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.



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.


#XDR #Klebsiella pneumoniae ST307 #outbreak, north-eastern #Germany, June to October 2019 (Euro Surveill., abstract)

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

Extensively drug-resistant Klebsiella pneumoniae ST307 outbreak, north-eastern Germany, June to October 2019

Sebastian Haller1, Rolf Kramer1, Karsten Becker5, Jürgen A Bohnert5, Tim Eckmanns1, Jörg B Hans6, Jane Hecht1, Claus-Dieter Heidecke5, Nils-Olaf Hübner5, Axel Kramer5, Kathleen Klaper2, Martina Littmann4, Lennart Marlinghaus6, Bernd Neumann2, Yvonne Pfeifer2, Niels Pfennigwerth6, Simone Rogge4, Katharina Schaufler7, Andrea Thürmer3, Guido Werner2, Sören Gatermann6

Affiliations: 1 Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany; 2 Robert Koch Institute, Division of Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany; 3 Robert Koch Institute, Genome Sequencing Unit, Berlin, Germany; 4 Regional Public Health Authority Mecklenburg-Western Pomerania, Rostock, Germany; 5 University Medicine Greifswald, Greifswald, Germany; 6 National Reference Centre for multidrug-resistant Gram-negative bacteria, Ruhr University Bochum, Bochum, Germany; 7 Institute of Pharmacy, University of Greifswald, Greifswald, Germany

Correspondence:  Sebastian Haller

Citation style for this article: Haller Sebastian, Kramer Rolf, Becker Karsten, Bohnert Jürgen A, Eckmanns Tim, Hans Jörg B, Hecht Jane, Heidecke Claus-Dieter, Hübner Nils-Olaf, Kramer Axel, Klaper Kathleen, Littmann Martina, Marlinghaus Lennart, Neumann Bernd, Pfeifer Yvonne, Pfennigwerth Niels, Rogge Simone, Schaufler Katharina, Thürmer Andrea, Werner Guido, Gatermann Sören. Extensively drug-resistant Klebsiella pneumoniae ST307 outbreak, north-eastern Germany, June to October 2019. Euro Surveill. 2019;24(50):pii=1900734. https://doi.org/10.2807/1560-7917.ES.2019.24.50.1900734

Received: 03 Dec 2019;   Accepted: 12 Dec 2019



From June to October 2019, 17 patients (six infected, 11 colonised) with an extensively drug-resistant (XDR) Klebsiella pneumoniae strain were notified from four Western Pomerania medical facilities. The XDR K. pneumoniae produced carbapenemases NDM-1 and OXA-48, and was only susceptible to chloramphenicol, tigecycline and cefiderocol. Synergistic activity was observed for the combination of aztreonam plus ceftazidime-avibactam. Genomic analyses showed all isolates belonged to K. pneumoniae sequence type 307. Control measures and further investigations are ongoing.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Nosocomial outbreaks; Germany.


A #cluster of #colistin- and #carbapenem-resistant #Klebsiella pneumoniae carrying #blaNDM-1 and #mcr-8.2 (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

A cluster of colistin- and carbapenem-resistant Klebsiella pneumoniae carrying blaNDM-1 and mcr-8.2

Ke Ma, Yu Feng, Lu Liu, Zhihong Yao, Zhiyong Zong

The Journal of Infectious Diseases, jiz519, https://doi.org/10.1093/infdis/jiz519

Published: 11 December 2019




Klebsiella pneumoniae resistant to both carbapenems and colistin imposes severe challenges for management. Here we report a cluster of five carbapenem-resistant K. pneumoniae clinical strains belonging to ST1 and K57 types, four of which were also resistant to colistin, from two hospitals.


The five strains were subjected to whole genome sequencing (WGS) using the short-read Illumina HiSeq platform and two strains were also selected for long-read WGS using MinION. Clonal relatedness of the five strains was determined based on single nucleotide polymorphisms (SNPs). Conjugation experiments were performed to obtain self-transmissible plasmids.


All five strains carried the carbapenemase-encoding gene blaNDM-1, whereas the four colistin-resistant strains also harbored a new variant of the mcr-8 colistin resistance gene, namely mcr-8.2. Mcr-8.2 differs from Mcr-8.1 by four amino acid substitutions (A51V, A232S, N365Y, and N480K). mcr-8.2 was located on a large, hybrid, non-self-transmissible plasmid containing IncQ, IncR, and IncFII replicons, whereas blaNDM-1 was carried by self-transmissible IncX3 plasmids. Phylogenetic analysis based on SNPs revealed that the five strains were likely to have a common origin.


Both the intra- and inter-hospital transfer of strains carrying mcr-8 and blaNDM-1 were identified, which represents an emerging threat for clinical management and infection control.

colistin resistance, mcr, plasmid, Klebsiella pneumoniae

Topic: plasmids – colistin – klebsiella pneumoniae – single nucleotide polymorphism – beta-lactamase ndm-1 – carbapenem resistance – whole genome sequencing

This content is only available as a PDF.

Author notes: These authors contributed equally.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: 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; Colistin; Carbapenem; Klebsiella pneumoniae; Nosocomial outbreaks; NDM1.


#Genome #investigations show host #adaptation and #transmission of LA- #MRSA CC398 from #pigs into #Danish #healthcare #institutions (Sci Rep., abstract)

[Source: Scientific Reports, full page: (LINK). Abstract, edited.]

Genome investigations show host adaptation and transmission of LA-MRSA CC398 from pigs into Danish healthcare institutions

Raphael Niklaus Sieber, Anders Rhod Larsen, Tinna Ravnholt Urth, Søren Iversen, Camilla Holten Møller, Robert Leo Skov, Jesper Larsen & Marc Stegger

Scientific Reports, volume 9, Article number: 18655 (2019)



Over the last decade, an increasing number of infections with livestock-associated methicillin-resistant Staphylococcus aureus of clonal complex 398 (LA-MRSA CC398) in persons without contact to livestock has been registered in Denmark. These infections have been suggested to be the result of repeated spillover of random isolates from livestock into the community. However, other studies also found emerging sub-lineages spreading among humans. Based on genome-wide SNPs and genome-wide association studies (GWAS), we assessed the population structure and genomic content of Danish LA-MRSA CC398 isolates from healthcare-associated infections from 2014 to 2016 (n = 73) and compared these to isolates from pigs in Denmark from 2014 (n = 183). Phylogenetic analyses showed that most human isolates were closely related to and scattered among pig isolates showing that the majority of healthcare-associated infections are the result of repeated spillover from pig farms, even though cases of human-to-human transmission also were identified. GWAS revealed frequent loss of antimicrobial resistance genes and acquisition of human-specific virulence genes in the human isolates showing adaptation in response to changes in selective pressures in different host environments, which over time could lead to the emergence of LA-MRSA CC398 lineages more adapted to human colonization and transmission.

Keywords: Antibiotics; Drugs Resistance; Staphylococcus aureus; MRSA; Pigs; Human; Nosocomial outbreaks; Denmark.


Molecular Characterization of #MRSA in a Tertiary Care #hospital in #Kuwait (Sci Rep., abstract)

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

Sci Rep. 2019 Dec 6;9(1):18527. doi: 10.1038/s41598-019-54794-8.

Molecular Characterization of Methicillin- Resistant Staphylococcus aureus in a Tertiary Care hospital in Kuwait.

Alfouzan W1,2, Udo EE3, Modhaffer A1, Alosaimi A1.

Author information: 1 Microbiology Unit, Department of Laboratory Medicine, Farwaniya hospital, Ministry of Health, Sabah Al Nasser, Kuwait. 2 Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait. 3 Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait. EDET@hsc.edu.kw.



Methicillin-resistant Staphylococcus aureus (MRSA) are a major cause of healthcare and community- associated infections due to their ability to express a variety of virulence factors. We investigated 209 MRSA isolates obtained from 1 January to 31 December 2016 using a combination of phenotypic and genotypic methods to understand the genetic backgrounds of MRSA strains obtained in a General hospital in Kuwait. Antibiotics susceptibility was performed with disk diffusion, and MIC was measured with Etest strips. Molecular typing was performed using SCCmec typing, spa typing, and DNA microarray for antibiotic resistance and virulence genes. The isolates were susceptible to vancomycin, teicoplanin, rifampicin, ceftaroline, and linezolid but were resistant to gentamicin, tetracycline, erythromycin, fusidic acid, chloramphenicol and ciprofloxacin. Molecular typing revealed six SCCmec types, 56 spa types and 16 clonal complexes (CC). The common SCCmec types were type IV (39.5%), type III (34.4%), type V (25.8%) and type VI (3.8%). The dominant spa types were t860 (23.9%), t945 (8.6%), t127 (6.7%), t688 (6.7%), t304 (6.2) and t044 (5.7%). The other spa types occurred sporadically. Genes for PVL was detected in 59 (28.2%) of the isolates. CC8-ST239-MRSA-III + SCCmer (23.3%) was the most prevalent clone, followed by CC6-MRSA-IV (8.3%), CC80-MRSA-IV [PVL+] (5.8%), CC5-MRSA-VI + SCCfus (5.0%), CC30-MRSA-IV[PVL+] (4.1%), CC1-MRSA-V + SCCfus [PVL+] (4.1%), CC5-MRSA-V + SCCfus (4.1%) and CC22-MRSA-IV[PVL+] (4.1%). The study revealed that despite the emergence of MRSA with diverse genetic backgrounds over the years, ST239-MRSA-III remained the dominant clone in the hospital. This warrants reassessment of infection prevention and control procedures at this hospital.

PMID: 31811246 DOI: 10.1038/s41598-019-54794-8

Keywords: Antibiotics; Drugs Resistance; MRSA; Staphylcoccus aureus; Nosocomial outbreaks; Kuwait.


Characterization of #azole #resistance in #Aspergillus fumigatus from #potting soil samples in a #Chinese #hospital:comparison of two typing methods (Antimicrob Agents Chemother., abstract)

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

Characterization of azole resistance in Aspergillus fumigatus from potting soil samples in a Chinese hospital:comparison of two typing methods

Hong Fan, Yong Chen, Liping Duan, Jingya Zhao, Chunping Qin, Haifeng Li, Jinke Sun, Li Han

DOI: 10.1128/AAC.01578-19



To understand the characterizations of azole resistance in A. fumigatus from potting soil samples in the hospital, a total of 58 samples were collected. Among 106 A. fumigatus obtained, five isolates from 4 soil samples located in the gerontology department were identified as azole resistant A. fumigatus (ARAF). Four ARAF harbored TR34/L98H allele and the other one had no mutation in cyp51A gene. Among 174 A. fumigatus selected for genotyping, TRESPERG typing obtained a close discriminatory power [DI=0.9941, 95% CI (0.9913,0.9968)] compared with the STR typing [DI=0.9997, 95% CI (0.9976,1.0000)]. Genotyping showed that the TR34/L98H isolates in the hospital had a close genetic relationship with ARAF isolates from China and many other countries. In conclusion, this study indicated the presence of ARAF in potting soil samples from hospital, which might pose a risk of acquiring ARAF infection for patients.

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

Keywords: Antibiotics; Drugs Resistance; Aspergillus fumigatus; Nosocomial outbreaks; China.


High- #Risk #International #Clones of #Carbapenem-Nonsusceptible #Pseudomonas aeruginosa Endemic to #Indonesian #ICUs: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level (MBio, abstract)

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

High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

Andreu Coello Pelegrin, Yulia Rosa Saharman, Aurélien Griffon, Mattia Palmieri, Caroline Mirande, Anis Karuniawati, Rudyanto Sedono, Dita Aditianingsih, Wil H. F. Goessens, Alex van Belkum, Henri A. Verbrugh, Corné H. W. Klaassen, Juliëtte A. Severin

Peter Gilligan, Editor

DOI: 10.1128/mBio.02384-19



Infection control effectiveness evaluations require detailed epidemiological and microbiological data. We analyzed the genomic profiles of carbapenem-nonsusceptible Pseudomonas aeruginosa (CNPA) strains collected from two intensive care units (ICUs) in the national referral hospital in Jakarta, Indonesia, where a multifaceted infection control intervention was applied. We used clinical data combined with whole-genome sequencing (WGS) of systematically collected CNPA to infer the transmission dynamics of CNPA strains and to characterize their resistome. We found that the number of CNPA transmissions and acquisitions by patients was highly variable over time but that, overall, the rates were not significantly reduced by the intervention. Environmental sources were involved in these transmissions and acquisitions. Four high-risk international CNPA clones (ST235, ST823, ST375, and ST446) dominated, but the distribution of these clones changed significantly after the intervention was implemented. Using resistome analysis, carbapenem resistance was explained by the presence of various carbapenemase-encoding genes (blaGES-5, blaVIM-2-8, and blaIMP-1-7-43) and by mutations within the porin OprD. Our results reveal for the first time the dynamics of P. aeruginosa antimicrobial resistance (AMR) profiles in Indonesia and additionally show the utility of WGS in combination with clinical data to evaluate the impact of an infection control intervention. (This study has been registered at www.trialregister.nl under registration no. NTR5541).



In low-to-middle-income countries such as Indonesia, work in intensive care units (ICUs) can be hampered by lack of resources. Conducting large epidemiological studies in such settings using genomic tools is rather challenging. Still, we were able to systematically study the transmissions of carbapenem-nonsusceptible strains of P. aeruginosa (CNPA) within and between ICUs, before and after an infection control intervention. Our data show the importance of the broad dissemination of the internationally recognized CNPA clones, the relevance of environmental reservoirs, and the mixed effects of the implemented intervention; it led to a profound change in the clonal make-up of CNPA, but it did not reduce the patients’ risk of CNPA acquisitions. Thus, CNPA epidemiology in Indonesian ICUs is part of a global expansion of multiple CNPA clones that remains difficult to control by infection prevention measures.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Pseudomonas aeruginosa; ICU; Nosocomial outbreaks; Indonesia.