Ciprofloxacin Resistance Rates Research Articles

Increased colistin resistance of Acinetobacter species in intensive care unit-acquired infections in a tertiary care hospital

Background: The aim of our study was to evaluate the antimicrobial resistance rates among pathogen microorganisms especially colistin resistant rates of Acinetobacter baumannii in intensive care unit (ICU)-acquired infections and to determine infection-specific correct treatment strategies.
 Methods: The data of adult and newborn infant patients diagnosed with ICU-acquired infection in a tertiary education and research hospital in Bursa in 2014 and 2016 were analyzed, retrospectively.
 Results: Acinetobacter baumannii was the most frequent pathogen of ICU-acquired infections in 2014 and 2016. There was a significant increase in colistin (CO) resistance rates in A. baumanii (0.0%-6.8%). A significant increase in CO, cefepime (FEP), ciprofloxacin (CIP) resistance rates was established in all gram negative bacteria (0.0%-7.9%, 50.0%-91.9%, 54.7%-74.6%), respectively. A significant increase in the rate of detection of A. baumanii as the pathogen microorganism in respiratory tract infection (RTI) was established (53.9% -79.5%). In addition, the average ventilator-associated pneumonia (VIP) infection rate also increased in 2016 compared to 2014 (VIP rate 2014: 7.12, 2016: 7.45, per 1000 ventilator days). A significant decrease in the rate of detection of all gram negative microorganisms in the surgical site infection (SSI), and a significant increase in the rate of detection of all gram positive microorganisms in the SSI was determined.
 Conclusion: Increased antimicrobial resistance, especially increased colistin resistance rates in ICU-acquired infections, necessitates the creation of new strategies in empirical therapy. Detection of antimicrobial resistance profiles of local and infectious pathogen microorganisms in ICUs is a good guide for correct antimicrobial management.

Phylogeny and antimicrobial resistance in Neisseria gonorrhoeae isolates from Rio de Janeiro, Brazil

Resistance in Neisseria gonorrhoeae is a global public health challenge. However, little is known about N. gonorrhoeae isolates from Brazil. In this study, we characterized 116N. gonorrhoeae isolates obtained in Rio de Janeiro between 2006 and 2015 according to antimicrobial susceptibility profiles, resistance mechanisms, and clonal diversity. We determined antimicrobial minimal inhibitory concentrations by agar dilution, and whole genome sequencing was conducted to investigate alleles related to resistance, determine multilocus sequence typing profiles, and group isolates based on core genome single nucleotide polymorphisms. Resistance to penicillin, tetracycline, ciprofloxacin, and azithromycin was observed since 2006. Resistance to penicillin was mediated by β-lactamase plasmids and chromosomal mutations in ponA and porB genes, and tetracycline resistance was mediated by TetM plasmids, and porB and rspJ mutations. Ciprofloxacin resistant isolates presented cumulative point mutations in the quinolone resistance-determining region (QRDR) of gyrA and parC. Alterations in rrl genes encoding 23S rRNA, mtrR, and the mtrR promoter region were responsible for resistance to azithromycin. Phylogenetic analysis identified seven main clades, which included isolates with similar resistance profiles that mainly belonged to a limited number of sequence types that occurred during different years. Our results demonstrated high penicillin, tetracycline, and ciprofloxacin resistance rates associated with the persistence of successful resistant gonococcal lineages, and the polyclonal emergence of azithromycin resistance. Moreover, we reinforce the importance of surveillance to monitor the evolution of this scenario and to allow the early detection of possible changes to azithromycin and ceftriaxone as effective treatment options in the city.

Molecular Antimicrobial Resistance Surveillance for Neisseria gonorrhoeae, Northern Territory, Australia.

Neisseria gonorrhoeae antimicrobial resistance (AMR) is a globally recognized health threat; new strategies are needed to enhance AMR surveillance. The Northern Territory of Australia is unique in that 2 different first-line therapies, based primarily on geographic location, are used for gonorrhea treatment. We tested 1,629 N. gonorrhoeae nucleic acid amplification test–positive clinical samples, collected from regions where ceftriaxone plus azithromycin or amoxicillin plus azithromycin are recommended first-line treatments, by using 8 N. gonorrhoeae AMR PCR assays. We compared results with those from routine culture-based surveillance data. PCR data confirmed an absence of ceftriaxone resistance and a low level of azithromycin resistance (0.2%), and that penicillin resistance was <5% in amoxicillin plus azithromycin regions. Rates of ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae were lower when molecular methods were used. Molecular methods to detect N. gonorrhoeae AMR can increase the evidence base for treatment guidelines, particularly in settings where culture-based surveillance is limited.

Study on the resistance genes of carbapenem-resistant Enterobacteriaceae collected from 5 hospitals in Northeast China

Objective To investigate the antibiotic resistance and resistance genes of carbapenem-resistant Enterobacteriaceaes (CRE) isolated from 5 hospitals in Northeast China. Methods This study collected 85 CRE isolates during January 2013 to June 2015 from five hospitals in Northeast China. Drug sensitivities of 14 antimicrobial agents were determined by the broth microdilution method. The phenotypes of carbapenemases were screened by modified Hodge test and EDTA test respectively. The genotypes of carbapenemases and other extended spectrum β-lactamases (ESBL) were detected by PCR gene amplification and DNA sequencing method. Using the PCR result as gold standard, the performances of other two carbapenemase detection methods were evaluated. Results Among the 85 CRE strains collected in this study, Klebsiella pneumoniae was the most frequently isolated species (61/85, 71.8%). The results of antimicrobial agent sensitivity showed that the 85 CRE strains had resistance rate of cephalosporin and β-lactams/enzyme inhibitor (piperacillin-tazobactam) over 80.0%. The resistance rate of carbapenem was high, with ertapenem 100.0% (85/85), meropenem 65.9% (56/85), imipenem 71.8% (61/85). There were 36 isolates resistant to both meropenem and imipenem. For fluoroquinolones, the resistance rates of levofloxacin and ciprofloxacin were 72.9% (62/85) and 65.9% (56/85), respectively. The resistance rate to fosfomycin and amikacin were 65.0% (55/85) and 54.1% (46/85), respectively. The resistance rate of colistin (21.2%, 18/85) and tigecycline (20.5%, 17/85) were low. Forty-nine strains were modified Hodge test positive and 12 strains were EDTA test positive. By PCR gene amplification and DNA sequencing method, 64 strains carried carbapenemase-encoding genes, of which KPC-2 was the main type (53/85, 62.4%), followed by IMP-4 (10/85, 11.8%), NDM-5 (7/85, 8.2%) and NDM-6 (1/85, 1.2%). At the same time, 85 CRE isolates had the ESBL gene detection and 47 isolates were CTX-M type ESBLs (47/85, 55.3%), with no TEM or SHV type. Conclusions Klebsiella pneumoniae is the majority of CRE strains from 5 large hospitals in Northeastern China. The CRE strains are resistant to most of antimicrobials. Most carbapenemases-producing isolates have the KPC-2 type. Nearly half of the carbapenemase-producing strains also carry ESBL genes, which makes the resistance mechanisms more complicated. Key words: Enterobacteriaceae; Carbapenemase; Extended-spectrum β-lactamases

Siderophores in clinical isolates of Klebsiella pneumoniae promote ciprofloxacin resistance by inhibiting the oxidative stress

To explore the relevance of and understand the potential mechanisms behind the production of siderophores by clinical isolates of K. pneumoniae and ciprofloxacin (CIP) resistance, we divided the K. pneumoniae isolates into two groups based on bacterial siderophores production: high siderophore-yielding group (39 strains) and low siderophore-yielding group (38 strains). The rate of CIP resistance in K. pneumoniae (27/39 = 69.23%) from the high siderophore-yielding group was significantly higher than that (16/38 = 42.11%) in the low siderophore-yielding group (p < 0.05). Furthermore, we noted that bacterial siderophores production was positively correlating with CIP resistance as indicated by the minimum inhibitory concentration (MIC; p < 0.05). However, siderophore-related antibiotic resistance had no relationship with DNA gyrase GyrA mutation (p > 0.05). Siderophore-related antibiotic resistance was accompanied by efflux pump functions, but was not directly relevant to it. Furthermore, we found that the oxidative stress response was significantly lower in high siderophore-yielding strains compared to those isolates which had a low siderophores yield (12.17 vs. 30.91 of average fluorescence value; p < 0.01). There was a consistent inverse correlation between the production of bacterial siderophores and oxidative stress response (p < 0.05). Although CIP induced oxidative stress in both high and low siderophore-yielding strains (p < 0.01), oxidative stress in high siderophore-yielding strains was significantly lower than in low siderophore-yielding strains (p < 0.01). Our data suggest that siderophores of K. pneumoniae clinical isolates promote CIP resistance through inhibition of the bacterial oxidative stress response, indicating that reduction of bacterial oxidative stress could provide a new avenue for control of bacterial drug resistance.

MP77-06 ANTIMICROBIAL LUBRICANT REDUCES RECTAL BACTERIA AT TRANSRECTAL PROSTATE BIOPSY. RESULTS FROM A LARGE PROSPECTIVE RANDOMIZED TRIAL

You have accessJournal of UrologyProstate Cancer: Detection & Screening VII1 Apr 2017MP77-06 ANTIMICROBIAL LUBRICANT REDUCES RECTAL BACTERIA AT TRANSRECTAL PROSTATE BIOPSY. RESULTS FROM A LARGE PROSPECTIVE RANDOMIZED TRIAL Katharina Boehm, Sandra Prues, Judith Saul, Lars Budäus, Derya Tilki, Axel Haferkamp, Markus Graefen, and Georg Salomon Katharina BoehmKatharina Boehm More articles by this author , Sandra PruesSandra Prues More articles by this author , Judith SaulJudith Saul More articles by this author , Lars BudäusLars Budäus More articles by this author , Derya TilkiDerya Tilki More articles by this author , Axel HaferkampAxel Haferkamp More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Georg SalomonGeorg Salomon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Antibiotic resistancy may lead to increasing infection rates at transrectal prostate biopsy (PBx). Previous studies showed promising results by using targeted antibiotic therapy by rectal swab culture. Nonetheless, performing rectal swabs may be time- and cost ineffective. In consequence, there is a strong need for agents that can achieve a reduction of bacteria. Aim of our study was to test, if an antimicrobial lubricant can reduce bacteria. METHODS Study population consisted of 384 pbx patients who received a rectal swab before and after biopsy in an European single center between March 2013 and June 2015. Patients were randomized for biopsy with pre-interventional instillation of an antimicrobial lubricant (intervention group) or with standard lubricant (control group). Bacteria were semi-quantitatively recorded (≤ 20 colonies: [+]; > 20 colonies, growth only within first streak: +; growth in second streak: ++; growth in third streak: +++). Colonies growing within the ciprofloxacin inhibition zone were identified. RESULTS Overall, 384 patients were included in the study. Out of them, 256 (66.7%) were in the intervention group and received antimicrobial lubricant, 128 (33.3%) were in the control group. Median age at biopsy was 65 years and mean PSA-levels was 7.5 ng/ml. In patients of the intervention group, semi-quantitative bacterial count was statistically significantly lower after instillation of antimicrobial lubricant(p<0.001). In the control group, no statistically significant difference was recorded at the bacteria count of the second rectal swab vs. bacteria count of the first rectal swab(p=0.4). Ciprofloxacin-resistance was shown in overall 30 (7.8%) patients. Instillation of antimicrobial lubricant reduced ciprofloxacin-resistant bacteria from 24 (9.4%) to 15 (5.9%), but reduction did not achieve statistical significance (p=0.5). For the control group, number of ciprofloxacin-resistance bacteria were comparable at first vs. second rectal swab (6 (4.7%) vs. 4 (3.1%); p=0.7). CONCLUSIONS Semi-quantitatively colonie count was significantly lower in patients of the intervention group (p<0.001). Preinterventional overall ciprofloxacin resistance rate was 7.8%. This is relatively low compared to other studies. In our study, the antimicrobial lubricant reduced ciprofloxacin resistant bacteria, but due to the low incidence the reduction was not significant. Our results show that antimicrobial lubricants might be helpful in patients with high risk for ciprofloxacin resistancy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1023-e1024 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Katharina Boehm More articles by this author Sandra Prues More articles by this author Judith Saul More articles by this author Lars Budäus More articles by this author Derya Tilki More articles by this author Axel Haferkamp More articles by this author Markus Graefen More articles by this author Georg Salomon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Epidemiology and antibiotic sensitivity of Staphylococcus aureus nasal carriage in children in Hungary.

The aim of this study was to assess the Staphylococcus aureus nasal carriage rate in healthy children all over Hungary and to specify some risk factors, the antibiotic resistance patterns of the bacteria, and their genetic relatedness. In total, 878 children (aged 3-6 years) were screened at 21 day-care centers in 16 different cities in Hungary, between February 2009 and December 2011. Samples taken from both nostrils were cultured on blood agar, and suspected S. aureus isolates were identified by β-hemolysis, catalase positivity, clump test, and nucA PCR. Methicillin-resistant strains were screened by mecA and mecC PCR. Antibiotic susceptibility was determined by agar dilution or gradient test strips. Pulsed-field gel electrophoresis was used for genotyping. S. aureus carriage rate was found to be 21.3%, which correlates well with international data. We found no statistically significant correlation between the gender or the sibling status and S. aureus carriage. All isolates were sensitive to oxacillin, trimethoprim-sulfamethoxazole, and mupirocin. The resistance rates for erythromycin, ciprofloxacin, clindamycin, gentamicin, and tetracycline were 7.5%, 0.5%, 1.1%, 3.7%, and 4.3%, respectively. The isolates showed very high genetic diversity. In summary, carried S. aureus isolates are more sensitive to antibiotics compared with clinical isolates in Hungary, and methicillin-resistant S. aureus carriage rate is very low yet.

Comparison of an Emergency Department-Specific Antibiogram to Hospital Antibiogram: Influence of Patient Risk Factors on Susceptibility

BackgroundTraditional antibiograms use local resistance patterns and susceptibility data to guide empiric antimicrobial therapy selection. However, antibiograms are rarely unit-specific and do not account for patient-specific risk factors. The objective was to develop an Emergency Department (ED)-specific antibiogram and evaluate the impact of risk factors on antimicrobial susceptibility.MethodsThis retrospective, single-center descriptive study used culture and susceptibility data from January 1 to December 31, 2016 to create an ED-specific antibiogram for the most commonly isolated organisms. Susceptibilities were then compared with the hospital antibiogram. All ED isolates were further stratified by the following risk factors: age, disposition from ED, previous antimicrobial use and/or hospitalization within 30 days, and presenting location. Descriptive statistics, Pearson Chi-Square/Fisher’s Exact Tests, and logistic regression were performed. A two-tailed p-value of <0.05 was considered statistically significant.ResultsA total of 2158 isolates from the ED were included: Escherichia coli (EC) (n = 1244), Klebsiella pneumoniae (KP) (n = 232), Proteus mirabilis (PM) (n = 131), Pseudomonas aeruginosa (PA) (n = 103), Staphylococcus aureus (SA) (n = 303), and Enterococcus faecalis (EF) (n = 145). The majority of patients were <65 years old (n = 1088) and presented from the community (n = 1800) with no antimicrobial exposure (n = 1628) nor hospitalization (n = 1895) within 30 days. There were no statistically significant differences between the ED and hospital antibiogram (n = 5739) for KP, PM, PA, SA, and EF. The hospital antibiogram overestimated EC resistance rates for cefazolin (20% vs. 15.6%, P = 0.049), ceftriaxone (9.6% vs. 6.4%, P < 0.033), and ciprofloxacin (23.7% vs. 15.4%, P < 0.006). There were significantly more risk factors present in patients discharged from the ED vs. those admitted (P < 0.0001). Healthcare facility residence had the greatest impact on susceptibility, especially EC (81.8% vs. 34.9%, P < 0.0001) and PM (75.3% vs. 33%, P < 0.0001) ciprofloxacin susceptibility.ConclusionDevelopment of an ED-specific antibiogram can aid physicians in prescribing appropriate empiric therapy when risk factors are included.Disclosures All authors: No reported disclosures.

Exploring quinolone resistance-determining region in Neisseria gonorrhoeae isolates from across India.

Background & objectives:Antimicrobial resistance in Neisseria gonorrhoeae, the causative agent of gonorrhoea, is a subject of worldwide attention. The present study was undertaken to examine the rates of ciprofloxacin resistance, to correlate mutations in gyrA and parC genes with the level of resistance and to look for a variation in mutation pattern, if any, in isolates from across the country.Methods:A total of 113 isolates of N. gonorrhoeae collected from sexually transmitted infection patients in six centres during November 2010 to October 2013 were investigated. Minimum inhibitory concentration (MIC) determination was done by E-test and results interpreted as per Calibrated Dichotomous Sensitivity criteria. DNA sequence analysis of gyrA and parC genes was done.Results:Of the 113 isolates, only three (2.6%) were susceptible whereas eight (7.07%) were less susceptible, 32 [28.3%, 95% confidence interval (CI): 20.4-37.6%] resistant (MIC 1-3 µg/ml) and 70 (61.9%, 95% CI: 52.2-70.7%) exhibited high-level resistance (HLR) (MIC ≥4 µg/ml) to ciprofloxacin. A S91F substitution in gyrA gene was demonstrated in all ciprofloxacin non-susceptible isolates. All resistant and HLR isolates had a double mutation in gyrA gene. However, only 5.7 per cent of HLR isolates showed double mutations in parC gene. One isolate (MIC 32 µg/ml) had a previously undescribed G85D substitution in the parC gene.Interpretation & conclusions:A S91F substitution in gyrA gene was seen in all non-susceptible isolates of N. gonorrhoeae. It may be used as a marker for ciprofloxacin resistance for molecular surveillance approaches to complement the culture-based methods.

Antibacterial potential and genetic profile of Enterococcus faecium strains isolated from human normal flora

Enterococci have a widespread attendance in the circumference and belongs to the enteric commensal microbiota. Most of them produce the antimicrobial compounds and have an inhibition effect on pathogenic microorganisms. The objective of this study was to characterize the enterococcal strains isolated from human normal flora and assess their antibacterial activity. Enterococcal isolates were obtained from the feces of eighteen healthy humans. All enterococcal species were identified by biochemical and species-specific polymerase chain reaction (PCR). These isolates were investigated further to examine their ability to inhibit growth of Salmonella typhi, Shigella flexneri and Escherichia coli by well diffusion assay. Furthermore, antibiotic susceptibility test was performed and genetic relatedness of all isolates was evaluated by Pulse Field Gel Electrophoresis (PFGE). In all, 432 isolates were obtained from fecal samples. All of the isolates identified as Enterococcus faecium by biochemical and molecular (PCR) methods. Using repetitive element palindromic (REP)-PCR method 54 patterns have been obtained and were selected for further evaluation. The results indicated that 66%, 38% and 24% of our isolates had antimicrobial effect against S. typhi, S flexneri and enteroaggregative Escherichia coli (EAEC), respectively. On the other hand, there was no significant inhibition effect against enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC). All isolates were sensitive to vancomycin, teicoplanin, linezolid, ampicillin, chloramphenicol and gentamicin. On the other hand, the resistance rates for erythromycin, tetracycline and ciprofloxacin were 20%, 22%, and 1.8% respectively. In addition, the analysis of PFGE showed forty patterns with eight (40.7%) common types (CT) and thirty two (59.2%) single types (ST). Among eight common types, only one common type (CT5) had similar antimicrobial effect.These results suggested that enterococcal isolates obtained from human normal flora have potential antibacterial effect against S. typhi, S. flexneri and E. coli.

Bayesian Approach to Urinary ESBL-Producing Escherichia coli

This is a retrospective study about the prevalence of ESBL-producing Escherichia coli (EEC) in urinary specimens from patients from the Comunitat Valenciana from January 2007 to December 2008. Data were retrieved from RedMIVA, and Bayesian generalized linear mixed models were considered to study the prevalence of EEC with regard to demographical and microbiological factors. The total number of infections considered was 164,502, the amount of urinary isolates was 70,827 belonging to 49,304 different patients, and 5,161 (7.3%) of the urinary isolates were EEC. Three out of four E. coli were isolated in women (76.8%), men showed higher rates of EEC (9.7% in men vs. 6.5% in women). EEC patients were, in average, 10.8 years older, and hospitalization was more frequent (9.9% vs. 6.9%). Resistance to non-β-lactams antimicrobials was higher in EEC. The rates of ciprofloxacin and co-trimoxazol resistance in EEC were 75.5% and 52.0%, respectively, whereas it ranged between 1.4-12.4% for the rest of antimicrobials. Prior EEC infection and hospitalization were the most relevant risk factors and increased the expected EEC probability approximately 400% and 50% respectively. Other infections played an important and positive role too, Enterobacteriaceae, P. aeruginosa and other bacteria being the most relevant elements. Female gender was a protective factor and reduced the risk by approximately 25% while age was an additive risk factor. Finally, an open-access web-based software was constructed to compute the probability that an E. coli in a urinary infection be an EEC from a specific combination of risk factors. This pharmacovigilance tool should prove useful to monitor and control antimicrobial resistance spread.

CIPROFLOXACIN RESISTANCE PATTERN AMONG BACTERIA ISOLATED FROM PATIENTS WITH COMMUNITY-ACQUIRED URINARY TRACT INFECTION

SUMMARYObjective: To identify the main bacterial species associated with community-acquired urinary tract infection (UTI) and to assess the pattern of ciprofloxacin susceptibility among bacteria isolated from urine cultures. Methods: We conducted a retrospective study in all the patients with community-acquired UTI seen in Santa Helena Laboratory, Camaçari, Bahia, Brazil during five years (2010-2014). All individuals who had a positive urine culture result were included in this study. Results: A total of 1,641 individuals met the inclusion criteria. Despite the fact that participants were female, we observed a higher rate of resistance to ciprofloxacin in males. The most frequent pathogens identified in urine samples were Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus. Antimicrobial resistance has been observed mainly for ampicillin, sulfamethoxazole + trimethoprim and ciprofloxacin. Moreover, E. coli has shown the highest rate of ciprofloxacin resistance, reaching 36% of ciprofloxacin resistant strains in 2014. Conclusion: The rate of bacterial resistance to ciprofloxacin observed in the studied population is much higher than expected, prompting the need for rational use of this antibiotic, especially in infections caused by E. coli. Prevention of bacterial resistance can be performed through control measures to limit the spread of resistant microorganisms and a rational use of antimicrobial policy.

E. coli Resistance to Ciprofloxacin and Common Associated Factors.

To determine the frequency of E. coli resistance to ciprofloxacin and common factors leading to it among patients presenting with urinary tract infection. Descriptive cross-sectional study. Department of Medicine, Ayub Teaching Hospital, Abbottabad, from December 2011 to June 2012. A total of 166 patients, > 18 years of age of both gender, who presented with features of UTI and had urine culture positive for E.coli were included in the study. The urine samples were further tested for ciprofloxacin resistance and the patients were further checked for the common factors leading to E.coli resistance to ciprofloxacin. Among 166 patients, 41 were male and 125 were female patients. Sixty-six (39.8%) E. coli isolates showed ciprofloxacin resistance. Male gender (p-value 0.001), previous history of recurrent UTI (p = 0.008, OR = 2.37), history of prior use of ciprofloxacin (p = 0.018, OR = 2.16) and history of catheterization (p = 0.005, OR = 4.80) were independent risk factors found in this study for the development of ciprofloxacin resistant UTIs. Ciprofloxacin resistance rates of E.coli were high at over 39.8%. The risk factors that affected the ciprofloxacin resistance rates of E.coli were prior use of ciprofloxacin, recurrent UTI, previous catheterization and male gender. Ciprofloxacin should be prescribed cautiously in patients with these risk factors and urine culture and sensitivity test should be performed for optimal treatment.

Resistance Patterns of Escherichia coli in Women with Uncomplicated Urinary Tract Infection Do Not Correlate with Emergency Department Antibiogram

BackgroundUrine cultures are not always performed for female Emergency Department (ED) patients with uncomplicated urinary tract infection (UTI). Accordingly, hospital, and even ED-specific, antibiograms might be skewed toward elderly patients with many comorbidities and relatively high rates of antimicrobial resistance, and thus do not accurately reflect otherwise healthy women. Our ED antibiogram indicates Escherichia coli resistance rates for ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX) of 42%, 26%, and 33%, respectively. ObjectivesThis study aims to compare resistance rates of urinary E. coli from otherwise healthy women with uncomplicated UTI and pyelonephritis in the ED to rates in our ED antibiogram. MethodsFemales > 18 years old with acute onset of urinary frequency, urgency, or dysuria with pyuria identified on urinalysis (white blood cell count > 10/high-power field) were prospectively enrolled in the ED of an urban, academic medical center. Exclusion criteria indicating a complicated UTI were consistent with Infectious Diseases Society of America guidelines. Susceptibility patterns of E. coli to ciprofloxacin, levofloxacin, and TMP-SMX in the study group were compared to our ED antibiogram. ResultsForty-five patients grew E. coli. Pyelonephritis was suspected in nine (20%) subjects. Compared with the ED antibiogram, significantly lower rates of resistance to ciprofloxacin (2% vs. 42%, p < 0.001), levofloxacin (2% vs. 26%, p < 0.001), and TMP-SMX (16% vs. 33%, p = 0.016) were observed. Six patients grew non-E. coli uropathogens. All were susceptible to both levofloxacin and TMP-SMX. ConclusionsED antibiograms may overestimate resistance rates for uropathogens causing uncomplicated UTIs. In cases where nitrofurantoin cannot be used, fluoroquinolones and possibly TMP-SMX may remain viable options for treatment of uncomplicated UTI and pyelonephritis in women.

Characterization of Inhibitor-Resistant TEM β-Lactamases and Mechanisms of Fluoroquinolone Resistance in Escherichia coli Isolates.

The aim of present work was to characterize the inhibitor-resistant TEM (IRT) β-lactamases produced by Escherichia coli in Hospital Clínico San Carlos (Madrid, Spain). Mechanisms of fluoroquinolone resistance among IRT-producing strains were also studied. Isolates with susceptibility to cephalosporins and amoxicillin-clavulanate (AMC) resistance were collected in our hospital (November 2011-July 2012) from both outpatients and hospitalized patients. Among 70 AMC-resistant E. coli strains, 28 (40%) produced IRT enzymes. Most of them were uropathogens (82.1%) and recovered from outpatients (75%). Seven different IRT enzymes were identified with TEM-30 (IRT-2) being the most prevalent, followed by TEM-40 (IRT-11). A high rate of ciprofloxacin resistance was found among IRT-producing strains (50%). Most of the ciprofloxacin-resistant isolates showed ciprofloxacin minimum inhibitory concentration >32 mg/L and contained two mutations in both gyrA and parC genes. Four IRT enzyme producers harbored the qnr gene. ST131 clone was mainly responsible for both IRT enzyme production and ciprofloxacin resistance. In conclusion, data from this study show that the frequency of IRT producers was 40% and a high rate of ciprofloxacin resistance was found among IRT-producing isolates. Current and future actions should be taken into account to avoid or reduce the development of AMC and fluoroquinolone resistance in E. coli.

MP48-01 PREVALENCE OF ANTIBIOTIC RESISTANCE IN FECAL FLORA BEFORE TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY AND CLINICAL IMPACT OF TARGETED ANTIBIOTIC PROPHYLAXIS

INTRODUCTION AND OBJECTIVES: In this study, we aimed to evaluate the clinical impact of targeted antibiotic prophylaxis on the sepsis rate after transrectal ultrasound guided prostate biopsy. METHODS: Between September 2012 and January 2014, 300 patients were randomized to two groups, while the first group (Group 1, n1⁄4156) received routine ciprofloxacin prophylaxis, and the second group (Group 2, n1⁄4144) received targeted prophylactic antibiotic regime adequate to rectal swab culture results. Rectal swab cultures were taken two weeks before the procedure. After the procedure, patients were followed one month and told to apply hospital if they see any symptoms such as fever (>38 C), shivering, dysuria or fatigue. RESULTS: Prostate specific antigen (PSA), prostate volume, digital rectal examination findings, pathology results and comorbidity rates were similar between two groups (Table 1.). While in Group 1 four patients (2.6%) applied to our clinic due to signs of sepsis, no patients (0%) applied to our clinic in Group 2 (p1⁄4 0.124). When rectal swab culture results of Group 2 were evaluated, ESBL presence in 18 patients (12.5%), quinolone resistance in 26 patients (18%), both the presence ESBL and quinolone resistance in 15 patients (10.4%) were observed. TMP-SMX to 6 patients, Cefuroxime to 10 patients, gentamicin to 4 patients, meropenem to 4 patients, amikacin to 1 patient and amoxicillin to 1 patient were received for prophylactic regimen who had fluoroquinolone resistant bacteria or ESBL. There were no statistically significance between antibiotic resistance and urologic operations, urinary tract infections, prior catheterization history, presence of catheter during prostate biopsy and antibiotic usage history due to high level of PSA. CONCLUSIONS: In our study, it has also been detected that rates of ESBL presence and ciprofloxacin resistance in rectal flora were not negligible. On the other hand, with obtaining rectal swab culture prior transrectal prostate biopsies and the use of targeted prophylaxis before prostate biopsy it has been observed that sepsis rates were reduced but these results were statistically insignificant.

Serotypes, seasonal trends, and antibiotic resistance of non-typhoidal Salmonella from human patients in Guangdong Province, China, 2009-2012.

BackgroundNon-typhoidal Salmonella is a common cause of infectious diarrhea in humans. Antimicrobial-resistant Salmonella has become a global concern.MethodsUsing laboratory-based surveillance system for Salmonella from September 2009 to December 2012 in Guangdong Province of China. The clinical information and samples of diarrhea patients were collected, according to the surveillance case definition. The lab tests were followed by standardized protocols, including sample isolation, isolates confirmation, serotyping, and antimicrobial susceptibility testing (AST).ResultsA total of 1,826 Salmonella isolates were identified from40,572 patients in 28 hospitals in11 prefectures. The isolates ratio was highest in autumn (38.8%, 708/1826) and lowest in winter (6.4%, 117/1826). Children aged <5 years were the group most affected by Salmonella in Guangdong Province accounting for 73% (1,329/1,826), of whom the infants (<1 year) were 81.5% (1084/1329) especially. A total of 108 serotypes were identified among the isolates. S. Typhimurium represented the most common serotype followed by serotype 4,5,12:i:-.S. Typhimurium was also the common serotype followed by S. Enteritidis among infants and children aged 1-3 years old. However, S. Enteritidis became the common serotype followed by S. Typhimurium among children aged 3–5 and >5 years.Resistance to at least one antimicrobial was found in 72% (1321/1,826) of the isolates. Resistance to at least three antimicrobials was found in 46% (850/1,826) of the isolates. Resistance to all 12 antimicrobials screened was observed in 8 isolates (0.44%, 8/1,826). The resistant prevalence to quinolones including nalidixic acid and ciprofloxacin was 61.9% (1131/1826), of which ciprofloxacin resistance rate was 8.05% (147/1826). The prevalence resistance to all three cephalosporin antimicrobials (cefepime, cefotaxime, and caftazidime) in <5 yr age group was accounted for 90% (89/99).ConclusionsAdditional data and more refined methods can improve future surveillance. The invasive Salmonella isolates should also be included to the antibiotic resistance surveillance for clinical care or public health.

Molecular epidemiology and genetic diversity of fluoroquinolone-resistant Escherichia coli isolates from patients with community-onset infections in 30 Chinese county hospitals.

The high frequency of fluoroquinolone resistance in Escherichia coli is a feature of clinical bacteriology in China, where the molecular epidemiology and genetic characteristics of this resistance in county hospitals remain unclear. A total of 590 nonduplicate E. coli isolates from 30 county hospitals located across seven Chinese regions were examined for plasmid-mediated quinolone resistance (PMQR) genes and mutations in quinolone resistance-determining regions (QRDRs). Multilocus sequence typing (MLST) and phylogenetic analysis of fluoroquinolone-resistant isolates were used to determine their genetic relatedness. The ciprofloxacin resistance rate of community-onset E. coli was 51.2%, and at least one PMQR gene was carried by 220 (37.3%) isolates. These included qnr (3.7%), aac(6')-Ib-cr (19.7%), qepA (14.4%), and oqxAB (3.8%). Two novel oqxB mutants were identified and named oqxB20 and oqxB29. From 60 sequence types (STs) isolated, 5 novel STs (ST4499 to ST4503) were identified. ST1193 (7.9%) was the second most abundant ST among fluoroquinolone-resistant isolates (ST131 was the most common, with 14.6%), and this is the first report of it in China. This is also the first report of ST2115 and ST3014 isolates from human samples. Ciprofloxacin-resistant E. coli isolates fell mainly into phylogroups B2 and D. The rates of fluoroquinolone resistance and the prevalence of PMQR genes in community-onset E. coli isolates from Chinese county hospitals were high. The wide-ranging molecular epidemiology of E. coli isolates from scattered locations across China indicates that fluoroquinolone resistance evolved from different sources.

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolated from a university teaching hospital in Japan.

Clostridium difficile infection control strategies require an understanding of its epidemiology. In this study, we analysed the toxin genotypes of 130 non-duplicate clinical isolates of C. difficile from a university hospital in Tokyo, Japan. Multilocus sequence typing (MLST) and eBURST analysis were performed for these isolates and nine strains previously analysed by polymerase chain reaction (PCR) ribotyping. Minimum inhibitory concentrations (MICs) were determined for six antibiotics, and the bacterial resistance mechanisms were investigated. Ninety-five toxigenic strains (73%), including seven tcdA-negative, tcdB-positive and cdtA/cdtB-negative strains (A(-)B(+)CDT(-)) and three A(+)B(+)CDT(+) strains, and 35 (27%) non-toxigenic strains, were classified into 23 and 12 sequence types, respectively. Of these, sequence type (ST)17 (21.8%) was the most predominant. MLST and eBURST analysis showed that 139 strains belonged to seven groups and singletons, and most A(+)B(+)CDT(-) strains (98%, 89/91) were classified into group 1. All isolates were susceptible to metronidazole, vancomycin and meropenem; the ceftriaxone, clindamycin and ciprofloxacin resistance rates were 49, 59 and 99%, respectively. Resistance rates to ceftriaxone and clindamycin were higher in toxigenic strains than in non-toxigenic strains (P < 0.001). All ST17 and ST81 strains were resistant to these antibiotics. The clindamycin- and fluoroquinolone-resistant strains carried erm(B) and mutations in GyrA and/or GyrB, respectively. To our knowledge, this is the first MLST-based study of the molecular epidemiology of toxigenic and non-toxigenic strains in Japan, providing evidence that non-toxigenic and toxigenic strains exhibit high genetic diversity and that toxigenic strains are more likely than non-toxigenic strains to exhibit multidrug resistance.

Management of complicated urinary tract infections in a referral center in Mexico.

Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard. To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance. The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed. One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %. There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role. Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.