Abstract
BackgroundBlood stream infections (BSI) caused by Extended Spectrum Beta-Lactamases (ESBLs) producing Enterobacteriaceae is a clinical challenge leading to high mortality, especially in developing countries. In this study, we sought to describe the epidemiology of ESBL-producing Escherichia coli strains isolated from Vietnamese individuals with BSI, to investigate the concordance of genotypic-phenotypic resistance, and clinical outcome of ESBL E. coli BSI.MethodsA total of 459 hospitalized patients with BSI were screened between October 2014 and May 2016. 115 E. coli strains from 115 BSI patients were isolated and tested for antibiotic resistance using the VITEK®2 system. The ESBL phenotype was determined by double disk diffusion method following the guideline of Clinical and Laboratory Standards Institute. Screening for beta-lactamase (ESBL and carbapenemase) genes was performed using a multiplex-PCR assay.Results58% (67/115) of the E. coli strains were ESBL-producers and all were susceptible to both imipenem and meropenem. Resistance to third-generation cephalosporin was common, 70% (81/115) were cefotaxime-resistant and 45% (52/115) were ceftazidime-resistant. blaCTX-M was the most common ESBL gene detected (70%; 80/115) The sensitivity and specificity of blaCTX-M-detection to predict the ESBL phenotype was 87% (76–93% 95% CI) and 54% (39–48% 95% CI), respectively. 28%% (22/80) of blaCTX-M were classified as non-ESBL producers by phenotypic testing for ESBL production. The detection of blaCTX-M in ESBL-negative E. coli BSI was associated with fatal clinical outcome (27%; 6/22 versus 8%; 2/26, p = 0.07).ConclusionA high prevalence of ESBL-producing E. coli isolates harbouring blaCTX-M was observed in BSI patients in Vietnam. The genotypic detection of blaCTX-M may have added benefit in optimizing and guiding empirical antibiotic therapy of E. coli BSI to improve clinical outcome.
Highlights
The emergence and spread of antimicrobial resistance (AMR) are of growing importance worldwide
A high prevalence of Extended Spectrum Beta-Lactamases (ESBLs)-producing E. coli isolates harbouring blaCTX-M was observed in Blood stream infections (BSI) patients in Vietnam
In Vietnam, BSIs are mostly caused by multidrugresistant pathogens listed in the Global Antimicrobial Resistance Surveillance System (GLASS) report, including those classified as critical and high priority levels by the World Health Organization [5], such as extended spectrum beta-lactamase- (ESBL) and carbapenemase-resistant Enterobacteriaceae (CREs) [6, 7]
Summary
The emergence and spread of antimicrobial resistance (AMR) are of growing importance worldwide. In Vietnam, BSIs are mostly caused by multidrugresistant pathogens listed in the Global Antimicrobial Resistance Surveillance System (GLASS) report, including those classified as critical and high priority levels by the World Health Organization [5], such as extended spectrum beta-lactamase- (ESBL) and carbapenemase-resistant Enterobacteriaceae (CREs) [6, 7]. The most common cause of both community- and hospital-acquired BSI in South-East Asia is Escherichia coli, a member of the Enterobacteriaceae family [8, 9]. In South-East Asia, Philippines and Vietnam have reported a high burden of ESBL-producing E. coli infections of 59% and 81%, respectively [16]. Blood stream infections (BSI) caused by Extended Spectrum Beta-Lactamases (ESBLs) producing Enterobacteriaceae is a clinical challenge leading to high mortality, especially in developing countries. We sought to describe the epidemiology of ESBL-producing Escherichia coli strains isolated from Vietnamese individuals with BSI, to investigate the concordance of genotypic-phenotypic resistance, and clinical outcome of ESBL E. coli BSI
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