ABSTRACT
Purpose: Compared with non-carbapenemase producing carbapenem-resistant Enterobacterales (non-CP-CRE), carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are associated with considerable mortality. However, given that the patients are treated with various therapeutic options, it remains unclear whether differences in types of carbapenemase genes yield different mortality rates. Therefore, this study aims to identify carbapenemase genes and identify whether clinical outcomes differ according to the prevalence of genotype and phenotype of carbapenemase among Enterobacterales clinical isolated. Patients and Methods: A retrospective cohort study was performed to determine whether types of carbapenemase genes have an impact on clinical outcomes. Carbapenem-resistant clinical isolates were collected at a tertiary care university hospital in Songkhla, Thailand, between June 2018 and February 2020. Demographic and microbiological data such as antimicrobial susceptibility, carbapenemase genes, and overall mortality were evaluated. Results: A total of 121 Enterobacterales clinical isolated were evaluated. The bla NDM-1 gene was detected in 44% of the isolates, followed by bla OXA-48 (28%) and bla NDM-1/OXA-48 (28%). NDM-1- or NDM-1/OXA-48- producing isolates were more likely to require meropenem MICs of ≥16 mg/L, while OXA-48-producing isolates were more likely to require meropenem MICs of <16 mg/L. The patients with NDM-1 or NDM-1/OXA-48 had a higher 14 days mortality rate than those with OXA-48 after treating with carbapenem-containing regimens (P-value 0.001) or colistin-containing regimens (P-value < 0.001). Conclusion: Our findings suggest that the mortality for CP-CRE infection in patients with NDM-1 or NDM-1/OXA-48 was higher than the mortality in those with OXA-48, which It seems that the type of carbapenemase gene may affect meropenem MIC levels. Hence, in treatment decisions involving the use of either carbapenem-containing regiment or colistin-containing regiment in patients with CP-CRE infection, especially those in the NDM-1 and NDM-1/OXA-48 groups, the patient symptoms should be closely monitored.
ABSTRACT
OBJECTIVES: To evaluate the accuracy of endoscopically guided middle meatal aspiration culture by comparing the culture results between middle meatal aspiration using the modified aspiration instrument and direct maxillary antral tap. MATERIAL AND METHOD: Sixteen patients with chronic rhinosinusitis underwent functional endoscopic sinus surgery (FESS) were enrolled. Both endoscopically middle meatal aspiration culture (EMAC) using modified aspiration instrument and direct antral tap culture (ATC) were performed before FESS. Microbiologic data were compared and analyzed for any statistical differences between EMAC and ATC. RESULTS: The positive culture rates were 93.75% in both EMAC and ATC groups. Aerobic and facultative anaerobic bacteria were found in 87.5% of EMAC group and 81.25% of ATC group. The two most common bacteria in both groups were coagulase-negative Staphylococcus and Staphylococcus aureus. The association between EMAC and ATC was strong to moderate (13/16) 81.25%. CONCLUSION: EMAC appears to be a valuable alternative to ATC for guiding bacterial-specific therapy in chronic rhinosinusitis. This modified aspiration instrument should be useful in clinical practice and serve as a cost effective procedure.
