ESBL-producing Microorganisms Research Articles

Tem Gene Detection as ESBL Marker in Clinical Isolates Klebsiella Pneumoniae

Klebsiella pneumoniae is one of the most common ESBL-producing microorganisms. The research aims to detect the Tem gene in clinical isolates of K. pneumonaie from the Laboratory of clinical pathology of Wahidin Sudirohusodo General Hospital. Methods: This research is a descriptive cross-sectional design. Fifty samples of K. pneumonieae were obtained from the Laboratory of clinical pathology from March to May 2018. Tem gene was detected using primary Tem 164.SE and Tem 165.AS (445 bp) of Polymerase Chain Reaction (PCR). The research results indicate that 48 isolates are positive, containing the Tem gene with the highest number found in the sputum specimen. Genotype detection of bacteria-producing ESBL is essential so that antibiotic therapy given to the patients is more effective and efficient.

Level of Detection (LOD50) of Campylobacter Is Strongly Dependent on Strain, Enrichment Broth, and Food Matrix.

The detection of thermotolerant Campylobacter in food may be difficult due to the growth of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae during enrichment, resulting in false-negative samples. Therefore, the ISO protocol (ISO 10272-1:2017) suggests that, next to Bolton broth (BB), Preston broth (PB) is used as an enrichment broth to inhibit competitive flora in samples with suspected high levels of background microorganisms, such as ESBL-producing bacteria. However, the application of the strains used for validation of this ISO was not clearly characterized. This study examined the LOD50 (level of detection, the concentration where the probability of detection is 50%) of the validation strains (three C. jejuni and two C. coli strains) in BB and PB using different food matrices, namely, raw milk, chicken skin, frozen minced meat, and frozen spinach. The LOD50 was calculated by inoculating multiple portions with at least two inoculum levels. For each reproduction, eight test portions were used for each inoculum level and the test portion size was 10 g (chicken skin, frozen minced meat, and frozen spinach) or 10 mL (raw milk). Furthermore, the effect of artificially inoculated ESBL-producing E. coli on the LOD50 was examined to mimic the presence of ESBL-producing background microorganisms in the food matrices, namely, raw milk and chicken skin. In BB, the LOD50 of all strains tested in raw milk, chicken skin, and frozen spinach was rather low (0.4–37 CFU/test portion), while the LOD50 in frozen minced meat was higher and much more variable (1–1,500 CFU/test portion), depending on the strain. Generally, enrichment in PB resulted in higher LOD50 than in BB, especially for C. coli. Co-inoculation with ESBL-producing E. coli increased the LOD50 in BB, while PB successfully inhibited the growth of this competitive microorganism. In conclusion, food matrix and enrichment broth may have a large influence on the LOD50 of different Campylobacter strains. Therefore, it is not possible to give an unequivocal advice on when to use which enrichment broth, and this advocates the use of both methods in case of doubt. Furthermore, this study indicates specific strains that would be a good choice to use for Campylobacter method verification as described in ISO 16140-3:2021.

What is the prognosis of emphysematous pyelonephritis associated with extended-spectrum beta-lactamases producing microorganisms?

ObjectiveTo describe the microbiological characteristics in emphysematous pyelonephritis (EPN), demonstrate the frequency of extended-spectrum beta-lactamase (ESBL) microorganisms, and determine if these microorganisms are associated with the prognosis of patients with EPN. MethodsWe conducted a retrospective study in patients with a diagnosis of EPN in a tertiary care hospital of the northeast region of Mexico during the period from January 2011 to January 2016. Clinical variables were analyzed to determine association with the presence of ESBL-producing microorganisms. Statistical significance was set with p<0.05. ResultsA total of 63 patients were included; 55 (87.3%) of them were females, with a median age of 55 (interquartile range: 45–65) years. Conservative management was indicated in 38.1%; 42.9% were treated with ureteral stent; 12.7% with open or percutaneous drainage; 15.8% with early nephrectomy; and 9.5% with delayed nephrectomy. Reported mortality was 13 (20.6%) cases; 23 (36.5%) cases required admission to the intensive care unit. The most frequent microorganism isolated was Escherichia coli (n=34, 53.9%). ESBL microorganisms were found in 31.7% of the population. No significant association of ESBL was found with admission to the intensive care unit, or with increased mortality. ConclusionsTo our knowledge, this is the first study that evaluates ESBL microorganisms as a prognostic factor in EPN. Risk factors associated with a poor prognosis in patients with EPN have been described. The microbiological factors, specifically ESBL-producing bacteria, do not seem to influence in the prognosis of these patients.

Effect of Mushroom against Extended Spectrum Beta Lactamase (ESBL) Producing Microorganisms

According to the WHO global report, ESBL (Extended-Spectrum Beta-Lactamase)-producing microorganisms is the most common cause of urinary tract infection; hospital-acquired infection as well as a foodborne infection. These include Escherichia coli, Salmonella, Shigella and Vibrio cholera. The carbapenems which include doripenem, ertapenem, imipenem and meropenem are the known choice of medication for life-threatening infections which is caused by ESBL-producing microorganisms. Recently there is the emergence of carbapenem-resistant Enterobacteriaceae and Pseudomonas which makes treatment an obstacle for the medical personnel for various infections. Natural products have been reported to be emerged as a potential possibility to be explored as antimicrobial drugs. The plant extracts could serve as an alternate source of resistance modifying agents owing to the wide variety of secondary metabolites (eg. flavonoids, phenols, tannins, alkaloids, etc). Mushroom are have been considered as a source that attracts the researchers to explore its properties as it has been established with various bioactive components that possess many health beneficial effects such as antimicrobial and antifungal compounds. In this paper, we summarizes the information available in the literature on the ESBL, mushroom and current treatment, with a special focus on the three different types of mushrooms (Fistulina hepatica, Leucopaxillus giganteus and Pleurotus Ostreatus) against spectrum beta-lactamase (ESBL) producing microorganisms. Electronic databases including SciFinder, Web of Science, Science Direct, PubMed, and Google Scholar were screened using the following keywords: “antibacterial, antimicrobial, mushroom, ESBL, Enterobacter, Fistulina hepatica, Leucopaxillus giganteus and Pleurotus Ostreatus”. We intend to enhance understanding in the field and promote further work on the development of phytocomponent based antimicrobial compounds.

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics.

The increasing resistance to antibiotics is compromising the empirical treatment of infections caused by resistant bacteria. Rapid, efficient, and clinically applicable phenotypic methods are needed for their detection. This study examines the phenotypic behavior of β-lactam-resistant Gram-negative bacteria grown on ChromID ESBL medium with ertapenem, cefoxitin, and cefepime disks, reports on the coloration of colonies, and establishes a halo diameter breakpoint for the detection of carbapenemase-producing bacteria. We studied 186 β-lactam-resistant Gram-negative microorganisms (77 with extended spectrum beta lactamase (ESBL), 97 with carbapenemases, and 12 with AmpC β-lactamases (AmpC)). Susceptibility profiles of Gram-negative bacteria that produced ESBL, AmpC, and carbapenemases were similar to the expected profiles, with some differences in the response to cefepime of ESBL-producing microorganisms. Coloration values did not differ from those described by the manufacturer of ChromID ESBL medium. In the screening of carbapenemase production, inhibition halo diameter breakpoints for antibiotic resistance were 18 mm for Enterobacterales and ertapenem, 18 mm for Pseudomonas and cefepime, and 16 mm for Acinetobacter baumannii and cefepime. This innovative phenotypic approach is highly relevant to clinical laboratories, combining susceptibility profiles with detection by coloration of high-priority resistant microorganisms such as carbapenemase-producing A. baumannii, carbapenemase-producing Pseudomonas spp., and ESBL and/or carbapenemase-producing Enterobacterales.

Renal abscess with bacteremia caused by extended-spectrum \u03b2-lactamase-producing Escherichia coli: a case report

BackgroundRenal abscess in children is a rare and severe form of infectious kidney disease that is responsible for several serious complications. In this report, we describe a previously healthy 5-year-old girl with a renal abscess caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli), which led to bacteremia and renal scarring.Case presentationThe patient presented to our department with high fever, headache, vomiting for 2 days and high inflammatory response. We diagnosed her with a urinary tract infection and initiated treatment with ampicillin and cefotaxime. Gram-negative bacilli bacteremia was noted on day 3. On day 4, her fever persisted, and a computed tomography (CT) scan revealed a renal abscess in the left kidney. After identifying the bacteria as ESBL-producing E. coli from the blood culture, we switched to the antibiotic meropenem and continued treatment for 3 weeks. The renal abscess was not drained. Although the renal abscess was successfully treated and it disappeared, a low-density area remained in same lesion on subsequent CT scans and a dimercaptosuccinic acid renal scan performed 4 months after onset revealed renal scarring.ConclusionGiven the increasing prevalence of ESBL-producing microorganisms, clinicians should be aware of the possibility of renal abscesses caused by community-acquired ESBL-producing organisms even in previously healthy children. Once a renal abscess is suspected, early diagnosis and management are important for reducing the risk of life-threating complications and renal scarring.

Colonization by multidrug-resistant microorganisms of hospitalized newborns and their mothers in the neonatal unit context.

The mother plays a fundamental role in the constitution and regulation of her child's healthy microbiota, however, preterm newborns are separated from their mothers soon after birth and transferred to Neonatal Intensive Care Units, being exposed the constant risk for the development of multidrug-resistant microorganisms' infections. The aim of this study was to explore the multidrug-resistant microorganism colonization of hospitalized babies and their mothers in the neonatal unit context. A prospective case study conducted with hospitalized babies and their mothers in the Neonatal Unit at a university hospital. The sample was composed of 433 binomials (mother-child). Colonization culture samples were taken at the moment of the baby's discharge, via two swabs in the oral, nasal, axillary, inguinal, and rectal regions. The colonization incidence among the binomials, 30 (6.9%) were both colonized by multi-resistant microorganisms. Mothers of colonized babies (24.4%) demonstrated a higher chance of colonization in comparison to mothers of non-colonized babies (11.9%) (p = 0.002). Relationships were drawn between baby colonization and prematurity, extremely low birth weight, and non-exclusive maternal breastfeeding (p<0.05). ESBL-producing Gram-negative microorganisms were more frequent in the cultures of the binomials, with 35.9% of the babies colonized with Klebsiella spp. ESBL and 42.0% of the mothers with Escherichia coli ESBL. Furthermore, 50% of the binomials were colonized with E. coli ESBL. The prematurity, extremely low birth weight, and non-exclusive breastfeeding at hospital discharge were associated with baby colonization by multidrug-resistant microorganism. Furthermore, mothers of colonized children presented higher chances of colonization.

Characteristics of Extended-Spectrum β-Lactamase-Producing Escherichia coli From Dogs and Cats Admitted to a Veterinary Teaching Hospital in Taipei, Taiwan From 2014 to 2017.

Extended-spectrum β-lactamases (ESBLs) are enzymes that mediate resistance to newer β-lactam antibiotics, including extended-spectrum cephalosporins and monobactams. The production of ESBL is primarily plasmid mediated, and such plasmids often comprise the genes that encode resistance to other classes of antimicrobials, such as aminoglycosides and fluoroquinolones. Therefore, ESBL-producing microorganisms leave clinicians with limited therapeutic options in both human and veterinary medicine. Compared with human medicine, information regarding ESBL-producing microorganisms is limited in veterinary medicine. We screened for ESBL-producing Escherichia coli in dogs and cats admitted to National Taiwan University Veterinary Hospital, Taipei, from 2014 to 2017 and further analyzed the genotypes and phylogenetic traits of these ESBL producers. Double disk tests specified by the Clinical and Laboratory Standards Institute were performed on 283 E. coli isolates and revealed a total of 65 E. coli (54 from dogs and 11 from cats) with the ESBL phenotype (22.8%). blaCTX−M−1 group and blaCTX−M−2group were the most commonly identified ESBL gene groups. blaCTX−M−55 was the main ESBL gene within the blaCTX−M−1group, whereas the blaCTX−M−2group contained only blaCTX−M−124. The ESBL-producing E. coli were all resistant to ampicillin. The resistance rate to ceftiofur, doxycycline, enrofloxacin, and ciprofloxacin was 93.8, 73.8, 80, and 78.5%, respectively. Of the antibiotics tested, greater sensitivity to imipenem and gentamicin was noted. Multilocus sequence typing indicated that ST457, ST131, and ST648 were the most common sequence types. Our study identified eight ST131/O25b isolates, which is a global zoonotic clone of public health concern. The major ESBL genes of these clones were blaCTX−M−174 and blaCTX−M−194. Because companion animals such as dogs and cats are in close contact with humans, the characterization of ESBL producers originating from them is crucial from the perspective of both public health and veterinary medicine.

Factores asociados con la presencia de patógenos productores de betalactamasas de espectro extendido en infecciones urinarias en una clínica privada, Lima (Perú)

Introducción: las infecciones del tracto urinario (ITU) son el segundo motivo más frecuente de atención médica, y la resistencia a los antibióticos entre las enterobacterias gramnegativas ha aumentado de manera importante en todo el mundo, dada la aparición de organismos productores de betalactamasa de espectro extendido (BLEE). Se busca identificar factores asociados a la presencia de ITU por patógeno productor de BLEE. Materiales y métodos: se realizó un estudio trasversal analítico, un análisis de la base de datos de urocultivos de una clínica privada y una evaluación de los factores posiblemente asociados a la presentación de ITU por el microorganismo BLEE, como el sexo, la edad, el número de hospitalizaciones e ITU previas. Resultados: se estudiaron 1405 urocultivos positivos y se encontró que el 85.48 % fueron de sexo femenino. La edad media de la población fue de 39.98 ± 24.51 años, el 24.13 % de edad mayor a 60 años, y el 55.56 % habían sido atendidos ambulatoriamente. El 49.18 % de los cultivos fue positivo para ITU BLEE, de los cuales el 96,58 % no habían presentado una ITU previa. Se encontró que existe una asociación estadísticamente significativa (0,007; p ≤ 0,05) entre el sexo y el desarrollo de ITU por microorganismo productor de BLEE. El masculino es el de mayor asociación (OR 1,224; IC95 %: 1,035-1,448). También se encontró una asociación con la edad, el número de hospitalizaciones previas y haber estado en UCI. No se encontró ninguna asociación entre la presencia de ITU previas. Conclusiones: existe una elevada frecuencia de ITU BLEE, y los factores asociados a dicha infección fueron tener sexo masculino, una edad mayor a 60 años y hospitalizaciones previas.

High prevalence of MDR gram-negative bacteria in feces of healthy blood donors in Mexico.

During the initial stage of a study to recruit universal intestinal microbiota donors in Mexico City, we found multiple "healthy" subjects that colonized with MDRO (Multidrug-resistant organisms). We aimed to describe clinical and demographic characteristics of these individuals. This was a prospective observational study. Participants were consecutively recruited among blood donors. A fecal sample was collected from each subject and analyzed at the same day in search of MDRO through chromographic culture media and, if growth observed, later confirmed by MALDI-TOF and susceptibility testing in Vitek 2 system. From July 2018 to March 2019, 85 individuals were screened for fecal colonization. Median age was 35years (IQR 27-46years), and 48/85 (56.4%) were males. Seventy-two (84.7%) subjects harbored at least one MDRO. ESBL-producing microorganisms were found in 72/85 (84.3%) subjects, and E. coli was the most frequent (63/85, 74.1%). Four samples (2 E. coli, 2 P. aeruginosa, 2.4% each) harbored carbapenem-resistant Enterobacteriaceae (CRE), together with an ESBL-producing microorganism. Antibiotic use (p = 0.06) and PPIs or H2-blockers intake (p = 0.03) were more common in the colonized subjects during the previous 6-month period. We report a high incidence of enteric colonization of healthy subjects with MDRO, a condition that may be related to antibiotics or PPIs/H2-blockers consumption. This surprisingly high MDRO colonization rate in potential FMT donors emphasizes the need for careful screening of donors to avoid possible transmission to FMT recipients.

188. Which patients with gram-negative bacteremia need follow-up blood cultures?

BackgroundUniversal follow-up blood culture (FUBC) in gram-negative bacteremia (GNB) is not recommended, but it has been routinely conducted in many acute-care hospitals. In contrast with Staphylococcus aureus bacteremia, risk factors for positive FUBC in GNB have not been well investigated. Therefore, we tried to identify the risk factors for and develop predictive scores of positive FUBC.MethodsAll adults (≥18 years-old) with GNB were identified in a tertiary-care hospital during the 2-year period, retrospectively. Death within 2 days of GNB and polymicrobial infection with gram-positive bacteria or fungus were excluded. GNB were classified into eradicable and non-eradicable source of infection groups, according to the possibility of source removal. We performed multivariate analyses for identifying risk factors for positive FUBC and built prediction scores using the coefficients of the multivariate logistic regression models.ResultsOf total 1,473 GNB, FUBC was drawn in 1,268 (86%) patients and 122 (9.6%) had positive results. In patients with eradicable source of infection, ESBL-producing microorganism, catheter-related bloodstream infection, unfavorable treatment response, and quick sequential organ failure assessment (qSOFA) score (≥2) were associated. On the other hand, administration of effective antibiotics and adequate source control were negatively associated with positive FUBC. In non-eradicable source of infection, end-stage renal disease on hemodialysis, and unfavorable treatment response were related to positive FUBC and administration of effective antibiotics was negatively associated (Table 1). When we built prediction scores according to the coefficients, the areas under the curves were 0.864 (95% confidence interval [CI95] 0.816–0.912) and 0.792 (CI95, 0.721–0.861), respectively. When we applied a cutoff of 0, specificities/negative predictive values in eradicable and non-eradicable source of infection groups were 84.7%/95.6% and 95.5%/95.0%, respectively (Table 2).ConclusionOur prediction scores based on adequate source control and use of effective antibiotics showed high specificities and negative predictive values. Therefore, we could expect these score systems to contribute to reducing unnecessary FUBC in GNB. Disclosures All authors: No reported disclosures.

Clinical Features and Outcomes in ESBL-Producing Microorganisms in Renal Transplant Recipients with Urinary Tract Infections

: Multidrug-resistant organisms have become an increasing challenge in the management of both solid and non-solid organ transplants. This is especially true with extended spectrum beta-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) infections. We performed a retrospective study of 62 renal transplant recipients at a tertiary care center in El Paso, Texas. In our study population, 43% of patients had a positive urine culture and were treated for a UTI. 30% of those UTIs were caused by an ESBL-producing organism. Of note, 43% of the patients who developed a UTI also had a recurrent episode. Notably, one patient had 25 recurrences of UTIs caused by ESBL producing E. coli. K. pneumoniae and E. coli were the most commonly cultured non-ESBL-producing bacteria (40.7%). E. coli was the most frequently cultured ESBL-producing bacteria (62.5%), while K. pneumoniae was the second most frequently cultured ESBL-producing bacteria (37.5%). There were three transplant rejections; two had ESBL UTIs and one had 11 recurrent UTIs prior to rejection. Diabetes, the length of ureteral stents, and higher troughs of immunosuppressant therapy were observed to be correlated with higher rates of UTIs in our patient population. Our findings are consistent with reports published in current literature regarding rates of UTIs among renal transplant recipients. Due to increasing prevalence of multi-drug resistant organisms and increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE), it becomes imperative for clinicians to include CRE in the differential diagnosis when evaluating renal transplant recipients with recurrent UTIs. More importantly, CRE must be considered when evaluating renal transplant recipients with recurrent UTIs caused by ESBL producing organisms.

Clinical Prediction Score for Community-Onset Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species.

BackgroundThis study aimed to identify the predictors and build a prediction score for community-onset bloodstream infections (CO-BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species.MethodsAll CO-BSIs caused by E. coli and Klebsiella species from 2012 to 2015 were grouped into derivation (BSIs from 2012 to 2014) and validation (BSIs in 2015) cohorts. A prediction score was built using the coefficients of the multivariate logistic regression model from the derivation cohort.ResultsThe study included 886 CO-BSIs (594 and 292 in the derivation and validation cohorts, respectively). The independent predictors of CO-BSIs caused by ESBL-producing E. coli and Klebsiella species included: 1) identification of ESBL-producing microorganisms from any clinical culture within one year of admission, 2) beta-lactam or fluoroquinolone treatment within 30 days (with 2 or more courses within 90 days; with 1 course within 90 days), 3) hospitalization within one year, 4) the presence of an indwelling urinary catheter at the time of admission. The area under the curve (AUC) of the clinical prediction score was 0.72 (95% confidence interval [CI], 0.68–0.77). In the validation cohort, the AUC was 0.70 (95% CI, 0.63–0.77).ConclusionsThe results of this study suggest a simple and easy-to-use scoring system to predict CO-BSIs caused by ESBL-producing E. coli and Klebsiella species.

Molecular detection of SHV-Type ESBL in E. coli and K.pneumoniae and their antimicrobial resistance profile

Background and objective: The increase in the incidence of Beta-lactam resistance in Gram-negative bacteria has become a main clinical problem worldwide that limits therapeutic options. The production of extended-spectrum blactamases is the major source of resistance to newer beta-lactam antibiotics in Enterobacteriaceae. This study aimed to check the presence of extended-spectrum β-lactamase producing K. pneumoniae and E. coli and the evaluation of ESBL among those isolates. Methods: A total of 120 E. coli and K. pneumoniae clinical isolates were obtained from Rizgary Teaching Hospital in Erbil City, Iraqi Kurdistan Region, during the first six months of 2016. All isolates were identified and checked for the production of ESBL using Vitek 2 automated system. The technique of PCR was performed for the detection of the presence of blaSHV gene from these isolates. The antibiotic resistant profiles for these isolates were also investigated. Results: The overall proportion of ESBL-producing E. coli and K. pneumoniae isolates, 77 (76.2%) and 15 (78.9%) isolates were ESBL producers, respectively. ESBL-producing isolates were significantly more resistant than Non-ESBL-producers (P < 0.05). PCR performed on 30 ESBL positive isolates, 21(70%) isolates were of E. coli, and 9 (30%) isolates were of K.pneumoniae. The ESBL B-lactamase related SHV gene was detected only in 11 (36.6%) isolates, 6 (28.5 %) of E. coli and 5(55.5%) of K. pneumoniae isolates respectively. All isolates were susceptible to carbapenems. Conclusion: The great diversity of ESBL and the prevalences of clinical isolates of E. coli and K. pneumoniae producing these enzymes indicate that this is an important problem in our region. The most active antimicrobial agent against isolates used in this study was carbapenem. It is, therefore strongly recommended to consider carbapenems as the drug of choice for such multi-drug resistant ESBL-producing microorganisms.

Surveillance of ESBL-producers causing UTIs over a 6 year period

Background: Urinary tract infections (UTIs) are one of the most prevalent community-acquired infections. ESBL-producing microorganisms are a growing threat to public health, and their presence among the community is spreading. The aim of this study was to access the prevalence of ESBL-producing isolates collected from urine of elderly attending the Emergency Room (ER) during a 6 year period (2011-2016). Methods & Materials: Bacterial strains were isolated from patients with primary diagnose UTI, older than 65 years, in the ER between 2011 and 2016. The Vitek2 system (according to EUCAST 2014 guidelines) and Advanced Expert System (BioM~rieux, Marcy L'toile, France) were used to identify and perform the antibiotic susceptibility profile of the isolates. ESBL production was confirmed using the Etest(r) (AB Biodisk) method, according to the manufacturer instructions. Results: 2925 samples were collected following the criteria listed above. The percentage of Escherichia coli isolates has been increasing since 2011, up to 51,7% in 2016, and the percentage of Klebsiella pneumoniae, which in 2011 was higher than E. coli, has been significantly decreasing in the last years, to around 15%. A reduction in the percentage of ESBL-producers until 2013 was noted, from where there has been an increase, both among E. coli and K. pneumoniae. In 2011, 82,5% of K. pneumoniae were ESBL-producers, and progressively decreases until 2015 to 32,5%. But a slightly increase in 2014 and 2016 (44,1% and 51,2%) shows the tendency of ESBL-producing K. pneumoniae spread in the community. E. coli ESBL-producers have also progressively diminished until 2013, then exhibiting an increase up to 24,0% in 2016. Conclusion: Considering the criteria used, we can conclude that they are carried by the patients who attend the ER repeatedly, thus spread in the community. Despite ESBL-producers have been significantly reduced in the last years, results show a possible increasing tendency. The same is observed both for E. coli and K. pneumoniae isolates, where the decrease in ESBL-producers until 2013 is now being overcome by higher percentages. Nevertheless, 2016 numbers are still high, being a motive of concern especially considering the elderly population.

Antimicrobial susceptibility in blood and urine samples at a third level national hospital in Lima-Peru 2011-2014

Background: The antimicrobial resistance map is a tool that allows to know the characteristics of microorganisms, its realization is necessary because the microorganisms are in constant change as a result of the exposure to antimicrobial therapy, which leads to modifications of antimicrobial susceptibility. At the national level, there are no updated reports on antimicrobial susceptibility, which is the reason this study is proposed; it allows to know the new patterns of antimicrobial resistance and implement treatment regimens of greater effectiveness for an adequate management of infections, avoiding inappropriate drug prescriptions, dosage and/or duration. Methods & Materials: A descriptive observational study was performed, 9662 samples of uroculture and blood culture were obtained between 2011 and 2014. The most prevalent microorganisms were selected for each year of each type of sample and 8045 samples were analyzed. Sample source, care service, Gram staining, microorganism, antimicrobials and antimicrobial susceptibility were taken as variables. Frequency distribution tables were used for univariate analysis and double-entry tables were used to associate them. Results: The majority of urine cultures and blood cultures were from patients of outpatient services and emergency room, 5840 (72.60%). The sample type that was most frequently analyzed was the urine sample, 6064 (75.38%). Of the microorganisms isolated, 5644 (70.16%) were Gram negative and 1006 (16.59%) were Gram positive.). The production of ESBL was evaluted in all the samples, 629 (12.21%%) of these were ESBL positive, of which 77.55%. were samples from outpatient services. There is a tendency to decrease antimicrobial susceptibility with regard to antimicrobials such as ciprofloxacin, norfloxacin, amikacin and gentamicin (p < 0.05). Conclusion: Antimicrobial susceptibility tends to decrese and is lower than other countries. Most microorganisms isolated were Gram negative. ESBL-producing microorganisms are derived in a large percentage of samples from outipatient services.

High prevalence of ESBL-Producing E. coli in private and shared latrines in an informal urban settlement in Dar es Salaam, Tanzania

BackgroundData about the burden of extended-spectrum beta-lactamase (ESBL)-producing microorganisms in Africa are limited. Our study aimed to estimate the prevalence of human faecal ESBL carriage in the community of an informal urban settlement in Dar es Salaam (Tanzania, East Africa) by using environmental contamination of household latrines with ESBL as a surrogate marker.MethodsWithin the context of a large survey in February 2014 assessing 636 randomly selected household latrines for faecal contamination by the detection of growth of E. coli and total faecal coliform bacteria, a randomly selected subset of the samples were screened for ESBL.ResultsSeventy latrines were screened for ESBL. An average of 11.4 persons (SD ±6.5) were sharing one latrine. Only three (4.3%) latrines had hand-washing facilities and 50 showed faeces on the floor. ESBL-producing Enterobacteriaceae were confirmed in 17 (24.3%) of the 70 latrine samples: 16 E. coli and 1 Klebsiella pneumoniae. Five ESBL E. coli strains were detected on door handles. The most prevalent ESBL type was CTX-M-1 group (76.5%). Pulsed-field gel electrophoresis typing of a subset of ESBL-producing E. coli isolates revealed both diverse singular types and a cluster of 3 identical isolates. There was no significant difference of the latrine and household characteristics between the group with ESBL (n = 17) and the group with non-ESBL E. coli (n = 53) (p > 0.05).ConclusionsAlmost a quarter of private and shared latrines in an informal urban settlement in Tanzania are contaminated with ESBL-producing microorganisms, suggesting a high prevalence of human ESBL faecal carriage in the community. Shared latrines may serve as a reservoir for transmission in urban community settings in Tanzania.

Clinical and microbiological determinants of severe and fatal outcomes in patients infected with Enterobacteriaceae producing extended-spectrum β-lactamase.

Although extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae have become a worldwide public health concern, little is known regarding the clinical course of colonized or infected individuals. Our objective was to characterize the determinants of fatal outcomes related to ESBL-producing microorganisms at a large hospital in Paris, France. In 2012-2013, all consecutive patients with clinical samples testing positive for ESBL-producing Enterobacteriaceae at Saint-Antoine Hospital were identified. Patient clinical data were obtained at hospital entry, while information on intensive care unit (ICU) admissions and death were prospectively collected. Risk-factors for fatal 1-year outcomes were assessed using logistic regression. In total, 643/4684 (13%) ESBL-positive samples were observed, corresponding to 516 episodes (n = 206, 40% treated) among 330 patients. Most episodes were nosocomial-related (n = 347/516, 67%) involving Escherichia coli (n = 232/516, 45%) or Klebsiella pneumoniae (n = 164/516, 32%). Empirical antibiotic therapy was adequate in 89/206 (43%) infections, while the median length of hospital stay was 30days [interquartile range (IQR) = 11-55] and 39/201 (19%) were admitted to the ICU. Overall, 104/241 patients (43%) with available data died within 1 year. In the multivariable analysis, 1-year death was associated with age >80years (p = 0.01), concomitant comorbidity (p = 0.001), nosocomial-acquired infection (p = 0.002), and being infected rather than colonized (p < 0.001). In this series of patients with identified samples of ESBL-producing Enterobacteriaceae, hospital burden was large and 1-year mortality rates high. Understanding which patients in this setting would benefit from broad-spectrum empirical antibiotic therapy should be further examined.

The Efficacy and Safety of Ertapenem Therapy in Children with Urinary Tract Infections due to ESBL-Producing Microorganisms

The Efficacy and Safety of Ertapenem Therapy in Children with Urinary Tract Infections due to ESBL-Producing Microorganisms

Characterization of Antimicrobial Resistance Pattern and Molecular Analysis among Extended Spectrum β-Lactamase-Producing Escherichia coli

Background: Infection is a serious problem in medicine and appropriate antibiotic therapy is very important. Because of broad spectrum activity and low toxicity of β-lactam antibiotics, they are the most commonly used drugs. But, bacterial resistance to β-lactam antibiotics, has been considered as the global healthcare concern. The aim of study was to evaluate the antimicrobial resistance pattern and molecular characterization among ESBL-producing Escherichia coli isolated from patients with diarrhea admitted to a hospital in Ilam, Iran. Methods: Totally, fifty E. coli isolates were investigated. Confirmatory tests for phenotypic detection of ESBLs were performed. Molecular identification of the blaTEM and blaSHV genes was carried out by PCR method. To identify genetic relatedness among isolates, Randomly Amplified Polymorphic DNA (RAPD) analysis was performed. Results: The antibiotic susceptibility results showed that the most effective antibiotic was imipenem and minimum effect was related to gentamicin. Thirty-one isolates (62%) were ESBL-producing organisms according to phenotypic method. The distribution of blaTEM and blaSHV genes among ESBL-producing isolates were 20 (64.5%) and 6 (19.3%), respectively. RAPD-PCR typing among isolates gave us eight different types. Twelve isolates were clustered in genotype A and all of them were ESBL-producer. Conclusion: The present study showed noticeable incidence of ESBL-producing E. coli isolated from outpatients and hospitalized patients with diarrhea. Therefore, it seems that constant supervision is crucial to monitor the ESBL-producing microorganisms in hospitals and community.