scholarly journals Community-Acquired Antimicrobial Resistant Enterobacteriaceae in Central America: A One Health Systematic Review

2020 ◽  
Vol 17 (20) ◽  
pp. 7622
Author(s):  
Lauren O’Neal ◽  
Danilo Alvarez ◽  
Renata Mendizábal-Cabrera ◽  
Brooke M. Ramay ◽  
Jay Graham
Keyword(s):  
Systematic Review ◽  
Central America ◽  
One Health ◽  
Carbapenem Resistance ◽  
Generation Cephalosporin ◽  
Beta Lactamase ◽  
Esbl Production ◽  
Colistin Resistance ◽  
Extended Spectrum Beta Lactamase ◽  
Cephalosporin Resistance

Community-acquired antimicrobial resistant Enterobacteriaceae (CA-ARE) are an increasingly important issue around the world. Characterizing the distribution of regionally specific patterns of resistance is important to contextualize and develop locally relevant interventions. This systematic review adopts a One Health framework considering the health of humans, animals, and the environment to describe CA-ARE in Central America. Twenty studies were identified that focused on antimicrobial resistance (AMR) in Enterobacteriaceae. Studies on CA-ARE in Central America characterized resistance from diverse sources, including humans (n = 12), animals (n = 4), the environment (n = 2), and combinations of these categories (n = 2). A limited number of studies assessed prevalence of clinically important AMR, including carbapenem resistance (n = 3), third generation cephalosporin resistance (n = 7), colistin resistance (n = 2), extended spectrum beta-lactamase (ESBL) production (n = 4), or multidrug resistance (n = 4). This review highlights significant gaps in our current understanding of CA-ARE in Central America, most notably a general dearth of research, which requires increased investment and research on CA-ARE as well as AMR more broadly.

scholarly journals First Global Report of Plasmid-Mediated mcr-1 and Extended-Spectrum Beta-Lactamase-Producing Escherichia coli from Sheep in Portugal

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1403
Author(s):  
Josman Dantas Palmeira ◽  
Marisa Haenni ◽  
Jean-Yves Madec ◽  
Helena Maria Neto Ferreira
Keyword(s):  
One Health ◽  
Diffusion Method ◽  
Beta Lactamase ◽  
Beta Lactam ◽  
Colistin Resistance ◽  
Disk Diffusion Method ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Beta Lactam Antibiotics ◽  
Extended Spectrum

Resistances to extended-spectrum cephalosporins (ESC) and colistin are One Health issues since genes encoding these resistances can be transmitted between all sectors of the One Health concept, i.e., human, animal, and the environment. Among food-producing animals, sheep farming has long been overlooked. To fill in this knowledge gap, we looked for ESC- and colistin resistance in 21 faecal samples collected from sheep in one farm in the south of Portugal. ESC-resistant isolates were selected on MacConkey agar plates supplemented with cefotaxime. Susceptibility testing was performed by the disk-diffusion method according to CLSI, while colistin MIC was determined by broth microdilution. ESC- and colistin-resistance genes were identified by PCR, and the clonality of all isolates was assessed by XbaI-PFGE. The replicon content was determined by PCR according to the PCR-based replicon typing (PBRT) scheme. Sixty-two non-duplicate ESC-resistant E. coli isolates were identified, which all presented an extended-spectrum beta-lactamase (ESBL) phenotype, mostly due to the presence of CTX-M genes. One CTX-M-1-producing E. coli was concomitantly colistin-resistant and presented the plasmid-mediated mcr-1 gene. Nearly all isolates showed associated resistances to non-beta-lactam antibiotics, which could act as co-selectors, even in the absence of beta-lactam use. The results showed a high proportion of ESBL-producing E. coli in sheep faeces. Their dissemination was very dynamic, with the spread of successful clones between animals, but also a large diversity of clones and plasmids, sometimes residing in the same animal. This study highlights the need for global surveillance in all food-producing sectors, in order to avoid the dissemination of genes conferring resistance to last-resort antibiotics in human medicine.

Extended Spectrum Beta Lactamase (ESBL), bla TEM,bla SHVand bla CTX-M,resistance genes in Community and Healthcare Associated Gram Negative Bacteria from Osun State, Nigeria

2020 ◽  
Vol 20 ◽  
Author(s):  
Ganiyat Shitta ◽  
Olufunmilola Makanjuola ◽  
Olusolabomi Adefioye ◽  
Olugbenga Adekunle Olowe
Keyword(s):  
Antibiotic Resistance ◽  
Resistance Genes ◽  
Gram Negative Bacteria ◽  
Beta Lactamase ◽  
Multiple Antibiotic Resistance ◽  
Esbl Production ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Healthcare Associated ◽  
Esbl Producers

Background: Extended Spectrum Beta Lactamase (ESBL) production in gram negative bacteria confers multiple antibiotic resistance, adversely affecting antimicrobial therapy in infected individuals. ESBLs result from mutations in β-lactamases encoded mainly by the bla TEM,bla SHVand bla CTX-Mgenes. The prevalence of ESBL producing bacteria has been on the increase globally especially its upsurge among isolates from community-acquired infections. Aim: To determine ESBL prevalence and identify ESBL genes among clinical isolates in Osun State, Nigeria. Material and Methods: A cross-sectional study was carried out from August 2016 –July 2017 in Osun State, Nigeria. Three hundred and sixty Gram negative bacteria recovered from clinical samples obtained from both community and healthcare associated infections were tested. They included147 Escherichia coli(40.8%), 116 Klebsiella spp(32.2%), 44 Pseudomo-nas aeruginosa(12.2%) and23 Proteus vulgaris (6.4%) isolates. Others were Acinetobacter baumannii, Serratia rubidae, Citrobacter spp, Enterobacter spp and Salmonella typhi. Disk diffusion antibiotic susceptibility testing was carried out, isolates were screened for ESBL production and confirmed using standard laboratory procedures. ESBLs resistance genes were identified by Polymerase Chain Reaction (PCR). Results: All isolates demonstrated multiple antibiotic resistance. Resistance to ampicillin, amoxicillin with clavulanate and erythromycin was 100%, whereas resistance to Imipenem was very low (5.0%). : Overall prevalence of ESBL producers was 41.4% with Klebsiellaspp as the highest ESBL producing Enterobacteriacaea. ESBL producers were more prevalent among the hospital pathogens than community pathogens, 58% vs 29.5% (p=0.003). ESBL genes were detected in all ESBL producers with the blaCTX-Mgene predominating (47.0%) followed by blaTEM(30.9%) and blaSHVgene was the least, 22.1%. The blaCTX-Mgene was also the most prevalent in the healthcare pathogens (62%) but it accounted for only 25% in those of community origin. Conclusion: A high prevalence of ESBL producing gram negative organisms occurs both in healthcare and in the community in our environment with the CTX-M variant predominating. Efforts to control spread of these pathogens should be addressed.

scholarly journals Ceftolozane-tazobactam versus meropenem for definitive treatment of bloodstream infection due to extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales (“MERINO-3”): study protocol for a multicentre, open-label randomised non-inferiority trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Adam G. Stewart ◽  
Patrick N. A. Harris ◽  
Mark D. Chatfield ◽  
Roberta Littleford ◽  
David L. Paterson
Keyword(s):  
Bloodstream Infection ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Definitive Treatment ◽  
Resistant Organism ◽  
Third Generation ◽  
Beta Lactamase ◽  
Open Label ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum

Abstract Background Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales are common causes of bloodstream infection. ESBL-producing bacteria are typically resistant to third-generation cephalosporins and result in a sizeable economic and public health burden. AmpC-producing Enterobacterales may develop third-generation cephalosporin resistance through enzyme hyper-expression. In no observational study has the outcome of treatment of these infections been surpassed by carbapenems. Widespread use of carbapenems may drive the development of carbapenem-resistant Gram-negative bacilli. Methods This study will use a multicentre, parallel group open-label non-inferiority trial design comparing ceftolozane-tazobactam and meropenem in adult patients with bloodstream infection caused by ESBL or AmpC-producing Enterobacterales. Trial recruitment will occur in up to 40 sites in six countries (Australia, Singapore, Italy, Spain, Saudi Arabia and Lebanon). The sample size is determined by a predefined quantity of ceftolozane-tazobactam to be supplied by Merck, Sharpe and Dohme (MSD). We anticipate that a trial with 600 patients contributing to the primary outcome analysis would have 80% power to declare non-inferiority with a 5% non-inferiority margin, assuming a 30-day mortality of 5% in both randomised groups. Once randomised, definitive treatment will be for a minimum of 5 days and a maximum of 14 days with the total duration determined by treating clinicians. Data describing demographic information, risk factors, concomitant antibiotics, illness scores, microbiology, multidrug-resistant organism screening, discharge and mortality will be collected. Discussion Participants will have bloodstream infection due to third-generation cephalosporin non-susceptible E. coli and Klebsiella spp. or Enterobacter spp., Citrobacter freundii, Morganella morganii, Providencia spp. or Serratia marcescens. They will be randomised 1:1 to ceftolozane-tazobactam 3 g versus meropenem 1 g, both every 8 h. Secondary outcomes will be a comparison of 14-day all-cause mortality, clinical and microbiological success at day 5, functional bacteraemia score, microbiological relapse, new bloodstream infection, length of hospital stay, serious adverse events, C. difficile infection, multidrug-resistant organism colonisation. The estimated trial completion date is December 2024. Trial registration The MERINO-3 trial is registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT04238390. Registered on 23 January 2020.

Prevalence of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae Isolated From Clinical Samples in Illorin Metropolis, Kwara State Nigeria

2021 ◽  
Vol 6 (2) ◽  
pp. 1-7
Author(s):  
Eze EM
Keyword(s):  
Escherichia Coli ◽  
Health Care ◽  
Health Care Facilities ◽  
Diffusion Method ◽  
Klebsiella Pneumonia ◽  
Beta Lactamase ◽  
Esbl Production ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Significant Difference

Background: This study investigated the prevalence of extended spectrum beta-lactamase producing enterobacteriaceae in Illorin metropolis using standard methods. The prevalence of ESBLs is increasingly being reported worldwide, and it varies according to geographic location and is directly linked to the use and misuse of antibiotics extended spectrum lactamases (ESBLs) are a major challenge in hospitalized patients worldwide and cause epidemic outbreaks in health care facilities, spreading in the community leading to various infections. Objectives: Screen for the extended spectrum β-lactamase producing Enterobacteriaceae and also determine the prevalence of ESBL producing Enterobacteriaceae in relation to gender, age and sample source. Methods: One hundred and sixty eight samples collected from routine clinical specimen such as high vagina swabs, urine, urethra swabs and wound swabs and sputum from October to December 2018 were studied. Fifty two enterobacteriaceae were isolated using spread plate method on macConkey and Cystein lactose electrolyte deficient media. The organisms were Klebsiella pneumoniae, Escherichia coli, Salmonella sp, Shigella sp, and Proteus sp. The isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer standardized disc diffusion method. The antibiotics used were ceftazidine (30ug), cefuroxime (30ug), gentamicin (10ug), ciprofloxacin (5ug), ofloxacin 5ug, amoxicillin/clavulanate 30ug, nitrofurantoin 30ug and ampicillin 10ug. Ceftazidime showed a susceptibility percentage of 84.6%,, cefuroxime 61.5%, gentamicin 71.2% ciprofloxacin 46.2%, ofloxacin 51.9%, augmentin 61.5%, nitrofurantoin 71.2% and ampicillin, 44.2% with a significant difference (P< 0.05).Extended spectrum beta-lactamase ESBL, production by clinical and laboratory standards institute (CLSI) methods showed that 15(28.9%) of isolates belonging to the genera Escherichia, Klebsiella and Proteus expressed ESBL production. The order of ESBL production by the isolates were Escherichia coli 9 (17.3%), Klebsiella pneumonia 5(9.3%) and Proteus 1(1.9%). Thus, attention needs to be given by health care personnel’s to ESBL producing organisms in order to reduce the spread.

scholarly journals Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-ProducingEnterobacteriaceae

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Jesús Rodríguez-Baño ◽  
Belén Gutiérrez-Gutiérrez ◽  
Isabel Machuca ◽  
Alvaro Pascual
Keyword(s):  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
New Drugs ◽  
Beta Lactamase ◽  
Content Type ◽  
Extended Spectrum Beta Lactamase ◽  
Development Of Resistance ◽  
Extended Spectrum ◽  
Invasive Infections ◽  
Risk Patients

SUMMARYTherapy of invasive infections due to multidrug-resistantEnterobacteriaceae(MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam–β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producingEnterobacteriaceae(CPE), only some “second-line” drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.

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