Mortality and molecular epidemiology associated with extended-spectrum β-lactamase production in Escherichia coli from bloodstream infection

Background: The rate of infections due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is growing worldwide. These infections are suspected to be related to increased mortality. We aimed to estimate the difference in mortality due to bloodstream infections (BSIs) with ESBL-positive and ESBL-negative E. coli isolates and to determine the molecular epidemiology of our ESBL-positive isolates. Materials and methods: We performed a cohort study on consecutive patients with E. coli BSI between 2008 and 2010 at the Charité University Hospital. Collected data were ESBL production, basic demographic parameters, and underlying diseases by the Charlson comorbidity index (CCI). The presence of ESBL genes was analyzed by polymerase chain reaction (PCR) and sequencing. Phylogenetic groups of ESBL-positive E. coli were determined by PCR. Risk factors for mortality were analyzed by multivariable regression analysis. Results: We identified 115 patients with BSI due to E. coli with ESBL phenotype and 983 due to ESBL-negative E. coli. Fifty-eight percent (n=67) of the ESBL-positive BSIs were hospital-acquired. Among the 99 isolates that were available for PCR screening and sequencing, we found mainly 87 CTX-M producers, with CTX-M-15 (n=55) and CTX-M-1 (n=21) as the most common types. Parameters significantly associated with mortality were age, CCI, and length of stay before and after onset of BSI. Conclusion: The most common ESBL genotypes in clinical isolates from E. coli BSIs were CTX-M-15 (58%) and CTX-M-1 (22%). ESBL production in clinical E. coli BSI isolates was not related to increased mortality. However, the common occurrence of hospital-acquired BSI due to ESBL-positive E. coli indicates future challenges for hospitals

Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period

HBsAg clearance by Peg-interferon addition to a long-term nucleos(t)ide analogue therapy.

The ideal endpoint of hepatitis B virus (HBV) antiviral therapy is HBsAg loss, a difficult goal to obtain, especially in HBeAg negative patients. Herein, we report the results obtained by the addition of peg-interferon α-2a to a long-lasting nucleos(t)ide analogue therapy in a HBeAg negative, genotype D patient with steadily HBV-DNA negative/HBsAg positive values. In 2002, our Caucasian 44-year-old male patient received lamivudine and, 4 years later, added adefovir because of a virological breakthrough. In 2011, considering his young age, liver stiffness (4.3 kPa) and HBsAg levels (3533 IU/mL), we added Peg-interferon α-2a for six months (3 in combination with nucleos(t)ide analogues followed by 3 mo of Peg-interferon α-2a monotherapy). A decrease of HBsAg levels was observed after 1 mo (1.21 log) of Peg-interferon and 3 mo (1.88 log) after the discontinuation of all drugs. Later, a complete clearance of HBsAg was obtained with steadily undetectable HBV-DNA serum levels (< 9 IU/mL). HBsAg clearance by the addition of a short course of Peg-interferon α-2a represents an important result with clinical and pharmaco-economic implications, considering that nucleos(t)ide analogues therapy in HBeAg negative chronic hepatitis B patients is considered a long-lasting/life-long treatment

RedLabRA; a Spanish Network of Microbiology Laboratories for the Surveillance of Antibiotic Resistant Microorganisms

Factor de impacto: 1,553 Q4There is an urgent need to control the clinical and public health impact that antibiotic resistance (AR) causes worldwide. Any measure for its control must be based on an up-to-date and comprehensive knowledge of the situation. However, it is difficult to determine the current dimension of AR because a large part of the available information is based on heterogeneous, insufficiently unified and retrospective data. The integration of genomic information in the surveillance of AR is another important factor for improvement. The Spanish Network of Laboratories for the Surveillance of Resistant Microorganisms (RedLabRA) is a structured network of interconnected microbiology laboratories developed within the Spanish National Plan against Antibiotic Resistance. Its main objective is to support the diagnosis of resistance to antibiotics, integrating molecular characterization in the surveillance.S

TEM-145 and TEM-146 &#223-lactamases produced by Escherichia coli isolates from state hospitals in KwaZulu-Natal, South Africa

Two Escherichia coli isolates which were isolated from the urine of patients in state hospitals in KwaZulu-Natal, South Africa were investigated to determine the sequence of the TEM -lactamases responsible for their resistance to -lactamase inhibitors. The isolates were subjected to MICdeterminations, iso-electric focusing analysis, plasmid analysis, polymerase chain reaction (PCR) for the detection of -lactamase genes and sequencing of the blaTEM. Analysis of the nucleotide sequencesrevealed the presence of two novel TEM -lactamases, TEM-145 and TEM-146 which had the R244H mutation. Mutations at position 244 have been previously reported in other inhibitor-resistant TEMs (IRTs)

Emergence of Raoultella ornithinolytica producing AmpC -Beta lactamases in the different clinical specimens

The incidence of AmpC β –lactamases producing member of Enterobacteriaceae is increasing in recent years. The aim of this study was to evaluate AmpC β –lactamases production by clinical isolates of Raoultella  ornithinolytica by phenotypic detection (AmpC  disc  test (ADT) and modified three dimensional test(MTDT)) . Twenty isolates(8.73%) of Raoultella sp. were identified among 229 (70.89%) different bacteria (gram negative and gram positive) that isolated from different clinical specimens (urine 8(9.8%), burns 5(12.19%), wound5(6.3%) and stool 2(8.6%)) .Three species of Raoultella were isolated in this study that included Raoultella  ornithinolytica (16(6.98%)), Raoultella  terrigena (3 (1.31%)) and Raoultella planticola(1(0.43%)). Thirteen (81%) and10(62.5%) of Raoultella  ornithinolytica were resist to cefoxitin and amoxicillin-clavulanate respectively,10 out of 13 cefoxitin resistant and all isolates that resistant to   amoxicillin-clavulanate were produced AmpC β –lactamases by two  phenotypic tests .The AmpC β – lactamases producers were distributed to 3(100%) from burns ,6(75%)from urine and 1(33.3%) from wounds .The study showed AmpC β – lactamases producers were also high resist to other antibiotics that included tetracycline (90%) and ciprofloxacin(80%),and all isolates (100%) were sensitive to imipenem . KEYWORDS: Raoultella ornithinolytica, AmpC β –lactamases, clinical specimens

Выявление связи между иммуногенной и антигенной активностью вакцины против колибактериоза животных

Studies of such quality indicators as immunogenic and antigenic activity of the vaccine against colibacteriosis of animals have been carried out in experiments with laboratory animals. Immunogenic activity was determined by vaccination of white mice with different doses of the vaccine, followed by infection with virulent strains of Escherichia , producers of adhesive antigens, and determination of ID The antigenic activity of the vaccine was studied in experiment on rabbits by determining the level of antibodies to adhesive antigens in agglutination reaction in blood serum of vaccinated animals. The relationship between immunogenic and antigenic activity of the vaccine was detected by studying preventive activity of sera obtained from vaccinated rabbits in the experiment on white mice. The analysis of the obtained research results was given. The relationship between the level of antibodies to adhesive antigens in the blood serum of vaccinated animals and the immunogenic activity of the vaccine in the experiment on laboratory animals was established.Проведены исследования показателей качества - иммуногенной и антигенной активности вакцины против колибактериоза животных в опытах на лабораторных животных. Иммуногенную активность определяли путем вакцинации белых мышей различными дозами вакцины с последующим заражением вирулентными штаммами эшерихий, продуцентами адгезивных антигенов и определением ИД . Антигенную активность вакцины изучали в опыте на кроликах путем определения уровня антител к адгезивным антигенам в реакции агглютинации в сыворотке крови вакцинированных животных. Взаимосвязь между иммуногенной и антигенной активностью вакцины выявляли путем изучения превентивной активности сывороток, полученных от вакцинированных кроликов, в опыте на белых мышах. Приведен анализ полученных результатов исследований. Установлена взаимосвязь между уровнем антител к адгезивным антигенам в сыворотке крови вакцинированных животных и иммуногенной активностью вакцины в опыте на лабораторных животных