Risk Factors For Multidrug Resistance Research Articles

Clinical features and risk factors for pyogenic liver abscess caused by multidrug-resistant organisms: A retrospective study

ABSTRACT The incidence rate of pyogenic liver abscess caused by multidrug-resistant bacteria has increased in recent years. This study aimed to identify the clinical characteristics and risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. We conducted a retrospective analysis of the clinical features, laboratory test results, and causes of pyogenic liver abscesses in 239 patients admitted to a tertiary hospital. Multivariable logistic regression was used to identify risk factors for multidrug resistance. Among patients with pyogenic liver abscesses, the rate of infection caused by multidrug-resistant organisms was observed to be 23.0% (55/239), with a polymicrobial infection rate of 14.6% (35/239). Additionally, 71 cases (29.7%) were associated with biliary tract disease. Patients with pyogenic liver abscesses caused by multidrug-resistant organisms had a significantly higher likelihood of polymicrobial infection and increased mortality (7/44 [15.9%] vs. 3/131 [2.3%]; p = .003). The Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.06–1.68), hospitalization (aOR: 10.34, 95% CI: 1.86–60.3) or an invasive procedure (aOR: 9.62; 95% CI: 1.66–71.7) within the past 6 months, and gas in the liver on imaging (aOR: 26.0; 95% CI: 3.29–261.3) were independent risk factors for pyogenic liver abscess caused by multidrug-resistant bacteria. A nomogram was constructed based on the risk factors identified. The nomogram showed high diagnostic accuracy (specificity, 0.878; sensitivity 0.940). Multidrug-resistant organisms causing pyogenic liver abscesses have specific characteristics. Early identification of patients at high risk of infection with multidrug-resistant organisms could help improve their management and enable personalized treatment.

Patterns of Drug Resistance and Bacterial Pathogen Distribution in Patients with Urinary Tract Infections in the Jiaxing Region from 2020 to 2022.

Urinary tract infections (UTIs) and the antibiotic resistance of pathogenic bacteria pose severe threats to public health in the current healthcare environment. The purpose of this study was to assess the frequency distribution of bacterial pathogens causing UTIs as well as the characteristics of antibiotic susceptibility and resistance. The retrospective study was conducted on 32,391 samples of midstream urine culture from January 1, 2020, to December 31, 2022, in Jiaxing. Bacteria were cultivated on blood agar and identified using MALDI-TOF, and their susceptibility to different antibiotics was assessed using the Kirby-Bauer disk diffusion method and drug sensitivity reaction cards. The SPSS 22 software was used for data analysis. Bivariate logistic regression was used to analyze the risk factors for multidrug resistance. The total number of positive growth samples was 5378 (16.6%), including 3206 females (59.6%) and 2172 males (40.4%). The four most common urinary pathogens were Escherichia coli (39.2%), Enterococcus faecalis (12.4%), Klebsiella pneumoniae (7.6%), and Enterococcus faecium (7.6%). As far as antibiotic resistance was concerned, Escherichia coli had a greater than 50% resistance rate to ampicillin (76.1%), ciprofloxacin (58.6%), and levofloxacin (51.2%). The multidrug resistance rate was high (41.8%). Low levels of resistance were seen to ertapenem (0.1%), imipenem (0.7%), meropenem (0.7%), piperacillin/tazobactam (0.7%), and nitrofurantoin (1.8%). Klebsiella pneumoniae was highly sensitive to ertapenem (100%). The resistance rates to nitrofurantoin, ceftriaxone, and ciprofloxacin were 37.4%, 37.1%, and 35.1%, respectively. Up to 41% of Escherichia coli strains and 26% of Klebsiella pneumoniae strains produced extended-spectrum lactamases (ESBL). Two species of enterococci were highly sensitive to tigecycline and linezolid (100%), and a small number of norvancomycin-resistant strains (0.2%/two strains) were found. Escherichia coli and Enterococcus faecium were the most common urinary pathogens in this study. The isolated pathogens showed different sensitivity patterns. Antibiotics should be selected reasonably according to the sensitivity mode of pathogenic bacteria to effectively treat and prevent urinary tract infections.

Multidrug-resistant Gram-negative bacteria rate and risk factors in the neonatal intensive care unit: A single-center ten-year experience

Objective: Multidrug resistance (MDR) in gram-negative neonatal infections is difficult to manage, and the risk factors differ among different studies. We aim to investigate the demographics, mortality, MDR status of gram-negative isolates, and risk factors for MDR gram-negative infections.
 Material-Methods: 
 We conducted a retrospective single-center study about MDR gram-negative infections in neonates between January 2012-January 2022 at Duzce University Hospital in Turkey. This study evaluates neonates with MDR gram-negative infections' risk factors and clinical features. All analyses were performed using IBM SPSS V23. Univariate analyses and multivariate logistic regression models were studied to determine MDR's risk factors.
 Results: Of 107 gram-negative bacteria, 41 (38.3%) accounted for Enterobacter, 30 (28%) for Klebsiella pneumonia, and 22 (20.6%) for Escherichia coli. Additionally, 61 (56.5%) were MDR microorganisms. Among the susceptibility tests performed for selected isolates, 41 (77.4%) had resistance to Piperacillin, 57 (75%) showed resistance to amoxiclav, and 16 (72.7%) had cefoxitin resistance. In addition, carbapenemase resistance was found in 24 (43.6%) and meropenem resistance in 13 (36.1%). Colistin, aztreonam, and tigecycline resistances were the least frequent. The following dependent risk factors increased the multidrug resistance risk in gram-negative infections; late-onset sepsis 3.547 fold (p=0.005), use of mechanical ventilation 3.143 fold (p=0.007), blood culture positivity 3.587-fold (p=0.013), bronchopulmonary dysplasia 6.702 fold, (p= 0.015) and total parenteral nutrition 5.591 fold (p=0.001), lower gestational age 1.122 (1/0.891) fold (p=0.026), and birth weight 1.001 (1/0.999) fold, (p=0.013). Similarly, anti-biotherapy duration was significantly higher in the MDR group than in the non-MDR group. 
 Conclusions: The reported risk factors for MDR in gram-negative neonatal infections are all dependent risk factors. Hence clinicians must be alert to all potential risk factors.

Impact of multidrug resistance on the management of bacterial infections in cirrhosis.

Patients with cirrhosis have an increased risk of infection and differently from other complications, that over the years are improving in their outcomes, infections in cirrhotic patients are still a major cause of hospitalization and death (up to 50% in-hospital mortality). Infections by multidrug-resistant organisms (MDRO) have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related impact. About one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent years. MDR infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection resolution. An adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects, such as the type of infection (spontaneous bacterial peritonitis, pneumonia, urinary tract infection and spontaneous bacteremia), bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition (community acquired, healthcare associated or nosocomial). Furthermore, regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological epidemiology. Antibiotic treatment is the most effective measure to treat infections caused by MDRO. Therefore, optimizing antibiotic prescribing is critical to effectively treat these infections. Identification of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce mortality. On the other hand, the supply of new agents to treat these infections is very limited. Thus, specific protocols that include preventive measures must be implemented in order to limit the negative impact of this severe complication in cirrhotic patients.

Risk factors for multidrug resistance in tuberculosis patients with diabetes mellitus

ObjectiveTo study the risk factors and prediction models of multidrug resistance in patients with tuberculosis and diabetes and those with a history of tuberculosis treatment.MethodsA total of 256 tuberculosis patients with diabetes who were registered in Luoyang city, Henan Province, from January 2018 to December 2021. Logistic regression analysis was performed to analyse the risk factors for multidrug resistance. ROC curves were used to analyse the predictive model for multidrug resistance.ResultsAge < 65 years old, HbA1c, and a history of tuberculosis treatment were independent risk factors for multidrug resistance in patients with tuberculosis and diabetes (P < 0.05). The area under the ROC curve of predictive model for MDR was 0.878 (95% CI (0.824, 0.932)). Age < 65 years old and HbA1c were independent risk factors for MDR in patients with TB and diabetes with a history of TB treatment. The area under the ROC curve of predictive model for MDR was 0.920 [95% CI (0.831, 0.999)].ConclusionThe predictive model had certain prediction value for the risk of multidrug resistance in patients with tuberculosis and diabetes.

Risk factors for antimicrobial resistance in patients with Escherichia coli bacteraemia related to urinary tract infection

NHS Lothian policy has recently changed to avoid first-line use of trimethoprim for uncomplicated urinary tract infections (UTI) in patients with risk factors for trimethoprim resistance, in line with national guidance. This study aimed to identify risk factors for antimicrobial resistance in Escherichia coli bacteraemia related to UTI. A retrospective cohort study of 687 patients with E.coli bacteraemia related to UTI in NHS Lothian from 01/02/18 to 29/02/20 was undertaken. Demographics and comorbidities were collected from electronic patient records. Community prescribing and microbiology data were collected from the prescribing information system and Apex. Univariate and multivariate analysis was undertaken using RStudio to analyse trimethoprim, gentamicin and multi-drug resistance (MDR). Trimethoprim resistance was present in 282/687(41%) of blood culture isolates. MDR was present in 278/687(40.5%) isolates. Previous urinary trimethoprim resistant E.coli was a significant risk factor for both trimethoprim resistance (OR 9.44, 95%CI 5.83-15.9) and MDR (OR 4.81, 95%CI 3.17-7.43) on multivariate modelling. Trimethoprim prescription (OR 2.10, 95% CI 1.33-3.34) and the number of community antibiotic courses (OR 1.19, 95%CI 1.06-1.35) were additional risk factors for trimethoprim resistance. Multiple independent risk factors were also identified for trimethoprim resistance, MDR and gentamicin resistance. This study showed a high prevalence of trimethoprim resistance and MDR in patients with E.coli bacteraemia related to UTI. This supports the withdrawal of trimethoprim from first-line treatment of UTIs in patients with risk factors for trimethoprim resistance. It has also identified risk factors for MDR in E.coli bacteraemia.

ДИНАМИКА ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТИ ВОЗБУДИТЕЛЕЙ ТУБЕРКУЛЁЗА ВО ВРЕМЯ ПАНДЕМИИ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ В Г. ДУШАНБЕ: НЕОБХОДИМОСТЬ ПРИНЯТИЯ СРОЧНЫХ МЕР

Objective: To study the frequency and structure of primary and secondary drug resistance in M. tuberculosis (MTB) and risk factors for primary multidrug/rifampicin resistance (MDR/RR) in MTB before (Group I: 2018-2019) and during the COVID-19 pandemic (Group II: 2019-2020) in Dushanbe in patients with pulmonary tuberculosis (PTB). Methods: A cohort retrospective study included all patients with PTB tested for susceptibility to anti-tuberculosis drugs (ATD). Odds ratio (OR), 95% confidence interval (95% CI), and p-value were used to determine the significance of the association between frequency and drug susceptibility spectrum (DSS) in groups I and II; risk ratio (RR) was applied to assess a possible association between exposure and outcome. Results: The study included 559 newly diagnosed and 87 previously treated patients. Primary MDR/RR MTB was found in 21.1%, secondary – in 39.8% of patients: in group I, patients with primary MDR/RR MTB constituted 22.4%, secondary – 34.7%; in group II, the prevalence of secondary MDR/RR MTB was found to be three times higher than that of the primary resistance (OR=2.97; 95% CI=1.67-5.27, p&lt;0.001) due to a decrease in the prevalence of primary MDR/RR MTB (19.5%) and an increase in the secondary MDR/RR MTB (47.4%). There was a statistically significant increase in the frequency of primary drug resistance to fluoroquinolones in group II compared with group I: OR=2.58 for levofloxacin (p=0.003) and OR=2.31 for moxifloxacin (p=0.027). An increase in primary MDR/RR MTB was found among healthcare workers in group II (RR=3.21; 95% CI=1.50-6.89; p=0.05), which was statistically significant in patients with diabetes mellitus in both groups: group I (RR=1.83; p=0.035) and group II (OR=2.68; p&lt;0.001). Conclusion: The current high prevalence of primary and secondary MDR, the increase in monoresistance during the COVID-19 pandemic, and the association of MDR with employment in healthcare institutions raise concerns regarding the quality of implementation of tuberculosis (TB) infection control measures in Dushanbe. The increased frequency of resistance to fluoroquinolones requires immediate action to control their prescription. It is recommended to improve anti-TB standards among patients with diabetes mellitus. Keywords: Drug resistance, M. tuberculosis, risk factors for multidrug resistance, COVID-19.

Clinical impact of multidrug-resistant bacteria in older hospitalized patients with community-acquired urinary tract infection

IntroductionPrevious studies have described some risk factors for multidrug-resistant (MDR) bacteria in urinary tract infection (UTI). However, the clinical impact of MDR bacteria on older hospitalized patients with community-acquired UTI has not been broadly analyzed. We conducted a study in older adults with community-acquired UTI in order to identify risk factors for MDR bacteria and to know their clinical impact.MethodsCohort prospective observational study of patients of 65 years or older, consecutively admitted to a university hospital, diagnosed with community-acquired UTI. We compared epidemiological and clinical variables and outcomes, from UTI due to MDR and non-MDR bacteria. Independent risk factors for MDR bacteria were analyzed using logistic regression.Results348 patients were included, 41.4% of them with UTI due to MDR bacteria. Median age was 81 years. Hospital mortality was 8.6%, with no difference between the MDR and non-MDR bacteria groups. Median length of stay was 5 [4–8] days, with a longer stay in the MDR group (6 [4–8] vs. 5 [4–7] days, p = 0.029). Inadequate empirical antimicrobial therapy (IEAT) was 23.3%, with statistically significant differences between groups (33.3% vs. 16.2%, p < 0.001). Healthcare-associated UTI variables, in particular previous antimicrobial therapy and residence in a nursing home, were found to be independent risk factors for MDR bacteria.ConclusionsThe clinical impact of MDR bacteria was moderate. MDR bacteria cases had higher IEAT and longer hospital stay, although mortality was not higher. Previous antimicrobial therapy and residence in a nursing home were independent risk factors for MDR bacteria.

Predictors of multidrug resistant Pseudomonas aeruginosa involvement in bloodstream infections.

In the last decades, there has been a worldwide worrisome spread of multidrug resistant (MDR) Pseudomonas aeruginosa. Treatment of these infections is challenging, in part due to the lack of therapeutic options, and the importance of prescribing an adequate empirical treatment. Bacteraemia is one of the most severe infections, with mortality rates ranging between 20 and 40%. It is key to understand which patients are at a higher risk of MDR P. aeruginosa bloodstream infection (BSI) to better direct empirical therapies and improve overall survival. Immunocompromised patients are among the most vulnerable for the worst outcomes. Environmental exposure, integrity of the microbiota, and host immunity are the key determinants for the initial colonization and expansion on mucosal surfaces and potential invasion afterwards by MDR P. aeruginosa. Available data suggest that high colonization pressure (settings with high prevalence like intensive care units), disruption of healthy microbiota (prior use of antibiotics, in particular fluoroquinolones), immunosuppression (neutropenia) and breaking natural barriers (venous or urine catheters), are the main risk factors for MDR P. aeruginosa BSI.

Utilization study in real clinical practice of ceftolozane/tazobactam vs aminoglycosides and/or colistin in the treatment of multirresistant or extremely resistant Pseudomonas aeruginosa

RESUMENIntroducciónSe necesitan datos comparativos en “vida real” sobre efectividad y seguridad de ceftolozano/tazobactam (C/T) frente otros regímenes (aminoglucósidos/colistina/combinación) en el tratamiento de Pseudomonas aeruginosa (PA) multirresistente (MDR) y extremadamente resistente (XDR) para establecer posicionamientos.Material y métodosEstudio observacional, retrospectivo de pacientes con confirmación microbiológica de PA MDR y XDR desde julio de 2016 a diciembre de 2018 en un hospital terciario. Variables: edad, sexo, comorbilidades, factores de riesgo de multirresistencia, variables relacionadas con infección, foco de infección, microorganismo y tipo de muestra, tratamiento antibiótico, curación clínica, curación microbiológica, recurrencia, mortalidad en ingreso y 30 días post-alta. Pacientes clasificados según tratamiento antibiótico recibido, C/T o aminoglucósidos/colistina/combinación.Resultados405 pacientes con infección por PA MDR y XDR (73,1% hombres, edad media 63 ± 15 años). 87,1% PA XDR y 12,9% MDR. Todos los pacientes recibieron C/T como tratamiento dirigido y en el grupo aminoglucósidos/colistina/ combinación fueron el 73,5%. El grupo C/T presenta factores de peor pronóstico: shock séptico (30,0%) y sondaje (90,0%) (p<0,05). Sin diferencias estadísticamente significativas en curación microbiológica (p=0,412), recurrencia (p=0,880) y curación clínica (p=0,566). Tampoco hubo diferencias estadísticamente significativas en la mortalidad en el ingreso (p=0,352) ni a los 30 días del alta (p=0,231). El 17,2% de los pacientes con aminoglucósidos/colistina/combinación presentaron lesión renal aguda según criterios RIFLE (4,3% con C/T).ConclusionesLos datos obtenidos plantean que no ha habido diferencias de efectividad (curación clínica ni microbiológica) a favor de C/T, si bien, en el periodo estudiado se utilizó en la mayoría de los casos en pacientes multitratados y con peor pronóstico. Se necesitarían estudios aleatorizados y pros-pectivos para establecer un posicionamiento adecuado.

BioFire® FilmArray® Pneumonia Panel for Severe Lower Respiratory Tract Infections: Subgroup Analysis of a Randomized Clinical Trial.

IntroductionThe epidemiology of severe lower respiratory tract infections (LRTI) is constantly changing. We aimed to describe it using the BioFire® FilmArray® Pneumonia plus (PNplus) Panel.MethodsIn a sub-study of the PROGRESS trial, sputum samples of 90 patients with sepsis and LRTI were retrospectively studied. The primary endpoint was the comparative detection rate of pathogens between conventional microbiology and PNplus Panel; secondary endpoints were microbiology and the association with the inflammatory host response.ResultsFifty-six patients with community-acquired pneumonia without risk factors for multidrug-resistant (MDR) pathogens and another 34 patients with risk factors for MDR were studied; median pneumonia severity index (PSI) was 113 (88–135). PNplus detection rate was 72.2% compared to 10% by conventional microbiology (p < 0.001); Streptococcus pneumoniae was the most common pathogen. PSI and procalcitonin were greater among patients with bacterial pathogens than viral pathogens. Median procalcitonin was 0.49 ng/ml and 0.18 ng/ml among patients with ≥ 105 and < 105 copies/ml of detected bacteria, respectively (p = 0.004). Resistance reached 14.4%.ConclusionPNplus detects severe pneumonia pathogens at a greater rate than conventional microbiology. High levels of inflammation accompany bacterial detection.Trial RegistrationPROGRESS, ClinicalTrials.gov NCT03333304, 06/11/2017.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00459-x.

Prospective cohort study on hospitalised patients with suspected urinary tract infection and risk factors por multidrug resistance

Urinary tract infections (UTIs) are among the most common bacterial infections and a frequent cause for hospitalization in the elderly. The aim of our study was to analyse epidemiological, microbiological, therapeutic, and prognostic of elderly hospitalised patients with and to determine independent risk factors for multidrug resistance and its outcome implications. A single-centre observational prospective cohort analysis of 163 adult patients hospitalized for suspected symptomatic UTI in the Departments of Internal Medicine, Infectious Diseases and Short-Stay Medical Unit of a tertiary hospital was conducted. Most patients currently admitted to hospital for UTI are elderly and usually present high comorbidity and severe dependence. More than 55% met sepsis criteria but presented with atypical symptoms. Usual risk factors for multidrug resistant pathogens were frequent. Almost one out of five patients had been hospitalized in the 90 days prior to the current admission and over 40% of patients had been treated with antibiotic in the previous 90 days. Infection by MDR bacteria was independently associated with the previous stay in nursing homes or long-term care facilities (LTCF) (OR 5.8, 95% CI 1.17–29.00), permanent bladder catheter (OR 3.55, 95% CI 1.00–12.50) and urinary incontinence (OR 2.63, 95% CI 1.04–6.68). The degree of dependence and comorbidity, female sex, obesity, and bacteraemia were independent predictors of longer hospital stay. The epidemiology and presentation of UTIs requiring hospitalisation is changing over time. Attention should be paid to improve management of urinary incontinence, judicious catheterisation, and antibiotic therapy.

Risk factors for chemoresistance in metastatic high-risk Gestational Trophoblastic Neoplasia

BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a tumor known to be sensitive to chemotherapy. However, a subset of patients still develop resistance to the primary intensive chemotherapy. OBJECTIVE: This study aimed to determine the risk factors for multidrug resistance among high-risk metastatic GTN patients at University of the Philippines–Philippine General Hospital from January 2014 to December 2018. MATERIALS AND METHODS: A case–control study involving 111 high-risk metastatic GTN patients who underwent primary intensive chemotherapy Etoposide Methotrexate Actinomycin Cyclophosphamide Oncovin (EMACO) was done at the Philippine General Hospital from January 2014 to December 2018. The medical records of eligible patients were retrieved and reviewed. A comparison of the profile between patients who achieved remission (controls) and those who exhibited chemoresistance (cases) to the EMACO regimen was done. Stepwise logistic regression analysis and Cox's proportional hazards regression were used to determine the significant risk factors that could predict EMACO chemoresistance among these high-risk patients. RESULTS: The cases and controls were comparable in terms of their clinicodemographic profiles. Adjusting for confounders, multivariate analysis showed that the number of metastasis, FIGO stage, and World Health Organization (WHO) prognostic scores were all predictors of survival. Using the fitted logistic regression model, the accuracy of predicted death and survival was 85.16%. CONCLUSION: The pretreatment serum beta-human chorionic gonadotropin level, number of metastasis, tumor size, FIGO stage, and WHO prognostic score were significant predictors of treatment failure. A higher number of metastatic lesions, stage, and WHO prognostic scores indicated poor survival.

Antibiogram Profiles and Risk Factors for Multidrug Resistance of Salmonella enterica Recovered from Village Chickens (Gallus gallus domesticus Linnaeus) and Other Environmental Sources in the Central and Southern Peninsular Malaysia.

The emergence of multidrug resistance (MDR), including colistin resistance, among Enterobacteriaceae recovered from food animals poses a serious public health threat because of the potential transmission of these resistant variants to humans along the food chain. Village chickens or Ayam Kampung are free-range birds and are preferred by a growing number of consumers who consider these chickens to be organic and more wholesome. The current study investigates the antibiogram profiles of Salmonella isolates recovered from village chicken flocks in South-central Peninsular Malaysia. A total of 34 isolates belonging to eight serotypes isolated from village chickens were screened for resistance towards antimicrobials including colistin according to the WHO and OIE recommendations of critical antibiotics. S. Weltevreden accounted for 20.6% of total isolates, followed by serovars Typhimurium and Agona (17.6%). The majority of isolates (73.5%) demonstrated resistance to one or more antimicrobials. Eight isolates (23.5%) were resistant to ≥3 antimicrobial classes. Colistin resistance (minimum inhibitory concentrations: 4–16 mg/L) was detected among five isolates (14.7%), including S. Weltevreden, S. Albany, S. Typhimurium, and Salmonella spp. Univariable analysis of risk factors likely to influence the occurrence of MDR Salmonella revealed that the flock size, poultry production system, and use of antibiotics in the farm were not significantly (p > 0.05) associated with MDR Salmonella. The current study highlights that MDR Salmonella occur at a lower level in village chickens compared to that found in live commercial chickens. However, MDR remains a problem even among free-range chickens with minimal exposure to antibiotics.

Multidrug-resistant Staphylococcus aureus nasal carriage among HIV-positive outpatients in Guangzhou, China: Prevalence, risk factors, phenotypic and molecular characteristics

IntroductionData on comprehensive characterization of multidrug-resistant (MDR) Staphylococcus aureus (S. aureus) carriage in human immunodeficiency virus (HIV)-positive patients are limited. The objective of the present study is to determine the prevalence, risk factors, phenotypic and molecular characterization of MDR S. aureus isolated from HIV-positive population. MethodsA cross-sectional study was conducted to determine the characteristics of MDR S. aureus nasal carriage among HIV-positive outpatients in an HIV clinic from June to August 2017. Nasal swabs and risk factor data of the enrolled HIV-positive outpatients were collected. Phenotypic and molecular characteristics of MDR and non-MDR S. aureus isolates were analyzed. Risk factors for nasal carriage with MDR S. aureus were estimated by logistic regression. The relationship between phenotypic and molecular characteristics of S. aureus isolates was assessed by the correspondence analysis. ResultsOverall, 1001 HIV-positive outpatients were included. The prevalence of MDR S. aureus nasal carriage was 15.18% (152/1001), and the proportion of multidrug resistance among S. aureus isolates was 60.08% (152/253). Having a history of respiratory tract infection was the risk factor for MDR S. aureus nasal carriage (adjusted odds ratio = 1.90, 95% confidence interval: 1.25–2.89). Multidrug resistance of S. aureus isolates was in good corresponding relationships with clonal complex (CC)5, CC15, CC59 and CC398. ConclusionsWe found high burden of multidrug resistance among S. aureus isolated from HIV-positive outpatients, particularly in those who had upper respiratory tract infection. Moreover, CC59 and CC398 are highly related to multidrug resistance of S. aureus isolates.

EMPIRICAL THERAPY IN MANAGEMENT OF PNEUMONIA WITH MULTI-DRUG RESISTANT RISK FACTORS: A RETROSPECTIVE ANALYSIS COMPARING VANCOMYCIN PLUS PIPERACILLIN/TAZOBACTAM VERSUS VANCOMYCIN PLUS CEFEPIME

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Vancomycin and piperacillin-tazobactam combination (combo A) has been the corner stone for treatment of patients with suspicion of multi-drug resistant (MDR) organisms causing pneumonia. But recent studies showed that this combination is proven to be nephrotoxic after 48 to 72 hours continued usage. An alternative combination that has come into use is vancomycin plus cefepime plus/minus metronidazole (Combo B).Sepsis is a debilitating illness and has a very high mortality rate if not treated with appropriate antibiotics and it should also be noted that the mortality rate increases by 11 % every hour without appropriate therapy. It is seldom forgotten that antibiotics are usually not administered simultaneously and are longer, separate infusions. As mentioned above the goal in sepsis patients is to initiate the antibiotics as early as possible and if we miss out the adequate coverage or delay the coverage because of the technical difficulties the mortality and morbidity rate is likely to rise. METHODS: Single center retrospective cohort study evaluated patients with diagnosis of pneumonia with MDR risk factors. Cohorts are divided into patients who received combo A and combo B.The primary outcome of interest is to see the resolution/improvement of systemic inflammatory response syndrome (SIRS) in the first 24 hours while secondary outcomes being the incidence of acute kidney injury, time for improvement normalization of lactate, the length of intensive care unit (ICU) stay and the length of hospital stay.Total (n) of 47 patients met the inclusion and exclusion criteria. 19 received combo A; 6 septic shock and 13 sepsis/severe sepsis. 28 received combo B; 6 septic shock and 22 sepsis/severe sepsis. RESULTS: Improvement of SIRS at 24 hours was noted in both combo A & B with 52% patients in both the groups (P <0.001) Matched pair analysis of SIRS on arrival vs SIRS at 24 hours showed t-ratio of 6.83 in combo A and 5.3 in combo B (P <0.001). Comparison of both the groups showed no combo was superior to the other in improving SIRS (P = 0.9). Matched pair analysis of creatinine on arrival vs creatinine at 48 hours showed that there was no worsening of creatinine function t-ratio of 2.15 in combo A and 2.1 in combo B (p = 0.02). Average length of stay in ICU for patient's with septic shock who received combo A was 6.6 +/- 3.6 days (CI: 2.8-10.5) vs combo B was 6.8 +/- 3.7 days (CI: 2.9 -10.7) showing no major changes in the outcome of length of stay. CONCLUSIONS: Our study showed that patients treated empirically with combo A or combo B showed statistically significant improvement in SIRS in first 24 hours with no signs of renal dysfunction at 48 hours, with no superiority over each other in obtaining the desired outcomes. CLINICAL IMPLICATIONS: Empirical therapy with combo A or combo B can be safely used in the treating pneumonia with MDR risk factors with aim to de-escalate the therapy in 48 hours. DISCLOSURES: No relevant relationships by Radha Kishan Adusumilli, source=Web Response No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Gloria Hong, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by Manishkumar Patel, source=Web Response No relevant relationships by Bernadette Schmidt, source=Web Response

Prevalence, Risk Factors, and Characterization of Multidrug Resistant and ESBL/AmpC Producing Escherichia coli in Healthy Horses in Quebec, Canada, in 2015-2016.

Simple SummaryAntimicrobial resistance has been recognised as a global threat by the WHO. ESBL/AmpC genes, responsible for cephalosporin resistance, are particularly worrisome. Escherichia coli is a ubiquitous bacterium. Most strains are commensal, although some can cause disease in humans and animals. Due to its genome plasticity, it is a perfect candidate to acquire resistance genes. We hypothesized that multidrug-resistant E. coli and E. coli resistant to cephalosporins are present in the fecal microbiota of healthy horses in Quebec. We characterised antimicrobial resistance, identified ESBL/AmpC genes and assessed potential risk factors for their presence. Fecal samples from 225 horses, distributed in 32 premises, were cultured for indicator E. coli (selected without enrichment) and specific E. coli (selected after enrichment with ceftriaxone). Of the 209 healthy horses in which E. coli were detected, 46.3% shed multidrug-resistant (resistant to three or more classes of antimicrobials tested) E. coli. Non-susceptibility was most frequently observed for ampicillin, amoxicillin/clavulanic acid or streptomycin. ESBL/AmpC genes were detected in E. coli from 7.3% of horses and 18.8% of premises. The number of staff and equestrian event participation within the last three months were identified as risk factors for horses shedding multidrug-resistant E. coli isolates. The horse intestinal microbiota is a reservoir for ESBL/AmpC genes. The presence of ESBL/AmpC in horses is both a public and equine health concern, considering the close contact between horses and owners.Although antimicrobial resistance is an increasing threat in equine medicine, molecular and epidemiological data remain limited in North America. We assessed the prevalence of, and risk factors for, shedding multidrug-resistant (MDR) and extended-spectrum β-lactamase (ESBL) and/or AmpC β-lactamase-producing E. coli in healthy horses in Quebec, Canada. We collected fecal samples in 225 healthy adult horses from 32 premises. A questionnaire on facility management and horse medical history was completed for each horse. Indicator (without enrichment) and specific (following enrichment with ceftriaxone) E. coli were isolated and tested for antimicrobial susceptibility. The presence of ESBL/AmpC genes was determined by PCR. The prevalence of isolates that were non-susceptible to antimicrobials and to antimicrobial classes were estimated at the horse and the premises level. Multivariable logistic regression was used to assess potential risk factors for MDR and ESBL/AmpC isolates. The shedding of MDR E. coli was detected in 46.3% of horses. Non-susceptibility was most commonly observed to ampicillin, amoxicillin/clavulanic acid or streptomycin. ESBL/AmpC producing isolates were detected in 7.3% of horses. The most commonly identified ESBL/AmpC gene was blaCTX-M-1, although we also identified blaCMY-2. The number of staff and equestrian event participation were identified as risk factors for shedding MDR isolates. The prevalence of healthy horses harboring MDR or ESBL/AmpC genes isolates in their intestinal microbiota is noteworthy. We identified risk factors which could help to develop guidelines to preclude their spread.

Characterisation and risk factor profiling of Pseudomonas aeruginosa urinary tract infections: pinpointing those likely to be caused by multidrug-resistant strains

This study aimed to characterise UTIs caused by Pseudomonas aeruginosa in hospitalised adults and to identify risk factors for infections caused by multidrug-resistant (MDR) strains. A retrospective case-case-control study was conducted in two Italian teaching hospitals. Totally, 242 monomicrobial P. aeruginosa UTIs were analysed; 65 (26.9%) were caused by MDR strains. Clinical treatment failure at 72 h in 215 patients receiving empirical therapy was more frequent in MDR versus non-MDR cases [35/59 (59.3%) vs. 55/156 (35.3%); P=0.001], particularly when a β-lactam/β-lactamase inhibitor or fluoroquinolone was initially prescribed. By Day 7 (when all regimens were consistent with antimicrobial susceptibility results), treatment failure rates were similar [MDR 15/65 (23.1%) vs. non-MDR 25/177 (14.1%); P=0.09]. In-hospital mortality rates remained low in both groups [6/65 (9.2%) vs. 22/177 (12.4%); P=0.49], but median hospital stay for MDR cases was longer (48 vs. 22 days; P ≤ 0.001). Models for predicting MDR and non-MDR P. aeruginosa UTIs displayed good discriminatory power. Presence of ≥3 risk factors for MDR P. aeruginosa UTI was associated with an OR for this outcome of 7.44 (95% CI 3.24-17.57; P < 0.001; specificity 91%, accuracy 75%). The model for predicting non-MDR P. aeruginosa UTI displayed similar accuracy (74%) with a risk factor burden threshold of ≥2 (OR=7.02, 95% CI 4.61-10.70; P < 0.001). Risk factor assessment can identify UTIs in hospitalised patients likely to be caused by MDR P. aeruginosa, thereby facilitating targeted infection control and timelier effective treatment.

Extended-Spectrum Beta-Lactamase Producing Bacteria: Epidemiology, Risk Factors, Diagnostic Methodology, and Antimicrobial Susceptibility Profile: A Prospective Study at a University Hospital in Western Saudi Arabia

Objective: To study the prevalence and incidence of extended-spectrum beta-lactamase -producing microorganisms, microbiological characteristics and antimicrobial-susceptibility patterns.&#x0D; Methods: A prospective study involving all cases of extended-spectrum beta-lactamase -producing microorganisms among all bacteriological samples collected over a 1-year period from 11 November 2015 to 10 November 2016, in the Clinical and Molecular Microbiology Laboratory at King Abdulaziz University Hospital, Jeddah. Detection of extended-spectrum beta-lactamase-producing microorganisms and antimicrobial-susceptibility profiles were done using automated Vitek 2 system. Clinical data such as recent use of antibiotics or invasive devices were investigated as risk factors for multidrug resistance.&#x0D; Results: The prevalence of extended-spectrum beta-lactamase-producing microorganisms was 5.4% (95% CI = 4.7% – 6.2%); for an incidence = 54 per 1,000 isolates-years. Distribution by species showed 70.0% Escherichia coli, 28.5% Klebsiella pneumoniae and 1.5% Proteus mirabilis. Vitek 2 system showed 6% of false positive ESBL detections by reference to confirmatory E-test. Antimicrobial- susceptibility tests showed that 86.5% of beta-lactamase-producing strains were resistant to ≥ 1 other antimicrobial class and 20% were multidrug resistant. Univariate logistic regression showed that the presence of multidrug resistance was significantly predicted by age (OR = 1.02; P = 0.026), use of urinary catheter (OR = 2.05; P = 0.046) and number of devices used (OR = 1.60; P = 0.046); only age (OR = 1.02; P = 0.022) was significant in the multivariate model.&#x0D; Conclusion: Clinicians and microbiologists should maintain a high level of alertness and contribute for effective screening and adequate treatment of infections caused by beta-lactamase-producing organisms according to international guidelines and the local epidemiological picture.

An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria.

Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens. The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adequate antimicrobial therapy, guided by local microbiological data and awareness of the risk factors for MDR bacteria. Due to the increasing prevalence of HAP/VAP caused by MDR Gram-negative pathogens, management should be guided by the local ecology and the patient's risk factors for MDR pathogens. The main risk factors are prior hospitalization for at least 5 days, prior use of broad-spectrum antibiotics, prior colonization with resistant pathogens, admission to hospital settings with high rates of MDR pathogens, and septic shock at the time of diagnosis with nosocomial pneumonia.