Abstract
BackgroundBroad-spectrum antimicrobials are commonly used as empirical therapy for infections of presumed bacterial origin. Increasing resistance to these antimicrobial agents has prompted the need for alternative therapies and more effective surveillance. Better surveillance leads to more informed and improved delivery of therapeutic interventions, potentially leading to better treatment outcomes.MethodsWe screened 1017 Gram negative bacteria (excluding Pseudomonas spp. and Acinetobacter spp.) isolated between 2011 and 2013 from positive blood cultures for susceptibility against third generation cephalosporins, ESBL and/or AmpC production, and associated ESBL/AmpC genes, at the Hospital for Tropical Diseases in Ho Chi Minh City.ResultsPhenotypic screening found that 304/1017 (30%) organisms were resistance to third generation cephalosporins; 172/1017 (16.9%) of isolates exhibited ESBL activity, 6.2% (63/1017) had AmpC activity, and 0.5% (5/1017) had both ESBL and AmpC activity. E. coli and Aeromonas spp. were the most common organisms associated with ESBL and AmpC phenotypes, respectively. Nearly half of the AmpC producers harboured an ESBL gene. There was no significant difference (p > 0.05) between the antimicrobial resistance phenotypes of the organisms associated with community and hospital-acquired infections.ConclusionAmpC and ESBL producing organisms were commonly associated with bloodstream infections in this setting, with antimicrobial resistant organisms being equally distributed between infections originating from the community and healthcare settings. Aeromonas spp., which was associated with bloodstream infections in cirrhotic/hepatitis patients, were the most abundant AmpC producing organism. We conclude that empirical monotherapy with third generation cephalosporins may not be optimum in this setting.
Highlights
Broad-spectrum antimicrobials are commonly used as empirical therapy for infections of presumed bacterial origin
Gram-negative organisms with reduced susceptibility against third generation cephalosporins isolated from bloodstream infections at the Hospital for Tropical Diseases Between January 2011 and December 2013, 1690 noncontaminant bacteria were isolated from the blood of febrile patients attending HTD in Ho Chi Minh City (HCMC)
We observed a high prevalence of Ampicillin-hydrolyzing cephalosporinase (AmpC) and Extended-spectrum β-lactamases (ESBLs) expressing organisms associated with Community Acquired Infection (CAI) and Hospital Acquired Infection (HAI) bloodstream infections hospitalised patients in HCMC
Summary
Broad-spectrum antimicrobials are commonly used as empirical therapy for infections of presumed bacterial origin. Increasing resistance to these antimicrobial agents has prompted the need for alternative therapies and more effective surveillance. The situation has been recognised internationally and the WHO have identified seven bacteria as the most important cause of AMR infections in hospitals and the community. This list includes Escherichia coli and Klebsiella pneumoniae, both commonly found to be resistant to third generation cephalosporins [1]. With the increasing threat of treatment failure, monitoring ESBL producing organisms in sentinel locations is imperative for surveillance and appropriate treatment strategies
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