Zusammenfassung
Im Spannungsfeld zwischen der Ausbreitung multiresistenter bakterieller Erreger und dem Mangel an neuen Antibiotika wird der rationale Umgang mit diesen Substanzen zunehmend wichtig. ...Resistenzentwicklung ist bakterielle Evolution und kann nicht vermieden, wohl aber durch einen umsichtigen Einsatz verzögert werden. Antibiotic-Stewardship(ABS)-Programme haben genau dieses Ziel. In der aktualisierten S3-Leitlinie zu ABS werden Angaben zur erforderlichen Mitarbeiterzahl und Zusammensetzung des ABS-Teams gemessen an Größe und Beschaffenheit des Hauses gemacht. Des Weiteren werden verschiedene ABS-Strategien und deren Evidenz dargelegt. Die zunehmende Verfügbarkeit einer schnelleren mikrobiologischen Diagnostik und Resistenztestung ermöglicht eine frühere zielgerichtete Therapie. So können das Outcome der Patienten und der Antibiotikaverbrauch optimiert werden. Ebenso wird die vermehrte Ausbildung von Ärzten im Bereich Infektiologie zu einer Verbesserung der Behandlungsqualität beitragen.
β-Lactamases: protein evolution in real time Petrosino, Joseph; Cantu, Carlos; Palzkill, Timothy
Trends in microbiology (Regular ed.),
08/1998, Letnik:
6, Številka:
8
Journal Article
Recenzirano
The evolution and spread of bacteria resistant to β-lactam antibiotics has progressed at an alarming rate. Bacteria may acquire resistance to a given drug by mutation of pre-existing genes or by the ...acquisition of new genes from other bacteria. One ongoing example of these mechanisms is the evolution of new variants of the TEM and SHV β-lactamases with altered substrate specificity.
Aims: To review the demographic characteristics, antecedents and outcome for early neonatal Escherichia coli sepsis. Secondary aims were to identify antenatal antibiotic use and to review the ...antimicrobial susceptibility.
Methods: A retrospective chart review was performed for all infants with a positive culture for E. coli from either blood or CSF samples obtained between January 1998 and October 2002.
Results: Nineteen liveborn infants with early onset sepsis and one stillborn baby with a positive maternal blood culture for E. coli were identified. Pregnancy complications included multiple pregnancy in five (25%), preterm rupture of membranes 10 (50%) and maternal urinary tract infection in five (25%). Eighteen of the cases were born preterm and two at term. The mortality was 8/20 (40%), and for nine cases with developmental outcome data available, 67% were within normal limits and 33% were abnormal. Of the 20 E. coli isolates 11 (55%) were resistant to amoxycillin and 1 (5%) was resistant to gentamicin.
Conclusions: Infants with early onset E. coli sepsis had a poor outcome with high mortality and a third of the survivors manifesting neurodevelopmental impairment. Although amoxycillin resistance is common, there is a low prevalence of gentamicin resistance in local isolates.
Klebsiella pneumoniae ranks high as a cause of community-acquired pneumonia in hospitalised patients in Malaysia.
A retrospective study of 5,990 clinical respiratory specimens in patients, with a ...mean age of 54 (standard deviation 18.5) years, admitted to an urban-based general hospital between 2000 and 2004, was conducted.
The percentages of K. pneumoniae isolates during these years were 11, 19.1, 41.4, 27.8 and 16.6 percent, respectively. During this time, the percentage of isolates resistant to ampicillin were consistently in excess of 80 percent, those resistant to cephalosporins were relatively stable between eight and 23 percent, while those resistant to beta-lactam/beta-lactamase inhibitors amoxicillin clavulanic acid/ ampicillin-sulbactam and aminoglycosides steadily increased between six and 58 percent. Compared with hospital consumption of these corresponding antibiotic classes, only beta-lactam/beta-lactamase inhibitors and aminoglycosides showed a clear trend of eight- and four-fold increases, respectively. Co-resistance rates in isolates resistant to ampicillin and amoxicillin-clavulanic acid/ampicillin-sulbactam were generally low to second to third generation cephalosporins (less than 20 percent).
Our local findings highlighted the changing trend in respiratory K. pneumoniae over a five-year period, and its escalating resistance to beta-lactam/beta-lactamase inhibitors and aminoglycosides that is possibly attributable to the widespread use of these antibiotics in our hospital.
A total of 90 Escherichia coli O157 isolates recovered from humans, cattle, and pigs, were examined for the presence of the H7 antigen, ability to produce Shiga toxins and enterohemolysin as well as ...for antimicrobial resistance and biochemical properties. Fourteen of the human strains (n = 23) and 21 of the bovine isolates (n = 29) were of the O157:H7 serotype as determined by agglutination and PCR methods. All E. coli O157 of porcine origin (n = 38) were H-negative. Based on the ability to produce Shiga toxins (Stxs), all human and cattle isolates and 11 strains recovered from swine were identified as Shiga toxin-producing E. coli (STEC). Among STEC, most human strains (18 isolates) were Stx1- and Stx2-positive whereas cattle strains were mostly Stx2-positive. Eleven porcine STEC produced either Stx1 (7 isolates) or Stx2 (4 strains) toxins; an additional 20 isolates recovered from these animals had the Stx2e toxin gene as previously determined by PCR. All human and cattle E. coli O157 produced enterohemolysin whereas only 4 strains recovered from pigs were ehly-positive. Moreover, the PCR identification of the lpfO113 gene performed earlier revealed that this putative virulence marker was present in all porcine isolates, only in 5 strains of bovine origin but in none of E. coli O157 recovered from humans. All 90 E. coli O157 strains tested displayed 10 biochemical profiles that were different at least in one of the reaction tested. The most common atypical reaction observed among porcine O157 isolates was ability to ferment sorbitol (all strains) and production of β-glucuronidase (25 isolates). Moreover, none of the sorbitol-positive strains was able to produce indol. Four antimicrobial resistance profiles among 90 E. coli O157 strains tested were observed. Most of the isolates recovered from humans and all strains from cattle were resistant only to rifampicin whereas the porcine strains showed resistance to either 3 antimicrobials (4 isolates) or to 4 drugs tested (34 isolates). The phenotypic data shown in the present study, together with the previously published genotypic analyses of these strains, confirm earlier suggestions that the porcine E. coli O157 strains are mostly different from those of bovine and human O157 isolates and could therefore play less important role in human STEC O157 infections.
A prevalência de Salmonella em produtos de frangos e ovos de galinhas, os sorovares mais freqüentes e sua sensibilidadea a antimicrobianos, foram investigados em Pelotas, Brasil, no período de maio ...de 1997 a outubro de 1998. Um total de 124 amostras de produtos de frangos obtidas em supermercados e açougues e 94 amostras de 6 unidades de ovos de galinhas obtidas em supermercados e feiras-livres foram analisadas através do método convencional de cultivo. Entre as amostras de produtos de frangos analisadas, 13 (10,48%) continham salmonelas. Os 13 isolamentos de salmonelas realizados foram sorotipificados como S. enteritidis (10), S. anatum (1) e S. enterica subespécie enterica sorovar 3,10:e,h:- (2). Todas as cepas isoladas foram resistentes à penicilina G e sensíveis aos demais antimicrobianos testados. Em amostras de ovos, não foram detectadas salmonelas.The prevalence of Salmonella in chicken products and hen's eggs, the most frequent serovars and their antimicrobial sensitivity, were investigated in the city of Pelotas, Brazil from May 1997 through October 1998. A total of 124 samples of chicken products obtained from local supermarkets and butcher shops, and 94 samples of eggs (6 units each) obtained from supermarkets and street vendors, were examined through standard cultivation procedures. Salmonella were detected in 13 (10,48%) samples of chicken products. Among the 13 strains of salmonellae isolated, 10 were serotyped as S. enteritidis, 1 was S. anatum and 2 were S. enterica subsp. enterica sorovar 3,10:e,h:-. All strains isolated were resistant to penicillin G and susceptible to the others antimicrobial drugs tested. Hen's eggs were not found contaminated with salmonellae.
The Burkholderia cepacia complex (Bcc) consists of several species that cause lung infections in patients with cystic fibrosis but are also capable to colonize immunocompromised patients. Once ...established, the infection is usually difficult to eradicate, as Bcc is intrinsically resistant to many antibiotics. Besides, the acquisition of additional resistance determinants by horizontal gene transfer makes very difficult the therapeutic approach to these infections. Among horizontally acquired DNAs, integrons have been frequently reported in many Gramnegative bacteria that affect human health, but they have not been found frequently in Burkholderia isolates until now. In the present work we report on a Bcc isolate, recovered from the blood of an immunocompromised patient, that carries a 2.3 kb class I integron already described in a Salmonella enterica isolate eight years ago, coding for aacA4, aadA1 and catB2 in its cassette array.
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