ABSTRACT
OBJECTIVES: This study aimed to determine potential host-, pathogen-, infection- and treatment-related risk factors that might predict a fulminant fatal course of bacteraemia caused by extensively drug-resistant Acinetobacter baumannii (XDR-Aba). METHODS: Eighty-seven patients with monomicrobial growth of XDR-Aba in blood cultures within a 6-year period (2011-2016) were studied. Patients were divided into three groups according to ICU outcome: Group A (n=40) consisted of patients who survived; Group B (n=10) included patients with fulminant sepsis who died early (≤48h); and Group C (n=37) included patients who died later (>48h) after the onset of bacteraemia. RESULTS: Regarding patient co-morbidities, patients who died from fulminant XDR-Aba bacteraemia had a significantly higher prevalence of chronic renal failure compared with patients who survived (40.0% vs. 7.5%; P=0.029). Patients with fulminant sepsis showed more severe organ dysfunction based on SOFA score compared with survivors (10.83±2.93 vs. 6.65±3.6; P=0.013). The primary to secondary bacteraemia ratio and appropriate treatment were similar among the three outcome groups. Patients with fulminant bacteraemia displayed higher rates of colistin-, tigecycline- and pandrug-resistant strains, although not statistically significant. CONCLUSIONS: Patients suffering from a fulminant course of XDR-Aba bacteraemia showed significantly higher rates of chronic renal failure and multiple organ dysfunction. Resistance patterns of XDR-Aba isolates and receipt of appropriate treatment did not affect outcomes. Further studies including larger samples of patients along with investigation of specific virulence determinants of individual Aba strains are needed.
Subject(s)
Acinetobacter Infections/mortality , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/pharmacology , Bacteremia/complications , Bacteremia/mortality , Drug Resistance, Multiple, Bacterial , Sepsis/etiology , Acinetobacter Infections/blood , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Carbapenems/pharmacology , Carbapenems/therapeutic use , Colistin/pharmacology , Colistin/therapeutic use , Female , Humans , Intensive Care Units/statistics & numerical data , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/microbiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Sepsis/drug therapyABSTRACT
This report describes the detection of Citrobacter koseri carrying K. pneumoniae carbapenemase (KPC-2) isolated in July 2011 from a Greek patient, who was also colonised by a Klebsiella pneumoniae strain coproducing KPC-2 and Verona integron-encoded metallo-beta-lactamase (VIM)-1.
Subject(s)
Bacterial Proteins/metabolism , Citrobacter koseri/isolation & purification , Enterobacteriaceae Infections/microbiology , beta-Lactamases/metabolism , Aged, 80 and over , Ciprofloxacin/therapeutic use , Citrobacter koseri/drug effects , Citrobacter koseri/enzymology , Citrobacter koseri/pathogenicity , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae Infections/drug therapy , Feces/microbiology , Greece , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/pathogenicity , Male , Microbial Sensitivity TestsABSTRACT
Serotype 19F pneumococci were a leading cause of infections among children in Athens, Greece during 2001-2006. In total, 143 19F isolates were typed by pulsed-field gel electrophoresis (PFGE), and 38 isolates representing the main PFGE types were also characterised by multilocus sequence typing. A diversity of distinct strains belonging to sequence types 236, 1035, 274, 172 and 319 were identified, but multidrug-resistant isolates related to the Taiwan(19F)-14 clone (ST236) constituted 76.9% of the isolates. Spread of the Taiwan(19F)-14 clone explains, in part, the high incidence of antibiotic resistance observed among pneumococci reported recently from Athens.
Subject(s)
Pneumococcal Infections/epidemiology , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/isolation & purification , Adolescent , Bacterial Typing Techniques , Child , Child, Preschool , Drug Resistance, Multiple, Bacterial , Electrophoresis, Gel, Pulsed-Field , Greece/epidemiology , Humans , Infant , Molecular Epidemiology , Sequence Analysis, DNAABSTRACT
An Escherichia coli clinical strain resistant to all beta-lactams except carbapenems was isolated in a Greek hospital. Analysis of beta-lactamase content by isoelectric focusing, PCR assays specific for various bla genes, and DNA sequencing showed that the strain produced TEM-1, a Citrobacter freundii AmpC-related cephalosporinase, and CTX-M-3. The blaCTX.M-3 gene was carried by a 120-kb plasmid that was readily transferable to a susceptible E. coli host.
Subject(s)
Escherichia coli/enzymology , beta-Lactamases/metabolism , Citrobacter freundii/genetics , Drug Resistance , Escherichia coli Infections/microbiology , Greece , Humans , Isoelectric Focusing , Microbial Sensitivity Tests , Molecular Sequence Data , Plasmids/genetics , beta-Lactam Resistance , beta-Lactamases/chemistryABSTRACT
An extended-spectrum beta-lactamase, IBC-2, produced by a clinical strain of Pseudomonas aeruginosa, was characterized. bla(IBC-2) was found, as a gene cassette, to be the sole gene within the variable region of a class 1 integron probably located in the chromosome. IBC-2 is a variant of IBC-1 and GES-1, differing by one amino acid from each of these beta-lactamases. When expressed in Escherichia coli, IBC-2 was observed to confer resistance to ceftazidime and decreased susceptibility to other oxyimino-beta-lactams.
Subject(s)
DNA Transposable Elements/genetics , Pseudomonas aeruginosa/genetics , beta-Lactamases/genetics , Amino Acid Sequence , Base Sequence , Ceftazidime/pharmacology , Cephalosporins/pharmacology , Escherichia coli/genetics , Humans , Molecular Sequence Data , Pseudomonas aeruginosa/drug effects , beta-Lactamases/biosynthesis , beta-Lactamases/chemistryABSTRACT
Eighty-seven out of 575 gonococci isolated in Greece from 1991 to 1998 belonged to serovar Bropyst and exhibited resistance to penicillin, tetracycline, erythromycin, and chloramphenicol. Conventional and molecular typing showed three clusters, A, B, and C, that were associated with networks of high- frequency transmitters (cluster A with homosexuals and clusters B and C with refugees from Eastern Europe). Study of one isolate revealed mutations in the penA, mtrR, and porB genes that may explain the multidrug-resistant phenotype.
Subject(s)
Bacterial Proteins , Drug Resistance, Microbial/physiology , Drug Resistance, Multiple/physiology , Ferredoxin-NADP Reductase , Neisseria gonorrhoeae/physiology , Porins , Anti-Bacterial Agents/pharmacology , Bacterial Outer Membrane Proteins/genetics , Chloramphenicol Resistance/genetics , Chloramphenicol Resistance/physiology , Drug Resistance, Microbial/genetics , Drug Resistance, Multiple/genetics , Erythromycin/pharmacology , Greece , Humans , Microbial Sensitivity Tests , Mutation , Neisseria gonorrhoeae/drug effects , Neisseria gonorrhoeae/genetics , Penicillin Resistance/genetics , Penicillin Resistance/physiology , Repressor Proteins/genetics , Tetracycline Resistance/genetics , Tetracycline Resistance/physiologyABSTRACT
Of the 331 Neisseria gonorrhoeae strains isolated in Greece from 1996 to 1999, 39 (11.8%) exhibited decreased susceptibility to quinolones due to gyrA and parC mutations. Conventional typing and pulsed-field gel electrophoresis showed that 34 of these isolates were clonally related. Epidemiological data indicated that the epidemic clone was sustained in a group of high-frequency transmitters.
Subject(s)
Anti-Infective Agents/pharmacology , Gonorrhea/microbiology , Neisseria gonorrhoeae/classification , Neisseria gonorrhoeae/drug effects , Urethritis/microbiology , DNA Gyrase , DNA Topoisomerase IV , DNA Topoisomerases, Type II/genetics , Drug Resistance, Microbial/genetics , Electrophoresis, Gel, Pulsed-Field , Fluoroquinolones , Gonorrhea/epidemiology , Greece/epidemiology , Humans , Male , Microbial Sensitivity Tests , Mutation , Neisseria gonorrhoeae/genetics , Urethritis/epidemiologySubject(s)
Anti-Bacterial Agents/pharmacology , Water Microbiology , Yersinia/drug effects , Yersinia/enzymology , beta-Lactamases/chemistry , Animals , Bivalvia/microbiology , Greece , Isoelectric Focusing , Microbial Sensitivity Tests , Yersinia/isolation & purification , beta-Lactamases/metabolism , beta-LactamsSubject(s)
Anti-Bacterial Agents/pharmacology , Erythromycin/pharmacology , Streptococcus/classification , Streptococcus/drug effects , Child , Child, Preschool , Clarithromycin/pharmacology , Clindamycin/pharmacology , Drug Resistance, Microbial , Greece , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Microbial Sensitivity Tests , PhenotypeABSTRACT
Of 37 Yersinia isolates from various aquatic environments, seven were Y. enterocolitica and 30 Y. intermedia. These isolates were biotyped, serotyped and tested for their susceptibility to 20 antibiotics. All Y. enterocolitica isolates were of biovar 1; those of Y. intermedia were distributed amongst four biovars (1, 2, 4 and 6). On the basis of combined biotyping and serotyping results, Y. enterocolitica isolates were distributed in five and Y. intermedia in 17 groups. With the exception of one Y. enterocolitica isolate which was resistant to tetracycline and streptomycin, the isolates were sensitive to the non-beta-lactam antibiotics. In contrast, various patterns of beta-lactam insensitivity were detected, including ampicillin and ticarcillin (35 isolates), cephalothin (33 isolates), carbenicillin (32 isolates), amoxycillin/clavulanate (23 isolates) and cefoxitin (22 isolates). No correlation between biotype or serotype and the susceptibility pattern of the isolates was apparent. Both inducible cephalosporinase activity against third-generation cephalosporins and inhibition of resistance to penicillins were detected in all Y. enterocolitica and Y. intermedia isolates by double-disk tests.
