ĐẶC ĐIỂM BỆNH NHÂN NHIỄM KHUẨN TIẾT NIỆU PHỨC TẠP ĐIỀU TRỊ TẠI BỆNH VIỆN TRUNG ƯƠNG THÁI NGUYÊN

Mục tiêu: Mô tả đặc điểm lâm sàng, cận lâm sàng và căn nguyên vi khuẩn học của bệnh nhân nhiễm khuẩn tiết niệu (NKTN) phức tạp. Đối tượng và phương pháp nghiên cứu: Mô tả cắt ngang 100 bệnh nhân được chẩn đoán NKTN phức tạp tại Bệnh viện Trung ương Thái Nguyên (BVTWTN) từ tháng 02/2020 đến tháng 8/2021. Kết quả: Tỷ lệ nam/nữ = 0,79. Tuổi trung bình của các bệnh nhân là 61,64±17,15 với 60% bệnh nhân ≥60 tuổi. Thời gian nằm viện trung bình của các bệnh nhân là 14,22±7,49 ngày với 87% bệnh nhân nằm viện >7 ngày. 41% bệnh nhân có biểu hiện sốt, 33% với tiểu buốt và 49% với đau hông lưng. 41% bệnh nhân có suy thận, 40% với sỏi thận và 32% với bệnh lý suy giảm miễn dịch. 100% bệnh nhân có bạch cầu trong nước tiểu, 44% có hồng cầu niệu và 45% có nitrit niệu dương tính. Cấy nước tiểu: 91% dương tính với vi khuẩn Gram âm, trong đó vi khuẩn E.coli chiếm 61%, P.aeruginosa là 8%; E.coli nhạy cảm cao với fosfomycin (93,8%), meropenem (93,2%), piperacillin + tazobactam (84,9%) và amikacin (71,2%); kháng >50% các kháng sinh nhóm fluoroquinolone và các thế hệ của cephalosporin, kháng >80% nhóm betalactam và ức chế acid folic. Vi khuẩn Gram dương phân lập được hai chủng là Staphylococcus spp (4%) và Enterococcus spp (5%). Trong đó, Staphylococcus spp đã kháng với hầu hết các nhóm kháng sinh đang được sử dụng tại bệnh viện. Kết luận: NKTN phức tạp thường gặp ở những bệnh nhân cao tuổi, có bệnh lý thận mạn tính, sỏi tiết niệu hoặc tình trạng suy giảm miễn dịch. Triệu chứng lâm sàng thường gặp là sốt, rối loạn đi tiểu. Căn nguyên vi khuẩn gây NKTN phức tạp thường gặp là E.coli. Nhiều vi khuẩn có tỷ lệ đề kháng cao với các kháng sinh đang được sử dụng để điều trị NKTN tại bệnh viện.

Antimicrobial Resistance in Enterococci

Background. Enterococcus spp. are opportunistic agents of community-acquired and in-hospital infections, which have been considered a threat to public health due to their antimicrobial resistance, primarily to glycopeptides, in recent years.The aim of the study is to determine the prevalence of various Enterococcus species causing infections in hospitalized patients and their antimicrobial resistance.Methods included identification by MALDI-TOF mass spectrometry and antimicrobial susceptibility testing in accordance with the EUCAST or, in their absence, CLSI guidelines.Results. Antimicrobial resistance in 1562 consecutive Enterococcus strains isolated from hospitalized patients was determined in a major medical center admitting patients from various regions of the Russian Federation in 2019. The predominance of E.faecalis and E.faecium (99.5%) was revealed; the frequency of isolation of the former was 56% higher than that of the latter. E.avium, E.casseliflavus, E.gallinarum, E.durans were isolated from 0.5% of biological samples. The highest level of resistance of enterococci was observed to erythromycin (84.8%), tetracycline (75.0%), and rifampicin (68.2%). Multidrug, as well as vancomycin resistance, prevailed in E.faecium. All E.faecium strains isolated from blood were multidrug resistant. Resistance to vancomycin in enterococci, causing bloodstream infections, was observed solely in 19.5% of E.faecium; all vancomycin-resistant isolates were also resistant to teicoplanin. Linezolid resistance was detected in 2 community-acquired strains of E.faecalis (0.1%). Rare enterococci have shown diverse patterns of antimicrobial resistance.Conclusions. E.faecalis and E.faecium prevailed among Enterococcus spp. causing infections in hospitalized patients. Multidrug resistance and vancomycin resistance were observed predominantly in E.faecium, especially in strains causing blood-stream infections. Further monitoring of the spread and antimicrobial resistance of various Enterococcus spp. in hospital and community-acquired infections is needed.

Understanding and Application of Daptomycin-Susceptible Dose-Dependent Category for Enterococcus: A Mixed-Methods Study

Background In 2018, the Clinical Microbiology Laboratory at our institution adopted updated daptomycin Enterococcus–susceptible dose-dependent breakpoints. While the introduction of susceptible dose-dependent (SDD) was intended to guide practice toward optimal dosing, the understanding and application of daptomycin SDD breakpoints for enterococci were unknown. Methods This mixed-methods study combined a clinician survey with a retrospective pre–post prescribing analysis. An 8-question survey was distributed to infectious diseases (ID) and internal medicine (IM) clinicians. A retrospective chart review of hospitalized adults with infections due to Enterococcus spp. was conducted before (pre-SDD) and after (post-SDD) adoption of SDD reporting for enterococci. Results Survey response rates were 40 of 98 (41%) for IM and 22 of 34 (65%) for ID clinicians. ID clinicians scored significantly higher than IM clinicians in knowledge of SDD. Chart review of 474 patients (225 pre- vs 249 post-SDD) showed that daptomycin dosage following susceptibility testing was significantly higher post-SDD compared with pre-SDD (8.5 mg/kg vs 6.4 mg/kg; P < .001) with no difference in empiric dosing (6.3 mg/kg vs 6.2 mg/kg; P = .67). Definitive daptomycin use varied between the pre- and post-SDD periods (35.1% vs 16.9%; P < .001). Conclusions The survey revealed that ID clinicians placed more importance on and had more confidence in the SDD category over IM clinicians. SDD reporting was associated with a change in definitive daptomycin dosing. ID specialist involvement is recommended in the care of infections due to enterococci for which daptomycin is reported as SDD given their expertise.

A Preliminary Study on Antimicrobial Susceptibility of Staphylococcus spp. and Enterococcus spp. Grown on Mannitol Salt Agar in European Wild Boar (Sus scrofa) Hunted in Campania Region—Italy

The importance of wild boar lies in its role as a bioindicator for the control of numerous zoonotic and non-zoonotic diseases, including antibiotic resistance. Mannitol Salt Agar (MSA) is a selective medium used for isolation, enumeration, and differentiation of pathogenic staphylococci. Other genera such as Enterococcus spp. are also salt tolerant and able to grow on MSA. The present study focused on the identification, by matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS), of bacteria grown on MSA isolated from the nasal cavities of 50 healthy wild boars hunted in Campania Region (southern Italy) in the year 2019. In addition, the antimicrobial resistance phenotype of the isolated strains was determined by disk diffusion method. Among genus Staphylococcus, coagulase-negative Staphylococcus (CoNS) were the most common isolated species, with Staphylococcus xylosus as the most prevalent species (33.3%). Furthermore, Enterococcus spp. strains were isolated, and Enterococcus faecalis was the species showing the highest frequency of isolation (93.8%). For staphylococci, high levels of resistance to oxacillin (93.3%) were recorded. Differently, they exhibited low frequencies of resistance to tested non-β-lactams antibiotics. Among enterococci, the highest resistances were observed for penicillin (93.7%), followed by ampicillin (75%), and ciprofloxacin (68.7%). Interestingly, 43.7% of the isolated strains were vancomycin-resistant. In conclusion, this study reports the phenotypic antibiotic resistance profiles of Staphylococcus spp. and Enterococcus spp. strains isolated from nasal cavities of wild boars hunted in Campania Region, highlighting that these wild animals are carriers of antibiotic resistant bacteria.

Prevalence of Cyclomodulin-Positive E. coli and Klebsiella spp. Strains in Mexican Patients with Colon Diseases and Antimicrobial Resistance

Colon diseases, such as colorectal cancer (CRC), are multifactor diseases that affect more than one million people per year; recently, the microbiota has been associated with an etiologic factor, specifically bacterial cyclomodulin positivity (CM+). Unfortunately, there are no studies from Mexico that detail the presence of bacterial CM+ in patients with colon diseases. We therefore performed a comprehensive study to investigate the associations and prevalence of cyclomodulin-positive Diarrheagenic E. coli (DEC), non-DEC, and Klebsiella spp. strains isolated from Mexican subjects with colon diseases. In this work, we analyzed 43 biopsies, 87 different bacteria were isolated, and E. coli was the most frequently noted, followed by Klebsiella spp., and Enterococcus spp. E. coli, non-DEC, and EPEC belonging to phylogroup B2 were the most prevalent. More than 80% of E. coli and Klebsiella were CM+. pks, cdt, cnf, and cif were identified. cdt was associated with non-DEC, cif and its combinations with EPEC, as well as cdt and psk with Klebsiella. Lastly, all the CM+ bacteria were resistant to at least one antibiotic (34% were MDR, and 48% XDR). In conclusion, the high prevalence of bacterial CM+ in colon disease patients suggests that these bacteria play an important role in the genesis of these diseases.

Prevalence and Antimicrobial Resistance of Enterococcus Species: A Retrospective Cohort Study in Italy

Antimicrobial resistance represents one of the main threats to healthy ecosystems. In recent years, among the multidrug-resistant microorganisms responsible for nosocomial infections, the Enterococcus species have received much attention. Indeed, Enterococcus have peculiar skills in their ability to acquire resistance genes and to cause severe diseases, such as endocarditis. This study showed the prevalence and antimicrobial resistance rate of Enterococcus spp. isolated from clinical samples, from January 2015 to December 2019 at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy. A total of 3236 isolates of Enterococcus faecalis (82.2%) and Enterococcus faecium (17.8%) were collected from urine cultures, blood cultures, catheters, respiratory tract, and other samples. Bacterial identification and antibiotic susceptibility were performed with VITEK 2. E. faecium showed a high resistance rate against ampicillin (84.5%), ampicillin/sulbactam (82.7%), and imipenem (86.7%), while E. faecalis showed the highest resistance rate against gentamicin and streptomycin high level, but both were highly sensitive to such antibiotics as tigecycline and vancomycin. Studies of surveillance are an important tool to detect changes in the resistance profiles of the main pathogens. These antimicrobial susceptibility patterns are necessary to improve the empirical treatment guideline of infections.