Multidrug-resistant ESBL-producing Enterobacteriaceae and associated risk factors in community infants in Lebanon

Introduction: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections are a growing threat to children, and the treatment of these infections becomes more and more challenging. A huge reservoir for ESBLs in the community is the fecal flora of children. This study investigates the rectal colonization, associated risk factors, antimicrobial susceptibility, and molecular characterization of ESBL-PE in Lebanese community infants. Methodology: A total of 117 rectal swabs were taken from healthy infants between 1 and 12 months of age. Detection of ESBLs was carried out using the double-disk synergy test, combination-disk method, and multiplex polymerase chain reaction (PCR). A questionnaire about the infant’s history and risk factors for carrying ESBL-PE was administered. Results: In total, 58 (49.6%) of 117 participants were ESBL-PE carriers. Some significant important risk factors for colonization in this study were male gender, hospital birth, caesarean delivery, and being formula-fed. Observed decrease in colonization rate was associated with intimate hygiene habits. Carriers of multiple bla genes were the most common. CTX-M type was the major harbored, gene and CTX-M-9 was the most predominant, followed by CTX-M-15 type. Conclusions: To the best of our knowledge, this is the first available data about the carriage rate of ESBL-PE in community infants in Lebanon and the Middle East, the first study showing that birth in hospital, caesarean delivery, and being formula-fed are all significantly associated risk factors for the high colonization rates in community – not hospitalized – infants, and showing the dominance of multiple resistance gene carriage and wide dissemination of CTX-M-9 ESBL.

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Detection, identification and characterization of extended-spectrum beta-lactamases producing Enterobacteriaceae in wastewater and salads marketed in Ouagadougou, Burkina Faso

International Journal of Biological and Chemical Sciences ◽

10.4314/ijbcs.v14i8.8 ◽

2020 ◽

Vol 14 (8) ◽

pp. 2746-2757

Author(s):

Souleymane Soré ◽

Yacouba Sawadogo ◽

Juste Isidore Bonkoungou ◽

Sephora P. Kaboré ◽

Saidou Béogo ◽

...

Keyword(s):

Multidrug Resistant ◽

Diffusion Method ◽

Beta Lactamases ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

Extended Spectrum Beta Lactamases ◽

Amoxicillin Clavulanic Acid ◽

Synergy Test ◽

Identification And Characterization

Extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) represent a threat for failure of empirical antibiotic therapy and are associated with high mortality, morbidity and expenses. The aims of this study was to determine the prevalence of ESBL-PE and multidrug resistant enterobacteria (MDR), enterobacteria profil, investigate the associated resistance in wastewater and salads. After wastewater and salad sampling, enterobacteria was isoled on (EMB + 4μg / L cefotaxim). The stains of Enterobacteriaceae were identified by using biochemical methods and confirmed as ESBL by double-disc synergy test (amoxicillin/clavulanic acid with cefotaxime 30 μg, ceftazidime 30 μg and ceftriaxone 30 μg). Finally, the associated resistance was investigated by testing the susceptibility of the strains by the disc diffusion method. Global prevalence of ESBL-PE was 53.92% (95% CI: 48,2-59,5) (153/293), 61.11% from wastewater and 42.47% from salads. Major ESBL-E was Escherichia coli (73.44%), followed by Klebsiella pneumoniae (21.88%). Resistance to the aminoglycoside , fluroquinolonones and sulfonamides classes were dominant, observed in 53,83%, 93,86% and 98,95% of the isolates, respectively. The frequence of MDR was hight to channel1 (32,40%) and channel2 (26,26%). This study reports very worrying results. There is an urgent need to develop measures to monitor the spread of these multidrug-resistant strains.Keywords: Wastewater, ESBL-PE, Salads, Ouagadougou.

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Colonization with Multidrug-Resistant Bacteria in the First Week of Life among Hospitalized Preterm Neonates in Serbia: Risk Factors and Outcomes

Microorganisms ◽

10.3390/microorganisms9122613 ◽

2021 ◽

Vol 9 (12) ◽

pp. 2613

Author(s):

Marija Milic ◽

Marina Siljic ◽

Valentina Cirkovic ◽

Milos Jovicevic ◽

Vladimir Perovic ◽

...

Keyword(s):

Risk Factors ◽

Care Center ◽

Tertiary Care ◽

Multidrug Resistant ◽

Preterm Neonates ◽

Resistant Bacteria ◽

Extended Spectrum Beta Lactamase ◽

Gut Colonization ◽

Previous Hospitalization

The aim of this prospective cohort study was to determine the prevalence of gut colonization with multidrug-resistant (MDR) bacteria, risk factors for colonization, infection risk, and outcomes among preterm neonates hospitalized at a tertiary-care center in Serbia. During the period from December 2017 to April 2018, 103 neonates were screened for rectal carriage at admission and on the seventh day of life. Characterization of MDR strains was done by conventional microbiology and molecular methods. Out of 61 (59.2%) colonized neonates, 12 (11.6%) were found colonized at admission, while 49 (47.6%) became colonized at the study site. Among a total of 72 MDR isolates, extended-spectrum beta-lactamase (ESBL)-producing enterobacteria prevailed (56/72, 77%), followed by Acinetobacter baumannii (14/72, 19%). The majority of ESBL-producing strains carried multiple genes (blaTEM/blaCTX-M-15 or blaTEM/blaSHV). Longer previous hospitalization and delivery by cesarean section were associated with MDR colonization, while mechanical ventilation was a risk factor for colonization at the study site. Infections due to MDR bacteria were more frequent among colonized than non-colonized neonates, but not significantly, and mortality was low (1%) in the studied neonates. These results indicate that hospitalized preterm neonates in Serbia are rapidly colonized with a diversity of MDR species and resistance phenotypes/genotypes.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.467 ◽

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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Prevalence and characterization of extended spectrum beta-lactamase-producing Enterobacter cloacae strains in Algeria

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3127 ◽

2013 ◽

Vol 7 (11) ◽

pp. 804-811 ◽

Cited By ~ 5

Author(s):

Sabrina Nedjai ◽

Abouddihaj Barguigua ◽

Nassima Djahmi ◽

Loubna Jamali ◽

Khalid Zerouali ◽

...

Keyword(s):

Enterobacter Cloacae ◽

Dilution Method ◽

Agar Dilution Method ◽

Extended Spectrum Beta Lactamase ◽

Agar Dilution ◽

Synergy Test ◽

High Level ◽

Genomic Typing ◽

Microbiological Data

Introduction: Expended spectrum β-lactamase (ESBL)-producing Enterobacter cloacae is an important nosocomial pathogen. In this study, the prevalence and the molecular epidemiology of ESBL producing E. cloacae strains isolated from various hospitals in Annaba, Algeria were investigated. Methodology: The study involved 63 isolates of E. cloacae obtained during 2009 at the four hospitals in Annaba. The detection of ESBL was performed using the double-disk synergy test and the combined disk test. Minimum inhibitory concentrations (MICs) were determined using the agar dilution method. The presence of blaCTX-M, blaSHV, blaTEM, and blaDHA β-lactamase genes was evaluated by PCR, and genomic typing was determined by pulsed-field gel electrophoresis (PFGE) analysis. The clinical and microbiological data were entered into the EpiI Info database. Results: Thirty isolates (47.6%) had an ESBL phenotype. BlaCTX-M group1 (76%); blaTEM (70%) were the most prevalent, followed by blaDHA (16.6%) and blaSHV (10%). Eighteen strains expressed at least two bla genes. MICs revealed a high level of resistance to cefotaxime, ceftazidime, and cefepime. PFGE revealed an epidemic clonal dissemination of these isolates. Various risk factors associated with the occurrence of ESBL-producing E. cloacae were detected. Conclusions: A higher frequency of ESBL-producing isolates and a diversity of β-lactamases were detected among ESBL-producing E. cloacae; these resulted from an epidemic clonal dissemination and high transference of ESBL genes between bacteria in hospital settings. Strict measures will be required to control the further spread of these pathogens in hospital settings.

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Molecular detection and antibiotic resistance pattern of extended-spectrum beta-lactamase producing Escherichia coli in a Tertiary Hospital in Enugu, Nigeria

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-019-0342-9 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Ifeyinwa N. Nwafia ◽

Martin E. Ohanu ◽

Samuel O. Ebede ◽

Uchenna C. Ozumba

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Beta Lactamase ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Associated Risk Factors

Abstract Background The use of antibiotic agents in the treatment of infectious diseases has greatly contributed to the decrease in morbidity and mortality, but these great advances in treatment are being undermined by the rapidly increasing antimicrobial resistant organisms. Extended-spectrum beta-lactamases are enzymes hydrolyzing the beta lactam antibiotics, including third generation cephalosporins and monobactams but not cephamycins and carbapenems. They pose a serious global health threat and have become a challenge for health care providers. The aim of this research was to assess the prevalence of extended-spectrum beta-lactamase producing Escherichia coli in University of Nigeria Teaching Hospital Ituku-Ozalla Enugu and to detect the risk factors for acquisition of the resistant organism. To proffer advice on antibiotic stewardship in clinical practice and public health interventions, to curb the spread of the resistant organisms in the hospital. Results Out of the 200 E. coli isolates, 70 (35.00%) were confirmed positive for extended-spectrum beta-lactamase production. Fifty-three (75.7%) were from hospital acquired infections. All the isolates were resistant to ampicillin, tetracycline and chloramphenicol while 68 (97.14%) of the 70 isolates were susceptible to imipenem. BlaTEM, blaSHV and blaTEM were detected in 66 (94%) of the 70 isolates. The ESBL bla genes detected were blaCTX-M (n = 26; 37.14%), blaTEM (n = 7; 10.00%), blaSHV (n = 2; 2.86%), blaCTX-M/TEM (n = 7; 10.0%), blaCTX-M/SHV (n = 14; 20.0%) and blaCTX-M/TEM/SHV (n = 10; 14.29%). The three bla genes were not detected in 4 (5.71%) of the isolates. Recent surgery, previous antibiotic and intensive care unit admission were the associated risk factors to infections caused by extended-spectrum beta-lactamase producing E. coli. Conclusion There is a high rate of infections caused by extended-spectrum beta-lactamase producing E. coli. Recent surgery, previous antibiotic and intensive care unit admission were associated risk factors.

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Prevalence of Extended-Spectrum β-Lactamases in E. coli of Rats in the Region North East of Gabon

Veterinary Medicine International ◽

10.1155/2020/5163493 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Richard Onanga ◽

Pierre Philippe Mbehang Nguema ◽

Guy Roger Ndong Atome ◽

Arsène Mabika Mabika ◽

Berthelemy Ngoubangoye ◽

...

Keyword(s):

Multidrug Resistant ◽

Resistant Bacteria ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

North East ◽

Molecular Tests ◽

Extended Spectrum ◽

Susceptibility Tests ◽

Animal Feces

Antibiotic resistance occurs in the environment by multiplication and the spread of multidrug-resistant bacteria that would be due to an improper and incorrect use of antibiotics in human and veterinary medicine. The aim of this study was to establish the prevalence of E.coli producing Extended-Spectrum beta-Lactamase (ESBL) antibiotics from rats and gregarious animals in a semirural area of Gabon and to evaluate the origin of a resistance distribution in the environment from animal feces. The bacterial culture was carried out, and the identification of E. coli strains on a specific medium and the antibiotic susceptibility tests allowed establishing the prevalence. Characterization of resistance genes was performed by gene amplification after DNA extraction. On 161 feces collected in rats, 32 strains were isolated, and 11 strains of E. coli produced ESBL with a prevalence of 34.37%. Molecular tests showed that CTX-M genes 214 bp were identified in rats. The presence of CTX-M genes could have a human origin. So, the rats can carry ESBL-producing Enterobacteriaceae which poses a risk to human health and pets in this region of Gabon.

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Molecular and phylogenetic characterization of multidrug resistant extended spectrum beta-lactamase producing Escherichia coli isolated from poultry and cattle in Odisha, India

Infection Genetics and Evolution ◽

10.1016/j.meegid.2014.11.003 ◽

2015 ◽

Vol 29 ◽

pp. 82-90 ◽

Cited By ~ 41

Author(s):

Debasish Kar ◽

Samiran Bandyopadhyay ◽

Debaraj Bhattacharyya ◽

Indranil Samanta ◽

Achintya Mahanti ◽

...

Keyword(s):

Escherichia Coli ◽

Multidrug Resistant ◽

Beta Lactamase ◽

Phylogenetic Characterization ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

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Molecular characterization of extended-spectrum beta-lactamase producing Enterobacteriaceae in a Saudi Arabian tertiary hospital

The Journal of Infection in Developing Countries ◽

10.3855/jidc.3809 ◽

2014 ◽

Vol 8 (03) ◽

pp. 282-288 ◽

Cited By ~ 20

Author(s):

Hoda Hassan ◽

Baha Abdalhamid

Keyword(s):

Tertiary Hospital ◽

Multidrug Resistant ◽

Beta Lactamase ◽

M Gene ◽

Extended Spectrum Beta Lactamase ◽

E Coli ◽

Extended Spectrum ◽

Vitek 2 ◽

High Level

Introduction: The aim of this study was to determine the prevalence of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Proteus mirabilis (P. mirabilis). In addition, different methods for detection of these enzymes, including the newly introduced CHROMagar ESBL, were evaluated. Methodology: A total of 382 Enterobacteriaceae clinical isolates were obtained from King Fahad Specialist Hospital – Dammam, during 2011 and screened for production of ESBL using advanced expert system of Vitek 2, CHROMagar and ESBL-E-strips. PCR assay was used to detect blaTEM, blaSHV, and blaCTX-M genes. Susceptibility to a panel of antibiotics was determined. Results: The overall proportion of ESBL-producing enterobacterial isolates was 30.6%, which was higher in E. coli (35.8%) than in K. pneumoniae (25.7%). ESBL genotypes showed remarkable increase in the CTX-M (97.4%) compared to SHV (23.1%). The predominant ESBL was CTX-M- 15 (92.1 %). No TEM ESBL was detected in this study. The Vitek2 showed the highest sensitivity (100%), and the CHROMagar had the lowest specificity (97.3%) compared to the molecular method. All isolates were susceptible to imipenem and meropenem. Conclusions: This study confirms a high level of blaCTX-M positive ESBL isolates are circulating in the Eastern Province of Saudi Arabia. The trend of a multidrug-resistant profile associated with the recovery of the blaCTX-M gene is alarming.

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