Analysis of drug resistance and risk factors of multi drug resistant bacteria in bloodstream infection / 中国热带医学

@#Abstract: Objective To analyze the antimicrobial resistance rate and risk factors of multi drug resistant organisms (MDRO) in bloodstream infection for rational treatment. Methods　A total of 696 cases of bloodstream infections of Staphylococcus aureus, Enterococcus, Enterobacteriaceae (excluding Salmonella and Shigella), Pseudomonas aeruginosa and Acinetobacter in our hospital from 2017 to 2021 were selected, and 711 pathogenic strains were isolated from their whole blood samples. The antimicrobial resistance rates of various multi drug resistant strains were analyzed and the risk factors of MDRO infection were analyzed. Results　696 non repeated cases were screened out from 13 187 whole blood culture specimens, with a positive rate of 5.3%, and a total of 711 blood influenza pathogens were detected, among them, 350 strains of MDRO were detected with a detection rate of 49.23% (350/711). Among the pathogenic bacteria of bloodstream infection, Escherichia coli was the most, with 277 strains accounting for 38.96% (277/711), of which 201 strains were MDRO, accounting for 57.43% (201/350); followed by Klebsiella pneumoniae and Staphylococcus aureus, with 155 strains accounting for 21.80% (155/711) and 89 strains accounting for 12.52% (89/711), among which 43 strains of Klebsiella pneumoniae MDRO accounted for 12.29% (43/350) and 38 strains of Staphylococcus aureus MDRO accounted for 10.86% (38/350). The change trend of the three pathogens during 2017-2021 was not obvious. The drug sensitivity test showed that Escherichia coli and Klebsiella pneumoniae were highly resistant to cephalosporins and fluoroquinolones, and the drug resistance rate of aminoglycosides was relatively low. They had almost no resistance to cephalosporins and carbapenems. Staphylococcus aureus has a high resistance rate to lincomycin and macrolides, but no resistance to oxazolidinone, glycopeptides and glycylcyclins. There were 350 cases of MDRO infection and 361 cases of non MDRO infection. Univariate analysis showed that the age, sex, cardiovascular and cerebrovascular history, renal insufficiency, lung disease, hypoalbuminemia, hepatobiliary disease, electrolyte disorder and anemia of the patients had no statistical significance in MDRO infection (P>0.05); diabetes, urinary tract infection, surgical operation and burn were the influencing factors of MDRO (P<0.05). According to logistic analysis, diabetes, urinary tract infection, surgical operation and burn were the risk factors of MDRO infection (P<0.05). Conclusion　The infection of MDRO in patients with bloodstream infection is serious, and early prevention and control should be paid attention to, and the principle of graded use of antibiotics should be strictly observed, and the rational application should be carried out to actively and effectively control the production of MDRO.

Analysis of Nosocomial Infection in a Cancer Hospital from 2019 to 2021 / 中山大学学报(医学科学版)

ObjectiveTo understand the situation of nosocomial infection in cancer hospitals and its changing trend， so as to provide a basis for adjusting the focus of nosocomial infection prevention and control in cancer hospitals. MethodsData of nosocomial infection quality control indices of Sun Yat-sen University Cancer Center from 2019 to 2021 were obtained through the nosocomial infection monitoring system， and the changes of these indices across the three years were analyzed by Chi-square test and Cochran-Armitage trend test. ResultsFrom 2019 to 2021， the incidence rates of nosocomial infection in this hospital were 0.80%， 0.78% and 0.57%， which decreased significantly year by year （P<0.001）. Among them， surgical site and respiratory system infection were more common， accounting for 35.75% and 31.08%， respectively. Gram-negative bacteria and fungi were the main pathogens. The incidence rate of multidrug-resistant bacteria in hospital increased year by year， from 0.08‰ to 0.14‰ （P<0.001）， among which methicillin-resistant staphylococcus aureus， carbapenem-resistant Enterobacter and bacteria producing ultra-broad spectrum β-lactamase （ESBLs） bacteria increased significantly. The incidence rates of three-tube associated infections were no different across 3 years （P>0.05）， which were still at high levels. ConclusionFrom 2019 to 2021， the prevention and control of nonsocomial infection in the cancer hospital has been improved overall. Meanwhile， the infections of respiratory system and surgical sites， ESBLs related multidrug-resistant bacteria and three-tube are weak links in cancer specialized hospitals， which need to be emphasized and improved.

Variación de la susceptibilidad a antimicrobianos en aislados clínicos de Klebsiella pneumoniae y Escherichia coli de pacientes hospitalizados / Variation of antimicrobial susceptibility in clinical isolates of Klebsiella pneumoniae and Escherichia coli in inpatients

Introducción: La presencia de enterobacterias multirresistentes en los hospitales es cada vez más frecuente. Objetivos: Describir la variación de la susceptibilidad a los antimicrobianos en aislados de Klebsiella pneumoniae y Escherichia coli e identificar la frecuencia de aislados multirresistentes. Métodos: Estudio descriptivo retrospectivo realizado entre el 1 de enero de 2018 y 31 de diciembre de 2021. Se estudió la susceptibilidad a los antimicrobianos por el método de difusión de discos Bauer-Kirby a 220 aislados (111 de K. pneumoniae y 109 de E. coli) obtenidos de muestras clínicas (sangre, lesiones de piel, catéteres vasculares, secreciones traqueobronquiales y de herida quirúrgica) de pacientes hospitalizados en el Hospital Clínico-Quirúrgico Docente Aleida Fernández Chardiet, provincia Mayabeque, Cuba. Resultados: Durante los 4 años de estudio, en los aislados de K. pneumoniae la resistencia mostró tendencia a crecer en el tiempo para todos los antimicrobianos probados, excepto para amoxicilina/ácido clavulánico con tendencia a decrecer de -3,34. La diferencia porcentual de la resistencia del año 2021 con respecto al 2018 fue mayor para meropenem, cloranfenicol y amikacina (108,3 %, 70,2 % y 70,2 %, respectivamente). Aun así, los datos mostraron significación estadística para los antibióticos cefepima, aztreonam y meropenem (p ≤ 0,05). En cuanto a los aislados de E. coli, la resistencia mostró tendencia a decrecer en ocho de los antimicrobianos investigados, pero el cloranfenicol y amikacina evidenciaron una tendencia al incremento de 3,65 y 4,83, respectivamente. La diferencia porcentual entre los años extremos del estudio en nueve antimicrobianos mostró valores inferiores al 50,0 %. Los datos evidenciaron significación estadística (p ≤ 0,05) para cefotaxima y ampicilina/sulbactam. Conclusiones: Hubo variación en la susceptibilidad a los antimicrobianos en los aislados de K. pneumoniae y E. coli durante los 4 años del estudio. Además, se observó una alta prevalencia de aislados multirresistentes.

Introduction: The presence of multidrug resistant enterobacteria in hospitals is increasingly frequent. Objectives: To describe the variation of the antimicrobial susceptibility pattern of Klebsiella pneumoniae and Escherichia coli isolates obtained from clinical samples of patients who were hospitalized and to identify the frequency of multidrug resistant isolates. Methods: A retrospective and descriptive study was performed between January 1, 2018 and December 31, 2021. The antimicrobial susceptibility was analyzed using the Bauer- Kirby disc diffusion method of 220 isolates (111 K. pneumoniae and 109 E. coli) obtained from clinical samples (blood, skin lesions, vascular catheters and tracheobronchial and surgical wound secretions) of patients hospitalized at the Hospital teaching surgical - clinic Aleida Fernández Chardiet, located in the province of Mayabeque, Cuba. Results: In the K. pneumoniae isolates during the four years of the study, resistance showed a tendency to increase over time, for all antibiotic tested, except for amoxicillin / ácid clavulánic, which showed a tendency to decrease from 3.34. The percentage difference of the resistance between the year 2021 in relation to 2018 were greater for meropenem, chloramphenicol and amikacin (108.3%, 70,2% y 70.2% respectively). Even so, the data provided evidence that showed statistical significance for the antibiotics cefepime, aztreonam y meropenem (p ≤ 0,05). Regarding the E. coli isolates, resistance showed a tendency to decrease over the course of the four years of the study in eight of the investigated antibiotics. chloramphenicol and amikacin showed an increasing trend of 3.65 y 4.83 respectively. The percentage difference between the extreme years of the study in nine antimicrobials showed values lower than 50.0%. The data provide elements to suggest the presence of statistical significance (p ≤ 0.05) for cefotaxim y ampicilin/sulbactam. Finally, 83.87% of K. pneumoniae isolates and 80.73% of E. coli isolates were multidrug resistant. Conclusions: There was variation in the susceptibility to antibiotic in the K. pneumoniae and E. coli isolates during the four years of the study. In addition, a high prevalence of multiresistant isolates was observed.

Riesgo de infección en pacientes oncológicos colonizados por bacterias productoras de p-lactamasas de espectro extendido y enterobacterias productoras de carbapenemasas / Risk of infection in cancer patients colonized by extended expectrum p-lactamases and carbapenem producing Enterobacteriaceae

INTRODUCCIÓN: La prevalencia de microorganismos multirresistentes es un problema de salud pública que continúa creciendo a lo largo del mundo. Existe una población principalmente susceptible de ser colonizada y posteriormente infectarse, son los pacientes oncológicos. OBJETIVO: Identificar las características clínicas y patológicas de los pacientes oncológicos y su relación con la infección con microorganismos productores de BLEE y EPC. PACIENTES Y MÉTODOS: Se condujo un estudio retrospectivo y de carácter analítico entre el primero de enero de 2019 y el 30 de junio de 2020 en tres unidades hemato-oncológicas. RESULTADOS: Incluyó a 3.315 pacientes, de los cuales 217 (6,5%) se encontraban colonizados por microorganismos productores de BLEE y EPC; de éstos, 106/217 (48,8%) presentaron al menos un episodio de infección. El microorganismo más frecuentemente aislado fue Klebsiella pneumoniae, en 29/106 (27,4%). De los infectados, 18/106 (17%) presentaron infección por el mismo microorganismo colonizador. La mucositis (p = 0,002), edad mayor a 65 años (p = 0,041), hipoalbuminemia (p < 0,01), neutropenia (p < 0,01) y la presencia dispositivos invasivos (p < 0,01) demostraron una relación con el desarrollo de infección. CONCLUSIÓN: La presencia de hipoalbuminemia (OR 3,3, IC 1,5-7,1, p < 0,01), dispositivos invasivos (OR 5,8, IC 3.0-11,4, p < 0,01) y neutropenia (OR 4,1, IC 1,5-11,4, p < 0,01) predicen el desarrollo de infecciones.

BACKGROUND: The prevalence of multi-resistant microorganisms is a public health problem that continues to grow globally. There is a population that is mainly susceptible to being colonized and subsequently infected, and these are cancer patients. AIM: To identify the clinical and pathological characteristics of cancer patients and their relationship with infection with ESBL and CPE producing microorganisms. METHODS: A retrospective and analytical study was conducted between January 1, 2019 and June 30, 2020 in three hematooncological units. RESULTS: We included 3315 patients of which 217 (6.5%) were colonized by microorganisms producing ESBL and CPE. Of these, 106/217 (48.8%) had at least one episode of infection. The most frequently isolated microorganism was Klebsiella pneumoniae 29/106 (27.4%). Of those infected, 18/106 (17%) presented infection by the same colonizing microorganism. Mucositis (p = 0.002), age over 65 years (p = 0.041), hypoalbuminemia (p < 0.01), neutropenia (p < 0.01) and the presence of invasive devices (p < 0.01) demonstrated a relationship with development of infection. The presence of hypoalbuminemia (OR 3.3, CI 1.5-7.1, P < 0.01), invasive devices (OR 5.8, CI 3.0-11.4, p < 0.01) and neutropenia (OR 4.1, CI 1.5-11.4, p < 0.01) predict the development of infections.

Genótipos e Fenótipos de Resistência a Metais Pesados e Agrotóxicos em Patógenos de Alto Risco em Saúde Única / Genotypes and Phenotypes of Resistance to Heavy Metals and Pesticides in High-Risk Pathogens in Single Health

As atividades industriais e de agronegócio, embora necessárias para o desenvolvimento da sociedade, tem causado sérios problemas ambientais devido à eliminação inadequada de seus efluentes, sendo o tratamento destes um dos assuntos mais importantes em relação ao controle de poluição. Os microrganismos podem ser utilizados como biomarcadores de contaminação, portanto, o conhecimento de mecanismos associados à resistência e a capacidade de imobilização e biotransformação de poluentes é um fator importante para a identificação de linhagens adaptadas, que podem ser eficientes no tratamento e na recuperação de áreas contaminadas. O objetivo do presente projeto foi avaliar o perfil de tolerância de patógenos bacterianos de alto risco em saúde única, aos metais pesados (mercúrio, prata, telúrio e arsênio) e ao agrotóxico glifosato; identificando o resistoma associado. A correlação fenótipo-genótipo foi avaliada em isolados de Klebsiella pneumoniae (n= 35), Escherichia coli (n=46), e Salmonella spp. (n=19), determinando a CIM pelo método de microdiluição, e analisando as respectivas sequências genômicas. Entre os isolados de K. pneumoniae, 32 cepas apresentaram CIM elevadas (64- 512µg/mL) para o metal prata, dos quais 20 carregam o operon silPABCRSE responsável por conferir resistência. Uma cepa de K. pneumoniae carregando genes terABCE apresentou uma CIM de 64 µg/mL para telúrio. Seis cepas de E. coli apresentaram uma CIM >32 µg/mL para telúrio, sendo que 3 cepas carregam os genes tehA/B. Outras 6 cepas de E. coli apresentaram CIM para prata de 256-512 µg/mL, mas só duas carregaram genes silPFCE. Duas cepas de Salmonella apresentaram CIM 64-128 µg/mL para telúrio, e carregam genes tehA/B e terABCDEF. Em relação ao arsênio, 24 cepas de E. coli apresentaram uma CIM ≥ 512 µg/mL, e destas, 12 cepas carregam os genes arsRBC. Salmonella spp., que carregam o gene merR apresentaram CIMs de 8-16 µg/mL para mercúrio. Não foi possível correlacionar a presença do operon phnC-P (sugerido como responsável pela tolerância ao glifosato) com CIMs elevadas para este composto. Os resultados obtidos suportam a hipóteses que a exposição de bactérias de origem humana, animal e ambiental, aos metais pesados pode estar contribuindo para a seleção de linhagens tolerantes, sendo que a tolerância à prata mediada pelo operon silPABCRSE em K. pneumoniae foi predominante no grupo clonal CG258, característica com potencial de biomarcador que pode ser utilizado para monitorar o impacto do uso deste metal nas diferentes atividades humanas. Neste trabalho foi possível padronizar a técnica de PCR com os genes do operon sil de interesse

Industrial and agribusiness activities have caused serious environmental problems due to the inadequate disposal of their effluents, the treatment of which being one of the most important issues in relation to pollution control. Microorganisms can be used as biomarkers of contamination, therefore the knowledge of mechanisms associated with resistance and the immobilization and biotransformation capacity of pollutants can be an important factor for the identification of adapted strains, efficient in the treatment and recovery of contaminated areas. The aim of this study was to evaluate the tolerance profile of critical priority bacterial pathogens relevant in One Health, to heavy metals (mercury, silver, tellurium, and arsenic) and to the pesticide glyphosate, identifying the associated resistome. The phenotype-genotype correlation was evaluated in antibiotic-resistant isolates of Klebsiella pneumoniae (n= 35), Escherichia coli (n= 46), and Salmonella spp. (n= 19), by MIC determination using the microdilution method, and by analysis of their respective genomic sequences. Among the isolates of K. pneumoniae, 32 strains showed elevated MIC (64-512 µg/mL) for silver metal, of which 20 carried the silPABCRSE operon responsible for conferring resistance. A strain of K. pneumoniae carrying terrace genes showed a MIC of 64 µg/mL for tellurium. Six strains of E. coli showed an MIC> 32 µg/mL for tellurium, with 3 strains carrying the Thea/B genes. Other 6 strainsof E. coli showed MIC for silver of 256-512 µg/mL, but only two carried silPFCE genes. Two strains of Salmonella showed MIC 64-128 µg/mL for tellurium and carried the/B and terABCDEF genes. In relation to arsenic, 24 strains of E. coli had a MIC 512 µg/mL, and of these, 12 strains carried the arsRBC genes. Salmonella spp., which carriedthe mer gene, had MICs of 8-16 µg/mL for mercury. It was not possible to correlate thepresence of the phonic-P operon (suggested as responsible for glyphosate tolerance) with elevated MICs for this compound. The silver tolerance mediated by the operon sil was a predominant feature in K. pneumoniae strains belonging to the clonal group CG258, suggesting a intrinsic property that has contributed to the persistence and wide dissemination of CG258 within a One Health context, which could be as a biomarkerto monitor the impact of the use of silver compounds and silver-based biomaterial on different human activities. In this work it was possible to standardize the PCR technique with the genes of the sil operon of interest

An overview on the current available treatment for COVID-19 and the impact of antibiotic administration during the pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused several problems in healthcare systems around the world, as to date, there is no effective and specific treatment against all forms of COVID-19. Currently, drugs with therapeutic potential are being tested, including antiviral, anti-inflammatory, anti-malarial, immunotherapy, and antibiotics. Although antibiotics have no direct effect on viral infections, they are often used against secondary bacterial infections, or even as empiric treatment to reduce viral load, infection, and replication of coronaviruses. However, there are many concerns about this therapeutic approach as it may accelerate and/or increase the long-term rates of antimicrobial resistance (AMR). We focused this overview on exploring candidate drugs for COVID-19 therapy, including antibiotics, considering the lack of specific treatment and that it is unclear whether the widespread use of antibiotics in the treatment of COVID-19 has implications for the emergence and transmission of multidrug-resistant bacteria.

Multi-department cooperation in prevention and control of multi-drug-resistant bacteria nosocomial infectionata hospital / 公共卫生与预防医学

Objective To explore the role of multi-department cooperation in the prevention and control of nosocomial infection of multi-drug-resistant bacteria(MDRO). Methods Theretrospective analysis was conducted on 1 478 inpatients before the implementation of multi-department cooperative management (January 2019 to December 2019). The implementation of multi-department cooperative management began in January 2020, including :(1) the establishment of multi-department cooperative management organization system; (2) Establish a three-level MANAGEMENT network of MDRO; (3) Multidisciplinary joint training; (4) Clinical departments shall be equipped with clinical pharmacists; (5) The hospital infection monitoring system was used to conduct real-time monitoring on the submission of microbial samples, the detection rate of MDRO, the changes of drug-resistant bacteria and the use of antibiotics; (6) Led by the department of hospital pathology and medical Service, regular joint ward rounds should be conducted in the departments and key departments with high DETECTION rate of MDRO; (7) PDCA cycle mode was adopted for quality control of all links of nosocomial infection prevention and control measures; After the implementation of multi-department cooperative management (January 2020 to December 2020), all the hospitalized patients in 1849 cases were detected and counted, and the incidence of nosocomial infection, the detection rate of MDRO, the compliance rate of hand hygiene, the implementation rate of contact isolation, and the specimen inspection rate of therapeutic use of antibiotics and the reasonable utilization rate of antibiotics were compared before and after the implementation. Results The incidence of nosocomial infection and the detection rate of MDRO were significantly lower after the implementation of multi-department cooperative management than before (χ2=46.611, χ2=16.814, P 2 = 25.357, χ2=29.227, P2=25.576, χ2=33.624, P<0.05). Conclusion The practice of multi-department cooperative management brings into full play the advantages of interdisciplinary complementarity, improves the ability of medical staff to implement the prevention and control measures for MDRO, and can effectively reduce the incidence of nosocomial infection in MDRO.

Visual analysis of research on multidrug-resistant bacteria in intensive care unit in China / 中华危重病急救医学

Objective:To identify the distribution of research hotspots and frontiers of multidrug-resistant bacteria in intensive care units in China through the method of visualization, and to predict future research directions, analyze the research development process, so as to provide reference basis for further research in this field.Methods:Studies related to multidrug-resistant bacteria in intensive care units published in China from 2000 to 2019 by CNKI were reviewed. According to the keywords by CiteSpace 5.6.R2, the co-occurring network was generated to analyze the distribution of research hotspots in this field. Meanwhile, the mutation map of keywords was used to forecast the future research directions to a certain extent.Results:A total of 1 324 articles were finally included in the quantitative analysis. From 2000 to 2019, the number of publications in the field of multi-drug resistant bacteria in intensive care units showed a gradual increase, of which the number of publications increased rapidly from 2008 to 2014 (the number of publications increased from 34 to 124 articles). In the initial stage of research, conceptual keywords appeared, such as intensive care unit, infection, pathogenic bacteria and drug resistance among others. A dense keywords group appeared from 2008 to 2014, which covered several aspects, such as nosocomial infection, Acinetobacter baumannii, pathogenic bacteria, drug resistance, pulsed field gel electrophoresis and nursing etc., suggesting that research in this field has entered a period of vigorous development. High-frequency keywords, such as risk factors, pathogens, antibiotics, nosocomial infections, drug resistance genes and homology appeared from 2015 to 2019, thus representing the hotspots in recent years. Conclusions:The overall research on multidrug-resistant bacteria in intensive care units in China has gradually improved. The current studies focus on homology analysis and multidrug-resistant bacteria infections, among other topics. Further explorations at the genetic level will be conducted to fill the research vacancy in this field and to provide molecular biological basis for reducing the occurrence of multidrug-resistant bacteria in the future.

Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria / Cinética de procalcitonina en infecciones causadas por bacterias multirresistentes

Resumen La cinética de la procalcitonina es útil para reducir la duración de la antibioticoterapia en pacientes críticos, pero no se analizó su rol en infecciones por gérmenes multirresistentes. Se realizó un estudio observacional retrospectivo, analizando las curvas de procalcitonina de pacientes con neumonías asociadas a ventilación mecánica (NAVM) y bacteriemias asociadas a catéter (BAC) con rescate bacteriano durante el período 1/11/16 a 1/7/19. Se estudiaron 16 pacientes con infección por gérmenes sensibles (10 BAC y 6 NAVM) y 10 por gérmenes multirresistentes (10 BAC y 10 NAVM). Los pacientes con BAC generadas por gérmenes multirresistentes presentaron valores de procalcitonina mayores que los pacientes con BAC por gérmenes sensibles: (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Los pacientes con NAVM generada por gérmenes sensibles y multirresistentes presentaron valores de procalcitonina similares. El descenso de procalcitonina a niveles 80% menores al valor máximo o menores a 0.5 μg/l (con tratamiento antibiótico efectivo) fue más veloz en pacientes con infección por gérmenes sensibles (5 ± 1.8 días vs. 7.2 ± 2.9 días, p = 0.03). En las infecciones por gérmenes multirresistentes, la respuesta inflamatoria medida por procalcitonina fue más intensa y prolongada, aun con un tratamiento antibiótico efectivo. Sin embargo, el descenso se produjo antes de que finalizaran los esquemas antibióticos convencionales. Por este motivo, se considera necesario estudiar la potencial utilidad de protocolos antibióticos guiados por procalcitonina en pacientes con infecciones por gérmenes multirresistentes para reducir la exposición a antibióticos.

Abstract Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). CRBSI generated by multidrug-resistant bacteria elicited significantly higher procalcitonin levels than CRBSI infections caused by sensitive bacteria (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Patients with VAP caused by sensitive and multidrug-resistant bacteria elicited similar procalcitonin levels. The time to a decrease in procalcitonin level to less than 80% of the peak value or less than 0.5 μg/l upon effective antibiotic treatment was 7.2 ± 2.9 days in multidrug-resistant bacteria vs. 5 ± 1.8 days in sensitive bacteria (p = 0.03). In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.

Microbiota oral e retal de calitriquídeos (Callithrix sp) em área antropizada de Mata Atlântica, Rio de Janeiro, Brasil / [Oral and rectal microbiota of callitrichids (Callithrix sp) in an anthropized area of the Atlantic Forest in Rio de Janeiro, Brazil]

A proximidade dos primatas não humanos (PNH) com o ser humano pode ser considerada um fator de risco para transmissão de bactérias entre essas duas populações. Neste estudo, foi investigada a microbiota anfibiôntica aeróbica oral e retal de calitriquídeos em um fragmento de Mata Atlântica localizado no Rio de Janeiro, Brasil, e foram realizados testes fenotípicos para detecção de bactérias multirresistentes nos isolados encontrados. Foram capturados 14 calitriquídeos e coletadas 21 amostras (14 de cavidade oral e sete de cavidade retal) em dois pontos da mata próximos às habitações humanas. As espécies mais frequentes, na cavidade oral, foram Klebsiella oxytoca (50,0%), K. pneumoniae (28,6%), Kluyvera ascorbata (21,4%) e Stenotrophomonas maltophilia (21,4%) e, na cavidade retal, K. pneumoniae (85,7%), Escherichia coli (28,6%) e Enterobacter spp. (42,9%). Todos os 48 isolados da família Enterobacteriaceae foram negativos para ESBL (betalactamase de espectro ampliado), mostrando-se não produtores da enzima nos dois métodos utilizados: disco-aproximação e método de detecção automatizado. Na pesquisa de ERC (enterobactérias resistentes a carbapenêmicos), esses mesmos isolados não apresentaram resistência aos antibióticos imipenem, meropenem e ertapenem. Todas as bactérias isoladas apresentam um potencial zoonótico, o que representa um risco à saúde pública e à conservação das espécies.(AU)

Proximity of nonhuman primates (NHP) to humans can be considered a risk factor for transmission of pathogens between these two populations. This study investigated the oral and rectal aerobic bacterial microbiota of marmosets in an anthropized area of the Atlantic Forest located in Rio de Janeiro, Brazil, and performed phenotypic tests for detection of multidrug-resistant bacteria. Twenty-one samples (14 from the oral cavity and seven from the rectum) were collected from 14 Callithrix sp. captured in two sites of the forest near human dwellings. The most frequent species identified from the oral cavity swabs were Klebsiella oxytoca (50.0%), K. pneumoniae (28.6%), Kluyvera ascorbata (21.4%) and Stenotrophomonas maltophilia (21.4%), whereas the species most commonly identified from the rectum swabs were K. pneumoniae (85.7%), Enterobacter spp. (42.9%) and Escherichia coli (28.6%). All isolates of family Enterobacteriaceae showed no extended spectrum ß-lactamase production by disk-diffusion and automated detection tests. In the search for carbapenem-resistant enterobacteriaceae these isolates presented no resistance to the imipenem, meropenem and ertapenem antibiotics. The isolate of Staphylococcus aureus was susceptible to oxacillin and the isolate of Enterococcus was susceptible to vancomycin. All isolated bacteria showed zoonotic potential, thus posing a risk to species conservation and public health.(AU)

Plant-derived secondary metabolites as the main source of efflux pump inhibitors and methods for identification / 药物分析学报

The upsurge of multiple drug resistance (MDR) bacteria substantially diminishes the effectiveness of antibiotic arsenal and therefore intensifies the rate of therapeutic failure. The major factor in MDR is efflux pump-mediated resistance. A unique pump can make bacteria withstand a wide range of struc-turally diverse compounds. Therefore, their inhibition is a promising route to eliminate resistance phenomenon in bacteria. Phytochemicals are excellent alternatives as resistance-modifying agents. They can directly kill bacteria or interact with the crucial events of pathogenicity, thereby decreasing the ability of bacteria to develop resistance. Numerous botanicals display noteworthy efflux pumps inhibi-tory activities. Edible plants are of growing interest. Likewise, some plant families would be excellent sources of efflux pump inhibitors (EPIs) including Apocynaceae, Berberidaceae, Convolvulaceae, Cucur-bitaceae, Fabaceae, Lamiaceae, and Zingiberaceae. Easily applicable methods for screening plant-derived EPIs include checkerboard synergy test, berberine uptake assay and ethidium bromide test. In silico high-throughput virtual detection can be evaluated as a criterion of excluding compounds with efflux substrate-like characteristics, thereby improving the selection process and extending the identification of EPIs. To ascertain the efflux activity inhibition, real-time PCR and quantitative mass spectrometry can be applied. This review emphasizes on efflux pumps and their roles in transmitting bacterial resistance and an update plant-derived EPIs and strategies for identification.

Interpretation of Guild to the Quality and Safety of Organs for Transplantation (6th edition): risk of infectious disease transmission / 器官移植

Donor infection can be transmitted to the recipients through the grafts, leading to complications and even death. Donor-derived infection is an important cause of early infection after solid organ transplantation. The Chinese version of Guide to the Quality and Safety on Organs for Transplantation (6th edition) drafted by European Union in 2016 has been officially published. The Chapter 8 entitled 'Risk of infectious disease transmission' elaborates the medical history and behavioral history of infection risk of asymptomatic donors, basic screening highlights of various types of infections, transmission risk, prevention and control strategies of various pathogens. This chapter was mainly interpreted in this article.

Surveillance of multidrug-resistant bacteria in pediatric and neonatal intensive care units in Rio de Janeiro State, Brazil

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.

Study of warning infection whiten inpatient samples / Эрүүл мэндийн лаборатори

Objective@#To retrospectively analyze the drug resistant characteristics and distribution of multi-drug resistant bacteria infection in State Second General Hospital.@*Methods@#Total 772 cases treated in our hospital from January 2017 to September 2019 were selected as subjects. The automatic microorganism analyzer VITEC-2 and manual method were used for bacterial identification; Kirby-Bauer disk diffusion method was used for susceptibility test; WHONET 5.6.2019 software and EXCEL 2013 were used to analyze the distribution and drug sensitivity of isolated bacteria.@*Results@#Among the 772 strains of multi drug resistant bacteria, the proportion of Gram-negative bacteria was 84.9%, and the proportion of Gram-positive bacteria was 15,1%; fluconazole resistant candida accounted for 3.2%. Multi -drug resistant bacteria mostly distributed in sputum, accounting for 23.5%; 50.5% multi-drug resistant strains were from intensive care unit. </br> Resistant rates of Escherichia Coli ESBL, Klebsiella ESBL and Enterobacter spp to cephalosporins and penicillin were 100%. Resistant rates of staphylococcus aureus to antibacterial agents; cephalosporins and penicillin were 100%.@*Conclusion@#Gram-negative bacteria were the main multi-drug resistant bacteria of our study in our hospital, mainly distributing in Intensive care unit patients. They are highly resistant to most antibacterial agents, which provides a theoretical basis for the prevention and control of multi-drug resistant bacteria infection in hospital.

Perfil de resistência aos antibióticos e prevalência dos genes qacEΔ1 e sul1 em Pseudomonas aeruginosa de efluente hospitalar / Antibiotic resistance pattern and prevalence of qacEΔ1 and sul1 genes in Pseudomonas aeruginosa from hospital wastewater

Introdução: Efluentes hospitalares representam riscos à saúde pública e ambiental devido à presença de microrganismos patogênicos, drogas e produtos químicos. Pseudomonas aeruginosa é um patógeno oportunista frequentemente encontrado no ambiente hospitalar. Objetivo: Avaliar o resistoma de isolados de P. aeruginosa da estação de tratamento de esgoto hospitalar (ETEH) de um complexo hospitalar na cidade do Rio de Janeiro. Método: Vinte isolados dos cinco estágios da ETEH foram identificados como P. aeruginosa pelo sequenciamento do gene 16S rRNA. A suscetibilidade aos antibióticos foi determinada segundo o CLSI e os genes qacEΔ1 e sul1 foram detectados pela PCR. Resíduos de sulfonamidas foram pesquisados por cromatografia líquida de alta eficiência acoplada à espectrometria de massas sequencial. Resultados: Foi demonstrada a presença de sulfametoxazol em nível inferior a 50 ng∙L−1, resistência às sulfonamidas (80%) seguida pelas quinolonas (50%) e 13 perfis de suscetibilidade aos antimicrobianos. Os genes qacEΔ1-sul1 foram detectados em 100% dos isolados, sugerindo a presença de integrons de classe 1 em toda a ETEH. Conclusões: Os resultados sinalizaram limitações no tratamento e a propagação de genes de resistência nas etapas da ETEH. Esses dados contribuem com órgãos competentes no desenho de ações preventivas frente aos impactos negativos à saúde pública.

Introduction: Hospital effluents may pose great environmental risk due to the presence of pathogenic microorganisms, drugs and chemical components. Pseudomonas aeruginosa is an opportunistic pathogen frequently found in hospital environment. Objective: To evaluate the resistome of P. aeruginosa from the hospital wastewater treatment plant (HWTP) in a hospital complex of Rio de Janeiro city. Method: Twenty isolates from the five stages of the HWTP were identified as P. aeruginosa by 16S rRNA gene sequencing analysis. Susceptibility to antibiotics was determined according to CLSI and qacEΔ1 and sul1 genes were detected by PCR. Sulphonamide residues were investigated by high performance liquid chromatography coupled to sequential mass spectrometry. Results: The sulfamethoxazole has been demonstrated at a level below 50 ng L-1. Sulfonamide resistance (80%) has been demonstrated followed by quinolone class (50%) and 13 susceptibility patterns to antimicrobials. The qacEΔ1-sul1 genes were detected in 100% of isolates suggesting the presence of class 1 integrons in the whole HWTP. Conclusions: The results signalized limitations of HWTP and propagation of resistance genes in all stages of the HWTP. These data also contribute to the environmental sanitary surveillance in the design of prevention actions against negative impact on the public health.

Biofilm production and multidrug resistant bacterial isolates in ventilator associated pneumonia

Context: Ventilator-associated pneumonia is the second most common complication among all types of nosocomial infections. Mechanical ventilation predisposes to formation of a biofilm which worsens the prognosis because of increased multidrug resistant isolates implicated in formation of biofilm. Aim of the Study: The study was conducted to find out the relationship between duration of mechanical ventilation, biofilm formation, and antibiotic resistance among VAPpathogens. Study Design and Methods: A descriptive analytical study of 150 clinically suspected VAPpatients was done. Patients were divided into Group I and II based on intubation duration for 1–5 days and more than 6 days, respectively. Endotracheal aspirate was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ? 106 CFU/ mLfor quantitative cultures were considered significant. Biofilm production was detected by tissue culture plate method. Multivariate analysis was done to find out the association of the various factors. Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacterbaumannii. Among Gram negative bacteria 66.8% were ?-lactamase producers. In biofilm production by tissue culture method, Group I patients, 72.4% of the isolates showed either strong / moderate biofilm formation and in Group II patients, 92.3% of the isolates showed either strong / moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAPoccurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested. Conclusion: Bacterial aetiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Hence removal of ET tube in regular intervals should be considered with a proper choice of antimicrobial treatment or using ETtube coated with drugs/ biomaterials that discourage biofilm formation may be explored.

Inhibitory Effect of Metal Surface on the Antimicrobial Resistance Microorganism / 대한임상미생물학회지

BACKGROUND: The aim of this study was to comparatively evaluate the bactericidal effects of copper, brass (copper 78%, tin 22%), and stainless steel against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VREFM), and multidrug-resistant Pseudomonas aeruginosa (MRPA). METHODS: The isolates (MRSA, VREFM, MRPA) used in this study were mixed wild type 3 strains isolated from patients treated at Uijeongbu St. Mary's Hospital in 2017. These strains showed patterns of multidrug resistance. The lyophilized strains were inoculated into and incubated for 24 hr in tryptic soy broth at 35℃. The initial bacterial inoculum concentration was adjusted to 105 CFU/mL. A 100-mL bacterial suspension was incubated in containers made of brass (copper 78%, tin 22%), copper (above 99% purity), and stainless steel at 35℃. Viable counts of bacteria strains were measured for 9 days. RESULTS: In this study, the bactericidal effects of copper and brass on MRSA, VREFM, and MRPA were verified. The bactericidal effect of stainless steel was much weaker than those of copper and brass. The bactericidal effect was stronger on MRPA than on MRSA or VREFM. CONCLUSION: To prevent cross infection of multidrug resistant bacteria in hospitals, further studies of longer duration are needed for testing of copper materials on objects such as door knobs, faucets, and bed rails.

Factores predictores de mortalidad intrahospitalaria en pacientes adultos con infecciones por Klebsiella pneumoniae resistente a carbapenémicos y colistín: un estudio de cohorte retrospectivo / Risk factors for in-hospital mortality among adult patients infected with colistin-resistant carbapenemase producing Klebsiella pneumoniae: a retrospective cohort study

Resumen Introducción: La emergencia de Klebsiella productora de carbapenemasas resistente a colistín representa un desafío clínico y un problema emergente. Objetivo: Evaluar la mortalidad intrahospitalaria y sus potenciales factores de riesgo en pacientes internados con infecciones clínicas por Klebsiella pneumoniae productora de carbapenemasas (KPC) resistente a colistín. Material y Método: Realizamos un estudio de cohorte retrospectivo, incluyendo pacientes adultos admitidos a un hospital universitario de tercer nivel en Buenos Aires, infectados por KPC resistente a colistín. El evento primario considerado fue la mortalidad intrahospitalaria. Se utilizaron modelos generalizados lineales para evaluar potenciales predictores de dicho evento. Resultados: En total, se identificaron 18 pacientes hospitalizados que presentaron una infección clínica por esta bacteria durante el año 2016 y que fueron incluidos en el análisis final. La mortalidad intrahospitalaria en esta cohorte fue de 38,9%. La presencia de bacteriemia, la injuria renal aguda al momento del diagnóstico y la presencia de shock séptico se asociaron a la ocurrencia del evento primario. Conclusión: El desarrollo de infecciones clínicamente relevantes por KPC resistente a colistín en pacientes internados es frecuente y presenta una elevada mortalidad. En nuestra cohorte, la presencia de shock e injuria renal aguda al momento del diagnóstico se asociaron a un incrementado riesgo de mortalidad intrahospitalaria. Futuras investigaciones deberían corroborar estos hallazgos e investigar factores adicionales que permitan identificar tempranamente a aquellos pacientes que presentarán eventos desfavorables.

ABSTRACT Background: The emergence of colistin resistant carbapenemase-producing Klebsiella represents a therapeutic challenge and a worldwide problem. Aim: To estimate the in-hospital mortality and identify the associated risk factors among patients with colistin-resistant carbapenemase-producing Klebsiella pneumoniae (KPC) that present with a clinical infection. Methods: We carried a retrospective cohort study, including adult patients infected with colistin-resistant KPC hospitalized at a tertiary teaching hospital in Buenos Aires, Argentina during the year 2016. The main outcome was in-hospital mortality. We used generalized lineal models to evaluate potential predictors of mortality. Results: 18 patients that developed a colistin-resistant KPC clinical infection were identified and included in the final analysis. In-hospital mortality in this cohort was 38.9%. The presence of bacteremia, acute renal injury at the time of diagnosis and septic shock were associated with the main outcome. Conclusions: Infections due to colistin-resistant KPC among in-hospital patients was frequent and was associated with high mortality rate. In our cohort, both shock and acute kidney injury were associated with a higher likelihood of poor outcomes. Further studies are warranted to evaluate the role of these and others risk factors so as to aid in the early detection of high risk patients.

Study on Identification of Lipid Metabolites of Endophytic Fungus Aspergillus terreus from Polygonum capitatum and Their Anti-multidrug Resistant Bacteria and Anti-inflammatory Effects / 中国药房

OBJECTIVE:To identify lipid metabolites of endophytic fungus Aspergillus terreus from Polygonum capitatum, and to investigate their anti-multidrug resistant bacteria and anti-inflammatory effects. METHODS:GC-MS was used to analyze and identify lipid metabolites of A. terreus. MIC of lipid metabolites and main composition to 10 strains of multidrug resistant bacteria (Klebsiella pneumoniae,Proteus common,Staphylococcus epidermidis,Escherichia coli,Staphylococcus aureus,Enterobacter cloacae,Pseudomonas aeruginosa,Proteus mirabilis,Enterococcus faecium and Acinetobacter baumanii) were determined by 96-well plate microdilution method. The spread plate method was used to determine MBC of samples to bacteria. LPS-induced RAW264.7 inflammatory model was used to investigate the effects of different mass concentrations(50,100,200 μg/mL)of lipid metabolites on the release of NO and TNF-α after treated for 24 h. RESULTS:A total of 13 compounds were identified in lipid metabolites of A. terreus,among which palmitic acid,stearic acid,linoleic acid and oleic acid were main components,and relative percentages of them were 29.35％,10.87％,21.94％,34.85％. The lipid metabolites displayed anti-bacterial activity against E. coli and K. pneumonia with MICs of 12.5 mg/mL and 50 mg/mL,MBC of 25 mg/mL and 100 mg/mL,respectively. The main 4 compositions could inhibit the growth of E. coli,with MIC of 0.5-1 mg/mL,among which palmitic acid showed significant antibacterial activity,especially to E. faecium(MIC of 0.25 mg/mL). 50,100 μg/mL lipid metabolites could signifiantly inhibit the release of inflammatory factor of NO and TNF-α in RAW264.7 in vitro. CONCLUSIONS:The lipid metabolites of endophytic fungus A. terreus from P. capitatum show anti- multi-drug resistant bacteria and anti-inflammatory effects.

Analysis of distribution of 15249 strains of nosocomial infection pathogens and drug resistance / 国际检验医学杂志

Objective To monitor the distribution of pathogens and the drug resistance of inpatients in Southwest Hospital in ChongQing ,and to analyze the prevalence of pathogens in various departments .Methods A total of 15249 pathogens cultured from clinical specimens in our hospital in 2016 and the antimicrobial susceptibility testing results were retrospectively analyzed .The anti-microbial susceptibility testing was carried out by using the paper diffusion method (K-B) or the automated instrument method (MIC) .The data were analyzed by WHONET5 .5 software according to the standard of CLSI2017-M100 .Results Compared with 2015 ,a total of 15249 pathogenic microorganisms were isolated from the hospital in 2016 ,among which 9742 were Gram-negative bacteria ,down 11 .45% and 4188 were Gram-positive bacteria ,up 15 .34% and 1319 were fungi ,down 11 .48% .Top five depart-ments which collected most microbiological culture specimen were Burn ,Pediatric ,ICU ,Hepatobiliary surgery ,Neurosurgery .The main specimen type of culture was sputum ,accounting for 27 .28% ,followed by blood ,wound secretion ,urine ,abdominal fluid .The first five pathogens were Klebsiella pneumoniae ,Acinetobacter baumannii ,Escherichia coli ,Staphylococcus aureus ,Pseudomonas aeruginosa .Conclusion Gram-negative bacteria are mainly infected organisms in our hospital .However ,Gram-positive bacteria are also important pathogens .Antibiotics should be selected according to the results of antimicrobial susceptibility testing .The distribu-tion of pathogens and the changes of drug sensitivity should be emphasized ,which can provide an effective theoretical basis for treat-ment .