#Mortality dynamics of #Pseudomonas aeruginosa #bloodstream #infections and the influence of defective OprD on mortality: prospective observational study (J Antimicrob Chemother., abstract)

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

Mortality dynamics of Pseudomonas aeruginosabloodstream infections and the influence of defective OprD on mortality: prospective observational study

Eun-Jeong Yoon, Dokyun Kim, Hyukmin Lee, Hye Sun Lee, Jeong Hwan Shin, Yoon Soo Park, Young Ah Kim, Jong Hee Shin, Kyeong Seob Shin, Young UhSeok Hoon Jeong

Journal of Antimicrobial Chemotherapy, dkz245, https://doi.org/10.1093/jac/dkz245

Published: 24 June 2019

 

Abstract

Background

To assess the mortality dynamics of patients with Pseudomonas aeruginosabloodstream infections (BSIs) and the influence of OprD deficiencies of the microorganism on early mortality.

Methods

A prospective multicentre observational study was conducted with 120 patients with P. aeruginosa BSIs occurring between May 2016 and April 2017 in six general hospitals in South Korea. PCR and sequencing were carried out to identify the alterations in oprD and the presence of virulence factors. Cox regression was used to estimate the risk factors for mortality at each timepoint and Kaplan–Meier survival analyses were performed to determine the mortality dynamics.

Results

During the 6 week follow-up, 10.8% (13/120) of the patients with P. aeruginosa BSIs died in 2 weeks, 14.2% (17/120) in 4 weeks and 20.0% (24/120) in 6 weeks, revealing a steep decrease in cumulative survival between the fourth and sixth weeks. ICU admission and SOFA score were risk factors for mortality in any weeks after BSI onset and causative OprD-defective P. aeruginosa had a risk tendency for mortality within 6 weeks. Among the 120 P. aeruginosa blood isolates, 14 were XDR, nine produced either IMP-6 or VIM-2 MBL, and 21 had OprD deficiency.

Conclusions

BSIs caused by OprD-defective P. aeruginosa resulted in a 2-fold higher 6 week mortality rate (33.3%) than that of BSIs caused by OprD-intact P. aeruginosa(17.2%), likely due to the decreased susceptibility to carbapenems and bacterial persistence in clinical settings.

Topic: pseudomonas aeruginosa – carbapenem – follow-up – mortality  – bloodstream infections – sequential organ failure assessment scores

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. 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; Carbapenem; Pseudomonas aeruginosa; Bacteremia.

——-

Advertisements

IncI1 ST3 and IncI1 ST7 #plasmids from CTX-M-1-producing #Escherichia coli obtained from #patients with #bloodstream infections are closely related to plasmids from E. coli of #animal origin (J Antimicrob Chemother., abstract)

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

IncI1 ST3 and IncI1 ST7 plasmids from CTX-M-1-producing Escherichia coli obtained from patients with bloodstream infections are closely related to plasmids from E. coli of animal origin

Adam Valcek, Louise Roer, Søren Overballe-Petersen, Frank Hansen, Valeria Bortolaia, Pimlapas Leekitcharoenphon, Helle B Korsgaard, Anne Mette Seyfarth, Rene S Hendriksen, Henrik Hasman, Anette M Hammerum

Journal of Antimicrobial Chemotherapy, dkz199, https://doi.org/10.1093/jac/dkz199

Published: 14 May 2019

 

Abstract

Objectives

Fully sequenced IncI1 plasmids obtained from CTX-M-1-producing Escherichia coli of human and animal origin were compared.

Methods

Twelve E. coli isolates sharing identical ESBL genes and plasmid multilocus STs sequenced on Illumina and MinION platforms were obtained from the Danish antimicrobial resistance surveillance programme, DANMAP. After de novoassembly, the sequences of plasmids harbouring blaCTX-M-1 were manually curated and ORFs annotated. Within-group comparisons were performed separately for the IncI1 ST3 plasmid type and the IncI1 ST7 plasmid type. The IncI1 ST3 plasmid group was obtained from 10 E. coli isolates (2 from patients with bloodstream infections, 6 from food and 2 from animals). The IncI1 ST7 plasmids originated from E. coli isolates obtained from a patient with bloodstream infection and from a pig. Sequences of IncI1 ST3 and IncI1 ST7 plasmids harbouring blaCTX-M-1 with determined origin were retrieved from GenBank and used for comparison within the respective group.

Results

The 10 IncI1 ST3 blaCTX-M-1 plasmids were highly similar in structure and organization with only minor plasmid rearrangements and differences in the variable region. The IncI1 ST7 blaCTX-M-1 plasmids also showed high similarity in structure and organization. The high level of similarity was also observed when including plasmids from E. coli of animal origin from Australia, Switzerland, the Netherlands and France.

Conclusions

This study shows broad spread of a very successful CTX-M-1-producing IncI1 type plasmid among E. coli of both human and animal origin.

Topic: plasmids – drug resistance, microbial – food – genes – ichthyosis, x-linked – sequence tagged sites – escherichia coli – sodium thiosulfate – bloodstream infections – genbank

Issue Section: ORIGINAL RESEARCH

© The Author(s) 2019. 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; E. Coli; Bacteremia; Pigs; Human; Plasmids.

——

Effect of #carbapenem #resistance on outcomes of #bloodstream #infection caused by #Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study

Andrew J Stewardson, MBBS  †, Kalisvar Marimuthu, MBBS †, Sharmila Sengupta, MD, Arthur Allignol, PhD, Maisra El-Bouseary, PhD, Maria J Carvalho, PhD, Brekhna Hassan, PhD, Monica A Delgado-Ramirez, MD, Anita Arora, MD, Ruchika Bagga, MD, Alex K Owusu-Ofori, MD, Joseph O Ovosi, MBBS, Shamsudin Aliyu, MBBS, Hala Saad, MD, Prof Souha S Kanj, MD, Prof Basudha Khanal, MD, Prof Balkrishna Bhattarai, MD, Samir K Saha, PhD, Jamal Uddin, MPH, Purabi Barman, MD, Latika Sharma, MD, Tarek El-Banna, PhD, Rabaab Zahra, PhD, Mansab Ali Saleemi, MPhil, Amarjeet Kaur, MD, Kenneth Iregbu, FWACP, Nkolika SC Uwaezuoke, FWACP, Pierre Abi Hanna, MD, Rita Feghali, MD, Prof Ana L Correa, MD, Maria I Munera, MD, Thi Anh Thu Le, MD, Thi Thanh Nga Tran, MD, Chimanjita Phukan, MD, Chiranjita Phukan, MD, Sandra L Valderrama-Beltrán, MD, Prof Carlos Alvarez-Moreno, MD, Prof Timothy R Walsh, DSc, Prof Stephan Harbarth, MD

Published: April 29, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30792-8

 

Summary

Background

Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.

Methods

The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis.

Findings

Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades.

Interpretation

Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs.

Funding

bioMérieux.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Enterobacteriaceae; Bacteremia.

——

Novel #Sequence Type in #Bacillus cereus Strains Associated with #Nosocomial #Infections and #Bacteremia, #Japan (Emerg Infect Dis., abstract)

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

Volume 25, Number 5—May 2019 / CME ACTIVITY – Research

Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan

Reiko Akamatsu, Masato Suzuki, Keiji Okinaka, Teppei Sasahara, Kunikazu Yamane, Satowa Suzuki, Daisuke Fujikura1, Yoshikazu Furuta, Naomi Ohnishi2, Minoru Esaki, Keigo Shibayama, and Hideaki Higashi

Author affiliations: Hokkaido University, Sapporo, Japan (R. Akamatsu, D. Fujikura, Y. Furuta, N. Ohnishi, H. Higashi); National Institute of Infectious Diseases, Tokyo, Japan (M. Suzuki, S. Suzuki, K. Shibayama); National Cancer Center Hospital, Tokyo (K. Okinaka, M. Esaki); Jichi Medical University, Tochigi, Japan (T. Sasahara); Yonago Medical Center, Tottori, Japan (K. Yamane)

 

Abstract

Bacillus cereus is associated with foodborne illnesses characterized by vomiting and diarrhea. Although some B. cereus strains that cause severe extraintestinal infections and nosocomial infections are recognized as serious public health threats in healthcare settings, the genetic backgrounds of B. cereus strains causing such infections remain unknown. By conducting pulsed-field gel electrophoresis and multilocus sequence typing, we found that a novel sequence type (ST), newly registered as ST1420, was the dominant ST isolated from the cases of nosocomial infections that occurred in 3 locations in Japan in 2006, 2013, and 2016. Phylogenetic analysis showed that ST1420 strains belonged to the Cereus III lineage, which is much closer to the Anthracis lineage than to other Cereus lineages. Our results suggest that ST1420 is a prevalent ST in B. cereus strains that have caused recent nosocomial infections in Japan.

Keywords: Bacillus cereus; Nosocomial Outbreaks; Bacteremia; Japan.

——

#Age-Dependent Increase in #Incidence of #Staphylococcus aureus #Bacteremia, #Denmark, 2008–2015 (Emerg Infect Dis., abstract)

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

Volume 25, Number 5—May 2019 / CME ACTIVITY – Research

Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015

Louise Thorlacius-Ussing  , Haakon Sandholdt, Anders Rhod Larsen, Andreas Petersen, and Thomas Benfield

Author affiliations: Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark (L. Thorlacius-Ussing, H. Sandholdt, T. Benfield); Statens Serum Institut, Copenhagen (A. Larsen, A. Petersen)

 

Abstract

Staphylococcus aureus bacteremia (SAB) is a major cause of illness and death worldwide. We analyzed temporal trends of SAB incidence and death in Denmark during 2008–2015. SAB incidence increased 48%, from 20.76 to 30.37 per 100,000 person-years, during this period (p<0.001). The largest change in incidence was observed for persons >80 years of age: a 90% increase in the SAB rate (p<0.001). After adjusting for demographic changes, annual rates increased 4.0% (95% CI 3.0–5.0) for persons <80 years of age, 8.4% (95% CI 7.0–11.0) for persons 80–89 years of age, and 13.0% (95% CI 9.0–17.5) for persons >90 years of age. The 30-day case-fatality rate remained stable at 24%; crude population death rates increased by 53% during 2008–2015 (p<0.001). Specific causes and mechanisms for this rapid increase in SAB incidence among the elderly population remain to be clarified.

Keywords: Staphylococcus aureus; Bacteremia; Denmark.

——

#Chlorhexidine versus routine #bathing to prevent #MDR organisms and all-cause #bloodstream #infections in general medical and surgical units (#ABATE Infection trial)… (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial

Prof Susan S Huang, MD,  Prof Edward Septimus, MD, Ken Kleinman, ScD, Julia Moody, MS, Jason Hickok, MBA, Lauren Heim, MPH, Adrijana Gombosev, MS, Taliser R Avery, MS, Katherine Haffenreffer, BS, Lauren Shimelman, BA, Prof Mary K Hayden, MD, Prof Robert A Weinstein, MD, Caren Spencer-Smith, MIS, Rebecca E Kaganov, BA, Michael V Murphy, BA, Tyler Forehand, MBA, Julie Lankiewicz, MPH, Micaela H Coady, MS, Lena Portillo, BS, Jalpa Sarup-Patel, BS, John A Jernigan, MD, Jonathan B Perlin, MD, Prof Richard Platt, MD, for theABATE Infection trial team

Published: March 05, 2019 / DOI: https://doi.org/10.1016/S0140-6736(18)32593-5

 

Summary

Background

Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units.

Methods

The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistantStaphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered withClinicalTrials.gov, number NCT02063867.

Findings

There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures ( figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73–0·87) in the decolonisation group versus 0·87 (95% CI 0·79–0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin.

Interpretation

Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients.

Funding

National Institutes of Health.

Keywords: Antibiotics; Drugs Resistance; Chlorhexidine; Mupirocin; MRSA; Bacteremia.

——

Dynamics of #resistance #plasmids in #ESBL-producing #Enterobacteriaceae during post-infection #colonization (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Dynamics of resistance plasmids in extended spectrum β-lactamase-producing Enterobacteriaceae during post-infection colonization

Alma Brolund, Fredrika Rajer, Christian G Giske, Öjar Melefors, Emilia Titelman, Linus Sandegren

DOI: 10.1128/AAC.02201-18

 

ABSTRACT

Extended spectrum β-lactamase-producing Enterobacteriaceae (EPE) are a major cause of bloodstream infections and the colonization rate of EPE in the gut microbiota of individuals lacking prior hospitalization or comorbidities is increasing. In this study we performed an in-depth investigation of the temporal dynamics of EPE and their plasmids during one year by collecting fecal samples from three patients initially seeking medical care for urinary tract infections. In two of the patients the same strain that caused the UTI was found at all consecutive samplings from the gut microbiota and no other EPEs were detected, while in the third patient the UTI strain was only found in the initial UTI sample. Instead, this patient presented a complex situation where a mixed microbiota of different EPE strain types, including three different E. coli ST131 variants, as well as different bacterial species was identified over the course of the study. Different plasmid dynamics were displayed in each of the patients including spread of plasmids between different strain types over time, transposition of blaCTX-M-15 from the chromosome to a plasmid followed by subsequent loss through homologous recombination. Small cryptic plasmids were found in all isolates from all patients and they appear to move frequently between different strains in the microbiota. In conclusion, we could demonstrate an extensive variation of EPE strain types, plasmid composition, rearrangements and horizontal gene transfer of genetic material illustrating the high dynamics nature and interactive environment of the gut microbiota during post UTI carriage.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; E. Coli; Enterobacteriaceae; Bacteremia.

——