scholarly journals Molecular epidemiology and clonality of Acinetobacter spp in a Lebanese hospital over a period of one year

2018 ◽  
Vol 12 (02.1) ◽  
pp. 17S
Author(s):  
Micheline Soudeiha ◽  
Elie Salem Sokhn ◽  
Ziad Daoud ◽  
Dolla Sarkis
Keyword(s):  
Medical Center ◽  
Pcr Amplification ◽  
Generation Cephalosporin ◽  
Control Measures ◽  
Pcr Analysis ◽  
Infection Control Measures ◽  
Microdilution Method ◽  
Keyhole Effect ◽  
Acinetobacter Spp ◽  
One Year

Introduction: The worldwide emergence of antimicrobial resistance in Acinetobacter spp and their clonal dissemination call for the investigation into Acinetobacter spp epidemiology. Methodology: 100 nonrepetitive Acinetobacter spp isolates were recovered from patients admitted at Saint- George-Hospital-University-Medical-Center-Beirut, in a one-year period. Identification of the isolates was determined by the API20NE and confirmed by PCR amplification of blaOXA-51-like. Susceptibility to carbapenems and colistin were determined by the microdilution method and interpreted according to the CLSI, 2015.The β lactamase inhibitors: PBA, EDTA, and Cloxacillin were used for the detection of KPC, MBL and AmpC, respectively. ESBL producers were detected whenever a keyhole effect was observed between 3rd generation cephalosporin and Augmentin®. Simplex PCR was conducted for the genotypic detection of β lactamases. ERIC and 3LST-PCR were performed to determine the clonality of the isolates. Results: Our findings showed that 84% were carbapenem resistant. Only one isolate was resistant to colistin. Phenotypically, 23 were ESBL, 15 KPC, 5 AmpC, and 4 MBL producers. PCR analysis showed that 99%, 93%, 77% and 3 % of the isolates harbored blaOXA-51-like, blaADC, blaOXA-23-like, and blaOXA-40-like, respectively. ERIC-PCR analysis showed that A.baumannii isolates were clustered in 19 possibly related and 30 closely related subtypes. The 3-LST-PCR showed that 86.2% of the A.baumannii isolates pertained to the ICII (international clone II). Conclusion: Our study showed a predominance of OXA-23-like producers and dissemination of ICII. Inhibitor based method was shown not to be accurate for the prediction of carbapenemases in Acinetobacter spp. Infection control measures are needed for management of Acinetobacter spp infections.

scholarly journals Investigation of carbapenemase and mcr-1 genes in carbapenem-resistant Klebsiella pneumoniae isolates

2019 ◽  
Vol 13 (06) ◽  
pp. 504-509 ◽  
Author(s):  
Çiğdem Arabacı ◽  
Tuba Dal ◽  
Tuğcan Başyiğit ◽  
Neslihan Genişel ◽  
Rıza Durmaz
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Bacterial Infections ◽  
Resistance Mechanisms ◽  
Control Measures ◽  
Epidemiological Methods ◽  
Infection Control Measures ◽  
Microdilution Method ◽  
Carbapenem Resistant ◽  
Susceptibility Tests

Introduction: Carbapenem-resistant Klebsiella pneumoniae are a major problem. We aimed to investigate carbapenemase-encoding genes and transferable mcr-1 genes among 57 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from hospitalized patients. Methodology: Antibiotic susceptibility tests were performed by Phoenix (BD). Results for ertapenem and colistin were confirmed by gradient diffusion and microdilution methods. Carbapenemase and mcr-1 genes were investigated by Polymerase Chain Reaction (PCR). Results: Thirty-two (56.14%) isolates were from intensive care units (ICU). Antibiotic resistance rates by Phoenix: 52.63% for amikacin; 73.69% trimethoprim sulfamethoxazole; 91.23% cefepime; 82.46% tigecycline; 59.65% colistin. Carbapenemases positivity: 82.45% (47) for blaOXA-48, 40.35% (23) blaOXA-55, 3.50% (2) blaOXA-51, 1.75% (1) blaOXA-23, 1.75% (1) blaOXA-24, 1.75% (1) blaIMP. blaOXA-58, blaKPC, blaNDM-1, and blaVIM were not detected. Twenty (35.08%) isolates had both blaOXA-48 and blaOXA-55. Three isolates were mcr-1 (+) and blaOXA-48 (+). One mcr-1 (+) isolates was blaOXA-51 (+). One colistin sensitive isolate determined by Phoenix, was found colistin resistant by microdilution. Conclusion: OXA-48 and OXA-55 co-harboring isolates and mcr-1 gene (+) isolates were spreading. Automated colistin susceptibility results should be confirmed by microdilution method. Resistance mechanisms in Enterobacteriaceae should be determined and the isolates should be monitored by molecular epidemiological methods. Effective infection control measures will contribute to reduce risk of antibiotic resistant bacterial infections and dissemination of antibiotic resistance.

scholarly journals Human Coronavirus Infections in Israel: Epidemiology, Clinical Symptoms and Summer Seasonality of HCoV-HKU1

Viruses ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 515 ◽  
Author(s):  
Nehemya Friedman ◽  
Hadar Alter ◽  
Musa Hindiyeh ◽  
Ella Mendelson ◽  
Yonat Shemer Avni ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Medical Center ◽  
Hospitalized Patients ◽  
Pcr Analysis ◽  
Virus Infections ◽  
Summer Period ◽  
The Public ◽  
Syncytial Virus ◽  
Human Coronaviruses ◽  
One Year

Human coronaviruses (HCoVs) cause mild to severe respiratory diseases. Six types of HCoVs have been discovered, the most recent one termed the Middle East respiratory syndrome coronavirus (MERS-CoV). The aim of this study is to monitor the circulation of HCoV types in the population during 2015–2016 in Israel. HCoVs were detected by real-time PCR analysis in 1910 respiratory samples, collected from influenza-like illness (ILI) patients during the winter sentinel influenza survey across Israel. Moreover, 195 HCoV-positive samples from hospitalized patients were detected during one year at Soroka University Medical Center. While no MERS-CoV infections were detected, 10.36% of patients in the survey were infected with HCoV-OC43 (43.43%), HCoV-NL63 (44.95%), and HCoV-229E (11.62%) viruses. The HCoVs were shown to co-circulate with respiratory syncytial virus (RSV) and to appear prior to influenza virus infections. HCoV clinical symptoms were more severe than those of RSV infections but milder than influenza symptoms. Hospitalized patients had similar HCoV types percentages. However, while it was absent from the public winter survey, 22.6% of the patients were HCoV-HKU1 positives, mainly during the spring-summer period.

scholarly journals Acinetobacter spp in a Third World Country with Socio-economic and Immigrants Challenges

2019 ◽  
Vol 13 (11) ◽  
pp. 948-955
Author(s):  
Iman Dandachi ◽  
Eid Azar ◽  
Ramzi Hamouch ◽  
Peter Maliha ◽  
Samah Abdallah ◽  
...  
Keyword(s):  
Human Infection ◽  
Control Measures ◽  
Health Concern ◽  
Acinetobacter Species ◽  
Infection Control Measures ◽  
Third World Country ◽  
Wide Range ◽  
Potential Pathogen ◽  
Acinetobacter Spp ◽  
The One

Introduction: In the last decade, Acinetobacter species have taken a major public health concern. This is mainly due the increased resistance to a wide range of antibiotics causing treatment challenges. In view of the constant population mobilization and the economic crisis that Lebanon is currently facing, it becomes a necessity to re-evaluate the real threat of Acinetobacter spp and its implication in the one health. Methodology: This review was conducted through the analysis of 45 research papers and reports pertaining to Acinetobacter spp performed in Lebanon. More than 82% of the papers consulted were published in international journals and more than 70 percent of them had received impact factor. Results: An in depth description of the involvement of this organism in human infection and its role as potential pathogen or simple colonizer was performed. In addition, the different aspects of resistance, mostly to carbapenems and colistin was studied and summarized. While in animals and environment, susceptible strains were mostly isolated, OXA-23/OXA-24 were predominant in humans. Recently, NDM-1 producing Acinetobacter spp was detected in a Syrian refugee which then was reported in Lebanese patients. The bacterial identification procedures are non-systematic and not always reliable in the Lebanese studies presenting sometimes discrepancies an inconsistency. Conclusion: Acinetobacter is commonly isolated Lebanon. In view of the spread of resistance among these isolated and their dissemination, Infection control measures attempting to control the spread of this genus in and outside hospitals are lacking and thus require more attention and stewardship activities.

scholarly journals Clinical and Demographic Characteristics of Patients With a New Diagnosis of Carriage or Clinical Infection With Carbapenemase-Producing Enterobacterales: A Retrospective Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Assaf Adar ◽  
Hiba Zayyad ◽  
Maya Azrad ◽  
Kozita Libai ◽  
Ilana Aharon ◽  
...  
Keyword(s):  
Antibiotic Susceptibility ◽  
Medical Center ◽  
Resistance Mechanism ◽  
Care Facility ◽  
Control Measures ◽  
Clinical Infection ◽  
Term Care ◽  
Long Term Care Facility ◽  
Infection Control Measures ◽  
New Diagnosis

Background: To examine the clinical, demographic, and microbiologic characteristics of new rectal carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) carriers vs. those with a clinical infection, hospitalized at Padeh-Poriya Medical Center between 2014 and 2017 and to examine the susceptibility profiles of isolates from clinical infections.Methods: In this retrospective, chart analysis, demographic and clinical data were collected from medical charts of 175 adult patients with either new- onset carbapenemase-producing Enterobacterales (CPE) carriage or clinical CPE infection. Collected data included age, ethnic group, place of residence, hospitalizations in the past 90 days, and 30-day mortality. Microbiological analyses considered bacterial genus, molecular resistance mechanism and antibiotic susceptibility.Results: A significantly higher percentage (42.4%) of CPE carriers were long-term care facility residents, and had been recently hospitalized (56.3%), as compared to patients with clinical CPE infection (29.2 and 45.9%, respectively). Additionally, we noted a high (58.3%) acquision of CPE in our hospital. The most common bacterial isolate was K. pneumoniae and the most common resistance mechanism was Klebsiella pneumoniae (K. pneumoniae) carbapenemases (KPC). High susceptibility rates to amikacin and chloramphenicol were also noted.Conclusions: This study reaffirmed the importance of CPE screening and infection control measures. The observed antibiotic susceptibility profile suggests amikacin and chloramphenicol as potential treatments for CPE infection.

scholarly journals Bacterial bloodstream infections in level-I trauma intensive care unit in Serbia: incidence, causative agents and outcomes

2018 ◽  
Vol 12 (12) ◽  
pp. 1079-1087 ◽  
Author(s):  
Olivera Djuric ◽  
Ljiljana Markovic-Denic ◽  
Bojan Jovanovic ◽  
Snezana Jovanovic ◽  
Vuk Marusic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Unknown Origin ◽  
Control Measures ◽  
Trauma Patients ◽  
Healthcare Associated Infection ◽  
Infection Control Measures ◽  
Causative Agents ◽  
Acinetobacter Spp

Introduction: We aimed to describe incidence, outcomes and antimicrobial resistance markers of causative agents of bacterial BSI in the intensive care unit (ICU) in a trauma center in Serbia. Methodology: Prospective surveillance was conducted from November 2014 to April 2016 in two trauma-surgical ICUs of the Emergency Department of Clinical center of Serbia. Bloodstream infections were diagnosed using the definitions of Center for Disease Control and Prevention. Results: Out of 406 trauma patients, 57 had at least one episode of BSI (cumulative incidence 14.0%). Overall 62 BSI episodes were diagnosed (incidence rate 11.8/1000 patient/days), of which 43 (69.4%) were primary BSI (13 catheter-related BSI and 30 of unknown origin) and 19 (30.6%) were secondary BSI. The most common isolated pathogen was Acinetobacter spp. [n = 24 (34.8%)], followed by Klebsiella spp. [n = 17 (24.6%)] and P. aeruginosa [n = 8 (1.6%)]. All S. aureus [n = 6 (100%)] and CoNS [n = 3 (100%)] isolates were methicillin resistant, while 4 (66%) of Enterococci isolates were vacomycin resistant. All isolates of Enterobacteriaceae were resistant to third-generation cephalosporins [n = 22 (100%)] while 7 (87.5%) of P. aeruginosa and 23 (95.8%) of Acinetobacter spp. isolates were resistant to carbapenems. All-cause mortality and sepsis were significantly higher in trauma patients with BSI compared to those without BSI (P < 0.001 each). Conclusions: BSI is a common healthcare-associated infection in trauma ICU and it is associated with worse outcome. Better adherence to infection control measures and guidelines for prevention of primary BSI must be achieved.

scholarly journals Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1307-1315 ◽  
Author(s):  
Gili Regev-Yochay ◽  
Gill Smollan ◽  
Ilana Tal ◽  
Nani Pinas Zade ◽  
Yael Haviv ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tap Water ◽  
Medical Center ◽  
Common Factor ◽  
Control Measures ◽  
Root Cause ◽  
Infection Control Measures ◽  
Single Clone ◽  
Environmental Reservoir

AbstractBackgroundCarbapenemase-producing Enterobacteriaceae (CPE) outbreaks are mostly attributed to patient-to-patient transmission via healthcare workers.ObjectiveWe describe successful containment of a prolonged OXA-48–producing S. marcescens outbreak after recognizing the sink traps as the source of transmission.MethodsThe Sheba Medical Center intensive care unit (ICU), contains 16 single-bed, semi-closed rooms. Active CPE surveillance includes twice-weekly rectal screening of all patients. A case was defined as a patient detected with OXA-48 CPE >72 hours after admission. A root-cause analysis was used to investigate the outbreak. All samples were inoculated on chrom-agar CRE, and carbapenemase genes were detected using commercial molecular Xpert-Carba-R. Environmental and patient S. marcescens isolates were characterized using PFGE.ResultsFrom January 2016 to May 2017, 32 OXA-48 CPE cases were detected, and 81% of these were S. marcescens. A single clone was the cause of all but the first 2 cases. The common factor in all cases was the use of relatively large amounts of tap water. The outbreak clone was detected in 2 sink outlets and 16 sink traps. In addition to routine strict infection control measures, measures taken to contain the outbreak included (1) various sink decontamination efforts, which eliminated the bacteria from the sink drains only temporarily and (2) educational intervention that engaged the ICU team and lead to high adherence to ‘sink-contamination prevention guidelines.’ No additional cases were detected for 12 months.ConclusionsDespite persistence of the outbreak clones in the environmental reservoir for 1 year, the outbreak was rapidly and successfully contained. Addressing sink traps as hidden reservoirs played a major role in the intervention.

scholarly journals Genetic Analysis of mcr-1-Carrying Plasmids From Gram-Negative Bacteria in a Dutch Tertiary Care Hospital: Evidence for Intrapatient and Interspecies Transmission Events

2021 ◽  
Vol 12 ◽  
Author(s):  
Nikolaos Strepis ◽  
Anne F. Voor in ’t holt ◽  
Margreet C. Vos ◽  
Willemien H. A. Zandijk ◽  
Astrid P. Heikema ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Control Measures ◽  
Interspecies Transmission ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Genetic Composition ◽  
Gram Negative ◽  
Infection Control Measures ◽  
Depth Analysis

The role of plasmids in the complex pandemic of antimicrobial resistance is increasingly being recognized. In this respect, multiple mobile colistin resistance (mcr) gene-carrying plasmids have been described. However, the characteristics and epidemiology of these plasmids within local healthcare settings are largely unknown. We retrospectively characterized the genetic composition and epidemiology of plasmids from mcr-1-positive bacterial isolates identified from patients from a large academic hospital in the Netherlands. Clinical Gram-negative bacteria with an MIC &gt; 2 μg/mL for colistin, obtained from patients hospitalized at the Erasmus MC University Medical Center Rotterdam during the years 2010–2018, were screened for presence of the mcr-1 gene. Extracted plasmids from mcr-1-positive isolates were sequenced using a combination of short- and long-read sequencing platforms, characterized by incompatibility type and genetic composition and compared to publicly available mcr-1-carrying plasmid sequences. In 21 isolates from 14 patients, mcr-1 was located on a plasmid. These plasmids were of diverse genetic background involving Inc types IncX4, IncI2(delta), IncHI2, as well as double Inc types IncHI2/IncN and IncHI2/IncQ. mcr-1-carrying plasmids were found in Escherichia coli, Klebsiella pneumoniae, and Kluyvera georgiana, and within the chromosome of an ST147 K. pneumoniae isolate. In depth analysis indicated intrapatient, interpatient, and interspecies transmission events of mcr-1-carrying plasmids. In addition, our results show that the mcr-1 gene resides in a rich environment full of other (mcr-1 negative) plasmids and of many different Inc types, enabling interplasmidal transfer events and facilitating widespread dissemination of the mcr-1 gene. Multiple mcr-1-carrying plasmid transmission events had likely occurred among isolates from hospitalized patients. Recognition and identification of plasmid transmission events within hospitals is necessary in order to design and implement effective infection control measures.

High prevalence of a globally disseminated hypervirulent clone, Staphylococcus aureus CC121, with reduced vancomycin susceptibility in community settings in China

2019 ◽  
Vol 74 (9) ◽  
pp. 2537-2543 ◽  
Author(s):  
Ping Shen ◽  
Kai Zhou ◽  
Yu Wang ◽  
Jingjie Song ◽  
Yang Liu ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Population Analysis ◽  
Drug Susceptibility ◽  
Control Measures ◽  
Pcr Analysis ◽  
Community Settings ◽  
Infection Control Measures ◽  
High Prevalence ◽  
Genetic Features ◽  
Susceptibility Evaluation

Abstract Objectives Most vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneous VISA (hVISA) are derived from hospital-associated MRSA due to treatment failure; however, the prevalence of hVISA/VISA in community settings remains unclear. Methods Four hundred and seventy-six community-associated isolates were collected between 2010 and 2011 during national surveillance for antimicrobial resistance in 31 county hospitals across China. Drug susceptibility evaluation and mecA detection were performed by using broth microdilution and PCR analysis, respectively. hVISA/VISA were identified by using macro-Etest and a modified population analysis profile (PAP)-AUC method. The genetic features of all hVISA/VISA isolates were genotyped. Results Among 476 isolates, MRSA and MSSA accounted for 19.7% (n = 94) and 80.3% (n = 382), respectively. Two VISA and 36 hVISA isolates were identified by PAP-AUC testing. The VISA isolates and 29 of the hVISA isolates were MRSA. The proportion of hVISA/VISA was significantly higher in MRSA (30.9%) than in MSSA (1.8%). The hVISA/VISA isolates were assigned to 18 STs classified into seven clonal complexes (CCs). CC121 (n = 12) followed by ST239 (n = 11) was the most prevalent hVISA/VISA clone. All ST239-hVISA/VISA were MRSA, while 12 CC121-hVISA isolates included 6 MSSA and 6 MRSA isolates. SCCmec III was predominant among MRSA-hVISA/VISA isolates. agr I and agr IV were detected in ST239 and CC121, respectively. All except two strains were positive for Panton–Valentine leucocidin genes. Conclusions To the best of our knowledge, this is the first report of CC121 as a prevalent hVISA clone in community settings, highlighting the necessity of surveillance and stricter infection control measures for this globally disseminated lineage.

scholarly journals In vitro analysis of colistin-carbapenem combination activity against Acinetobacter spp infection

2018 ◽  
Vol 12 (02.1) ◽  
pp. 11S ◽  
Author(s):  
Micheline Soudeiha ◽  
Elie S Sokhn ◽  
Ziad Daoud ◽  
Dolla Sarkis
Keyword(s):  
Medical Center ◽  
Pcr Amplification ◽  
Carbapenem Resistance ◽  
Antagonistic Effect ◽  
Amplification Method ◽  
Carbapenem Resistant ◽  
Acinetobacter Spp ◽  
Vitro Analysis ◽  
Time Kill

Introduction: Increasing carbapenem resistance in Acinetobacter spp calls for the appraisal of alternative strategies in Acinetobacter spp infection therapy. This study aims at evaluating colistin-carbapenem combination against Acinetobacter spp using the checkerboard, Etest, and time-kill methods. Methodology: One hundred nonrepetitive Acinetobacter spp isolates were collected from patients admitted at the Saint-George-Hospital-University-Medical-Center over a one year period. The identification was performed using the API20NE and confirmed by the amplification of the blaOXA-51-like. Susceptibility to colistin, and carbapenems were determined using the Etest, microdilution methods and interpreted according to the CLSI, 2015. Detection of the carbapenemases was performed by PCR amplification method. Clonality was determined by the 3-Locus PCR-typing and ERIC-PCR methods. The synergistic potential of the combination was determined by calculating the Fractional-Inhibitory-Concentration-Index, which determines a synergistic, additive, indifferent or antagonistic effect. Results: In our study (84%) of the isolates were carbapenem resistant. Only one strain showed resistance to colistin. (99%) and (77%) of the Acinetobacter spp isolates harbored blaOXA-51-like and blaOXA-23-like respectively. (86.2%) of the A.baumannii isolates pertained to the International Clone II. An additive effect of the colistin-carbapenem combination was determined using the 3 methods. A decrease of 2.6 and 2.8 folds in the MIC of colistin was showed in colistin-meropenem and colistin-imipenem, respectively (p < 0.001). The Colistin-meropenem showed better effects when compared to colistin-imipenem (p < 0.05). Only a few isolates showed a synergistic effect in the time-kill assay. Conclusion: Our study showed that the decrease in the MIC of colistin following colistin-carbapenem combination might be a promising antimicrobial approach for treating carbapenem-resistant Acinetobacter spp.

scholarly journals COVID-19 Care Clinic in a Medical Center: Lessons Learned

2021 ◽  
Vol 12 ◽  
pp. 215013272110567
Author(s):  
Sidna M. Tulledge-Scheitel ◽  
Thomas A. Billings ◽  
Karen M. Fischer ◽  
Jason H. Homme ◽  
Jennifer M. Miller ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Lessons Learned ◽  
Control Measures ◽  
Care Clinic ◽  
Face To Face ◽  
Patient Demographics ◽  
Infection Control Measures ◽  
Primary Care Practices ◽  
Age Range

Objective: The purpose of this report is to describe the elements of a Covid-19 Care Clinic (CCC), patient demographics, and outcomes. Methods: Descriptive statistics were used to describe demographics, clinical characteristics, and outcomes. This report is based on 4934 unique patients seen in the CCC who provided research authorization within a 10-month period of time (April 1, 2020-January 31, 2021). The CCC infection control processes consisted of a rooming process that mitigated SARS-COV-2 transmission, preparing examination rooms, using PPE by staff, in room lab drawing, and escorting services to minimize the time in clinic. Results: Of the 4934 unique patients seen (age range newborn-102 years), 76.8% were tested for COVID-19. Of those tested, 11.8% were positive for SARS-CoV-2. Ninety-two percent of the patients with the reason for the visit documented had COVID-19 type symptoms. Cough, shortness of breath, and chest pain were the most common presenting symptom in those with COVID-19. At the time of the visit in the CCC, 5.8% of the patients were actively contagious. Thirty days after being seen in the CCC, 9.1% of the patients were seen in the emergency department (ED) and 0.2% died. During the 10-month period there were no known occupationally related COVID-19 infections. Conclusion: The COVID-19 Care Clinic provided face-to-face access for all ages with COVID-19 type symptoms. A minority of patients had COVID-19 who were seen in the clinic. The clinic provided an additional venue of care outside of the ED. The infectious control measures employed were highly effective in protecting the staff. Lessons learned allow for decentralization of COVID-19 symptom care to the primary care practices employing the infection control measures.

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