Prevalence Of Extended-spectrum Β-lactamase Research Articles

Decline in ESBL Production and Carbapenem Resistance in Urinary Tract Infections among Key Bacterial Species during the COVID-19 Pandemic.

The COVID-19 pandemic has led to significant changes in healthcare practices, including increased antibiotic usage. This study aimed to investigate the impact of the pandemic on the prevalence of extended-spectrum β-lactamase (ESBL) production and carbapenem resistance among key bacterial species causing urinary tract infections (UTIs). Conducted at King Fahad Medical City in Riyadh from January 2018 to December 2022, the study analyzed urine samples from 9697 UTI patients. Patients were categorized into 'pre-COVID-19' and 'during COVID-19' groups. Bacterial isolates were identified, and antimicrobial susceptibility testing was performed following guidelines. ESBL production was detected using the Double-Disc Synergy Test. Escherichia coli and Klebsiella pneumoniae were the main pathogens. During the pandemic, ESBL production decreased in E. coli by 1.9% and in K. pneumoniae by 6.0%. Carbapenem resistance also declined, with E. coli displaying a 1.2% reduction and K. pneumoniae and Pseudomonas aeruginosa displaying 10.7% and 7.9% reductions, respectively. Notably, logistic regression analysis revealed that the odds of ESBL presence were 10% lower during the COVID-19 pandemic (OR 0.91; 95% CI 0.83-0.99; p = 0.040), and there was a significant reduction in the odds of carbapenem resistance (OR 0.43; 95% CI 0.37-0.51; p < 0.001). This study reveals a significant decrease in ESBL production and carbapenem resistance among UTI pathogens during the COVID-19 pandemic, hinting at the impact of modified antibiotic and healthcare approaches. It emphasizes the need for persistent antimicrobial resistance surveillance and policy adaptation to address resistance challenges, offering key directions for future public health actions.

Prevalence of Extended-spectrum beta-lactamases- producing Escherichia coli and Klebsiella pneumonia from patients attending Tripoli University Hospital, Tripoli, Libya

Prevalence of extended-spectrum β-lactamases (ESBLs)- producing E. coli and K. pneumoniae has been increased globally. The study aimed to detect the prevalence of ESBL-producing E. coli and K. pneumoniae isolated from clinical specimens in Tripoli university hospital (TUH) and to evaluate their antimicrobial resistance profile. We retrospectively reviewed the recorded cultures results in the microbiology laboratory, TUH during the first half of the year 2021. 77% of E. coli and 72.5% K. pneumonia were multidrug resistant. ESBL phenotype detected in 20% of K. pneumonia and 17.5% E. coli. ESBLs were isolated more frequently from the surgical ward (32.4%). ESBLs show high resistance to beta-lactam and other antibiotics including TMP/SMZ, and aminoglycosides. Our study showed a considerably high prevalence of ESBLs positive strains of E. coli and k. pneumoniae

Role of Healthy Human Gut Microbiota in the Emergence and Dissemination of Extended-Spectrum \(\beta\)-lactamase-Producing Enterobacteriaceae and Genes Associated with \(\beta\)-lactam Resistance in Community Settings in Abidjan, Côte d'Ivoire

Overuse of β-lactam antibiotics in communities in developing countries has transformed healthy human intestinal flora into a reservoir of antibiotic-resistant organisms. The prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in community settings remains undetermined. In order to obtain data on ESBL enterobacteria, 265 stool samples were collected from August 2019 to February 2020 from individuals residing in the urban districts of Abidjan and attending medical consultations at the Institut Pasteur de Côte d'Ivoire. Isolates belonging to family Enterobacteriaceae were isolated on MacConkey and identified using the API 20E galerie and antibiotic susceptibility was determined using Clinical Laboratory Standard Institute disc diffusion method. Detection of extended spectrum β-lactamases (TEM, SHV, GES, PER, VEB, CTXM 1, CTXM 2, CTXM 8 and CTXM 9) was done by simplex and multiplex PCR. The human stools strains consisted of 513 species of Enterobacteria multidrug resistants. Among the 513 strains, 75 (14.6%) of the enterobacterial strains produced ESBLs, while 438 (85.4%) produced high-level cephalosporinases. Enterobacteria producing extended-spectrum β-lactamase we dominated by the species Escherichia coli (46.7%), Klebsiella pneumoniae (17.3%), Enterobacter cloacae (13.3%), Enterobacter aerogenes (6.7%), Proteus mirabilis (6.7%), Klebsiella oxytoca (4%), Proteus vulgaris (2.7%), Citrobacter koseri (1.3%), and Citrobacter freundii (1.3%). Strains were resistant (100%) to antibiotics from beta-lactam family (penicillin with inhibitor, monobactam, cephalosporin) but low level resistant (1,3%) was observed to carbapenem (imipénème, méropénème, Ertapenem). The rate of resistance to quinolones and aminoglycosides were respectively between 22.9% - 43.3% and 7.9-35.1%. The resistance genes TEM, SHV, CTXM 1, CTXM 2, CTXM 8 and CTXM 9 were detected. No GES and PER genes were not detected. The high fecal carriage rate of ESBL-PE associated with genes in community settings of Ivory Coast highlights the risk for transmission and dissemination because healthy people are potential patients on borrowed time.

Prevalence of Extended-Spectrum β-Lactamase and Carbapenemase Producers of Gram-Negative Bacteria, and Methicillin-Resistant Staphylococcus aureus in Isolates from Diabetic Foot Ulcer Patients in Ethiopia.

BackgroundInfectious diabetic foot ulcers (IDFU) are a widespread health issue that affects people all over the world. IDFU, like other medical disorders, can have negative implications if drug resistance develops. Clinicians will be able to choose the optimal antibiotics to treat impacted patients based on the antibiotic susceptibility pattern of bacterial strains. In this project, we attempted to evaluate the levels of extended-spectrum beta-lactamase (ESBL), carbapenemase, and MRSA in patients with diabetic foot ulcers.MethodsA sterile swab was used to collect a sample from the leg ulcer, while a sterile needle was used to collect the aspirated pus. Bacteria identification and antibiotic susceptibility tests are carried out based on conventional bacterial culture. The double-disc inactivation method and modified carbapenem (meropenem) were used to screen the production of ESBL and carbapenemase.ResultsOf the 76 isolates tested, 53.9% (41/76) were phenotypically ESBL producers. K. pneumoniae 75% (6/8), Acinetobacter species 75% (9/12), Serratia species 75% (3/4), Pseudomonas species 64.3% (14/9), E. coli 57.8% (11/19), Citrobacter species 50% (2/4) and Proteus mirabilis 25% (1/4) had the highest frequency of ESBL production. Of the 68 GNB isolates tested, 27.9% (19/68) were carbapenemase-producing organisms. K. pneumoniae 62.5% (5/8), Serratia 50% (3/6), Acinetobacter species 40% (4/10), Pseudomonas species 23.5% (4/17) and E. coli 15.8% (3/19) are the top five major carbapenemase producers. In this study, 32 isolates of Staphylococcus aureus were tested for methicillin resistance. Among them, 81.3% (26/32) were methicillin-resistant Staphylococcus aureus (MRSA), and 18.7% (6/32) of the remaining isolates were methicillin-sensitive Staphylococcus aureus (MSSA).ConclusionThe result draws attention to the management of diabetic foot ulcer infections based on the results of microbiological analysis and drug susceptibility testing.

1057. Tebipenem In vitro Activity Against a Collection of Pathogens Responsible for Urinary Tract Infections in the US

1057. Tebipenem <i>In vitro</i> Activity Against a Collection of Pathogens Responsible for Urinary Tract Infections in the US

Prevalence of Extended-Spectrum β-Lactamase and Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas in Tertiary Care Centre of Kutch

Aim: The current research was performed with an aim to discover the prevalence of ESBL producing P. aeruginosa and also to provide as a direct for doctors administration subjects by executing suitable infection control events as well as inventing an efficient antibiotic policy.&#x0D; Materials and Methods: The current research was performed in the Department of Microbiology at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat over a period for one year. All 250 isolates of Pseudomonas aeruginosa acquired from different clinical samples established in microbiology laboratory from IPD &amp; OPD were incorporated in the research. Different clinical specimens established in our laboratory were coursed and Pseudomonas aeruginosa was recognized as apiece normal microbiological method. All isolates were subjected for ESBL screening test. Antimicrobial susceptibility test was performed by Kirby.&#x0D; Results: Highest samples established from middle age group (30- 50). Out of 250 isolates, 177 (70.7%) isolates of Pseudomonas aeruginosa demonstrated zone of inhibition≤ 22 mm for Ceftazidime. All ESBL positive Pseudomonas aeruginosa isolates demonstrated elevated confrontation to ciprofloxacin 43 (91.04%), Gentamicin 34 (72.3%) and tobramycin 33 (70.21%).&#x0D; Conclusion: The majority of isolates were from hospitalized subjects which point out additional probability of their nosocomial predominance.

Prevalence of extended-spectrum β-lactamase (ESBL)-producing Salmonella enterica from retail fishes in Egypt: A major threat to public health

The increase in multidrug-resistant Salmonella enterica and its spread from food to humans are considered a serious public health concern worldwide. Little is currently known about the prevalence of extended-spectrum β-lactamase (ESBL)-producing S. enterica in fish in Africa. Therefore, this study aimed to investigate the existence of ESBL-producing S. enterica in retail fish in Egypt. In total, 200 fish samples were collected randomly from various retail fish markets in Egypt. S. enterica were detected in 19 (9.5%; 95% CI: 5.8–14.4) of the fish samples analyzed. Of the 19 non-repetitive S. enterica isolates, 18 were serologically categorized into eight S. enterica serovars and a non-typable serovar. All 19 S. enterica isolates (100%) showed multidrug-resistant phenotypes to at least three classes of antimicrobials, and 11 (57.9%) exhibited an ESBL-resistant phenotype and harbored at least one ESBL-encoding gene. The ESBL-producing S. enterica serovars were as follows: Kentucky (3 isolates; 15.8%), Enteritidis (2 isolates; 10.5%), Typhimurium (2 isolates; 10.5%), and 1 isolate (5.3%) each of Infantis, Virchow, Paratyphi B, and Senftenberg. The identified β-lactamase-encoding genes included ESBL-encoding genes blaCTX-M-3, blaCTX-M-14, blaCTX-M-15, blaSHV-1, blaSHV-2 and blaSHV-12; the AmpC β-lactamase-encoding gene blaCMY-2; and the narrow-spectrum β-lactamase-encoding genes blaTEM-1 and blaOXA-1. All S. enterica isolates were negative for carbapenemase-encoding genes. Molecular analysis of plasmid transferability and replicon typing revealed that most plasmids (with β-lactamase-encoding genes) were transferrable, and the most common incompatibility groups were IncI1, IncA/C, IncHI1, and IncN. To the best of our knowledge, this is the first report for molecular characterization of ESBL-producing S. enterica in fish in Egypt. The occurrence of ESBL-producing S. enterica in retail fish constitutes a potential public health threat with the possibility of transmission of these strains with resistance genes to humans. Such transmission would exacerbate the resistance to an important class of antibiotics commonly used in hospitals to treat typhoid and non-typhoidal Salmonella infections.

Prevalence of Extended-spectrum β-lactamases in Escherichia coli Isolated from Chicken, Water and the Poultry Farm Workers

Prevalence of Extended-spectrum β-lactamases in Escherichia coli Isolated from Chicken, Water and the Poultry Farm Workers

Analysis of pathogen spectrum and antimicrobial resistance of pathogens associated with hospital-acquired infections collected from 11 teaching hospitals in 2018

Objective: To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China, 2018. Methods: Non-duplicated nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 11 teaching hospitals across China were collected. The minimum inhibitory concentrations (MICs) of clinically significant strains were determined by agar dilution method or broth microdilution method. The Clinical and Laboratory Standards Institute (CLSI) M100-S29 criteria were used for interpretation, and the WHONET-5.6 software was used in data analysis. Results: A total of 1 590 cases were collected, including 831 cases from BSI, 450 cases from HAP and 309 cases from IAI. The most prevalent pathogens causing BSI were Escherichia coli (29.2%, 243/831), Klebsiella pneumoniae (16.2%, 135/831) and Staphylococcus aureus (10.1%, 84/831); the most prevalent pathogens causing IAI were E. coli (26.2%, 81/309), Enterococcus faecium (15.5%, 48/309) and K. pneumoniae (13.3%, 41/309); while Acinetobacter baumanii (24.7%, 111/450), Pseudomonas aeruginosa (20.7%, 93/450) and K. pneumoniae (16.2%, 73/450) were dominated in HAP. All S. aureus were susceptible to tigecycline, linezolid, daptomycin and glycopeptides; 77.8% (105/135) of S. aureus strains were susceptible to ceftaroline. Methicillin-resistant S. aureus (MRSA) accounted for 29.6% (40/135) of all the S. aureus, and was lower than the accounted rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) (83.7%, 41/49). One E. faecium strain (1.1%, 1/95) resistant to vacomycin and teicoplanin and one E. faecalis strain (2.3%, 1/43) resistant to linezolid was found. The prevalence of extended-spectrum β-lactamase (ESBL) was 56.1% (193/344) in E. coli and 22.1% (55/249) in K. pneumonia; the rate of carbapenem resistant E. coli and K. pneumonia was 4.1% (14/344) and 22.9% (57/249), respectively; the percentage of ceftazidime/avibactam resistant E. coli and K. pneumonia was 2.3% (8/344) and 2.0% (5/249), respectively; the percentage of colistin resistant E. coli and K. pneumonia was 1.5% (5/344) and 7.6% (19/249), respectively; no E. coli and K. pneumonia strains were found resistant to tigecycline. The rate of carbapenem resistant A. baumanii and P. aeruginosa were 78.9% (146/185) and 36.7% (66/180), respectively. A. baumanii showed low susceptibility to the antimicrobial agents except colistin (99.5%, 184/185) and tigecycline (91.4%, 169/185). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rate of 100% (180/180), 93.3% (168/180) and 85.6% (154/180), respectively. Conclusions: Nosocomial Gram-negative pathogens show high susceptibilities to tigecycline, colistin and ceftazidime/avibactam in vitro. Antimicrobial resistance in A. baumannii is a serious problem. The prevalence of carbapenem-resistant Enterobacteriaceae has increased, which should be monitored continuously in China.

Investigating the relationship between extended spectrum β-lactamase producing Escherichia coli in the environment and food chains with the presence of this infection in people suspected of septicemia: Using the fuzzy set qualitative comparative analysis

Among antibiotic resistance cases, resistance to β-lactam antibiotics is a major concern for the treatment of microbial infections. Furthermore, the prevalence of extended-spectrum β-lactamases (ESBL) Escherichia coli (E. coli) in environment, food, and human resources of Iran has increased over the past few years. This study aimed to predict the relationship between the prevalence of ESBL E. coli in the environment and the food chains with the presence of this infection in people suspected of septicemia using fuzzy set qualitative comparative analysis model. In this analytical cross sectional study samples were collected from the environment (hospital sewage, downstream and upstream urban sewage, and slaughterhouse sewage), food (chicken), and human chains (people suspected of septicemia) in Tehran province, Iran. This study was conducted from September to February 2019 and the prevalence of ESBL E. coli was calculated in each resource. Then, the relationship between the prevalence of ESBL E. coli in the environment and food chains and its prevalence in the human chain was predicted using the fuzzy set qualitative comparative analysis. The results showed the prevalence of ESBL E. coli in those suspected of septicemia in September, October, November, December, January and February was 58.1%, 60%, 33.3%, 100%, 43%, and 57.8%, respectively. Also, the results of the fuzzy set qualitative comparative analysis indicated hospital wastewater and chicken contamination with ESBL E. coli were the main causes of contamination with ESBL E. coli in people suspected of septicemia. According to the results of this study, if there is a contamination of hospital wastewater and chickens in an area, it can be claimed that people suspected of septicemia are infected with ESBL E. coli, and the percentage of this contamination can be high. On the other hand, controlling ESBL E. coli in hospital wastewater (environmental chain) and chickens (food chain) can prevent contamination in people with suspected septicemia.

How much of antibiotics can enter surface water with treated wastewater and how it affects the resistance of waterborne bacteria: A case study of the Białka river sewage treatment plant

This study aimed to gain insight into the presence of antibiotics, occurrence of antimicrobial resistance and prevalence of extended-spectrum β-lactamase (ESBL) genes in Escherichia coli in surface water, based on the example of the Białka river, located in one of the most attractive tourist destinations in Poland. Water samples were collected in three sites: in the Tatra National Park (TNP), by the sewage discharge from the local treatment plant (STP) and c.a. 3 km downstream (DSTP). The analyses included determination of antibiotic content, enumeration of bacterial indicators of poor water quality, isolation and identification of Escherichia coli, which was subjected to antimicrobial susceptibility tests and assessment of ESBL-determining genes. Fourteen antimicrobials out of 24 tested were detected in river waters in varying concentrations. Trimethoprim and ofloxacin were most frequently detected. Most antibiotics were absent in the TNP, the highest numbers and the highest concentrations of antibiotics were observed by the STP discharge to decrease their content downstream. Culture-based tests of microbiological contamination showed similar results. Resistance to ampicillin was most frequent (64.5% strains), followed by cefazolin (50%). 20.6% of strains were ESBL-positive, while ESBL-determining gene, blaTEM was detected in 23.8% of E. coli strains. The largest percentage of antibiotic resistant and MDR E. coli strains was detected nearby the STP, indicating that malfunctioning STP may contribute largely to river water contamination downstream, also having significant environmental and economic impact.

Prevalence of Extended-Spectrum β-lactamases in Enterobacteriaceae Isolated from Polluted Wild Fish

Background:Antibiotic resistance is becoming a major public health concern worldwide. In marine animals, pollution is associated with the emergence of extended-spectrum β-lactamase (ESBL)-expressing bacteria, resulting in antibiotic resistance. However, the prevalence of these bacteria in wild fish has not been reported.Objective:Accordingly, in this study, we explored the influence of pollution oxidative stress on the incidence of ESBL-expressingEnterobacteriaceaein the gut of wild fish species from the Red Sea coastal region of Jeddah City, Saudi Arabia. Additionally, we evaluated the incidence of varied ESBL genes contributing to the ESBL+ phenotype.Methods:Antibiotic susceptibility tests were performed using cephalosporins and carbapenems against ESBL- and carbapenem-resistantEnterobacteriaceae(CRE)-producing bacteria. Frequent genes contributing to the ESBL+ phenotype were analyzed. Primers targeting ESBLs (e.g.,blaCTX,blaSHV,blaTEM, andblaOXA) were used in polymerase chain reaction assays to detect the ESBL+ phenotype.Results:Screening results from the polluted site revealed ESBL-resistantKlebsiella pneumoniaeB8 and CRE-resistantMorganella morganiiA4. The evolution of theblaCTX-M gene inM. morganiiwas a consequence of aquatic pollution. The other isolatesAcinetobacter pittiiandProvidencia rettgeriwere found in the clean reference site. The isolateM. morganiishowed resistance to most mutual antibiotics and expressed some β-lactamase genes.Conclusion:Our findings provide useful data for selecting marine molecular genomic biomarkers caused by aquatic pollution.

Fecal Carriage of Extended-Spectrum β-Lactamase and Carbapenemase-Producing Enterobacterales Strains in Patients with Colorectal Cancer in the Oncology Unit of Amizour Hospital, Algeria: A Prospective Cohort Study.

Background: The prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) is now disseminated worldwide. This study aims to describe the prevalence of ESBL and CPE fecal carriage in colorectal cancer patients. Methods: All patients admitted to the oncology service of Amizour hospital (Algeria) for colorectal cancer chemotherapy from March to May 2019 were screened for ESBL-E or CPE fecal carriage. After culturing on chromogenic media, the presumptive colonies were identified by mass spectroscopy. Antibiotic susceptibility testing was performed according to the European Committee on Antimicrobial Susceptibility Testing. The β-lactamases encoding genes and plasmid-mediated quinolone-resistant genes were screened by PCR and sequencing. Results: ESBL-E strains were recovered from rectal swabs in 6 patients (14.3%) and only 1 patient (2.4%) was found a carrier for OXA-48-producing Klebsiella pneumoniae. The most frequently encountered species among ESBL-E was Escherichia coli (n = 5), followed by K. pneumoniae (n = 1). PCR and sequencing showed that four isolates harbored the blaCTX-M-15 gene and two strains harbored the blaCTX-M-14 gene. Also, one strain of K. pneumoniae was found to harbor both qepA and qnrS genes. Conclusion: This study highlighted the fecal carriage of ESBL-E and OXA-48-producing Enterobacterales strains in colorectal cancer patients.

Prevalence of extended-spectrum β-lactamase (ESBL) and molecular detection of blaTEM, blaSHV and blaCTX-M genotypes among Enterobacteriaceae isolates from patients in Khartoum, Sudan.

Introductionthe emergence of antibiotic resistance pathogens is an important health risk. Usually Gram negative bacteria acquire resistance to beta-lactam antibiotics by beta-lactamase production. The objectives of this study was to assess the prevalence of ESBL and to detect the frequency of blaTEM, blaSHV and blaCTX-M genotypes among ESBL producing Enterobacteriaceae isolates from patients in Khartoum, Sudan.Methodsa total of 171 isolates of Enterobacteriaceae were recovered from hospitals in Khartoum, Sudan (2014 -2015) were used to detect ESBL production using disc diffusion method. blaTEM, blaSHV and blaCTX-M genes were investigated by PCR based methods using gene-specific primers.Resultsthe high resistance among Enterobacteriaceae was noticed in ciprofloxacin (72%) and ofloxacin (73%). ESBL production was mainly in Escherichia Coli (38%) and Klebsiella pneumonia (34%). Prevalent genotypes were blaTEM (86%), blaCTX-M (78%) and blaSHV (28%). These were found mainly in Escherichia Coli (38%, 37%, 2%) and K. pneumonia (34%, 31%, 26.1%). The majority of ESBL producing isolates possess more than one ESBL genes.Conclusionthe ESBL production in Enterobacteriaceae was high, with blaTEM and blaCTX-M genotypes more prevalent. Public health and laboratory standard of excellence is needed to reducing the spread of resistant pathogens.

Inactivation of Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli by UVA-LED irradiation system.

The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is increasing rapidly and spreading worldwide, particularly in Asia, compared to other regions. In the last ten years, in our hospital, in particular, there has been a < 30% increase. To prevent the spread of ESBL in hospitals and the community, the ultraviolet (UV) A-light-emitting diode (LED) irradiation device was used to inactivate ESBL-E. coli in human livestock and the environment. ESBL-E. coli and E. coli bacterial samples were collected from patients at Tokushima University Hospital (Tokushima City, Japan). The UVA-LED irradiation system had 365 nm single wavelength, and the current of the circuit was set to 0.23 or 0.50 A consistently. Results demonstrated that UVA-LED was useful for the inactivation of ESBL-E. coli and E. coli. The minimum energy dosage required to inactivate ESBL-E. coli and E. coli was 40.76 J/cm2 (45 min) in the first type of UVA-LED and 38.85 J/cm2 (5 min) in the second type. There were no significant differences between ESBL-E. coli and E. coli. The inactivation of ESBL-E. coli was dependent on energy. These findings suggest that UVA-LED with 365 nm single wavelength could be useful for surface decontamination in healthcare facilities. J. Med. Invest. 67 : 163-169, February, 2020.

Determination of the frequency of β-lactamase genes (bla SHV, bla TEM, bla CTX-M) and phylogenetic groups among ESBL-producing uropathogenic Escherichia coli isolated from outpatients

Abstract Background Escherichia coli accounts for 70–95% of community-acquired urinary tract infections (UTIs). Recently, there has been an increase in the prevalence of extended-spectrum β-lactamase (ESBL) in the community which required an accurate identification for better management. Therefore, the current study was performed to determine the antimicrobial resistance pattern, investigate ESBL phenotypes and genotypes (blaCTX-M, bla TEM and bla SHV genes) and determine the phylogenetic groups among ESBL-positive isolates from outpatients. Methods One hundred and eighty-three positive urine samples were collected from 4450 outpatient clinic attendees. Antibiotic susceptibility was determined and ESBL phenotype screening was carried out using disk diffusion agar and combination disk techniques, respectively. The assessment of the presence of the blaCTX-M, bla TEM and blaSHV genes and phylogenetic grouping were performed using the polymerase chain reaction (PCR) method. Results Out of 183 E. coli isolates, 59 (32.2%) showed a positive ESBL phenotype. The prevalence of ESBL-producing E. coli was higher in males (57.4%). Fifty-seven of the ESBL-producing strains carried at least one of the β-lactamase genes (bla CTX-M, bla TEM, bla SHV). Phylotyping of multi-drug resistant isolates indicated that the isolates belonged to B2, A and D phylogroups. Analysis of resistance patterns among these phylogroups revealed that 74.4%, 55.3% and 29.7% of the isolates in the B2 group were resistant to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin, respectively. Most of the strains in the phylogroup B2 carried the bla CTX-M gene. Conclusions All the ESBL-producing isolates were placed in one of the four phylogenetic groups. The presence of CTX-M and resistance to quinolones were more frequent in B2 strains than in non-B2 strains.

Prevalence of virulence and extended-spectrum β-lactamase (ESBL) genes harbouring Vibrio spp. isolated from cockles (Tegillarca granosa) marketed in Korea.

The present study aimed to investigate the incidence, virulence and antibiotic properties in Vibrio spp. isolated from cockles (Tegillarca granosa) marketed in Korea. A total of 32 Vibrio spp. isolates including V. parahaemolyticus (n=4), V. alginolyticus (n=11), V. diabolicus (n=14) and V. harveyi (n=3) were detected using gyrB sequencing. The phenotypic pathogenicity revealed that the DNase, amylase and phospholipase activities were 100%, while lipase, slime production, gelatinase and caseinase were detected in 72, 88, 88 and 81% of the isolates respectively. The PCR amplification for the detection of V. parahaemolyticus species-specific tdh, tlh, trh and toxR genes were positive in 4 (13%), 16 (50%), 0 (0%) and 4 (13%) isolates respectively. The V. alginolytuicus species-specific tdh, tlh, trh, toxR and vac genes were carried by 15 (47%), 29 (91%), 0 (0%), 15 (47%) and 25 (78%) of the isolates respectively. In addition, multidrug resistance was observed by 27 (84%) isolates, whereas higher resistant rates were observed against ampicillin, piperacillin, streptomycin and cephalothin. The occurrence of blaCTX (78%), blaTEM (40%), blaSHV (22%) and aac(6')-Ib (94%) were prevalent, while strAB, tetB, aphAI-IAB, intl1 and aadA1 gene cassettes were also detected. The results signify the potential health risks resulting from the consumption of raw cockles in Korea. SIGNIFICANCE AND IMPACT OF THE STUDY: Vibrios are well known to cause human infections following consumption of raw or undercooked seafood. This phenomenon has undoubtedly increased the number of health issues over the past few years in Korea. Among the identified Vibrio spp., we could detect V. diabolicus and V. harveyi for the first time in marketed cockles in Korea. The presence of species-specific genes (tdh-VA, tlh-VP, tlh-VA and toxR-VA) in V. diabolicus exhibits the close genetic affinity among V. parahaemolyticus and V. alginolyticus. Furthermore, the prevalence of extended-spectrum β-lactamases (ESBLs) and other antibiotic resistance genes along with multidrug resistance signifies the potential threat for consumers.

500. Prevalence of Extended-Spectrum β-lactamase and Carbapenem-Resistant Gram-Negative Bacteria in Patients with Urinary Tract Infection and Urosepsis Admitted through Emergency Departments in the United States

BackgroundGram-negative infections due to extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE) and non-fermenting (CR-NF) strains, are increasingly encountered. Study objectives were to determine prevalence and associated risk factors and outcomes for these strains among emergency department patients hospitalized for urinary tract infection (UTI) at 11 US hospitals.MethodsThis was a prospective observational study of patients ≥18 years hospitalized for UTI. Clinical data were collected at the index visit. Urine was obtained for culture and susceptibility testing. Electronic medical record and telephone follow-up were conducted after 30 days for site laboratory results, treatment, and clinical outcomes. Positive culture was defined as 1 uropathogen with growth at ≥104 cfu/mL, or 2 with 1 or both at ≥105 cfu/mL, or ≥3 with 1 or 2 at ≥105 cfu/mL. Isolates with ceftriaxone (CRO) or meropenem MIC >1 μg/mL will undergo reference laboratory (IHMA, Inc., Schaumburg, IL) susceptibility testing, including against newer antibiotics and cefiderocol.ResultsWe enrolled 774 participants between 2018 and 2019; 289 (37.3%) excluded due to urine culture not done, no growth, or contamination. Of 485 culture-positive participants (median age 56 years, 62.0% female), 432 (89.1%) grew 1 uropathogen, 48 (9.9%) 2, and 5 (1.0%) ≥3. Prevalences of CRO-resistant Enterobacteriaceae, CRE, and CR-NF were 19.9%, 2.1%, and 10.7%, respectively. At sites, 95.7% of CRO-resistant Enterobacteriaceae isolates were ESBL. Among participants with any or no antibiotic resistance risk factors, i.e., antibiotics, hospitalization, long-term care, or travel within 90 days, prevalence of CRO-resistant Enterobacteriaceae was 68/228 (29.8%) and 10/155 (6.5%), respectively. Among those with CRO-resistant vs. susceptible Enterobacteriaceae infections, ICU admission and death occurred in 9.9% vs. 6.6% and 3.7% vs. 1.0%, with median time home over 30 days, 24 vs. 27 days, respectively.ConclusionAmong US hospitalized patients with UTI, infections due to CRE remain uncommon; however, ESBL and CR-NF now account for a substantial proportion of cases and are associated with resistance risk factors and worse outcomes.Disclosures All authors: No reported disclosures.

First Report of Extended-Spectrum β-Lactamases TEM-116 and OXA-10 in Clinical Isolates of Alcaligenes Species from Kuala Lumpur, Malaysia.

There is an alarming increase in the prevalence of extended-spectrum β-lactamases (ESBLs) present mainly in Enterobacteriaceae and other nonfermenting gram-negative bacteria, such as Alcaligenes faecalis, which is the only species in that genus that is clinically relevant. We investigated Alcaligenes species from 7 cases (6 inpatients and one outpatient) at our tertiary-care hospital. Four patients had urinary tract infections, and one each had systemic lupus erythematosus, pulmonary stenosis, and diabetic ulcer. All 7 isolates were identified as Alcaligenes spp. based on their 16S rRNA gene sequences, and antibiotic susceptibility was determined using a Vitek 2 system with AST-GN87 cards. All the strains were resistant to cefazolin; 6 were resistant to trimethoprim/sulfamethoxazole; 5 manifested resistance to ampicillin/sulbactam, cefepime, tobramycin, ciprofloxacin, and nitrofurantoin; whereas 5 had multidrug resistance profiles. All the strains (7/7) expressed ESBL activity; PCR screening and sequencing showed evidence of genes blaTEM-116 (7/7) and blaOXA-10 (4/7), and we believe that this is the first report on the presence of TEM-116 and OXA-10 in an Alcaligenes spp. A combination of the 2 genes was present in 4 strains. All 7 strains were found to harbor at least one ESBL gene probably contributing to the drug resistance.

Current Status and Trends of Antibacterial Resistance in China.

The bacterial resistance surveillance system is relatively well established at the national, provincial, and hospital levels in China. Two representative national surveillance networks for bacterial resistance are the China Antimicrobial Resistance Surveillance System (CARSS) and the China Antimicrobial Surveillance Network (CHINET), both established in 2005. CARSS data show the different bacterial resistance rates among different provinces and autonomous regions for each specific bacterium. CHINET data mainly represent the bacterial resistance profiles of teaching hospitals and show the changing trends of bacterial resistance in China. For clinical isolates, the ratio of gram-negative bacilli to gram-positive cocci is approximately 7 to 3. In general, gram-negative bacilli have higher antimicrobial resistance profiles in China. Regarding different bacterial species, antimicrobial resistance is multifaceted. The prevalence of extended-spectrum β-lactamases is high; Acinetobacter baumannii has a high antimicrobial resistance profile; and, notably, the prevalence of CRKP has been showing a marked increase since 2005. In addition, the prevalence of vancomycin-resistant Enterococcus is low, and the prevalence of methicillin-resistant Staphylococcus aureus and antimicrobial resistance in Pseudomonas aeruginosa showed decreasing trends from 2005 to 2017.