associated with other drugs. Aims: The aim of this study is to evaluate the sensitivity profile of E. coli ATCC 25922 strain against clinical antimicrobials associated with (+) -α-pinene and how it behaves after successive exposures to subinhibitory concentrations of the phytochemicals. Methods: : The minimum inhibitory concentration (MIC) was determined using the microdilution method. The study of the modulating effect of (+) -α-pinene on the activity of antibiotics for clinical use in strains of E. coli and the analysis of the strain's adaptation to the monoterpene were tested using the adapted disk-diffusion method. Results: The results demonstrate that the association of monoterpene with the antimicrobials ceftazidime, amoxicillin, cefepime, cefoxitin and amikacin is positive since it leads to the potentiation of the antibiotic effect of these compounds. It was observed that the monoterpene was able to induce crossresistance only for antimicrobials: cefuroxime, ceftazidime, cefepime and chloramphenicol. Conclusion: It is necessary to obtain more concrete data for the safe use of these combinations, paying attention to the existence of some type of existing toxicity reaction related to the herbal medicine and to understand the resistance mechanisms acquired by the microorganism.


KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 681-686
Author(s):  
Md Shakhaowat Hossain ◽  
Rehana Khatun ◽  
Mohammed Solayman ◽  
Babul Aktar ◽  
Abdullah Akhtar Ahmed

Infections due to multidrug resistant E.coli range from uncomplicated urinary tract infections to life-threatening sepsis. A retrospective study was conducted to determine the patterns of antimicrobial susceptibility in 173 (12.84%) Escherichia coli strains isolated from 1347 clinical specimens of different types. Isolation and identification of E.coli were done as per routine laboratory protocol directed by Cheesbrough1. The isolation rate of E.coli was 48.57% in stool followed by 17.68% in urine, 25% in wound swabs, and 15.38% in tracheal aspirate etc. Among the 173 isolates 102 (59%) were from males and 71 (41%) were from females. Patients were classified into five age groups: 0-15, 16-30, 31-45, 46-60 and >60 years. E.coli was found highest number in females (13.9%) of age range 31-45 years and in males (22%) belonged to age group of over 60 years. Antimicrobial susceptibility testing by the disk diffusion method was conducted for 22 different antibiotics. The majority of isolated E.coli were highly sensitive to Imipenem (98.18%), Meropenem (97.37%), Amikacin (91.67%), Amoxiclav (80%), Ceftazidime (73.33%), and Gentamycin (71.76%). The antibiotics Tobramycin and Azithromycin were found as moderately sensitive against E.coli with the susceptibility rate of 52.5% and 50% respectively. The isolates show low degree of susceptibility to Penicillin G (9.52%), Carbenicillin (10%), Erythromycin (19.48%), Amoxycillin (19.59%), and Ampicillin (25%). These findings have clinical and epidemiological significance and provide a benchmark for future studies on the pattern of susceptibility of clinical isolates of E.coli in this region as well as may help the clinician to prescribe the right empirical treatment.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 681-686


2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Mildred Azucena Rivera-Galindo ◽  
Gauddy Lizeth Manzanares-Leal ◽  
Luz Marcela Caro-Gonzalez ◽  
Erika Santos-Ramirez ◽  
Hugo Mendieta-Zeron ◽  
...  

Background: Gram-negative bacilli are primarily responsible for the most common pediatric infections. Frequently, Escherichia fergusonii is identified as E. coli because of its close genetic proximity. Objectives: We aimed at the isolation and identification of multi-resistant strains of E. fergusonii, affecting children under two months of age. Methods: Strains were isolated from infectious processes and were identified phenotypically and molecularly. The microdilution method (MicroScan, autoSCAN-4) and the disk diffusion method (modified Kirby Bauer) were used to analyze antibiotic susceptibility. Results: Strains isolated were multi-resistant. Molecular identification provided the correct taxonomic assignment. Escherichia fergusonii strains were wrongly identified as E. coli with the phenotypic identification method. In addition, Pseudomonas aeruginosa and Klebsiella pneumoniae were identified. The best sensitivity results were obtained with Ceftazidime/avibactam and ceftolozane/tazobactam. Conclusions: We provided the first report of isolation and identification of multi-resistant E. fergusonii strains affecting children under two months of age in a neonatal intensive care unit.


Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mahoko Ikeda ◽  
Tatsuya Kobayashi ◽  
Fumie Fujimoto ◽  
Yuta Okada ◽  
Yoshimi Higurashi ◽  
...  

Abstract Background Although Escherichia coli is the most frequently isolated microorganism in acute biliary tract infections with bacteremia, data regarding its virulence are limited. Results Information on cases of bacteremia in acute biliary tract infection in a retrospective study was collected from 2013 to 2015 at a tertiary care hospital in Japan. Factors related to the severity of infection were investigated, including patient background, phylogenetic typing, and virulence factors of E. coli, such as adhesion, invasion, toxins, and iron acquisition. In total, 72 E. coli strains were identified in 71 cases, most of which primarily belonged to the B2 phylogroup (68.1%). The presence of the iutA gene (77.3% in the non-severe group, 46.4% in the severe group, P = 0.011) and the ibeA gene (9.1% in the non-severe group, and 35.7% in the severe group, P = 0.012) was significantly associated with the severity of infection. Among the patient characteristics, diabetes mellitus with organ involvement and alkaline phosphatase were different in the severe and non-severe groups. Conclusions We showed that bacteremic E. coli strains from acute biliary tract infections belonged to the virulent (B2) phylogroup. The prevalence of the iutA and ibeA genes between the two groups of bacteremia severity was significantly different.


2021 ◽  
Vol 9 (2) ◽  
pp. 326
Author(s):  
Frederick Adzitey ◽  
Nurul Huda ◽  
Amir Husni Mohd Shariff

Meat is an important food source that can provide a significant amount of protein for human development. The occurrence of bacteria that are resistant to antimicrobials in meat poses a public health risk. This study evaluated the occurrence and antimicrobial resistance of E. coli (Escherichia coli) isolated from raw meats, ready-to-eat (RTE) meats and their related samples in Ghana. E. coli was isolated using the USA-FDA Bacteriological Analytical Manual and phenotypic antimicrobial susceptibility test was performed by the disk diffusion method. Of the 200 examined meats and their related samples, 38% were positive for E. coli. Notably, E. coli was highest in raw beef (80%) and lowest in RTE pork (0%). The 45 E. coli isolates were resistant ≥ 50% to amoxicillin, trimethoprim and tetracycline. They were susceptible to azithromycin (87.1%), chloramphenicol (81.3%), imipenem (74.8%), gentamicin (72.0%) and ciprofloxacin (69.5%). A relatively high intermediate resistance of 33.0% was observed for ceftriaxone. E. coli from raw meats, RTE meats, hands of meat sellers and working tools showed some differences and similarities in their phenotypic antimicrobial resistance patterns. Half (51.1%) of the E. coli isolates exhibited multidrug resistance. The E. coli isolates showed twenty-two different resistant patterns, with a multiple antibiotic resistance index of 0.0 to 0.7. The resistant pattern amoxicillin (A, n = 6 isolates) and amoxicillin-trimethoprim (A-TM, n = 6 isolates) were the most common. This study documents that raw meats, RTE meats and their related samples in Ghana are potential sources of antimicrobial-resistant E. coli and pose a risk for the transfer of resistant bacteria to the food chain, environment and humans.


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