Risk factors for ESBL-positive Escherichia coli urinary tract infections / Factores de riesgo para infección urinaria por Escherichia coli BLEE positiva

Abstract Objective: to determine the association of prior antibiotic use, prior hospitalizations, prior urinary tract infections, age, sex and comorbidities in adult patients hospitalized with urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. Materials and methods: a case-control study carried out in the hospital setting of private clinics in Lima. Thirty cases and 30 controls were included, with cases defined as hospitalized patients with an ESBL-producing E. coli urinary tract infection diagnosed by urine culture, and controls defined as hospitalized patients without ESBL-producing E. coli infection. Data were taken from incident cases. A bivariate analysis was performed followed by multivariate logistic regression using the significant variables from the bivariate analysis. Results: the associated factors were: prior antibiotic use OR: 261 (22.5-11,017.4), prior hospitalization OR: 4.6 (1.39-16.1), and prior urinary tract infection OR: 36 (6.9-227.2). After adjusting for potential confounding factors using logistic regression, the main statistically significant associated factor was prior antibiotic use, OR: 97.7 (8.4-1,128.3, p<0.000). Conclusion: evidence was found that prior antibiotic use is a risk factor significantly associated with ESBL E. coli urinary tract infections. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2131).

Resumen Objetivo: establecer la asociación del uso previo de antibióticos, hospitalizaciones previas, infección urinaria previa, edad, sexo y comorbilidades en pacientes adultos hospitalizados con infección urinaria por Escherichia coli productora de beta lactamasas de espectro extendido (BLEE). Material y métodos: estudio caso control, realizado en clínicas privadas de Lima en ámbito hospitalario. Se incluyeron 30 casos y 30 controles, definiéndose como caso al paciente hospitalizado que cuente con diagnóstico de infección urinaria por urocultivo de E. coli productora de BLEE y como control al paciente hospitalizado sin infección por E. coli BLEE. Se recolectó la información de casos incidentes. Se realizó un análisis bivariado y regresión logística multivariable con las variables que fueron significativas en el análisis bivariado. Resultados: los factores asociados fueron: uso previo de antibióticos OR: 261 (22.5-11017.4), hospitalización previa OR: 4.6 (1.39-16.1), infección urinaria previa OR: 36 (6.9-227.2). Al ajustar por variables potencialmente confusoras mediante regresión logística, se observó que el principal factor asociado con significación estadística fue el uso previo de antibióticos, OR: 97.7 (8.4-1128.3, p<0.000). Conclusión: se encontró evidencia de que el uso previo de antibióticos es un factor de riesgo asociado significativamente a infección urinaria por E. coli BLEE. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2131).

Isolation and Molecular Characterization of Extended Spectrum Beta Lactamase Producing Escherichia coli from Milk

Milk plays a major role as a source of nutrition in the diet but contaminated milk can be a source of harmful bacteria. Escherichia coli is opportunistic pathogen and is responsible for a wide range of infections. The prevalence of pathogenic multi-drug resistant extended-spectrum β-lactamase (ESBL)-producing E. coli is increasing and becoming a global concern. A study was carried out to isolate ESBL producing E. coli from 150 milk samples from Anand and around villages. Total 94(62.66%) samples were found positive as E. coli by isolation on MacConkey and Eosin Methylene Blue agar which were confirmed by primary & biochemical tests including Gram’s staining. Antibiotic sensitivity test (ABST) was performed against 6 antibiotics and isolates found resistant to Aztrionem: 58(61%), Cefoxitin: 20(21%), Ceftriaxone: 56(59%), Ceftazidime: 62(65%), Cefpodoxime: 34(44.73%) & Ceftazidime + Clavulanic acid: 8(8.5%). A total 34(36.17%) ESBL producing E. coli were phenotypically confirmed by ABST and Epsilometer test. Genotypic confirmation of 34 isolates was done by PCR and isolates found positive for bla CTX M-3 gene: 18(52.94%), bla CTX M-9 gene 6(17.64%), bla SHV gene: 5(14.70%) and bla TEM gene: 5(14.70%). In summary, analyzed milk samples were found to have a health risk for consumers due to contamination by ESBL producing E. coli, their pathogenicity and treatment failure as a result of antibiotic resistance

Evaluation Of Hand Hygiene Training And Its Effect On Mdr Bacteria Detection In Various Intensive Care Units Of Era’S Lucknow Medical College

Hand hygiene is nowadays considered as one of the most important measures to prevent transmission and acquisition of HCAIs (health care associated infections). Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion programme. A total of 50 ICU staffs(resident doctors, faculty & nurses e.t.c.) were included in this interventional study. Baseline data of hand hygiene practices of all staffs and pre-intervention hand culture were obtained. Post intervention hand culture were taken after 30 days of training and interactive sessions as well as continous availability of ABHR in the ICU. Results of post-intervention hand culture showed a marked decrease in isolation of bacteria specially those of MRSAand ESBL. MRSAwas low by 35% and in non of the cases ESBL was reported. In all the ICUs frequency of hand hygiene was poor(average 31%) but improved significantly after intervention (70%).Introduction of ABHR was found to be an effective tool for improving hand hygiene. As a result of periodic training, monitoring, surveillance hand cultures and awareness generating campaign, transmission of resistant bacteria can be reduced, thus reducing the burden of nosocomial infection in a hospital set-up.

Detección molecular de belactamasas de espectro extendido (BLEE) en enterobacterias aisladas en Asunción / Molecular detection of extended spectrum beta-lactamase (esbl) in enterobacteria isolated in Asunción

Las betalactamasas de espectro extendido (BLEE), son enzimas responsables de la hidrólisis del anillo betalactámico de penicilinas y cefalosporinas, excepto carbapemenes, inhibiendo así su actividad terapéutica. Si bien es posible la detección fenotípica de este mecanismo de resistencia por métodos convencionales, sólo los métodos moleculares permiten la identificación del gen responsable de dicha resistencia. El objetivo de este estudio descriptivo retrospectivo fue identificar los genes blaCTX-M2, blaPER-2, blaSHV y blaTEM, en aislamientos de enterobacterias productoras de BLEE,; de muestras clínicas colectadas entre julio 2007 y abril 2008, provenientes de dos hospitales de referencia de Asunción, Paraguay. La detección molecular de los genes se realizó por reacción en cadena de la polimerasa empleando oligonucleótidos específicos. De los 232 aislados BLEE analizados, el 83% (n=192) portó al menos un gen bla, en el 17% (n=40) restante no fue detectado ninguno de los genes incluido en el estudio. Se observaron las siguientes frecuencias: 49% (94/192) blaCTX-M2, 45% (86/192) blaSHV, 40% (77/192) blaTEM y 7% (13/192) blaPER-2. En el 47% (90/192) se detectó más de un gen, siendo la combinación blaCTX-M2+blaTEM+blaSHV, la más frecuente observada en 32 aislados. El blaCTX-M2 como el gen más frecuente en este estudio; concuerda con lo reportado en nuestro país y en Argentina. Este es el primer reporte de la presencia de blaTEM y blaSHV en Paraguay. Es de gran importancia el estudio de otros genes codificantes de resistencia, considerando la emergencia de otras BLEE en la región como blaCTX-M15 con actividad predominantemente ceftazidimasa.

Extended spectrum beta-lactamases (ESBLs), are enzymes responsible for thehydrolysis of the beta-lactam ring and resistance to both cephalosporins and penicillins,except carbapenems, therefore inhibiting its therapeutics activity. Even though, detectionof the phenotypic resistance mechanism by conventional methods is possible, onlymolecular methods allow identification of the gene responsible for the resistance. Theobjective of this retrospective study was to identify the blaCTX-M2, blaPER-2, blaSHV, blaTEMgenes in ESBL-producing enterobacteriaceae isolates, recovered from clinical samples collected between July 2007 and April 2008, from two reference hospitals in Asunción,Paraguay. Molecular gene detection was performed by polymerase chain reaction usingspecifics oligonucleotides. Out of the tested 232 ESBL-producing isolates, 83% (n=192)carried at least one of the bla genes as follows; 49% (94/192) blaCTX-M2, 45% (86/192)blaSHV, 40% (77/192) blaTEM and 7% (13/192) blaPER-2. In the rest 17% (n=40) none of thegenes included in this study was detected; in 47% (90/192) more than one gene wasdetected, resulting blaCTX-M2 + blaTEM + blaSHV as the most frequent combination in 32isolates. The presence of blaCTX-M2, as the most frequent codifying genes of BLEE is inagreement with previous reports in Paraguay and Argentina. This is the first report of thepresence of blaTEM and blaSHV circulating in Paraguay. It is of much importance the study ofothers codifying resistance genes, taking into account the emergence of other BLEE in theregion, such as blaCTX-M15, predominantly with ceftazidimase activity.

Rapid Detection of Extended Spectrum beta-Lactamase (ESBL) for Enterobacteriaceae by use of a Multiplex PCR-based Method / 감염과화학요법

A multiplex PCR method has been developed to classify extended spectrum beta-lactamase (ESBL) and plasmid-mediated AmpC beta-lactamase (PABL). This method consists of the use of two four-multiplex PCRs for the detection of TEM, OXA, SHV, CTX-M, CMY, and DHA type beta-lactamases. We have compared findings from the use of conventional detection methods with that of this newly developed typing method. In testing for 73 ESBL-producing and PABL-producing isolates, 100% of the isolates were correctly identified as previously characterized types and, 44 types of beta-lactamases were additionally identified from 33 isolates. This assay not only reduces the time for classification but also increases the accuracy for detection.

Rapid Detection of Extended Spectrum beta-Lactamase (ESBL) for Enterobacteriaceae by use of a Multiplex PCR-based Method / 감염과화학요법

A multiplex PCR method has been developed to classify extended spectrum beta-lactamase (ESBL) and plasmid-mediated AmpC beta-lactamase (PABL). This method consists of the use of two four-multiplex PCRs for the detection of TEM, OXA, SHV, CTX-M, CMY, and DHA type beta-lactamases. We have compared findings from the use of conventional detection methods with that of this newly developed typing method. In testing for 73 ESBL-producing and PABL-producing isolates, 100% of the isolates were correctly identified as previously characterized types and, 44 types of beta-lactamases were additionally identified from 33 isolates. This assay not only reduces the time for classification but also increases the accuracy for detection.

Disco-aproximação e E-teste na pesquisa de enterobactérias produtoras de Beta-lactamase de espectro estendido (ESBL) / Double-disk synergy and E-test in the producing research of enterobacteriaceae of extended-spectrum- beta-lactamase (ESBL)

Atualmente, diferentes bactérias vêm apresentando mecanismos de resistência aos antimicrobianos, destacando-se aqueles associados à produção enzimática. Segundo vários autores, as enterobactérias produtoras de beta-lactamase de espectro estendido(ESBL) continuam proliferando-se rapidamente. Essas enzimas são plamídeo-mediadas e conferem resistência a vários antimicrobianosbeta-lactâmicos. De um total de 60 isolados de bactérias resistentes à cefalotina, obtidos em laboratório de Novo Hamburgo (RS), 23,3% foram positivos nos testes fenotípicos para pesquisa da enzima (classe A de Ambler). Foram empregados, simultaneamente, fitas de E-teste e aproximação de discos, conforme proposto por Jarlier e colaboradores (1988). A última metodologia ofereceu resultados equivalentes ao E-teste, com a vantagem de custo muito inferior. Até o momento da execução deste estudo as amostras não eram triadas nem confirmadas para tal enzima, possibilitando, em cerca de 20% dos pacientes, desfecho clínico não favorável como conseqüência de tratamento inadequado.

Currently different bacteria are showing resistance mechanisms to antimicrobial, especially those associated with enzymeproduction. According to several authors, the species of Enterobacteriaceae family producers of extended-spectrum-beta-lactamase(ESBL) remain proliferating quickly. These enzymes are plasmid mediated and confer resistance to various beta-lactams antimicrobial agents. Within a total of 60 isolates of bacteria resistant to cefalotin, obtained in a hospital of the city of Novo Hamburgo (RS), 23,3% were positive in tests for phenotypic search of the enzyme (class A of Ambler). They had been employees, simultaneously, E-test and double-disk synergy, as considered for Jarlier and collaborators (1988). The last methodology offers resulted equivalents to the E-test with the advantage of very inferior cost. So far the execution of this study, the samples were not screened or confirmed for this enzyme, leading in about 20% of patients, not favorable clinical outcome as a result of inadequate treatment.

Clonal Dissemination of Extended-Spectrum beta-Lactamase (ESBL)-Producing Klebsiella pneumoniae Isolates in a Korean Hospital

In this study, we investigated the molecular characteristics of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae isolates that were recovered from an outbreak in a Korean hospital. A new multilocus sequence typing (MLST) scheme for K. pneumoniae based on five housekeeping genes was developed and was evaluated for 43 ESBL-producing isolates from an outbreak as well as 38 surveillance isolates from Korea and also a reference strain. Overall, a total of 37 sequence types (STs) and six clonal complexes (CCs) were identified among the 82 K. pneumoniae isolates. The result of MLST analysis was concordant with that of pulsedfield gel electrophoresis. Most of the outbreak isolates belonged to a certain clone (ST2), and they produced SHV-1 and CTX-M14 enzymes, which was a different feature from that of the K. pneumoniae isolates from other Korean hospitals (ST20 and SHV-12). We also found a different distribution of CCs between ESBL-producing and -nonproducing K. pneumoniae isolates. The MLST method we developed in this study could provide unambiguous and well-resolved data for the epidemiologic study of K. pneumoniae. The outbreak isolates showed different molecular characteristics from the other K. pneumoniae isolates from other Korean hospitals.

Hospital outcomes of adult respiratory tract infections with extended-spectrum b-lactamase (ESBL) producing Klebsiella pneumonia

Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalization in Malaysia. To study whether extended-spectrum b-lactamase (ESBL) producing K. pneumoniae was linked to hospital outcomes, we retrospectively studied 441 cases of adult respiratory tract infections with microbial proven K. pneumoniae from an urban-based university teaching hospital between 2003 and 2004. 47 (10.6%) cases had ESBL. Requirement for ventilation and median length of hospital stay, were greater in ‘ESBL’ than in ‘non-ESBL’ group [34% vs. 7.4%, p<0.001; 14 days vs. 5 days, p<0.001 respectively] but not crude hospital mortality rate [21.3% vs. 12.4%, p=0.092]. There was a four-fold increased risk of requiring ventilation [4.61 (2.72-7.85)] when ESBL was present. Our findings support the association of ESBL producing K. pneumoniae with adversed hospital outcomes and reiterate the need for vigilance on the part of treating clinicians.

Antibiotic Sensitivity Pattern of Pathogens from Children with UTI

PURPOSE: We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum beta-lactamase(ESBL)- producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. METHODS: We recruited 137 patients who grew more than 105 CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. RESULTS: The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin(91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin (24.2%). CONCLUSION: The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.

Clinical Characteristics and Epidemiologic Study of Infection Due to Extended Spectrum beta-Lactamase Producing Organism in a Neonatal Intensive Care Unit / 소아과

PURPOSE: The extended-spectrum beta-lactamase(ESBL) producing organism have emerged to be an important pathogen in neonatal intensive care unit(NICU). This study was conducted to investigate incidence, characteristics and risk factors associated with ESBL organism among newborns in NICU. METHODS: The subjects included 98 newborns admitted to NICU at Asan Medical Center between September 1998 to July 2002, from whom a total of 177 ESBL organisms were detected. Annual number of isolates, distribution of cultured sites, types of illness and patient profile were retrospectively reviewed and risk factors associated with the infection were identified between control group of 115 non-infected newborns. RESULTS: Of 177 ESBL isolates, 150(84.7%) and 27(15.3%) were ESBL producing K. pneumoniae and E. coli, respectively. The annual number of isolates were 2(1.1%), 23(13.0%), 126(71.2%), 17(9.6%) and 9(5.1%) for years 1998 to 2002. The annual incidence of sepsis due to ESBL organism was 2.9%, 8.2%, 17.8%, 3.1% and 2.8% for years 1998 to 2002:Year 2000 being an outbreak. The ESBL organisms were largely found in bronchial aspirates and urine. The infected patients were younger gestational age. The mean cultivation period was at 29.1+/-2.8 days. The risk factors for infection included, in the order of frequency, total parenteral nutrition, central venous catheterization, ventilator care, respiratory distress syndrome and dexamethasone therapy. CONCLUSION: Awareness of increasing infection due to ESBL producing organism in NICU is important not only for infection control but also placing a great limit in use of antibiotics, especially in premature infants.

The characteristics of extended-spectrum beta-lactamases in Korean isolates of Enterobacteriaceae

Extended-spectrum beta-lactamases (ESBLs) in gram-negative organisms have been implicated as the enzymes responsible for resistance to oxyimino-cephalosporins. The incidence of ESBL- producers in Korean isolates of Escherichia coli and Klebsiella pneumoniae were in the range of 4.8 7.5% and 22.5 22.8%, respectively. The ESBL-producing isolates revealed variable levels of resistance to cefotaxime, ceftazidime and aztreonam. They also showed the elevated MIC values of non-beta-lactam antibiotics. SHV-12 and SHV-2a were the enzymes most frequently found in K. pneumoniae strains, but TEM-52 was the most prevalent in E. coli isolates. About 15% of ESBL-producing isolates of Enterobacteriaceae produced CMY-1 enzyme, which conferred resistance to cephamycins such as cefoxitin as well as oxyimino-cephalosporins. Thus, the most common types of ESBLs in Korea are TEM-52, SHV-12, SHV-2a, and CMY-1.