Analysis of #drug #resistance of #ESBL-producing #Escherichia coli and #Klebsiella pneumoniae in #children with #UTI (Saudi Med J., abstract)

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

Saudi Med J. 2019 Nov;40(11):1111-1115. doi: 10.15537/smj.2019.11.24547.

Analysis of drug resistance of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae in children with urinary tract infection.

Keshi L1, Weiwei X, Shoulin L, Xiadong L, Hao W, Junhai J, Xiangwei W, Rui W, Pei Z.

Author information: 1 Department of Urology, Shenzhen Children’s Hospital,Shenzhen,Guangdong Province, China. E-mail. keshilu@szu.edu.cn.

 

Abstract

OBJECTIVES:

To investigate the drug resistance of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli ) and Klebsiella pneumoniae (K. pneumoniae) in children with urinary tract infection  (UTI) and to provide the rationale for clinical use of antibiotics.

METHODS:

This is a retrospective analysis of drug susceptibility in children with E. coli or K. pneumoniae-positive urine culture between August 2013 and August 2017,  Shenzhen Children’s Hospital, Shenzhen, China. Drug resistance was statistically assessed using Fisher exact test and χ2 test.

RESULTS:

A total of 698 cases of E. coli, 426 of which were confirmed ESBL-producing strains, and 217 cases of K. pneumoniae, including 111 ESBL-producing strains, were detected, and the difference in proportion of positive ESBL-producing strains (61.03% versus 51.15%) was statistically significant (p=0.010). The average drug resistance rates of E. coli and K. pneumoniae to piperacillin/tazobactam, meropenem, ertapenem, imipenem, and amikacin were less than 15%. The average resistance rates of ESBL-producing E. coli and K. pneumoniae to cefpodoxime, cefixime, cefazolin, and ceftriaxone was less than 98%, while average resistance rates for non-ESBL-producing bacteria to the above 4 drugs was less than 20%.

CONCLUSION:

In southern China, the proportion of ESBL-producing strains and the drug resistance rates of E. coli and K. pneumoniae in UTI in children was high, but their resistance rates to carbapenems and β-lactamase inhibitor complexes containing tazobactam were low. Carbapenems are the most effective antibacterial drugs for the treatment of ESBL-producing bacteria.

PMID: 31707407 DOI: 10.15537/smj.2019.11.24547

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; Carbapenem; E. Coli; Klebsiella pneumoniae; UTI; China; Pediatrics.

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A 7-year #surveillance of the #drug #resistance in #Klebsiella pneumoniae from a primary #healthcare center (Ann Clin Microbiol Antimicrob., abstract)

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

Ann Clin Microbiol Antimicrob. 2019 Nov 9;18(1):34. doi: 10.1186/s12941-019-0335-8.

A 7-year surveillance of the drug resistance in Klebsiella pneumoniae from a primary health care center.

Li G1, Zhao S1, Wang S1, Sun Y1, Zhou Y1, Pan X2.

Author information: 1 Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China. 2 Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuningxi Road, Dongyang, Zhejiang, China. panfengyuwuzu@163.com.

 

Abstract

BACKGROUND:

The increased prevalence of Klebsiella pneumoniae infections and resistance rates are a current cause for concern. However, data for resistance rates in K. pneumoniae strains from primary hospitals and the resistance distribution among the different isolate sample sources are scarce.

METHODS:

All the K. pneumoniae strains were isolated from patients who visited a primary health care center located in Central Zhejiang Province from January 2011 to December 2017. The specimens included blood, sputum, cervical secretions and urine. The species were identified by the Vitek 2 Compact Bacterial Identification and Monitoring System or VITEK-MS and the extended spectrum β-lactamase (ESBL) and drug resistance profiles were identified using the AST-GN13 Gram negative susceptibility card (VITEK-2). The genotype of strains from urine sources was analyzed by detecting TEM and SHV genes. Finally, the drug resistance rates among the isolates from different sample sources were analyzed using the Chi square test with SPSS software.

RESULTS:

A total of 5319 K. pneumoniae strains were isolated in this study. Among the 20 antimicrobial drugs studied, the resistance rates of K. pneumoniae strains varied from 1.4% (ertapenem) to 23.1% (nitrofurantoin). The antibiotic resistance rates varied significantly among the isolate samples sources for all, with the highest rates for all antibiotics except for nitrofurantoin found in urine samples. In addition, the ESBL-positive rate in urine samples was 27.1%, significantly higher than that of cervical secretions (20.2%), blood (16.5%) and sputum (15.2%). Compared to the ESBL-negative strains, higher resistance rates were detected in the ESBL-positive strains. The most common genotype of isolates from urine was SHV (28%, 23/82), following by TEM (14.6%, 12/82).

CONCLUSION:

The highest resistance rates of K. pneumoniae strains to most antibiotics found in urine samples are partly due to the ESBLs, indicating that a special attention should be paid in the treatment of urinary tract infection.

KEYWORDS: Drug resistance; ESBL; Klebsiella pneumoniae; Urine

PMID: 31706307 DOI: 10.1186/s12941-019-0335-8

Keywords: Antibiotics; Drugs Resistance; UTI; China; Nosocomial outbreaks.

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#Carbapenem-containing #combination #antibiotic therapy against carbapenem-resistant uropathogenic #Enterobacteriaceae (Antimicrob Agents Chemother., abstract)

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

Carbapenem-containing combination antibiotic therapy against carbapenem-resistant uropathogenic Enterobacteriaceae

Maria Loose, Isabell Link, Kurt G. Naber, Florian M.E. Wagenlehner

DOI: 10.1128/AAC.01839-19

 

ABSTRACT

Objectives:

The increasing global prevalence of carbapenem-resistant Enterobacteriaceae (CRE) combined with the decline in effective therapies is a public healthcare crisis. After respiratory tract infections, urinary tract infections and associated urosepsis are the second most affected by CRE pathogens.

Methods:

By using checkerboard analysis, we tested eight different antibiotics in combination with carbapenems in CAMHB and artificial urine against seven CRE and three susceptible strains. To further determine whether these combinations are also effective in a dynamic model, we have performed growth curves analyses in a dynamic bladder model with three uropathogenic CRE strains. In this model we simulated the urinary pharmacokinetic after application of 1000 mg i.v. ertapenem alone or in combination with 500 mg i.v. levofloxacin, 1000 mg oral rifampicin or 3000 mg oral fosfomycin. Bacterial growth was measured for 48 h, simulating voiding of the bladder every 3 h.

Results:

According to the median fractional inhibitory concentration indices (∑FICI) values we found additive to synergistic results across all tested CRE strains for combinations of carbapenems with colistin sulphate, levofloxacin, fosfomycin, rifampicin and tigecycline in CAMHB and artificial urine. In the dynamic bladder model, all three CRE strains tested showed regrowth after treatment with ertapenem up to 48 hours. Regrowth could be prevented by combination with levofloxacin, fosfomycin or rifampicin.

Conclusion:

Carbapenem-containing combination therapy with fosfomycin or rifampicin could be an option for better treatment of UTIs caused by CRE strains. This should be further investigated in clinical studies.

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

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

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Characterization of #cefotaxime #resistant #urinary #Escherichia coli from primary care in South-West #England 2017–18 (J Antimicrob Chemother., abstract)

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

Characterization of cefotaxime-resistant urinary Escherichia coli from primary care in South-West England 2017–18

Jacqueline Findlay, Virginia C Gould, Paul North, Karen E Bowker, Martin O Williams, Alasdair P MacGowan, Matthew B Avison

Journal of Antimicrobial Chemotherapy, dkz397, https://doi.org/10.1093/jac/dkz397

Published: 20 September 2019

 

Abstract

Objectives

Third-generation cephalosporin-resistant Escherichia coli from community-acquired urinary tract infections are increasingly reported worldwide. We sought to determine and characterize the mechanisms of cefotaxime resistance employed by urinary E. coli obtained from primary care, over 12 months, in Bristol and surrounding counties in South-West England.

Methods

Cefalexin-resistant E. coli isolates were identified from GP-referred urine samples using disc susceptibility testing. Cefotaxime resistance was determined by subsequent plating onto MIC breakpoint plates. β-Lactamase genes were detected by PCR. WGS was performed on 225 isolates and analyses were performed using the Center for Genomic Epidemiology platform. Patient information provided by the referring general practices was reviewed.

Results

Cefalexin-resistant E. coli (n = 900) isolates were obtained from urines from 146 general practices. Following deduplication by patient approximately 69% (576/836) of isolates were cefotaxime resistant. WGS of 225 isolates identified that the most common cefotaxime-resistance mechanism was blaCTX-M carriage (185/225), followed by plasmid-mediated AmpCs (pAmpCs) (17/225), AmpC hyperproduction (13/225), ESBL blaSHV variants (6/225) or a combination of both blaCTX-M and pAmpC (4/225). Forty-four STs were identified, with ST131 representing 101/225 isolates, within which clade C2 was dominant (54/101). Ciprofloxacin resistance was observed in 128/225 (56.9%) of sequenced isolates, predominantly associated with fluoroquinolone-resistant clones ST131 and ST1193.

Conclusions

Most cefalexin-resistant E. coli isolates were cefotaxime resistant, predominantly caused by blaCTX-M carriage. The correlation between cefotaxime resistance and ciprofloxacin resistance was largely attributable to the high-risk pandemic clones ST131 and ST1193. Localized epidemiological data provide greater resolution than regional data and can be valuable for informing treatment choices in the primary care setting.

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; Cephalosporins; Fluoroquinolones; E. Coli; UTI; Cefalexin; Cefotaxime; UK; England.

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#Community-acquired #UTIs in #children: #Resistance patterns of #uropathogens in a tertiary care center in #Saudi Arabia (Int J Pediatr Adolesc Med., abstract)

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

Int J Pediatr Adolesc Med. 2019 Jun;6(2):51-54. doi: 10.1016/j.ijpam.2019.02.010. Epub 2019 Mar 8.

Community-acquired urinary tract infections in children: Resistance patterns of uropathogens in a tertiary care center in Saudi Arabia.

Hameed T1,2,3, Al Nafeesah A4, Chishti S1,3, Al Shaalan M1,2,3, Al Fakeeh K1,2,3.

Author information: 1 Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City – Central Region, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 2 King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 3 King Abdullah International Medical Research Center, Ministry of National Guard – Health Affairs, Riyadh, Saudi Arabia. 4 Unaizah College of Medicine and Medical Sciences, Al-Qassim University, Unaizah, Saudi Arabia.

 

Abstract

OBJECTIVE:

The aim of the present study was to investigate the bacterial pathogens and their resistance patterns in children presenting with their first admission for a urinary tract infection (UTI) in a large tertiary care center in Riyadh, Saudi Arabia.

METHODS:

A retrospective chart review was conducted of pediatric patients 0-14 years of age who were admitted for their first community-acquired UTI in a large tertiary care center in Riyadh, Saudi Arabia. The review covered a 6-year period (2006-2012).

RESULTS:

Data were obtained from 202 children, of which 162 (80.2%) were female. The most frequently isolated uropathogens were Escherichia coli (75.7%), followed by Klebsiella pneumoniae (9.4%), Pseudomonas aeruginosa (5.9%) and Enterococcus species (3.5%). Sixteen (7.9%) isolates were ESBLs. Among all uropathogens, 68% were resistant to ampicillin, 54% resistant to co-trimoxazole, and 30% resistant/intermediate sensitivity to amoxicillin/clavulinic acid. Overall, there was a low resistance rate to cefotaxime (4.4%).

CONCLUSION:

E. coli is the predominant uropathogen causing UTIs in children, yet there is a high rate of multidrug-resistant organisms. For children admitted for a community-acquired UTI, a third-generation cephalosporin remains an appropriate empiric antibiotic. Our study and the work of others emphasize the importance of choosing empiric antibiotics for pediatric UTIs based on local resistance patterns.

PMID: 31388546 PMCID: PMC6676371 DOI: 10.1016/j.ijpam.2019.02.010

Keywords: Antibiotics; Drugs Resistance; UTI; Pediatrics; Saudi Arabia.

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Susceptibility of #carbapenemase-producing #Enterobacterales (CPE) to #nitroxoline (J Antimicrob Chemother., abstract)

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

Susceptibility of carbapenemase-producing Enterobacterales (CPE) to nitroxoline

Frieder Fuchs, Axel Hamprecht

Journal of Antimicrobial Chemotherapy, dkz275, https://doi.org/10.1093/jac/dkz275

Published: 10 July 2019

 

Abstract

Background

Infections caused by carbapenemase-producing Enterobacterales (CPE) constitute a major global health concern and are associated with increased morbidity and mortality. Nitroxoline is an old antibiotic, which has recently been re-launched for the treatment of uncomplicated urinary tract infection. Because of low resistance rates it could be an interesting option for treatment of MDR isolates, yet data on CPE susceptibility are scarce.

Objectives

To analyse the in vitro activity of nitroxoline against CPE.

Methods

MICs of nitroxoline were determined by agar dilution for a collection of well-characterized carbapenemase producers (n = 105), producing OXA-48-like (n = 36), VIM (n = 21), IMI (n = 9), IMP (n = 6), NDM (n = 22), KPC (n = 11), OXA-58 (n = 2) and GES (n = 2). For comparison, MICs of ertapenem, imipenem and meropenem were determined by agar gradient diffusion.

Results

For all 105 isolates, the MIC50/90 of nitroxoline was 8/16 mg/L. All Escherichia coli isolates (30/30, 100%) showed low MICs of 2–8 mg/L and were susceptible to nitroxoline. MICs of 32 mg/L were recorded for five isolates of VIM- and IMI-producing Enterobacter cloacae (n = 3) and OXA- and VIM-producing Klebsiella pneumoniae (n = 2).

Conclusions

Nitroxoline exhibited excellent in vitro activity against most isolates producing common and rare carbapenemases. If the current EUCAST susceptibility breakpoint of ≤16 mg/L for E. coli in uncomplicated urinary tract infections was applied, 95.2% (100/105) of isolates would be classified as susceptible. Nitroxoline could therefore be an alternative oral option for treatment of uncomplicated urinary tract infections caused by CPE.

Topic: antibiotics – urinary tract infections – diffusion – agar – enterobacter cloacae – imipenem – klebsiella pneumoniae – world health – infection – morbidity – mortality – meropenem – ertapenem – escherichia coli – dilution technique – dilute (action) – malnutrition-inflammation-cachexia syndrome

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; UTI; Enterobacteriaceae; Nitroxoline.

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#Trends and prediction of #antimicrobial susceptibility in #urinary #bacteria isolated in #European emergency departments: the #EuroUTI 2010-2016 Study (J Antimicrob Chemother., abstract)

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

Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study

Alice Quaegebeur, Loïc Brunard, François Javaudin, Marie-Anne Vibet, Pascale Bemer, Quentin Le Bastard, Eric Batard, Emmanuel Montassier, EuroUTI 2010-2016 Study Group

Journal of Antimicrobial Chemotherapy, dkz274, https://doi.org/10.1093/jac/dkz274

Published: 30 June 2019

 

Abstract

Objectives

To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).

Methods

In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.

Results

We included 88 242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).

Conclusions

Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.

Topic: antibiotics – cephalosporins – adult – emergency service, hospital – fluoroquinolones – pyelonephritis – urinary tract – bacteria – urine culture – antimicrobial susceptibility

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; Fluoroquinolones; Cephalosporins; UTI; European Region.

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