scholarly journals Genomic Epidemiology of Colistin-resistant Enterobacterales from Dutch Patients: A Prospective Matched Case-control Study

2021 ◽  
Author(s):  
Karuna Vendrik ◽  
Angela de Haan ◽  
Sandra Witteveen ◽  
Antoni Hendrickx ◽  
Daan Notermans ◽  
...  
Keyword(s):  
Case Control Study ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Case Control ◽  
Colistin Resistance ◽  
Genomic Epidemiology ◽  
Confirmatory Tests ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Abstract Colistin is a last-resort treatment option for infections with multidrug-resistant Gram-negative bacteria. However, colistin resistance is increasing. A six-month prospective matched case-control study was performed in which 22 Dutch laboratories with 32 associated hospitals participated. Laboratories were invited to send a maximum of five colistin-resistant Escherichia coli or Klebsiella pneumoniae (COLR-EK) isolates and five colistin-susceptible isolates (COLS-EK), matched on patient location, material of origin and bacterial species. After confirmatory tests, 72 COLR-EK/COLS-EK pairs (75% E. coli and 25% K. pneumoniae) were included. Twenty-one percent of COLR-EK patients had received colistin, in contrast to 3% of COLS-EK patients (OR>2.9). Of COLR-EK isolates, five contained mcr-1 and two mcr-9. One isolate lost mcr-9 after repeated sub-culturing, but retained colistin resistance. Among 46 sequenced COLR-EK isolates, genetic diversity was large and 19 (41.3%) isolates had chromosomal mutations potentially associated with colistin resistance. In conclusion, colistin resistance is not rare in the Netherlands and caused by the mcr gene in a minority of COLR-EK isolates.

scholarly journals Risk factors for colistin-resistant Enterobacteriaceae in a low-endemicity setting for carbapenem resistance – a matched case–control study

2018 ◽  
Vol 23 (30) ◽  
Author(s):  
Andrea C Büchler ◽  
Christian Gehringer ◽  
Andreas F Widmer ◽  
Adrian Egli ◽  
Sarah Tschudin-Sutter
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Carbapenem Resistance ◽  
Case Control ◽  
Prior Exposure ◽  
Colistin Resistance ◽  
E Coli ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Background Emergence of colistin resistance has been related to increased use in clinical settings, following global spread of carbapenem-resistant Gram-negative bacteria. Use of colistin in animal production may constitute a further source of spread of resistant strains to humans. We sought to determine risk factors for human colonisation or infection with colistin-resistant Escherichia coli and Klebsiella pneumoniae in a setting where colistin is mainly used for animal production. Methods: This retrospective matched case–control study was performed during a 5-year period at two university-affiliated hospitals in Basel, Switzerland. Conditional univariable logistic regression was used to calculate odds ratios (OR) for colistin resistance. All variables found to be significant in univariable analyses were included in the conditional multivariable regression model using stepwise forward and backward selection. Results: Forty-two cases (33 with colistin-resistant E. coli, 9 with colistin-resistant K. pneumoniae) and 126 matched controls were identified. Baseline characteristics, comorbidities, prior exposure to antibiotics and healthcare settings did not differ between cases and controls, except for prior exposure to carbapenems, hospitalisation and stay abroad during the prior 3 months. In multivariable analyses, only prior exposure to carbapenems remained associated with colistin resistance (OR: 5.00; 95% confidence interval (95% CI): 1.19–20.92; p = 0.028). Conclusion: In a low-endemicity setting for carbapenem resistance, prior exposure to carbapenems was the only risk factor for colonisation or infection with colistin-resistant E. coli or K. pneumoniae. Prior exposure to colistin was not significantly associated with detection of colistin resistance, which mainly occurred in the absence of concurrent carbapenem resistance.

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