ABSTRACT
This study evaluates whether the rapid fosfomycin resistance (fosfomycin NP) method can be used for detecting fosfomycin resistance in routine laboratory work. Results from the disk diffusion and rapid fosfomycin NP methods were compared with the reference agar dilution method for Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections. The study included 57 E. coli and 48 Klebsiella spp. isolates from urinary tract infections. The reference agar dilution and disk diffusion methods were performed in accordance with EUCAST recommendations, and the results were evaluated according to EUCAST V.10.0. The method developed by Nordmann et al. was used for rapid detection of fosfomycin resistance (Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18). The acceptable categorical agreement (CA ≥ 90%) and the rates of major error (ME <3%) and very major error (VME < 3%) of the two methods were compared with the reference method according to the criteria of ISO 20776-1. Fosfomycin resistance was detected in 15.8% of E. coli and 75% of Klebsiella spp. isolates using the reference method. Disk diffusion method showed CA 89.5%, ME 12.5% in E. coli isolates, and CA 75%, ME 100% in Klebsiella spp. isolates. No VME was detected in both methods. The rapid fosfomycin NP method resulted in CA 96.4%, ME 0.0%, VME 22.2% in E. coli isolates, and CA 77.3%, ME 81.8%, and VME 3% in Klebsiella spp. isolates. We believe the results from both of disk diffusion assay and rapid fosfomycin NP for the E. coli and Klebsiella spp. isolates are incompatible with the reference method and should not be used as an alternative to the agar dilution method.
Subject(s)
Drug Resistance, Bacterial , Escherichia coli/isolation & purification , Fosfomycin/pharmacology , Klebsiella/isolation & purification , Microbial Sensitivity Tests/methods , Urinary Tract Infections/diagnosis , Agar , Anti-Bacterial Agents/pharmacology , Diagnostic Tests, Routine/methods , Escherichia coli/drug effects , Escherichia coli Infections/diagnosis , Escherichia coli Infections/microbiology , Humans , Klebsiella/drug effects , Klebsiella Infections/diagnosis , Klebsiella Infections/microbiology , Klebsiella pneumoniae/isolation & purification , Urinary Tract Infections/microbiologyABSTRACT
PURPOSE: In this study, we aimed to evaluate the compliance of rapid antibiotic susceptibility test (RAST) and conventional laboratory procedures. METHODS: The RAST was performed directly from the blood cultures of 71 Gram negative bacilli (GNB) and 38 Gram positive cocci (GPC) isolates. The results were evaluated at fourth, sixth and eighth hour. Categorical agreement (CA), very major error (VME), major error (ME) and minor error (mE) were calculated and compared with the results of conventional Vitek-2 system. RESULTS: Categorical agreement was detected ≥90 in cefotaxime and meropenem at fourth hour in Escherichia coli isolates. An encourage positive CA results were obtained from meropenem, ceftazidime and ciprofloxacin at the fourth hour in Klebsiella pneumoniae isolates. CA was compatible in imipenem, ciprofloxacin, gentamicin, and tobramycin for Pseudomonas aeruginosa at sixth hour. CA was low (<90%) in piperacillin-tazobactam for E. coli and K. pneumoniae, and meropenem in P. aeruginosa isolates. A good CA (≥90) with all tested antibiotics were found at all hours for Acinetobacter baumannii and also very high CA (100%) was detected at sixth and eighth hour in Staphylococcus aureus isolates. CA remained below the standard criteria at fourth hour in vancomycin and high level gentamicin, in addition to imipenem at sixth hours in enterococci isolates. VME and ME were not detected and mE was 12.7% in GNB and 50% in GPC at eighth hour. CONCLUSIONS: EUCAST RAST at eighth hour will be beneficial in urgent patients due to their high CA rate, easy preparation, inexpensive, and could be performed with the available equipment and personnel.
Subject(s)
Anti-Bacterial Agents , Blood Culture , Microbial Sensitivity Tests , Acinetobacter baumannii , Anti-Bacterial Agents/pharmacology , Ceftazidime , Ciprofloxacin , Escherichia coli , Gentamicins , Gram-Negative Bacteria , Gram-Positive Cocci , Humans , Imipenem , Klebsiella pneumoniae , Meropenem , Pseudomonas aeruginosa , Staphylococcus aureus , VancomycinABSTRACT
As most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered the single most important intervention to prevent nosocomial infections. However, previous studies have shown that handwashing practices are poor, especially among medical personnel. The objective of this study was to assess the rate of handwashing among intensive care unit (ICU) healthcare personnel, and then to propose realistic suggestions so that hand hygiene' could be performed at an optimal level. To achieve this, each healthcare worker in the ICU of Istanbul Medical Faculty was observed directly, and, a comprehensive microbiological investigation was carried out among personnel and of the inanimate environment. The frequency of handwashing was low; 12.9% among medical personnel. Moreover, there was a widespread contamination in the ICU and 28.1% of the healthcare workers were carriers for methicillin-resistant Staphylococcus aureus (MRSA). The factors that contributed to low compliance of handwashing protocols were: a low staff to patient ratio, excessive use of gloves and deficiencies in the infra-structure of ICU. In heavy workload conditions, alcoholic handrub solutions for quick hand decontamination can be considered as an alternative to handwashing.
