Association Between #Treatment with Oral Third-Generation #Cephalosporin #Antibiotics and #Mortality #Outcomes in #Ebola Virus Disease: A Multinational Retrospective Cohort Study (Trop Med Int Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Trop Med Int Health. 2020 Jan 7. doi: 10.1111/tmi.13369. [Epub ahead of print]

Association Between Treatment with Oral Third-Generation Cephalosporin Antibiotics and Mortality Outcomes in Ebola Virus Disease: A Multinational Retrospective Cohort Study.

Aluisio AR1, Perera SM2, Yam D3, Garbern S1, Peters JL4, Abel L4, Cho DK4, Woldemichael D2, Kennedy SB5, Massaquoi M5, Sahr F6, Liu T3, Levine AC1.

Author information: 1 Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, USA. 2 International Medical Corps, Washington, DC, USA. 3 Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, USA. 4 Warren Alpert Medical School of Brown University, Providence, USA. 5 Ministry of Health, Monrovia, Liberia. 6 College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone, Freetown.

 

Abstract

OBJECTIVE:

To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola Virus Disease (EVD).

METHODS:

This retrospective cohort studied EVD-infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with Cefixime 400 mg once daily for five days was the clinical protocol: however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with Cefixime within 48 hours of admission to those not treated within 48 hours. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI).

RESULTS:

Of 424 cases analyzed, 360 (84.9%) met the Cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median Cefixime treatment duration was 4 days (IQR: 3, 5). Among Cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%), vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving Cefixime (OR=0.48, 95% CI: 0.32-0.71; p=0.01). In the bootstrap analysis, a non-significant risk reduction was found with Cefixime treatment (RR=0.82, 95% CI: 0.64-1.16, p=0.11).

CONCLUSION:

Early oral Cefixime may be associated with reduced mortality in EVD and warrants further investigation.

© 2020 John Wiley & Sons Ltd.

KEYWORDS: Antibiotics; Cephalosporin; Cohort Study; Ebola Virus; Viral hemorrhagic fevers

PMID: 31912627 DOI: 10.1111/tmi.13369

Keywords: Antibiotics; Cephalosporins; Cefixime; Ebola.

——

#NDM-β-Lactamase-5–Producing #Escherichia coli in Companion #Animals, #USA (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 2—February 2020 / Research Letter

New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States

Stephen D. Cole, Laura Peak, Gregory H. Tyson, Renate Reimschuessel, Olgica Ceric, and Shelley C. Rankin

Author affiliations: University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA (S.D. Cole, S.C. Rankin); Louisiana State University, Baton Rouge, Louisiana USA (L. Peak); US Food and Drug Administration, Silver Spring, Maryland, USA (G.H. Tyson, R. Reimscheussel, O. Ceric)

 

Abstract

We report isolation of a New Delhi metallo-β-lactamase-5–producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States. Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare. We describe a unique cluster of blaNDM-5–producing E. coli in a veterinary hospital.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Beta-lactams; NDM1; USA.

——

Novel Subclone of #Carbapenem-Resistant #Klebsiella pneumoniae Sequence Type 11 with Enhanced #Virulence and Transmissibility, #China (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 2—February 2020 / Research

Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China

Kai Zhou1, Tingting Xiao1, Sophia David1, Qin Wang, Yanzi Zhou, Lihua Guo, David Aanensen, Kathryn E. Holt, Nicholas R. Thomson, Hajo Grundmann2, Ping Shen2, and Yonghong Xiao2

Author affiliations: First Affiliated Hospital of Southern University of Science and Technology (Shenzhen People’s Hospital); Shenzhen, China (K. Zhou); The Second Clinical Medical College of Jinan University, Shenzhen (K. Zhou); Zhejiang University, Hangzhou, China (T. Xiao, Q. Wang, Y. Zhou, L. Guo, P. Shen, Y. Xiao); Centre for Genomic Pathogen Surveillance, Cambridge, UK (S. David, D. Aanensen); University of Melbourne, Melbourne, Victoria, Australia (K.-E. Holt); London School of Hygiene and Tropical Medicine, London, UK (K.E. Holt, N.R. Thomson); Wellcome Trust Sanger Centre, Cambridge (N.R. Thomson); University of Freiburg, Freiburg, Germany (H. Grundmann).

 

Abstract

We aimed to clarify the epidemiologic and clinical importance of evolutionary events that occurred in carbapenem-resistant Klebsiella pneumoniae (CRKP). We collected 203 CRKP causing bloodstream infections in a tertiary hospital in China during 2013–2017. We detected a subclonal shift in the dominant clone sequence type (ST) 11 CRKP in which the previously prevalent capsular loci (KL) 47 had been replaced by KL64 since 2016. Patients infected with ST11-KL64 CRKP had a significantly higher 30-day mortality rate than other CRKP-infected patients. Enhanced virulence was further evidenced by phenotypic tests. Phylogenetic reconstruction demonstrated that ST11-KL64 is derived from an ST11-KL47–like ancestor through recombination. We identified a pLVPK-like virulence plasmid carrying rmpA and peg-344 in ST11-KL64 exclusively from 2016 onward. The pLVPK-like–positive ST11-KL64 isolates exhibited enhanced environmental survival. Retrospective screening of a national collection identified ST11-KL64 in multiple regions. Targeted surveillance of this high-risk CRKP clone is urgently needed.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; China.

——

Low-temperature #laminar #flow #ward for the #treatment of #MDR #Acinetobacter baumannii #pneumonia (Eur J Clin Microbiol Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Eur J Clin Microbiol Infect Dis. 2020 Jan 2. doi: 10.1007/s10096-019-03790-x. [Epub ahead of print]

Low-temperature laminar flow ward for the treatment of multidrug resistance Acinetobacter baumannii pneumonia.

Gong Z1,2, Li J, Luo H1,2, Zhan D2,3, Liu X1,2, Gao C1,2, Huang J1,2, Qian Y1,2, Song Y1,2, Quan W1,2, An S1,2, Tian Y1,2, Hu Z4, Sun J1,2, Yuan H5,6, Jiang R7,8.

Author information: 1 Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. 2 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. 3 Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. 4 Department of clinical laboratories, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. 5 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. hengjieyuan@163.com. 6 Department of Pharmacy, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, 300052, China. hengjieyuan@163.com. 7 Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, China. jiang116216@163.com. 8 Tianjin Neurological Institute, Key Laboratory of Post-neurotrauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China. jiang116216@163.com.

 

Abstract

This study was designed to investigate the effect of low-temperature laminar flow ward (LTLFW) on the Acinetobacter baumannii pneumonia (MDR-ABP) in neurosurgical intensive care unit (NICU) patients. We evaluated whether patients in a LTLFW had significantly improved clinical outcomes as compared to those in nonconstant-temperature NICU (room temperature). The association of temperature with the prevalence of ABP and A. baumannii isolates (ABI) found in NICU patients was specifically investigated. In vitro microbiological experiments were conducted to measure the proliferation, antibiotic sensitivity, and genomic profiles of A. baumannii (AB) that grew in variable temperatures. MDR-ABP patients in LTLFW had significantly improved outcomes than those in the room temperature NICU. In addition, the numbers of ABI were positively associated with mean ambient outdoor temperatures (P = 0.002), with the incidence of ABP and average numbers of ABI among NICU patients being substantially lower in the winter as compared to other seasons. However, there were no significant seasonal variations in the other strains of the top five bacteria. Consistent with these clinical observations, AB growing at 20°C and 25°C had significantly reduced viability and antibiotic resistance compared to those growing at 35°C. The expression of genes related to AB survival ability, drug resistance, and virulence also differed between AB growing at 20°C and those at 35°C. LTLFW is effective in promoting the recovery of MDR-ABP patients because low temperatures reduced the density and virulence of AB and enhanced the efficacy of antibiotics, likely at the genetic level.

KEYWORDS: Acinetobacter baumannii; Pneumonia; Temperature; Treatment; Variation

PMID: 31898800 DOI: 10.1007/s10096-019-03790-x

Keywords: Antibiotics; Drugs Resistance; Acinetobacter baumannii; Nosocomial outbreaks; Pneumonia; Intensive care.

——

Occurrence and #antibiogram of #Listeria monocytogenes Isolates from Retail #Meat #Shops at #Erbil City, #Kurdistan Region, #Iraq (Ital J Food Saf., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Ital J Food Saf. 2019 Dec 5;8(4):8451. doi: 10.4081/ijfs.2019.8451. eCollection 2019 Dec 5.

Occurrence and antibiogram of Listeria monocytogenes Isolates from Retail Meat Shops at Erbil City, Kurdistan Region, Iraq.

Al-Mashhadany DA1.

Author information: 1 Department of Pathological Analysis, College of Science, Knowledge University, Erbil, Kurdistan Region, Iraq.

 

Abstract

Listeria monocytogenes is well-known globally as one of the most significant foodborne bacterial pathogens. Listeriosis may trigger life-threatening illness, such as severe sepsis, meningitis, sometimes resulting in lifelong harm and even death. This study aimed to determine the occurrence and antibiotic resistance pattern of L. monocytogenes in red meats sold at retail outlets in Erbil city, Kurdistan region, Iraq. Three hundred and seventy-five (375) samples were aseptically collected from retail meat shops between July and December 2018. For isolation of L. monocytogenes, samples were cultured on selective media and tested for their susceptibility to common antibiotics by disk diffusion assay. The results revealed that the overall occurrence of L. monocytogenes in red meat samples was 13.9%. Warm season was associated with increase in L. monocytogenes occurrence. The results of antimicrobial susceptibility testing showed that 98.1%, 94.2%, and 82.7% of isolates were resistant to Streptomycin, Gentamicin, and Ampicillin respectively. This resistance pattern of L. monocytogenes is critically alarming owing to the aforementioned antibiotics are the drugs of choice of treatment of listeriosis. This level of resistance requires further investigations and effective countermeasures since it may pose a public health hazard.

©Copyright: the Author(s), 2019.

KEYWORDS: Antibiogram; Erbil City; Iraq; Kurdistan region; L. monocytogenes; Occurrence; Retail Meat

PMID: 31897400 PMCID: PMC6912135 DOI: 10.4081/ijfs.2019.8451

Keywords: Antibiotics; Drugs Resistance; Listeriosis; Food Safety; Iraq.

——

Emergence of #ceftriaxone #resistant #Neisseria gonorrhoeae strains harbouring a novel mosaic penA gene in #China (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Emergence of ceftriaxone-resistant Neisseria gonorrhoeae strains harbouring a novel mosaic penA gene in China

Leshan Xiu, Qianqin Yuan, Yamei Li, Chi Zhang, Lingli Tang, Junping Peng

Journal of Antimicrobial Chemotherapy, dkz530, https://doi.org/10.1093/jac/dkz530

Published: 03 January 2020

 

Abstract

Objectives

The continuous emergence of ceftriaxone-resistant Neisseria gonorrhoeae strains threatens the effectiveness of current treatment regimens for gonorrhoea. The objective of the present study was to characterize three ceftriaxone-resistant N. gonorrhoeae strains with a novel mosaic penA allele isolated in China.

Methods

Three ceftriaxone-resistant Neisseria gonorrhoeae strains (GC150, GC161 and GC208) isolated in 2017 were characterized by N. gonorrhoeae multiantigen sequence typing (NG-MAST), MLST and N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR). Recombination analyses were performed using the SimPlot software.

Results

Three strains had the same antibiotic resistance profiles, with resistance to ceftriaxone (MIC 0.5 mg/L), ciprofloxacin (MIC 8.0 mg/L), penicillin (MIC 2.0 mg/L) and tetracycline (MIC 2.0–8.0 mg/L). STs were assigned as MLST7360, NG-MAST14292 and NG-STAR1611/NG-STAR1612. The penA gene of these three strains differed from previous ceftriaxone-resistant gonococcal strains and harboured a novel mosaic allele (penA-121.001). Like N. gonorrhoeae FC428, a widely disseminated ceftriaxone-resistant strain that was initially described in Japan in 2015, all strains also possessed substitutions A311V and T483S in PBP2, which are associated with resistance to ceftriaxone. Potential recombination events were detected in penA between N. gonorrhoeae strain FC428 and commensal Neisseria species. Our results provide further evidence that the commensal Neisseria species (Neisseria cinerea and Neisseria perflava) can serve as a reservoir of ceftriaxone resistance-mediating penA sequences in clinical gonococcal strains.

Conclusions

The emergence of such strains may be the result of the interspecies recombination of penA genes between N. gonorrhoeae strain FC428 and commensal Neisseria species.

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Ceftriaxone; Neisseria gonorrhoeae; China.

——

Effect of #Treating #Parents Colonized With #Staphylococcus aureus on #Transmission to #Neonates in the #ICU – A #RCT (JAMA, abstract)

[Source: Journal of American Medical Association, full page: (LINK). Abstract, edited.]

Preliminary Communication / December 30, 2019

Effect of Treating Parents Colonized With Staphylococcus aureus on Transmission to Neonates in the Intensive Care Unit – A Randomized Clinical Trial

Aaron M. Milstone, MD, MHS1,2,3; Annie Voskertchian, MPH1; Danielle W. Koontz, MAA1; et al. Dina F. Khamash, MD1,4; Tracy Ross, BS5; Susan W. Aucott, MD6; Maureen M. Gilmore, MD6; Sara E. Cosgrove, MD, MS2,7; Karen C. Carroll, MD8; Elizabeth Colantuoni, PhD9

Author Affiliations: 1 Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 3 Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland; 4 Department of Pediatrics, Cooper University Health Care, Camden, New Jersey; 5 Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland; 6 Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; 7 Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 8 Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; 9 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

JAMA. Published online December 30, 2019. doi: https://doi.org/10.1001/jama.2019.20785

 

Key Points

  • Question  – Does treating parents with short-course intranasal mupirocin and topical chlorhexidine bathing compared with placebo reduce acquisition of Staphylococcus aureus colonization in neonates?
  • Findings  – In this randomized clinical trial that included 190 neonates with parents colonized with S aureus, treating parents with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced the hazard of acquiring colonization with a parental S aureus strain (hazard ratio, 0.43).
  • Meaning  – Treating colonized parents may reduce risk of S aureus transmission to neonates, but these findings are preliminary and require further research for replication and to assess generalizability.

 

Abstract

Importance  

Staphylococcus aureus is a leading cause of health care–associated infections in the neonatal intensive care unit (NICU). Parents may expose neonates to S aureus colonization, a well-established predisposing factor to invasive S aureus disease.

Objective  

To test whether treating parents with intranasal mupirocin and topical chlorhexidine compared with placebo would reduce transmission of S aureus from parents to neonates.

Design, Setting, and Participants  

Double-blinded randomized clinical trial in 2 tertiary NICUs in Baltimore, Maryland. Neonates (n = 236) with S aureus–colonized parent(s) were enrolled. The study period was November 7, 2014, through December 13, 2018.

Interventions  

Parents were assigned to intranasal mupirocin and 2% chlorhexidine–impregnated cloths (active treatment, n = 117) or petrolatum intranasal ointment and nonmedicated soap cloths (placebo, n = 119) for 5 days.

Main Outcomes and Measures  

The primary end point was concordant S aureus colonization by 90 days, defined as neonatal acquisition of an S aureus strain that was the same strain as a parental strain at time of screening. Secondary outcomes included neonatal acquisition of any S aureus strain and neonatal S aureus infections.

Results  

Among 236 randomized neonates, 208 were included in the analytic sample (55% male; 76% singleton births; mean birth weight, 1985 g [SD, 958 g]; 76% vaginal birth; mean parent age, 31 [SD, 7] years), of whom 18 were lost to follow-up. Among 190 neonates included in the analysis, 74 (38.9%) acquired S aureus colonization by 90 days, of which 42 (56.8%) had a strain concordant with a parental baseline strain. In the intervention and placebo groups, 13 of 89 neonates (14.6%) and 29 of 101 neonates (28.7%), respectively, acquired concordant S aureus colonization (risk difference, –14.1% [95% CI, –30.8% to –3.9%]; hazard ratio [HR], 0.43 [95.2% CI, 0.16 to 0.79]). A total of 28 of 89 neonates (31.4%) in the intervention group and 46 of 101 (45.5%) in the control group acquired any S aureus strain (HR, 0.57 [95% CI, 0.31 to 0.88]), and 1 neonate (1.1%) in the intervention group and 1 neonate (1.0%) in the control group developed an S aureus infection before colonization. Skin reactions in parents were common (4.8% intervention, 6.2% placebo).

Conclusions and Relevance  

In this preliminary trial of parents colonized with S aureus, treatment with intranasal mupirocin and chlorhexidine-impregnated cloths compared with placebo significantly reduced neonatal colonization with an S aureus strain concordant with a parental baseline strain. However, further research is needed to replicate these findings and to assess their generalizability.

Trial Registration  ClinicalTrials.gov Identifier: NCT02223520

Keywords: Intensive Care; Staphylococcus aureus; Pediatrics; Antibiotics; Mupirocin; Chlorhexidine.

——