Extended-spectrum Beta-lactamase Organisms Research Articles

Plasmid and Total Protein Analyses of Extended Spectrum Beta Lactamase Producing Bacteria from Periplaneta americana (Coackroaches)

Background: The importance of plasmid-encoded Extended Spectrum Beta Lactamase (ESBL) organisms in the dissemination of multi-drug resistance and complicated infections are contributory factors to treatment failure. Despite these, there is a paucity of information regarding plasmid-borne associated infection from primary sources including cockroaches while studies correlating total protein and plasmid-encoded ESBL are also limited especially in cockroaches. The objective of this study was therefore aimed at determining the presence of plasmid in the ESBL organisms from cockroaches as well as their total protein profiles.
 Materials and Methods: Bacterial isolation, characterization and molecular identification were carried out in our previous work following standard recommended techniques. These molecularly identified organisms which were delineated into twenty-two (22) were further subjected to plasmid and total protein analyses using alkaline lysis and Sodium Dodecyl Sulfate Poly Acrylamide Gel Electrophoresis (SDS-PAGE) respectively.
 Results: Results obtained identifies 18(81.8%) of the ESBL isolates to be harbouring plasmids of different molecular weights (2-21.5kbp). The total protein profile of the plasmid-encoded ESBL and the non-plasmid encoded ESBL reveals differential protein expression patterns except for two non- plasmid encoded ESBL isolates that have similar patterns as that of plasmid-encoded ESBL organisms (isolates 2 and 3).
 Conclusion: There is a need to monitor the primary sources of infection in the epidemiological distribution of resistance. Improving environmental sanitation through proper disinfection of carrier insects may be a means to curtailing such spread.

Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria

ObjectivesNeonatal sepsis, a major cause of death amongst infants in sub-Saharan Africa, is often gut derived. Gut colonisation by Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) or carbapenemase enzymes can lead to antimicrobial-resistant (AMR) or untreatable infections. We sought to explore the rates of colonisation by ESBL or carbapenemase producers in two neonatal units (NNUs) in West and East Africa.MethodsStool and rectal swab samples were taken at multiple timepoints from newborns admitted to the NNUs at the University College Hospital, Ibadan, Nigeria and the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, western Kenya. Samples were tested for ESBL and carbapenemase genes using a previously validated qPCR assay. Kaplan–Meier survival analysis was used to examine colonisation rates at both sites.ResultsIn total 119 stool and rectal swab samples were taken from 42 infants admitted to the two NNUs. Colonisation with ESBL (37 infants, 89%) was more common than with carbapenemase producers (26, 62.4%; P = 0.093). Median survival time before colonisation with ESBL organisms was 7 days and with carbapenemase producers 16 days (P = 0.035). The majority of ESBL genes detected belonged to the CTX-M-1 (36/38; 95%), and CTX-M-9 (2/36; 5%) groups, and the most prevalent carbapenemase was blaNDM (27/29, 93%).ConclusionsGut colonisation of neonates by AMR organisms was common and occurred rapidly in NNUs in Kenya and Nigeria. Active surveillance of colonisation will improve the understanding of AMR in these settings and guide infection control and antibiotic prescribing practice to improve clinical outcomes.

Risk factors for extended-spectrum beta-lactamase- and carbapenem- resistant Enterobacteriaceae in patients with urinary tract infection from a tertiary care hospital

Background: Urinary tract infection (UTI) is a common health problem in both community and nosocomial settings. However, the predisposing factors which are responsible for production of extended spectrum beta-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae makes the treatment option narrow and cause multidrug resistance. Aim and Objectives: This study demonstrate various risk factors associated with multidrug resistance in Enterobacteriaceae from UTI at tertiary care center in Gujarat. Material and Methods: A retrospective observational study was conducted at a tertiary-care hospital. Urine samples were received from various departments and outpatient department (OPD). Organisms from Enterobacteriaceae group were isolated and identified by various biochemical methods. ESBL and Carbapenemase producing organisms were then processed for Antibiotic susceptibility test as per CLSI guideline. Results: A total of 196 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. The most prevalent in people aged 45–65 years (36%) followed by those aged 17–30 (22%) years. UTI due to ESBL and Carbapenemase producer are more isolated in female (28%, 11%) as compare to male (16%, 6%). Indoor patients had higher prevalence of ESBL (29%) and carbapenemases (10%) isolation compare to OPD patient (ESBL-15%, Carbapenemases-7%) and among them most common ward was medicine department. The most common predisposing factor was catheterization followed by diabetes mellitus and obstructive uropathy. Discussion: High prevalence of ESBL and Carbapenemase producing Enterobacteriaceae is found in Indoor patients than OPD patients. Most of these patients are from Medicine department. Catheterization is the most common risk factor associated with ESBL and carbapenemase producing organism.

Extended-spectrum beta-lactamase and Antibiotic susceptibility pattern in uropathogens.

Objective: To identify rapidly changing antibiotic susceptibility of ESBL & Uropathogens. Study Design: Comparative Cross-sectional prospective study. Setting: Allied Hospitals of Peshawar Medical College. Period: 8th November 2021 to 5th March 2022. Material & Methods: 10-15ml of midstream urine was collected in a sterile container from 158 patients Pus cells, red blood cells, and bacteria were examined using microscopy. The standard loop technique was used to inoculate urine specimen on MacConkey and Blood agar. Plates were incubated for 24 hours at 37oC. A colony count of 105 cfu/ml was thought to be significant. Gram staining of the colonies was performed. The biochemical tests were conducted on API 10S for the identification of organisms. Extended-spectrum beta-lactamase organisms were identified by the double-disc synergy method. The Kirby-Bauer disc diffusion method was used to test antibiotic susceptibility on Mueller-Hinton agar according to CLSI guidelines 2021. A statistical package for the social sciences (SPSS) version 20.0 was used for statistical analysis. Results: Out of 158 urine samples 135 (85.5%) had positive culture growth with 35 (25.9%) ESBL confirmed. Antibiotic susceptibility was Nitrofurantoin (70.1%), Trimethoprim-sulfamethoxazole (26.8%), Ciprofloxacin (51.5%), Levofloxacin (51.5%), Ceftriaxone (25.77%) Cefotaxime (23.7%) Ceftazidime (19.5%) Cefepime (27.8%) Aztreonam (2.1%) Meropenem (86.6%) Amoxicillin/clavulanic (37.1%) Gentamycin (73%) Penicillin (0%). Conclusion: Surprisingly, only nitrofurantoin was found to be advised orally as a suitable drug for the treatment of UTIs among the 13 commonly used antibiotics.

Dealing with Hidden Threats: The Antimicrobial Effect of the Embalming Process.

Individuals naturally carry bacteria and other microbes as part of their natural flora, with some being opportunistic pathogens. Approximately 30% of the population is known to carry Staphylococcus aureus in their nasal cavity, an organism that causes infections ranging from soft tissue abscesses to toxic shock syndrome. This problem is compounded by the presence of antibiotic-resistant strains such as Methicillin-Resistant Staphylococcus aureus (MRSA). Commensal bacteria present on cadavers pose a risk to those who handle the body. As a Medical School Anatomy laboratory that performs hands-on cadaveric dissection, we wanted to know whether the embalming process is sufficient to kill all commensal bacteria that pose a risk to staff and students. Even if these strains do not cause disease in these individuals, secondary transmission could occur to friends and family, who may be at higher risk of acquiring an infection. Embalming is assumed to eliminate all microbial contamination on the body. However, there are limited studies to confirm this. This study characterises the incidence of antibiotic sensitive and resistant bacteria in cadavers donated for medical teaching and research. We have screened for Methicillin-Resistant Organisms (MRO) and Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria. In this study group of cadavers, approximately 46% (16/35) carry an MRO, while 51% (18/35) carry an ESBL positive organism prior to embalming. By determining the organisms' presence pre- and post-embalming, we can evaluate the embalming procedure's effectiveness. Our results show embalming eliminates detectable microbes in about 51% (18/35) of the cadavers. MRO dropped by 75% (16 to 4 positive cadavers), while ESBL organisms went down by almost 95% (from 18 to 1 positive cadaver). There was a further decrease in the number of positive cadavers after storage at 4 °C to 6% (2/32). Thus, although the embalming process does not immediately sterilise all the cadavers, prolonged storage at 4 °C can further reduce the number of viable bacteria.

Extended-Spectrum Beta-Lactamase and Carbapenem-Resistant Gram-Negative Pathogens in Makkah, Saudi Arabia.

This study aimed to determine the prevalence of extended-spectrum-beta-lactamase (ESBL) and carbapenem-resistant gram-negative bacteria (GNB) isolated from patients at the King Faisal Hospital in Makkah, Saudi Arabia. In this cross-sectional study, a total of 298 patients admitted to the intensive care unit for 48 hours and who had a central venous catheter were selected using a census sampling method. Only patients with ESBL and carbapenem-resistant GNB-isolated organisms (175 patients) were included. The susceptibility test of GNB was carried out according to the standard recommendations. The identified strains were tested in-vitro against several antimicrobial drugs. Statistical analysis was performed using SPSS version 24. 36(20.6%) of samples were ESBL-producing GNB, whereas 139(79.4%) were carbapenem-resistant GNB. The pooled proportional estimates of ESBL-producing GNB Escherichia coli, Klebsiella pneumoniae, and other GNB were 44.4%, 41.6%, and 14.0%, respectively; the pooled proportional estimates of carbapenem resistance GNB Klebsiella pneumoniae, Acinetobacter baumannii complex/hemolyticus and other GNB were 82.8%, 10.8%, and 6.4%, respectively. All ESBL-producing GNB and carbapenem-resistance GNB were multidrug-resistant pathogens. The highest carbapenem resistance GNB 139(100%) was to ampicillin, and the lowest 122(87.7%) was to Amoxicillin/clavulanic acid (Amox/clav). All ESBL-producing GNB 36 (100%) were resistant to cefotaxime, and 35 (97.2%) were resistant to ampicillin, cefuroxime, cefepime, and ceftazidime. Additionally, the effective antibiotic against ESBL-producing GNB was imipenem. Antibiotic utilization measures appear to contribute to the control of the emergence of multidrug-resistant pathogens such as ESBL and carbapenem-resistant GNB. Strict adherence to well-accepted infection control guidelines along with caution in using broad-spectrum antimicrobial agents represents the best strategy for preventing the emergence and spread of multidrug-resistant pathogens.

Microbial Etiology and Antibiotic Resistance Patterns of Urinary Tract Pathogens in Hospitalized Infants in Bahrain: A Tertiary Care Center Experience.

Introduction: Urinary tract infections (UTIs) are fairly common in infants. Early diagnosis and prompt treatment are crucial to avoid complications. However, providing appropriate antibiotic treatment is a challenge to any clinician considering the rise in the urinary pathogens that are resistant to the commonly used antibiotics especially with the emergence of extended-spectrum beta-lactamase (ESBL)-producing organisms. Consequently, this leaves the physician with limited options of antibiotic choices. This study aims to investigate the local resistance patterns of uropathogens causing UTIs in hospitalized infants in Bahrain and to provide guidance for the preferred choice of empirical antibiotic treatment.Methods: A retrospective cross-sectional study with an analysis of the medical records of infants from birth to one year of age admitted with UTIs at Salmaniya Medical Complex between June 2015 and June 2017 was conducted.Results: Data were obtained from 117 term infants (no preterm infants were included), with 80 (68.4%) being male. A total of 106 (90.6%) patients were less than six months of age. The most frequently isolated organisms were Escherichia coli found in 66 (49.6%) patients, followed by Klebsiella in 43 (32.3%). Forty-eight (36%) were ESBL-producing organisms (31 and 17 of E. coli and Klebsiella, respectively). The highest antibiotic resistance of E. coli was found against cephalosporin (55.5%), while penicillin resistance was only 19.4% and co-trimoxazole was 14.4%. Resistance rates of non-E. coli organisms were highest against cephalosporin (44.6%), followed by nitrofurantoin (19.1%) and penicillin (18.5%). The overall resistance to cephalosporin antibiotics was highest against cephalothin (a first-generation cephalosporin) (54.9%). The second highest resistance rate was demonstrated against cefuroxime (a second-generation cephalosporin) (50.5%), followed by ceftriaxone (a third-generation cephalosporin) (45.1%). Lower resistance rates were found against cefotaxime (22.3%), followed by ceftazidime (33.3%). A resistance rate of zero was found against cefepime (a fourth-generation cephalosporin). Aminoglycosides and nitrofurantoin demonstrated the lowest resistance rates among all cultured uropathogens. Among all cultures, 3.9% of the E. coli were resistant to aminoglycosides, while non-E. coli organisms showed zero resistance to aminoglycosides. Regarding the nitrofurantoin antibiotic, 19% of non-E. coli bacteria showed resistance, while only 1.7% of E. coli were resistant to this antibiotic. Zero resistance to carbapenem was found in E. coli organisms (both ESBL and non-ESBL), compared to 1.9% resistance by non-E. coli organisms (both ESBL and non-ESBL combined).Conclusion: E. coli is the predominant uropathogen causing UTI in infants with high rates of ESBL organisms in our community. Since the highest resistance was found against cephalosporins, aminoglycosides and nitrofurantoin are the preferred empirical antibiotic options for the treatment of UTIs. For infants with ESBL organisms, carbapenem antibiotics represent a good treatment option.

1420. Descriptive Epidemiology of UTI Hospitalizations in the US, 2018

BackgroundIn parallel with an increase in antimicrobial resistance, urinary tract infections (UTI), one of the most common diagnoses among hospitalized patients in the US, have been on the rise. Though mostly emphasized as a hospital-acquired complication among patients with an indwelling catheter, quantification of the full contemporary burden of UTI-associated hospitalizations is limited. MethodsWe conducted a cross-sectional multicenter study within the National Inpatient Sample (NIS) database, a 20-percent stratified sample of discharges from US community hospitals, from 2018, to explore characteristics of patients discharged with a UTI diagnosis. We divided UTI into mutually exclusive categories of complicated (cUTI), uncomplicated (uUTI), and catheter-associated (CAUTI). We applied survey methods to develop national estimates. ResultsAmong 2,837,385 discharges with a UTI code, 77.9% were uUTI, 17.6% cUTI, and 4.4% CAUTI. Compared to patients with uUTI (mean age 69.0 years), those with CAUTI and cUTI were older (70.1 and 69.7 years), but had same comorbidity burden (mean Charlson 4.3) as cUTI (4.3) and lower than CAUTI (4.6). Compared to other geographic regions, the Northeast had the lowest proportion of uUTI (74.6%) and highest of cUTI (20.8%) while the South had highest uUTI (80.2%) and lowest cUTI (15.7%). Over 60% of all UTI, regardless of type, were in large, and nearly ½ in urban teaching, institutions, and >80% came through the emergency department. Antimicrobial resistance codes were infrequent, but extended spectrum beta-lactamase organisms were more common in CAUTI (2.7%) and cUTI (2.1%) than in uUTI (1.6%). Among the 83.0% of discharges whose UTI was a secondary diagnosis, sepsis was the most common principal diagnosis, ranging from 17.7% in uUTI to 22.3% in cUTI. Although relatively low across the board, hospital mortality was lowest in cUTI (2.8%) and highest in uUTI (3.9%). Discharges to a chronic care facility were most common in CAUTI (46.7%) and least common in cUTI (33.3%). ConclusionThere are nearly 3 million hospital admissions with a UTI, comprising fully 8% of all annual admissions in the US. Though most are considered uncomplicated, there are few differences in characteristics or outcomes across the categories. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Kate Sulham, MPH, Spero Therapeutics (Consultant)

1560. Microbiology of Necrotizing Fasciitis and Implications on Antimicrobial Stewardship

BackgroundNecrotizing fasciitis (NF) is a rare but deadly soft tissue infection. Early diagnosis, antibiotics, and surgical management are critical in treatment. Current IDSA guidelines recommend broad empiric antibiotics (eg, vancomycin + piperacillin-tazobactam or a carbapenem). At our institution, this invariably consists of empiric treatment for methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms (eg, Pseudomonas aeruginosa), usually with piperacillin-tazobactam. Clindamycin is the common third agent used empirically; however, the literature supports use of clindamycin only in confirmed cases of Group A Streptococcus (GAS). With the increasing dangers of antibiotic resistance, use of such broad agents may not be necessary for NF. We evaluated the microbiology of NF and the implications on empiric antibiotic treatment.MethodsRetrospective chart review of adults (≥18 years) with a diagnosis of NF from January 2016 to May 2020.ResultsTwenty-five cases of NF in 22 patients were recorded. The median age was 54.5 (IQR 37-59.8) and 15 (60%) were male. On presentation, 24 (96%) met systemic inflammatory response syndrome criteria with a median laboratory risk indicator for necrotizing fasciitis score of 15 (IQR 9-31.3, n = 20). The median presenting white blood cell count was 17.5 x 103 cells/uL (IQR 13.5-25.2), median C-reactive protein was 321.6 mg/L (IQR 25.9-37.6) and median creatinine was 1.2 mg/dL (IQR 0.7-1.6). The most frequently isolated organisms were anaerobes (n=9, 36%) and Streptococci other than GAS (n = 9, 36%). GAS was isolated in 6 patients (24%) and S. aureus in 2 patients (8%). All cases of S. aureus were methicillin-susceptible. No Pseudomonas species (PsA) or extended-spectrum beta-lactamase (ESBL) gram negative organisms were isolated. Three patients (12%) had no organisms isolated from surgical cultures. Seven patients (28%) had positive blood cultures. Of the empiric antibiotics used, 24 (96%) patients were exposed to clindamycin and an anti-pseudomonal antibiotic.ConclusionEmpiric treatment of PsA and ESBL organisms is not necessary in NF. This infection should be considered a priority target for antimicrobial stewardship to reduce prescribing of broad-spectrum antibiotics to empirically treat these organisms.Disclosures All Authors: No reported disclosures

1668. Clinical Risk Score Model for Predicting Extended Spectrum Beta Lactamase (ESBL)-Positive Urinary Tract Infection among Hospitalized Filipino Patients: a Retrospective Single-Center Study

BackgroundInfections caused by Extended-Spectrum B-lactamases (ESBL) organisms are an emerging health concern worldwide. In the background of progressive rise of antibiotic resistant organisms, efforts should be started to minimize antibiotic resistance. The development of clinical risk score models to predict the possibility of infection with these drug resistant organisms will bridge the gap between treating too late and treating too early and too much.MethodsThis is a single-center cross-sectional study of ESBL positive urinary tract infection (UTI) among patients admitted at St Luke’s Medical Center - Global City from January 2018 to December 2018. A total of 93 patients positive for ESBL-positive UTI and 186 patients with ESBL-negative UTI were included in the study. Clinical characteristics, medical and medication histories were obtained from the computerized medical database. To develop the risk score, clinical risk indicators measured at the time of recruitment were built by logistic regression. Regression coefficients were transformed into item scores and added up to a total score. A risk-scoring scheme was developed from clinical predictors.ResultsThe following factors were observed to be predictive of ESBL UTI: hospital-acquired or healthcare-associated infection, prior ESBL infection, cardiac comorbidity and history of carbapenem intake. Scoring for the predictive model is as follows: having age at least 50 years old=1.5, hospital-acquired or healthcare-associated infection=1, having prior ESBL infection=2, having cardiac comorbidity (NYHA I-II)=1, having cardiac comorbidity (NYHA III-IV)=2.5, and history of carbapenem intake=3. ROC analysis showed that the optimum cut point in the model predictive of ESBL is 3.5/10. The risk prediction model for ESBL had high sensitivity of 87%, medium specificity of 68%, and good predictive accuracy of 0.78.ConclusionA simple and non-invasive scoring scheme of three predictors provides good prediction indices for presence of ESBL organisms in patients diagnosed with UTI. However, a large sample study is needed to improve the power of the study. Validation studies are also needed.Disclosures All Authors: No reported disclosures

Prevalence, antibiotic sensitivity pattern and genetic analysis of extended spectrum beta lactamase producing Escherichia coli and Klebsiella spp among patients with community acquired urinary tract infection in Galle district, Sri Lanka

Community acquired urinary tract infections (CA-UTI) are commonly caused by Escherichia coli and Klebsiella spp which are known extended spectrum beta lactamase (ESBL) producers. To determine, the prevalence and characteristics of ESBL producing of E. coli and Klebsiella spp in the community, and the association of risk factors with ESBL CA-UTI. Descriptive cross-sectional study with urine cultures performed from clinically suspected CA-UTI patients by CLSI standards. Conventional multiplex PCR was performed for gene analysis. Cultures were positive in 178 (38%) patients from 465. Majority were females (103, 58%). Most frequently isolated was E. coli (149, 84%) with 68(46%) ESBL producers followed by 16(9%) Klebsiella pneumoniae with 4 (25%) ESBL producers. Majority of patients with ESBL CA-UTI were >50 yrs (35/72, 49%) and 13 (18%) children <10 years were present. ABST of ESBL producers revealed high resistance rates for quinolones (41%) and >80% sensitivity for nitrofurantoin, fosfomycin, mecillinam, aminoglycosides and carbapenems. Presence of ESBL genes were 83% CTX –M, 71% OXA, 24% TEM and 9% SHV with one organism often producing more than one gene in 29 isolates (71%). Haematuria and structural abnormalities of urinary tract were significantly associated with increased ESBL CA-UTI (p<0.01). ESBL prevalence of this community was 40% in CA-UTI with E.coli predominance among female majority. >80% ESBL organisms show high sensitivity for aminoglycosides, carbapenems, nitrofurantoin, mecillinam and fosfomycin. Frequently isolated ESBL gene was CTX-M. Haematuria and structural abnormalities of urinary tract were significantly associated with ESBL CA-UTI

Prevalence and Antimicrobial Susceptibility Pattern of Extended Spectrum Beta Lactamase Producers in Gram-negative Urine Isolates at MBN Clinical Laboratories, Kampala Uganda

Introduction: Occurrence of Extended Spectrum beta-lactamase (ESBLs) producing bacteria have presented impediment in treatment choices for urinary tract infections. ESBLs embody a major cluster of lactamases accountable for resistance to novel generations of s-lactam drugs worldwide. The study determined prevalence of ESBL organisms in urine isolates and susceptibility patterns to 13 antibacterial agents. Materials and methods: Two hundred samples were cultured on blood agar, MacConkey agar and incubated at 37°C utmost 48 hours. Isolates identified based on standard bacteriological culture and biochemical characteristics. Drug susceptibility centered on Clinical Laboratory Standard Institute recommended and WHO modified Kirby- Bauer disc diffusion methods. Isolates with reduced susceptibility to Ceftazidime were considered to be possible ESBL producers. Phenotypically confirmed ESBL required use of Ceftazidime in combination with Clavulanic acid. A five milimeter increase zone diameter for Ceftazidime in combination with Clavulanic acid versus its zone tested alone was considered as ESBL. Results: Out of 200 samples, 45 (22.5%) had significant growth, majority Escherichia coli 28 (62.2%), Klebsiella pneumonae 11 (24.4%) followed and Citrobacter fruendii 2 (4.4%). Enterobacter species, Morganella morganii, Proteus mirabilis and Seratia marcescens each 1 (2.2%). Prevalence of ESBLs was 56%. Out of 25 (56%) ESBLs, highest prevalence was among Escherichia coli (15/25; 60%) followed by Klebsiella pneumonae (5/25; 24%) while Citrobacter fruendii, Enterobacter species, Morganella morganii and Proteus mirabilis each had (1/25; 4%). Susceptibility was highest to Imipenem 22 (88%) and least to Ampicillin, Amoxicillin-Clavulanic acid and Tetracycline each 1 (4%). No susceptibility to Cefuroxime and Ceftazidime was observed. Conclusion: The study showed that resistant ESBLs generating bacteria were present among urine isolates. We recommend that ESBLs bacteria isolated in urine be treated based on antibiotics susceptibility, continuous surveillance to guide correct treatment for urinary tract infection and to prevent the occurrence of multi drug resistant bacteria. This should be reflected in the policies developed by the Ministries of health to promote rational use of antibiotics.

Sites of colonization in hospitalized patients with infections caused by extended-spectrum beta-lactamase organisms: a prospective cohort study

BackgroundThe objective of this study was to determine whether patients infected with extended-spectrum beta-lactamase (ESBL)-producing organisms are colonized at multiple body sites.MethodsThis was a prospective cohort study at a tertiary care center in Beirut, Lebanon. Hospitalized patients with infections caused by ESBL-producing organisms were included. Cultures were obtained from the primary site of infection as well as from other sites (skin, nasopharynx, urine, rectum). Molecular analysis was performed on isolates to determine clonal relatedness.ResultsOne hundred patients were included in the study. Only 22 patients had positive cultures from sites other than the primary site of infection. The most common ESBL gene was CTX-M-15 followed by TEM-1. In 11 of 22 patients, isolates collected from the same patient were 100% genetically related, while in the remaining patients, genomic relatedness ranged from 42.9% to 97.1%.ConclusionsColonization at sites other than the primary site of infection was not common among our patient population infected with ESBL-producing organisms. The dynamics of transmission of these bacterial strains should be studied in further prospective studies to determine the value of routine active surveillance and the need for expanded precautions in infected and colonized patients.

Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU.

Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gram-negative bacteria (MDR-GNB) frequently results in life-threatening infections. Universal screening of ICU patients upon admission has been suggested. The aim of the current study was to evaluate the prevalence and pattern of MRSA, ESBL, and MDR-GNB colonization in patients upon admission to an Egyptian medical ICU, along with the related demographic and clinical risk factors. Throat, axillary, and groin swabs were obtained from all study participants in addition to rectal swabs from consenting patients. These swabs were screened for MRSA, ESBL, and MDR-GNB. Of the patients included in the study, 33%, 13%, and 63% were colonized with ESBL, MDR-GNB, and MRSA organisms, respectively. Those suffering from a more severe disease with a simplified acute physiology score II (SAPS II) > 29 demonstrated higher levels of MDR-GNB colonization upon admission, while MDR-GNB or ESBL colonization upon admission was associated with higher ICU mortality. Colonization of ICU patients with superbugs upon admission has an impact on outcome and mortality. In this Egyptian example, colonization rates were higher than in other literature reports, demonstrating the need for routine screening and decolonization, if applicable.

Extended-Spectrum Beta-Lactamase Bacteria From Urine Isolates in Children.

Multidrug-resistant Gram-negative bacteria, including extended-spectrum beta-lactamase (ESBL)-producing organisms, are a growing problem. The primary objective of this study was to describe the proportion of children with ESBL-producing urinary isolates at a tertiary medical center as well as these organisms' susceptibility patterns. The secondary objective was to identify the risk factors for acquiring ESBL urinary pathogens. This retrospective study evaluated a cohort of children with ESBL urinary isolates, admitted to a tertiary children's hospital during a 6-year period. The proportion of patients with an ESBL-producing urinary isolate among all patients who grew a Gram-negative isolate is described together with the organism's susceptibility pattern. Patients with non-ESBL Gram-negative urinary organisms were used as a control group for identifying patient risk factors for ESBL. A total of 7.8% (29 of 370) of patients in our cohort grew Gram-negative urinary isolates with an ESBL strain. Most of the ESBL organisms isolated were sensitive to carbapenems (100% of ESBL organisms susceptible to ertapenem and 93.8% susceptible to meropenem) and amikacin (92.3% of ESBL organisms susceptible). Patients with longer hospitalization, recent antibiotic use, and recent intensive care unit admission were found to be at increased risk for ESBL organisms in the urine. When selecting empiric antibiotic therapy for suspected urinary tract infection in children, it may be prudent to consider the risk factors identified for acquiring an ESBL urinary pathogen.

Risk factors of organ failure in cholangitis with bacteriobilia.

To identify the risk factors for organ failure (OF) in cholangitis with bacteriobilia. This study included 182 patients with acute cholangitis who underwent percutaneous transhepatic biliary drainage between January 2005 and April 2013. We conducted a retrospective analysis of comprehensive clinical and laboratory data. There were 24 cases (13.2%) of OF and five deaths (2.7%). Bile culture was positive for microbial growth in 130 out of 138 (94.2%) patients. In multivariate analysis of 130 patients with positive bile cultures, significant predictive factors for OF were the presence of extended-spectrum beta-lactamase (ESBL) organisms in blood cultures, pre-existing renal dysfunction, and choledocholithiasis as an etiology, with odds ratios of 15.376, 6.319, and 3.573, respectively. We developed a scoring system with a regression coefficient of each significant variable. The OF score was calculated using the following equation: (2.7 × ESBL organisms in blood cultures) + (1.8 × pre-existing renal dysfunction) + (1.3 × choledocholithiasis). This scoring system for predicting OF was highly specific (99.1%) and had a positive predictive value of 86.2%. ESBL organisms in blood cultures, pre-existing renal dysfunction, and choledocholithiasis are risk factors for OF in cholangitis with bacteriobilia. The OF scoring system may aid clinicians to identify a poor prognosis group.

A Retrospective Study of the Variability in Etiological Agents of Urinary Tract Infections among Patients in Windhoek-Namibia

Urinary tract infections (UTIs) are one of the most common infections that affect patients of both genders of all age groups. The common bacteria causing UTIs have not yet been identified in Namibia. Due to empirical treatment in the country, antibiotic resistance might be on the rise. The objective of the study was to identify the organisms that frequently caused UTIs, and the antibiotic sensitivity patterns of the bacteria isolated. A retrospective analysis was performed on 20,438 urine results submitted to the Namibia Institute of pathology (NIP), the public health laboratory in the country from January 2012 to December 2012. The raw data from NIP was compiled using Microsoft Excel. It was then imported to the IBM SPSS 22 statistical program for further analysis. The results showed that there were 3865 (18.9%) UTI cases due to Escherichia coli making it the most prevalent organism isolated, followed by Proteus mirabilis 758 (3.7%), Enterococcus faecalis 706 (3.5%) and Klebsiella pneumoniae 640 (3.1%). Female patients were more affected by UTIs than males. The eleven most common causes of UTIs in this study were mostly isolated from females. The most common cause of urinary tract infections in males was Extended Spectrum Beta Lactamase (ESBL) Klebsiella pneumoniae. The drugs to which these common organisms were resistant to were amoxicillin and cotrimoxazole (SXT). Cefapime, ofloxacin and piptaze were the most effective antibiotics in this study. There were 6 cases of UTIs due to Mycobacterium tuberculosis and 10 cases due to Schistosoma haematobium. The most common UTI etiology in Windhoek was Escherichia coli. Most of the isolates were resistant to at least one antibiotic, with ESBL organisms having resistance to more than ten antibiotics.

Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital

In 1995, beta-lactam inhibitor combinations replaced third-generation cephalosporins as empirical therapy in an effort to manage extended-spectrum beta-lactamase (ESBL) resistance. This study investigated the relationship between antibiotic usage and ESBL organisms from 1994 through 2002 using epidemiological and molecular analysis. A case-control study of 119 patients with ESBL organisms and 132 patients with non-ESBL organisms was conducted. Demographics, co-morbidities, device utilization and antibiotic use were analysed for all patients and infected patients only (cases = 75, controls = 83). Both exposure and degree of exposure (in grams) to antibiotics were included. A dot blot hybridization technique was used to identify genes in plasmid extracts from the ESBL organisms. Ventilator days OR 1.1 (1.06, 1.15) P < 0.001, adult respiratory distress syndrome (ARDS) OR 3.1 (1.0, 9.7) P = 0.05, prior aminoglycoside use OR 2.7 (1.2, 6.1) P = 0.02, prior third-generation cephalosporin use OR 7.2 (2.6, 20) P < 0.001, and prior trimethoprim/sulfamethoxazole use OR 8.8 (3.1, 26) P < 0.001 were significantly associated with ESBL organisms by multivariate analysis. All models were concordant with a significant association of ventilator days, third-generation cephalosporins and trimethoprim/sulfamethoxazole with ESBL organisms. beta-Lactamase inhibitor combinations were not associated with ESBL organisms. Hybridization of plasmid extracts demonstrated that 95% of the ESBL organisms carried intI1, a mobile DNA element with a sulphonamide-resistance (R) gene and a frequent carrier of other R factors. Genes for specific types of trimethoprim-R and aminoglycoside-R were present in 26% and 40% of the extracts, respectively. These data indicate that, besides patient risk factors and third-generation cephalosporins, other antibiotics may provide selective pressures in maintaining ESBL organisms due to multiple resistance genes on plasmids. beta-Lactamase inhibitor combinations appear to be an acceptable substitute to third-generation cephalosporins in strategies to control ESBL organisms.

Cataract aspiration-irrigation. Modified needle-tubing-handle combination for push-pull machine.

A modification of the needle-tubing combination for the push-pull machine used for aspiration-irrigation of congenital and traumatic cataracts, is described. The new needle-tubing-handle combination is advantageous in that the incorporated handle makes the insertion and maneouvring in the anterior chamber easier and also the whole combination can easily be autoclaved as silastic tubing is used.