Antimicrobial susceptibility profiles of anaerobic bacteria, isolated from human clinical specimens, within different European and surrounding countries. A joint ESGAI study.

OBJECTIVES: Studies on the antimicrobial susceptibility profile of anaerobic bacteria are underrepresented in the literature. Within this study we aim to give an extensive overview of the differences in antimicrobial susceptibility profiles between different European and surrounding countries. METHODS: Minimal inhibitory concentration (MIC) data of different antibiotics were collected from 10 participating laboratories, representing an equal number of countries. All MIC's were determined using Etest, according to the protocol used by the participating laboratory. Anaerobic genera represented by at least 10 clinical isolates were included in the study. RESULTS: Each country tested different antibiotics, sometimes depending on the kind of infection and/or the anaerobic species isolated. All countries tested clindamycin and metronidazole. Resistance rates differed remarkably between the different countries. Especially in Kuwait, resistance was high for all tested antibiotics. Unexpected metronidazole resistance was observed for Finegoldia magna isolates, Peptoniphilus isolates and Eggerthella lenta isolates. CONCLUSIONS: Due to the extensive differences in antimicrobial susceptibility profile of anaerobic bacteria isolated within different countries, we strongly recommend to perform this kind of study on a regular basis.

Successful control of the first OXA-48 and/or NDM carbapenemase-producing Klebsiella pneumoniae outbreak in Slovenia 2014-2016.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) occur only sporadically in Slovenia. AIM: To describe the first Slovenian carbapenemase-producing (CP) Klebsiella pneumoniae and Escherichia coli outbreak which occurred at the tertiary teaching hospital University Medical Centre Ljubljana from October 2014 to April 2015. METHODS: A CPE-positive case was defined as any patient infected or colonized with CPE. A strict definition of a contact patient was adopted. Measures to prevent cross-transmission included cohorting of all CPE carriers with strict contact precautions and assignment of dedicated healthcare workers, cohorting of all contact patients until obtaining the result of screening cultures, systematic rectal screening of contact patients, and tagging of all CPE-positive cases and their contacts. Educational campaigns on CPEs were implemented. Clinical specimens were processed using standard procedures. Pulsed-field gel electrophoresis (PFGE) was used to determine relatedness. Multi-locus sequence typing was performed on CP K. pneumoniae isolates that belonged to different pulsotypes. FINDINGS: Before the outbreak was brought under control, 40 patients were colonized or infected with OXA-48 and/or New Delhi metallo-ß-lactamase (NDM)-producing CPE; in 38 patients OXA-48 and/or NDM-producing K. pneumoniae was detected, in seven OXA-48 and/or NDM-producing E. coli was found together with K. pneumoniae, and in two patients only CP E. coli was isolated. The outbreak was oligoclonal with two major CP K. pneumoniae clusters belonging to ST437 and ST147 in epidemiologically linked patients. CONCLUSION: Initial standard control measures failed to prevent the outbreak. Once the problem had been recognized, strict infection control measures and the education of healthcare workers contributed to the successful control of the outbreak.

Treatment failure of pharyngeal gonorrhoea with internationally recommended first-line ceftriaxone verified in Slovenia, September 2011.

We describe the second case in Europe of verified treatment failure of pharyngeal gonorrhoea, caused by an internationally occurring multidrug-resistant gonococcal clone, with recommended first-line ceftriaxone 250 mg in Slovenia. This is of grave concern since ceftriaxone is last remaining option for empirical treatment. Increased awareness of ceftriaxone failures, more frequent test-of-cure, strict adherence to regularly updated treatment guidelines, and thorough verification/falsification of suspected treatment failures are essential globally. New effective treatment options are imperative.

Nationwide survey of CTX-M-type extended-spectrum beta-lactamases among Klebsiella pneumoniae isolates in Slovenian hospitals.

Among 177 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates collected from 11 Slovenian hospitals in 2005 and 2006, 60 (34%), from eight hospitals, harbored genes for CTX-M enzymes, with bla(CTX-M-15) detected by sequencing. These 60 isolates comprised 11 pulsed-field gel electrophoresis-defined strains, with several clusters of closely related isolates. Plasmids encoding CTX-M-15 enzyme were highly transmissible.

Prevalence of hepatitis G virus infection in Slovenian hemodialysis patients as determined by the detection of viral genome and E2 antibodies.

The prevalence of hepatitis G virus (HGV) infection was assessed by the detection of viral genome and HGV E2 antibodies in hemodialysis patients from a dialysis unit with the highest prevalence of hepatitis C virus infection in Slovenia. HGV RNA was detected in 7 (11.9%) and HGV E2 antibodies in 20 (33.9%) of 59 hemodialysis patients. One patient had detectable HGV RNA as well as HGV E2 antibodies in her serum sample at the time of the study. The total prevalence of HGV infection was 44.1%. Our results clearly indicate that the mere detection of HGV RNA in serum samples would seriously underestimate the real prevalence of HGV infection in hemodialysis patients. Therefore, when assessing the prevalence of HGV infection in hemodialysis patients, detection of both antibody and nucleic acid is requisite.