scholarly journals Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1221
Author(s):  
Giancarlo Pérez-Lazo ◽  
Susan Abarca-Salazar ◽  
Renata Lovón ◽  
Rocío Rojas ◽  
José Ballena-López ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Bacterial Resistance ◽  
Antibiotic Consumption ◽  
Antimicrobial Consumption ◽  
Carbapenem Resistant ◽  
Resistance Patterns ◽  
Medical Wards ◽  
Eskape Pathogens

A descriptive design was carried out studying the correlation between antimicrobial consumption and resistance profiles of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) in a Peruvian hospital, including the surgical, clinical areas and the intensive care unit (ICU) during the time period between 2015 and 2018. There was a significant correlation between using ceftazidime and the increase of carbapenem-resistant Pseudomonas aeruginosa isolations (R = 0.97; p < 0.05) and the resistance to piperacillin/tazobactam in Enterobacter spp. and ciprofloxacin usage (R = 0.97; p < 0.05) in the medical wards. The Pseudomonas aeruginosa resistance to piperacillin/tazobactam and amikacin in the intensive care unit (ICU) had a significant reduction from 2015 to 2018 (67% vs. 28.6%, 65% vs. 34.9%, p < 0.001). These findings give valuable information about the rates and dynamics in the relationship between antibiotic usage and antimicrobial resistance patterns in a Peruvian hospital and reinforce the need for continuous support and assessment of antimicrobial stewardship strategies, including microbiological indicators and antimicrobial consumption patterns.

Integrons and Antiseptic Resistance Genes Mediate Resistance of Acinetobacter baumannii and Pseudomonas aeruginosa Isolates from Intensive Care Unit Patients with Wound Infections

2019 ◽  
Vol 19 (4) ◽  
pp. 286-293
Author(s):  
Walid F. Elkhatib ◽  
Mahmoud A.F. Khalil ◽  
Hossam M. Ashour
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Resistance Genes ◽  
Bacterial Resistance ◽  
Multiple Drug Resistance ◽  
Multiple Drug ◽  
High Prevalence ◽  
Resistance Patterns

Background: Acinetobacter baumannii and Pseudomonas aeruginosa are of major concern for hospitalized patients. Methods: We evaluated antibiotic and antiseptic resistance of A. baumannii (n = 29) and P. aeruginosa (n = 37) isolates recovered from 66 intensive care unit (ICU) patients and determined the prevalence of qacE, qacEΔ1, and integrons in these clinical isolates. Antibiotic and antiseptic susceptibility testing was performed via Kirby Bauer disk diffusion and broth microdilution methods, respectively. The resistance genes and integrons were detected by PCR. A. baumannii and P. aeruginosa ICU isolates showed 100% and 70.3% antibiotic multiple drug resistance patterns, respectively. Results: The isolates also revealed high levels of resistance (MIC ≥ 16 µg/ml) against antiseptics commonly used in Egyptian hospitals (Benzalkonium, Benzethonium, and Chlorhexidine). The qacEΔ1 gene showed higher levels of prevalence in both A. baumannii and P. aeruginosa isolates (93.5% and 78%, respectively) as compared to that of qacE gene (52.0% and 33.0%, respectively). The intI1 was more prevalent among A. baumannii isolates (65.5%) compared to P. aeruginosa isolates (37.8%). P. aeruginosa resistance genotypes were significantly associated with antibiotic and antiseptic resistance patterns. A. baumannii resistance genotypes were associated with antiseptic-resistance patterns. Conclusion: The excessive usage of antiseptics may escalate bacterial resistance, especially with high prevalence of intI1 integron in these pathogens.

scholarly journals Effects of Carbapenem Exposure on the Risk for Digestive Tract Carriage of Intensive Care Unit-Endemic Carbapenem-Resistant Pseudomonas aeruginosa Strains in Critically Ill Patients

2007 ◽  
Vol 51 (6) ◽  
pp. 1967-1971 ◽  
Author(s):  
C. Peña ◽  
A. Guzmán ◽  
C. Suarez ◽  
M. A. Dominguez ◽  
F. Tubau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Digestive Tract ◽  
Bacterial Resistance ◽  
Clonal Diversity ◽  
Carbapenem Resistant ◽  
Resistance Patterns ◽  
Cross Transmission ◽  
Imipenem Resistance

ABSTRACT To determine the epidemiology and risk factors for carbapenem-resistant Pseudomonas aeruginosa (CR-PA) digestive tract colonization, weekly rectal and pharyngeal swabs were obtained in two serial incidence surveys (266 patients). Forty-two (16%) patients were CR-PA colonized (12 [29%] on admission and 30 [71%] in intensive care units). Pulsed-field gel electrophoresis showed extensive clonal diversity, although one specific clone (type B) was isolated from 11 patients. The presence of similar genotypes of CR-PA colonizing 30% of the CR-PA-colonized patients suggests the occurrence of cross-colonization; in addition, 10 pairs of carbapenem-susceptible P. aeruginosa (CS-PA) and subsequent CR-PA strains isolated from the same patients were found to be clonally identical and were considered to have been endogenously acquired (33%). All endogenously acquired CR-PA strains were isolated after exposure to a carbapenem, and 80% showed a phenotype of imipenem resistance (IR pattern) alone, while 67% of the CR-PA strains acquired by cross-transmission exhibited a multiresistant (MR) phenotype, with previous carbapenem exposure in 44%. Logistic regression analysis identified severity of acute illness (odds ratio [OR], 1.0; 95% confidence interval [CI], 1.0 to 1.1), prior carbapenem use (OR, 7.8; 95% CI, 1.7 to 35.3), and prior use of fluoroquinolones (OR, 11.0; 95% CI, 1.7 to 67.9) as independent risk factors for CR-PA digestive tract colonization. Overall, the local epidemiology of CR-PA digestive tract colonization was characterized by polyclonal endemicity with phenotype patterns of IR and MR divided evenly between patients. Restricting the use of particular agents, such as carbapenems and fluoroquinolones, should be considered advisable to minimize the problem of this antibiotic resistance. However, the possible risk for development of collateral unexpected bacterial resistance patterns should be accurately monitored.

scholarly journals Carbapenem-resistant Pseudomonas aeruginosa outbreak in an intensive care unit of a teaching hospital

2004 ◽  
Vol 8 (4) ◽  
Author(s):  
Ana C. Gales ◽  
Patrícia L. Torres ◽  
Dominique S. O. Vilarinho ◽  
Renata S. Melo ◽  
Claudinéia F. L. Silva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Teaching Hospital ◽  
Carbapenem Resistant

scholarly journals blaVIM- and blaOXA-mediated carbapenem resistance among Acinetobacter baumannii and Pseudomonas aeruginosa isolates from the Mulago hospital intensive care unit in Kampala, Uganda

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Dickson Aruhomukama ◽  
Christine F. Najjuka ◽  
Henry Kajumbula ◽  
Moses Okee ◽  
Gerald Mboowa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Mulago Hospital ◽  
Class 1 Integrons ◽  
Carbapenem Resistant ◽  
Hospital Intensive Care Unit ◽  
Carbapenemase Gene ◽  
Class 1

Abstract Background Between January 2015 and July 2017, we investigated the frequency of carbapenem resistant Acinetobacter baumannii (CRAB) and carbapenem resistant Pseudomonas aeruginosa (CRPA) at the Mulago Hospital intensive care unit (ICU) in Kampala, Uganda. Carbapenemase production and carbapenemase gene carriage among CRAB and CRPA were determined; mobility potential of carbapenemase genes via horizontal gene transfer processes was also studied. Methods Clinical specimens from 9269 patients were processed for isolation of CRAB and CRPA. Drug susceptibility testing was performed with the disk diffusion method. Carriage of carbapenemase genes and class 1 integrons was determined by PCR. Conjugation experiments that involved blaVIM positive CRAB/CRPA (donors) and sodium azide resistant Escherichia coli J53 (recipient) were performed. Results The 9269 specimens processed yielded 1077 and 488 isolates of Acinetobacter baumannii and Pseudomonas aeruginosa, respectively. Of these, 2.7% (29/1077) and 7.4% (36/488) were confirmed to be CRAB and CRPA respectively, but 46 were available for analysis (21 CRAB and 25 CRPA). Majority of specimens yielding CRAB and CRPA were from the ICU (78%) while 20 and 2% were from the ENT (Ear Nose & Throat) Department and the Burns Unit, respectively. Carbapenemase assays performed with the MHT assay showed that 40 and 33% of CRPA and CRAB isolates respectively, were carbapenemase producers. Also, 72 and 48% of CRPA and CRAB isolates respectively, were metallo-beta-lactamase producers. All the carbapenemase producing isolates were multidrug resistant but susceptible to colistin. blaVIM was the most prevalent carbapenemase gene, and it was detected in all CRAB and CRPA isolates while blaOXA-23 and blaOXA-24 were detected in 29 and 24% of CRAB isolates, respectively. Co-carriage of blaOXA-23 and blaOXA-24 occurred in 14% of CRAB isolates. Moreover, 63% of the study isolates carried class 1 integrons; of these 31% successfully transferred blaVIM to E. coli J53. Conclusions CRAB and CRPA prevalence at the Mulago Hospital ICU is relatively low but carbapenemase genes especially blaVIM and blaOXA-23 are prevalent among them. This requires strengthening of infection control practices to curb selection and transmission of these strains in the hospital.

scholarly journals Antimicrobial consumption, costs and resistance patterns: a two year prospective study in a Romanian intensive care unit

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Carmen Axente ◽  
Monica Licker ◽  
Roxana Moldovan ◽  
Elena Hogea ◽  
Delia Muntean ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Study ◽  
Antimicrobial Consumption ◽  
Resistance Patterns

scholarly journals Gastrointestinal Microbiota Disruption and Risk of Colonization With Carbapenem-resistant Pseudomonas aeruginosa in Intensive Care Unit Patients

2018 ◽  
Vol 69 (4) ◽  
pp. 604-613 ◽  
Author(s):  
Melinda M Pettigrew ◽  
Janneane F Gent ◽  
Yong Kong ◽  
Alison Laufer Halpin ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Medical Center ◽  
Protective Role ◽  
Gastrointestinal Microbiota ◽  
Icu Patients ◽  
Icu Admission ◽  
Carbapenem Resistant ◽  
Increased Risk

Abstract Background Carbapenem-resistant Pseudomonas aeruginosa (CRPA) colonizes the gastrointestinal tract of intensive care unit (ICU) patients, and CRPA colonization puts patients at increased risk of CRPA infection. Prior studies have not examined relationships between the microbiota, medications, and CRPA colonization acquisition. Methods Data and perirectal swabs were obtained from a cohort of ICU patients at the University of Maryland Medical Center. Patients (N = 109) were classified into 3 groups by CRPA colonization-acquisition status and antimicrobial exposure. We conducted 16S ribosomal RNA gene sequencing of an ICU admission swab and ≥1 additional swab and evaluated associations between patient characteristics, medications, the gastrointestinal microbiota, and CRPA colonization acquisition. Results ICU patients had low levels of diversity and high relative abundances of pathobionts. Piperacillin-tazobactam was prescribed more frequently to patients with CRPA colonization acquisition than those without. Piperacillin-tazobactam was associated with low abundance of potentially protective taxa (eg, Lactobacillus and Clostridiales) and increased risk of Enterococcus domination (odds ratio [OR], 5.50; 95% confidence interval [CI], 2.03–14.92). Opioids were associated with dysbiosis in patients who did not receive antibiotics; potentially protective Blautia and Lactobacillus were higher in patients who did not receive opioids. Several correlated taxa, identified at ICU admission, were associated with lower risk of CRPA colonization acquisition (OR, 0.58; 95% CI, .38–.87). Conclusions Antibiotics differed in their impact on the microbiota, with piperacillin-tazobactam being particularly damaging. Certain bacterial taxa (eg, Clostridiales) were negatively associated with CRPA colonization acquisition. These taxa may be markers of risk for CRPA colonization acquisition and/or serve a protective role.

scholarly journals Prevalence rates of infection in intensive care units of a tertiary teaching hospital

2003 ◽  
Vol 58 (5) ◽  
pp. 254-259 ◽  
Author(s):  
Carlos Toufen Junior ◽  
André Luiz Dresler Hovnanian ◽  
Suelene Aires Franca ◽  
Carlos Roberto Ribeiro Carvalho
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Mortality Rates ◽  
Prevalence Rates ◽  
Related Factors ◽  
Resistance Patterns ◽  
And Staphylococcus Aureus

OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69%) received antimicrobials on the day of study, 72 (57%) for treatment, and 15 (12%) for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%), non- intensive care unit nosocomial infection in 24 (33.3%), and intensive care unit-acquired infection in 22 patients (30.6%). Eleven patients (15.3%) had no defined type. The most frequently reported infections were respiratory (58.5%). The most frequently isolated bacteria were Enterobacteriaceae (33.8%), Pseudomonas aeruginosa (26.4%), and Staphylococcus aureus (16.9%; [100% resistant to methicillin]). Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007), use of a nasogastric tube (p = 0.017), and postoperative status (p = 0.017). At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088). CONCLUSION: The rate of nosocomial infection is high in intensive care unit patients, especially for respiratory infections. The predominant bacteria were Enterobacteriaceae, Pseudomonas aeruginosa, and Staphylococcus aureus (resistant organisms). Factors such as nasogastric intubation, postoperative status, and age ³60 years were significantly associated with infection. This study documents the clinical impression that prevalence rates of intensive care unit-acquired infections are high and suggests that preventive measures are important for reducing the occurrence of infection in critically ill patients.

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