Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 17-21
Author(s):  
Lam Nguyen-Ho ◽  
Duong Hoang-Thai ◽  
Vu Le-Thuong ◽  
Ngoc Tran-Van
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Resistant Organism ◽  
Healthcare Associated Infection ◽  
Female Ratio ◽  
High Prevalence ◽  
Need To Evaluate ◽  
Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

scholarly journals Modeling Regional Transmission and Containment of a Healthcare-associated Multidrug-resistant Organism

2019 ◽  
Author(s):  
Prabasaj Paul ◽  
Rachel B Slayton ◽  
Alexander J Kallen ◽  
Maroya S Walters ◽  
John A Jernigan
Keyword(s):  
Multidrug Resistant ◽  
Resistant Organism ◽  
Healthcare Associated

scholarly journals High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An “Iceberg Effect”

2020 ◽  
Vol 21 (12) ◽  
pp. 1937-1943.e2
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Raveena D. Singh ◽  
Gabrielle Gussin ◽  
Ken Kleinman ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
High Prevalence

scholarly journals High Prevalence and Diversity of Cephalosporin-Resistant Enterobacteriaceae Including Extraintestinal Pathogenic E. coli CC648 Lineage in Rural and Urban Dogs in Northwest Spain

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 468 ◽  
Author(s):  
Fátima Abreu-Salinas ◽  
Dafne Díaz-Jiménez ◽  
Isidro García-Meniño ◽  
Pilar Lumbreras ◽  
Ana María López-Beceiro ◽  
...  
Keyword(s):  
High Risk ◽  
Antimicrobial Resistance ◽  
One Health ◽  
Potential Role ◽  
Multidrug Resistant ◽  
E Coli ◽  
Rural And Urban ◽  
High Prevalence ◽  
Healthy Dogs

The aim of this work was to assess the prevalence of extended spectrum-β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae in fecal samples recovered from rural and urban healthy dogs in Northwest Spain (Galicia) to identify potential high-risk clones and to molecularly characterize positive isolates regarding the genes coding for ESBL/pAmpC resistance and virulence. Thirty-five (19.6%) out of 179 dogs were positive for cephalosporin-resistant Enterobacteriaceae, including Escherichiacoli and Klebsiella pneumoniae (39 and three isolates, respectively). All the isolates were multidrug resistant, with high rates of resistance to different drugs, including ciprofloxacin (71.4%). A wide diversity of ESBL/pAmpC enzymes, as well as E. coli phylogroups (A, B1, C, D, E, F and clade I) were found. The eight isolates (20.5%) found to conform to the ExPEC status, belonged to clones O1:H45-clade I-ST770 (CH11-552), O18:H11-A-ST93-CC168 (CH11-neg), O23:H16-B1-ST453-CC86 (CH6-31), and O83:H42-F-ST1485-CC648 (CH231-58), with the latter also complying the uropathogenic (UPEC) status. The three K. pneumoniae recovered produced CTX-M-15 and belonged to the ST307, a clone previously reported in human clinical isolates. Our study highlights the potential role of both rural and urban dogs as a reservoir of high-risk Enterobacteriaceae clones, such as the CC648 of E. coli and antimicrobial resistance traits. Within a One-Health approach, their surveillance should be a priority in the fight against antimicrobial resistance.

A Statewide Approach to Coordinating Use of Healthcare-Associated Infection and Antimicrobial Resistance Prevention Funds

2018 ◽  
Vol 46 (6) ◽  
pp. S27
Author(s):  
Candi Shearen ◽  
Camella Rossiter ◽  
Sarah Brinkman ◽  
Susan Klammer ◽  
Janet Lilleberg ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

scholarly journals Swine Farming Is a Risk Factor for Infection With and High Prevalence of Carriage of Multidrug-Resistant Staphylococcus aureus

2015 ◽  
Vol 61 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Shylo E. Wardyn ◽  
Brett M. Forshey ◽  
Sarah A. Farina ◽  
Ashley E. Kates ◽  
Rajeshwari Nair ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Multidrug Resistant ◽  
High Prevalence

scholarly journals 156. How Does Exposure to C. Diffogenic Antibiotics Impact Multidrug-resistant Organism Colonization and Environment Contamination in Nursing Homes?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S207-S207
Author(s):  
Kyle J Gontjes ◽  
Kristen Gibson ◽  
Bonnie Lansing ◽  
Julia Mantey ◽  
Karen Jones ◽  
...  
Keyword(s):  
Risk Factor ◽  
Acute Care ◽  
Independent Risk Factor ◽  
Multivariable Analysis ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Antibiotic Exposure ◽  
Study Enrollment ◽  
Environment Contamination ◽  
Post Acute Care

Abstract Background Antimicrobial stewardship program (ASP) outcomes are often measured in the acute care setting, less is known about the effect of acute care antibiotic exposures on multidrug-resistant organism (MDROs) colonization of nursing home (NH) patients. We assessed exposure to antibiotics commonly associated with Clostridioides difficile (C. diffogenic agents) on post-acute care patient colonization and room environment contamination (Figure 1). Figure 1. Conceptual Diagram of Hospital Antibiotic Exposure’s Influence on Patient Colonization and Room Environment Contamination with Multidrug-Resistant Organisms Methods MDRO surveillance of post-acute care patients in 6 NHs between 2013–16. We screened patient hands, nares, oropharynx, groin, perianal area, and high-touch room environment surfaces for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and resistant Gram-negative bacilli (rGNB). C. diffogenic agents were defined as fluoroquinolones, 3rd/4th generation cephalosporins, penicillin combinations, lincosamides, and carbapenems. Multivariable logistic regression was used to assess whether hospital antibiotic exposure is an independent risk factor for MDRO colonization and room environment contamination on study enrollment. Results We enrolled 618 patients: average age was 74.4 years; 57.4% female; 62.3% white; 9.9% had indwelling devices (Table 1). Three hundred-fifty patients (56.6%) were MDRO colonized on enrollment: 98 (15.9%), MRSA; 208 (33.7%); VRE; 196 (31.7%), rGNB. Sixty-eight percent of patient rooms were MDRO contaminated: 166 (26.9%), MRSA; 293, (47.4%). VRE; 182 (29.5%), rGNB. A majority (59.4%) of patients were exposed to an antibiotic before admission. Of which, 239 (65.1%) were exposed to a C. diffogenic antibiotic. In multivariable analysis, C. diffogenic antibiotic exposure was an independent risk factor for MDRO colonization (OR, 1.94; 95% CI, 1.35–2.79), MDRO room environment contamination (OR, 1.94; 95% CI, 1.43–2.63), VRE colonization (OR, 4.23; 95% CI, 2.59–6.90), and VRE room environment contamination (OR, 2.58; 95% CI, 2.00–3.33). Table 1. Clinical Characteristics and MDRO Burden on Study Enrollment, Stratified by Hospital Antibiotic Exposure Status Multivariable Analysis of Hospital Antibiotic Exposure Status as Risk Factor for Proximal and Distal MDRO Outcomes Conclusion Hospital exposure to antibiotics is associated with an increased risk of VRE colonization and room environment contamination on NH study enrollment. These observations highlight the potential influence of hospital-based ASPs on MDRO prevalence and transmission in NHs. Disclosures All Authors: No reported disclosures

scholarly journals 699. Relationship Between Klebsiella pneumoniae Antimicrobial Resistance and Biofilm Formation

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S252-S252
Author(s):  
Jaclyn Cusumano ◽  
Kathryn Daffinee ◽  
Megan Luther ◽  
Vrishali Lopes ◽  
Aisling Caffrey ◽  
...  
Keyword(s):  
Protein Synthesis ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Rhode Island ◽  
Biofilm Formation ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Protein Synthesis Inhibitors ◽  
Carbapenem Resistant ◽  
Research Grant

Abstract Background Klebsiella pneumoniae is a frequently multidrug-resistant organism with a high propensity to form biofilm. K. pneumoniae is the most common carbapenem-resistant Enterobacteriaceae (CRE), and labeled an urgent threat by the CDC. The relationship between K. pneumoniae biofilm formation and specific antimicrobial resistance patterns has not been well defined. Methods K. pneumoniae isolates (n = 139) were evaluated for antimicrobial resistance and biofilm formation (CDC, Providence VA Med. Ctr., Rhode Island Hosp., BEI, and ATCC). Susceptibility was based predominantly on 2017 CLSI (Clinical and Laboratory Standards Institute) breakpoints. Isolates were categorized as multidrug-resistant (MDR: resistant to ≥ 1 antimicrobial in ≥ 3 out of 16 antimicrobial categories) or extensively drug-resistant (XDR: resistant to ≥ 1 antimicrobial in all but ≤ 2 out of 16 antimicrobial categories) based on expert consensus criteria for Enterobacteriaceae (European CDC (ECDC)/CDC, 2012). We collapsed antimicrobial categories described by the ECDC/CDC consensus group into nine categories: penicillins, cephalosporins, monobactam, carbapenems, protein synthesis inhibitors, fluoroquinolones, folate pathway inhibitors, fosfomycin, and colistin. Biofilm formation was assessed using a modified crystal violet method (OD570) and defined by tertile cut-points. Antimicrobial resistance was compared for weak (n = 47) vs. strong (n = 46) biofilm formation by chi-square or Fisher’s exact test. Predictors of strong biofilm formation were identified using logistic regression. Results MDR isolates were more common among weak (n = 46/47, 97.9%) vs. strong biofilm formers (n = 35/46, 76.1%; P = 0.002), whereas XDR was similar between groups (n = 12/47, 25.5% vs. n = 13/46, 28.3% P = 0.77). Resistance to penicillins, cephalosporins, monobactams, carbapenems, protein synthesis, or fluoroquinolones was more common among weak biofilm formers (P < 0.05). Carbapenem resistance was inversely associated with strong biofilm formation (odds ratio 0.09; 95% confidence interval 0.02–0.33). Conclusion Carbapenem-resistant K. pneumoniae was 91% less likely to form strong biofilm. Potential trade-off mechanisms between antimicrobial resistance and biofilm formation require further exploration. Disclosures A. Caffrey, Merck: Grant Investigator, Research grant. The Medicine’s Company: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. K. LaPlante, Merck: Grant Investigator, Research grant. Pfizer Pharmaceuticals: Grant Investigator, Research grant. Allergan: Scientific Advisor, Honorarium. Ocean Spray Cranberries, Inc.: Grant Investigator and Scientific Advisor, Honorarium and Research grant. Achaogen, Inc.: Scientific Advisor, Honorarium. Zavante Therapeutics, Inc.: Scientific Advisor, Honorarium.

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