scholarly journals Microbiological profile and antibiotic susceptibility pattern in Blood stream infections in patients with Acute Cholangitis: A prospective observational study

2020 ◽  
Vol 8 (2) ◽  
pp. 68-75
Author(s):  
Khan Md Nazmus Saqeb
Keyword(s):  
Risk Factors ◽  
Antibiotic Resistance ◽  
Nosocomial Infection ◽  
Acute Cholangitis ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Antibiotic Susceptibility Pattern ◽  
Factors Associated ◽  
Source Of Infection

Background: I analyzed the organisms isolated from the blood of patients with acute cholangitis and determined their antibiotic resistance characteristics. In addition, I evaluated risk factors associated with antibiotic-resistant bacteria and their impact on clinical outcomes. Methods: 113 consecutive cases of acute cholangitis who met the diagnostic criteria were included in the study. Acute cholangitis was defined by TG18 criteria. Blood culture was obtained from every patient. The microbiological results of blood cultures & the antibiotic susceptibility pattern of the organisms were analyzed by SPSSv22.0. Multivariate analysis was performed to identify risk factors associated with antibiotic resistance & mortality. Result: Among 113 patients, 71(62.8%) were male & the median age was 51 years. Choledocholithiasis was the most common underlying biliary disease followed by malignant and benign strictures. Severe cholangitis occurred in 17(15%) cases. 32(28.3%) cases had nosocomial infection. Causative organisms were isolated from 55(48.7%) of 113 blood cultures. Escherichia coli was the most common bacterium isolated (36.36%) from blood, followed by Klebsiella pneumoniae (23.64%), Pseudomonas aeruginosa (7.27%) & Enterococcus (7.27%). Anaerobic bacteria were isolated from 5(9.09%) specimens. Multiple organisms were isolated in 6(10.91%) specimens. Most organisms were susceptible to meropenem (86.7%), imipenem (83.1%), colistin (89.1%), amikacin (76.1%), piperacillin-tazobactam (79.6%) & polymyxin-B (83.3%). Multidrug resistant bacteria comprised 30.91% of blood isolates. Risk factors associated with antibiotic resistance were presence of an indwelling biliary device (OR:7.7), prior biliary intervention (OR:6.167) and a nosocomial source of infection (OR:9.09). Thirteen (11.5%) patients died from acute cholangitis. Risk factors associated with mortality were severe cholangitis (OR:6.9), malignant biliary obstruction (OR:8.4), nosocomial infection (OR:7.5) and isolation of multidrug resistant organisms in blood (OR:6.9). Conclusion: E. coli was the most common organism isolated, followed by Klebsiella, Pseudomonas & Enterococcus. Colistin, meropenem, polymyxin-B, imipenem, amikacin & piperacillin-tazobactam were the most effective of all antibiotics. Risk factors associated with isolation of multidrug resistant bacteria from blood were presence of an indwelling biliary device, prior biliary intervention and a nosocomial source of infection. Risk factors associated with mortality were severe cholangitis, malignant biliary obstruction, nosocomial infection and isolation of multidrug resistant organisms in blood. Bangladesh Crit Care J September 2020; 8(2): 68-75

scholarly journals Evolution under low antibiotic concentrations: a risk for the selection of Pseudomonas aeruginosa multidrug resistant mutants in nature

2021 ◽  
Author(s):  
Fernando Sanz-García ◽  
Sara Hernando-Amado ◽  
José Luis Martínez
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antibiotic Resistance ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Published Data ◽  
Natural Ecosystems ◽  
Clinical Value ◽  
Drug Concentrations ◽  
Resistant Mutants

ABSTRACTBACKGROUNDAntibiotic pollution of non-clinical environments might have a relevant impact on human health if resistant pathogens are selected. However, this potential risk is often overlooked, since drug concentrations in nature are usually below their minimal inhibitory concentrations (MICs). Albeit, antibiotic resistant bacteria can be selected even at sub-MIC concentrations, in a range that is dubbed the sub-MIC selective window, which depends on both the antibiotic and the pathogen.OBJECTIVESDetermine the sub-MIC selective windows of seven antibiotics of clinical relevance in the opportunistic pathogen Pseudomonas aeruginosa and evaluate the risk for selecting resistant mutants in nature, based on published data about the amount of antimicrobials detected in natural environments.METHODSWe conducted evolution experiments of P. aeruginosa PA14 in presence of sub-MIC concentrations of ceftazidime, amikacin, levofloxacin, ciprofloxacin, tetracycline, polymyxin B or imipenem, and measured drug susceptibility of the evolved populations.RESULTSSub-MIC selective window of quinolones was the largest, and the ones of polymyxin B and imipenem, the narrowest. Clinically relevant multidrug resistant (MDR) mutants (presenting MICs above EUCAST clinical breakpoints) arose within the sub-MIC selective windows of the majority of antibiotics tested, being these phenotypes probably mediated by efflux pumps′ activity.DISCUSSIONOur data show that the concentration of antibiotics reported in aquatic ecosystems -colonizable by P. aeruginosa- are, in occasions, higher than the ones able to select MDR mutants. This finding has implications for understanding the role of different ecosystems and conditions in the emergence of antibiotic resistance from a One-Health point of view. Further, it highlights the importance of delineating the sub-MIC selective windows for drugs of clinical value in pathogens with environmental niches, in order to evaluate the health risks due to antibiotic pollution of natural ecosystems and ultimately tackle antibiotic resistance.

scholarly journals Antibiotic Susceptibility Pattern of Bacterial Pathogens Isolated from Infected Lesions

2019 ◽  
Vol 16 (41) ◽  
pp. 446-451
Author(s):  
Jatan Bahadur Sherchan ◽  
Pranita Gurung
Keyword(s):  
Risk Factors ◽  
Wound Infection ◽  
Antibiotic Susceptibility ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Microbiological Analysis ◽  
Susceptibility Pattern ◽  
Multidrug Resistant Bacteria ◽  
Antibiotic Susceptibility Pattern ◽  
Number Of Patients

Background: Wound infection with multidrug resistant bacteria along with risk factors is a major burden and challenge to the health care persons. This study focuses on antibiotic susceptibility pattern of bacterial isolates and risk factors of patients with infected wounds.Methods: This was a cross-sectional study conducted between November 2017 to June 2018 in Kathmandu University Hospital. Pus sample and wound swabs collected from patients during the study period were included. All microbiological processing were done following standard guidelines and patient’s information was collected following ethical guidelines.Results: Total number of patients observed for wound infection was 2,763. Pathogenic bacteria were detected in 252(9.12%) samples. 167(66.27%) were multidrug resistant. 118(46.82%) had risk factors. Among risk factors 14 had malignancy, 12 had diabetes, 32 were above age 60 without other risk factors, 45 received prior antibiotics and had critical illness and 15 were renal failure patients. Multidrug resistant bacteria was detected more among patients with risk factors 101(85.59%) in comparison to patients without risk factor 66(49.25%). When p value was calculated it was found significant. (p=<0.05).Conclusions: Significant amount of multidrug resistant bacteria were found in wounds of patients with risk factors. Prevention of wound infection by taking care of postoperative wounds, controlling and treating the risk factors, avoiding misuse of antibiotics and early microbiological analysis of infected wound might help to reduce the burden in healthcare centers.Keywords: Extended spectrum beta-lactamase; methicillin resistant staphylococcus aureus; multidrug resistant.

scholarly journals Testudines as Sentinels for Monitoring the Dissemination of Antibiotic Resistance in Marine Environments: An Integrative Review

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 775
Author(s):  
Kezia Drane ◽  
Roger Huerlimann ◽  
Michelle Power ◽  
Anna Whelan ◽  
Ellen Ariel ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Anthropogenic Activities ◽  
Sea Turtles ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Marine Environments ◽  
Beta Lactam ◽  
Antibiotic Resistant ◽  
Sensitivity Tests ◽  
Standard Culture

Dissemination of antibiotic resistance (AR) in marine environments is a global concern with a propensity to affect public health and many ecosystems worldwide. We evaluated the use of sea turtles as sentinel species for monitoring AR in marine environments. In this field, antibiotic-resistant bacteria have been commonly identified by using standard culture and sensitivity tests, leading to an overrepresentation of specific, culturable bacterial classes in the available literature. AR was detected against all major antibiotic classes, but the highest cumulative global frequency of resistance in all represented geographical sites was against the beta-lactam class by a two-fold difference compared to all other antibiotics. Wastewater facilities and turtle rehabilitation centres were associated with higher incidences of multidrug-resistant bacteria (MDRB) accounting for an average of 58% and 49% of resistant isolates, respectively. Furthermore, a relatively similar prevalence of MDRB was seen in all studied locations. These data suggest that anthropogenically driven selection pressures for the development of AR in sea turtles and marine environments are relatively similar worldwide. There is a need, however, to establish direct demonstrable associations between AR in sea turtles in their respective marine environments with wastewater facilities and other anthropogenic activities worldwide.

scholarly journals Antibiotic Resistance in Pediatric Infections: Global Emerging Threats, Predicting the Near Future

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 393
Author(s):  
Alessandra Romandini ◽  
Arianna Pani ◽  
Paolo Andrea Schenardi ◽  
Giulia Angela Carla Pattarino ◽  
Costantino De Giacomo ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Pediatric Population ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Pediatric Age ◽  
Carbapenem Resistant ◽  
Pediatric Infections ◽  
Surgical Treatments ◽  
Developing System ◽  
Near Future

Antibiotic resistance is a public health threat of the utmost importance, especially when it comes to children: according to WHO data, infections caused by multidrug resistant bacteria produce 700,000 deaths across all ages, of which around 200,000 are newborns. This surging issue has multipronged roots that are specific to the pediatric age. For instance, the problematic overuse and misuse of antibiotics (for wrong diagnoses and indications, or at wrong dosage) is also fueled by the lack of pediatric-specific data and trials. The ever-evolving nature of this age group also poses another issue: the partly age-dependent changes of a developing system of cytochromes determine a rather diverse population in terms of biochemical characteristics and pharmacokinetics profiles, hard to easily codify in an age- or weight-dependent dosage. The pediatric population is also penalized by the contraindications of tetracyclines and fluoroquinolones, and by congenital malformations which often require repeated hospitalizations and pharmacological and surgical treatments from a very young age. Emerging threats for the pediatric age are MRSA, VRSA, ESBL-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and the alarming colistin resistance. Urgent actions need to be taken in order to step back from a now likely post-antibiotic era, where simple infections might cause infant death once again.

Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

2005 ◽  
Vol 26 (1) ◽  
pp. 13-20 ◽  
Author(s):  
François L'Hériteau ◽  
Corinne Alberti ◽  
Yves Cohen ◽  
Gilles Troché ◽  
Pierre Moine ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Multiple Correspondence Analysis ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Central Venous ◽  
Venous Catheterization ◽  
Structural Variables ◽  
Tract Infections

AbstractObjectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

scholarly journals Prevalence of Antibiotic-Resistant Bacteria ESKAPE among Healthy People Estimated by Monitoring of Municipal Wastewater

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 495
Author(s):  
Masateru Nishiyama ◽  
Susan Praise ◽  
Keiichi Tsurumaki ◽  
Hiroaki Baba ◽  
Hajime Kanamori ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
General Population ◽  
Municipal Wastewater ◽  
Treatment Plant ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Municipal Wastewater Treatment ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Wastewater Samples

There is increasing attention toward factors that potentially contribute to antibiotic resistance (AR), as well as an interest in exploring the emergence and occurrence of antibiotic resistance bacteria (ARB). We monitored six ARBs that cause hospital outbreaks in wastewater influent to highlight the presence of these ARBs in the general population. We analyzed wastewater samples from a municipal wastewater treatment plant (MWWTP) and hospital wastewater (HW) for six species of ARB: Carbapenem-resistant Enterobacteria (CARBA), extended-spectrum β-lactamase producing Enterobacteria (ESBL), multidrug-resistant Acinetobacter (MDRA), multidrug-resistant Pseudomonas aeruginosa (MDRP), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE). We registered a high percentage of ARBs in MWWTP samples (>66%) for all ARBs except for MDRP, indicating a high prevalence in the population. Percentages in HW samples were low (<78%), and no VRE was detected throughout the study. CARBA and ESBL were detected in all wastewater samples, whereas MDRA and MRSA had a high abundance. This result demonstrated the functionality of using raw wastewater at MWWTP to monitor the presence and extent of ARB in healthy populations. This kind of surveillance will contribute to strengthening the efforts toward reducing ARBs through the detection of ARBs to which the general population is exposed.

scholarly journals 157. patient to Environment Transmission of Multidrug-resistant Bacteria Within Intensive Care Units

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S207-S208
Author(s):  
Matthew J Ziegler ◽  
Brendan Kelly ◽  
Michael Z David ◽  
Lauren Dutcher ◽  
Pam C Tolomeo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multiple Time ◽  
Extended Spectrum Beta Lactamase ◽  
Environmental Transmission ◽  
Body Culture ◽  
Clinical Culture ◽  
Multiple Time Points

Abstract Background Identifying risk factors for environmental contamination with multidrug-resistant organisms (MDROs) is essential to prioritize methods for prevention of hospital transmission. Methods Patients admitted to an ICU with an MDRO detected on clinical culture in the prior 30 days were enrolled. Patients (4 body sites) and high-touch objects (HTO) (3 composite sites) in ICU rooms were sampled. Environmental transmission was defined by shared MDRO species cultured on patient and HTO cultures obtained on multiple time points during the patient’s stay. Risk factors for environmental transmission were identified with logistic regression. Results Forty-five patients were included (median 2 days of longitudinal sampling [IQR 1–4 days]). Enrollment anatomic cultures included extended-spectrum beta-lactamase-producing Enterobacterales (ESBLE) (n=12, 27%), carbapenem-resistant organisms (CRO) (n=4, 9%), methicillin-resistant S.aureus (MRSA) (n=11, 24%), vancomycin-resistant Enterococci (VRE) (n=4, 9%), and C.difficile (CDIFF) (n=14, 31%). Patient colonization during serial sampling was common with CRO (n=21, 47%), ESBLE (n=16, 36%), and VRE (n=16, 36%) and less so with MRSA (n=7, 16%) and CDIFF (n=5, 11%). Detection of MDROs on environmental surfaces was also common with identification of CRO in 47% of patient rooms (n=21) and ESBLE in 29% (n=13); MRSA (n=2, 4%), VRE (n=9, 20%), and CDIFF (n=3, 7%) were rarer. Patient to environment transmission was observed in 40% of rooms (n=18). Thirteen (29%) rooms had foreign MDRO contamination (i.e., one not detected on a body culture), most (n=10) with CRO. Environmental MDROs were most common in bathroom/sinks (n=22), followed by surfaces near the patient (n=10), and least common surfaces often touched by staff within the room (n=6). On multivariable logistic regression, naïve to clustering by patient, recent receipt of a proton pump inhibitor (OR 2.35, 95% CI 1.00 – 5.52, P=0.049) and presence of one or more wounds (OR 2.56, 95% CI 1.05 – 6.26, P=0.038) were significantly associated with environmental transmission (OR 1.56, 95% CI 1.01 – 2.43, P=0.046) (Table 1). Conclusion MDRO contamination of patient rooms is common with detection of organisms attributed to, and foreign to, the occupant. Disclosures Michael Z. David, MD PhD, GSK (Consultant)

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