An analysis was made about the evolution of resistance to 3rd generation cephalosporins, imipenem, and other antibiotics in invasive isolates of Klebsiella pneumoniae according to the Spanish ...EARS-Net database (2010–2014).
Forty-two hospitals from 16 Autonomous Communities with an approximate population coverage of 33% participated.
A total 7140 pneumoniae corresponding to the same number of patients were studied. Overall resistance percentages (I+R) were: cefotaxime 15.8%, ceftazidime 13.7%, imipenem 1.7%, ciprofloxacin 20.1%, tobramycin 14.1%, gentamicin 10.4%, and amikacin 1.9%.
Resistance to 3rd generation cephalosporins increased from 9.8% (2010) to 19% (2014); to ciprofloxacin from 15.4% (2010) to 19.6% (2014); to gentamicin from 6.2% (2010) to 10.3% (2014) and to tobramycin from 7.1% (2010) to 14.2% (2014) (p<0.001 in all cases). Combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides increased from 3.3% (2010) to 9.7% (2014) (p<0.001). Resistance to imipenem also increased from 0.27% (2010) to 3.46% (2014) (p<0.001). A total of 121 isolates were resistant to imipenem, of which 104 (86%) produced carbapenemases: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 and 3 KPC-3), 6 IMP, and 1 GES.
Over the 5 year period (2010–2014), resistance to 3rd generation cephalosporins in invasive K. pneumoniae in Spain has doubled. The combined resistance to 3rd generation cephalosporins, ciprofloxacin, and aminoglycosides has tripled, and imipenem resistance has increased almost 13 times, mostly due to the spread of carbapenemase-producing isolates.
Se analizó la evolución de la resistencia a cefalosporinas de 3.a generación, imipenem y otros antibióticos en aislamientos invasivos de Klebsiella pneumoniae (K. pneumoniae) según resultados de EARS-Net entre 2010 y 2014 en España.
Participaron 42 hospitales de 16 Comunidades Autónomas, con una cobertura poblacional aproximada del 33%.
Se aislaron 7.140 cepas de K. pneumoniae de un mismo número de pacientes. Las resistencias globales (I+R) fueron: cefotaxima 15,8%, ceftazidima 13,7%, imipenem 1,7%, ciprofloxacina 20,1%, tobramicina 14,1%, gentamicina 10,4% y amikacina 1,9%.
La resistencia a cefalosporinas de 3.a generación aumentó desde el 9,8% (2010) al 19% (2014); la de ciprofloxacina desde el 15,4% (2010) al 19,6% (2014); la de gentamicina desde el 6,2% (2010) al 10,3% (2014) y la de tobramicina desde el 7,1% (2010) al 14,2% (2014) (p<0,001 en todos los casos). Las cepas resistentes a la vez a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos aumentaron desde el 3,3% (2010) al 9,7% (2014) (p<0,001). La resistencia a imipenem aumentó desde el 0,27% (2010) al 3,46% (2014) (p< 0,001); 121 aislados fueron resistentes a imipenem, de los cuales 104 (86%) produjeron carbapenemasas: 74 OXA-48, 14 VIM, 9 KPC (6 KPC-2 y 3 KPC-3), 6 IMP y 1 GES.
En un periodo de 5 años (2010-2014), la resistencia a cefalosporinas de 3.a generación en K. pneumoniae invasivas en España se ha duplicado; la resistencia combinada a cefalosporinas de 3.a generación, ciprofloxacina y aminoglucósidos se ha triplicado; la resistencia a imipenem ha aumentado casi 13 veces, principalmente por la diseminación de aislados productores de carbapenemasas.
Control of infections caused by carbapenem-resistant Klebsiella pneumoniae continues to be challenging. The success of this pathogen is favored by its ability to acquire antimicrobial resistance and ...to spread and persist in both the environment and in humans. The emergence of clinically important clones, such as sequence types 11, 15, 101, and 258, has been reported worldwide. However, the mechanisms promoting the dissemination of such highrisk clones are unknown. Unraveling the factors that play a role in the pathobiology and epidemicity of K. pneumoniae is therefore important for managing infections. To address this issue, we studied a carbapenem-resistant ST-15 K. pneumoniae isolate (Kp3380) that displayed a remarkable adherent phenotype with abundant pilus-like structures. Genome sequencing enabled us to identify a chaperone-usher pili system (Kpi) in Kp3380. Analysis of a large K. pneumoniae population from 32 European countries showed that the Kpi system is associated with the ST-15 clone. Phylogenetic analysis of the operon revealed that Kpi belongs to the littlecharacterized γ₂-fimbrial clade. We demonstrate that Kpi contributes positively to the ability of K. pneumoniae to form biofilms and adhere to different host tissues. Moreover, the in vivo intestinal colonizing capacity of the Kpi-defective mutant was significantly reduced, as was its ability to infect Galleria mellonella. The findings provide information about the pathobiology and epidemicity of Kpi⁺ K. pneumoniae and indicate that the presence of Kpi may explain the success of the ST-15 clone. Disrupting bacterial adherence to the intestinal surface could potentially target gastrointestinal colonization.
ScopePseudomonas aeruginosa, a ubiquitous opportunistic pathogen considered one of the paradigms of antimicrobial resistance, is among the main causes of hospital-acquired and chronic infections ...associated with significant morbidity and mortality. This growing threat results from the extraordinary capacity of P. aeruginosa to develop antimicrobial resistance through chromosomal mutations, the increasing prevalence of transferable resistance determinants (such as the carbapenemases and the extended spectrum β-lactamases), and the global expansion of epidemic lineages. The general objective of this initiative is to provide a comprehensive update of P. aeruginosa resistance mechanisms, especially for the extensively drug-resistant (XDR)/difficult to treat resistance (DTR) international high-risk epidemic lineages, and how the recently approved β-lactams and β-lactam/β-lactamase inhibitor combinations may affect resistance mechanisms and the definition of susceptibility profiles.MethodsTo address this challenge, the European Study Group for Antimicrobial Resistance Surveillance (ESGARS) from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) launched the “Improving Surveillance of Antibiotic-Resistant Pseudomonas aeruginosa in Europe” (ISARPAE) initiative in 2022, supported by the Joint programming initiative on antimicrobial resistance (JPIAMR) network call and included a panel of over 40 researchers from 18 European Countries. Thus, an ESGARS-ISARPAE position paper was designed and the final version agreed after four rounds of revision and discussion by all panel members.Questions addressed in the position paperTo provide an update on (i) the emerging resistance mechanisms to classical and novel antipseudomonal agents, with a particular focus on β-lactams, (ii) the susceptibility profiles associated with the most relevant β-lactam resistance mechanisms, (iii) the impact of the novel agents and resistance mechanisms on the definitions of resistance profiles and (iv) the globally expanding XDR/DTR high-risk lineages and their association with transferable resistance mechanisms.ImplicationThe evidence presented herein can be used for coordinated epidemiological surveillance and decision-making at the European and global level.
Analysis of sequencing data for 143
bla
NDM-1
- and
bla
OXA-48
-positive
Klebsiella pneumoniae
isolates from 13 European national collections and the public domain resulted in the identification of ...15 previously undetected multi-country transmission clusters. For 10 clusters, cases had prior travel/hospitalisation history in countries outside of the European Union including Egypt, Iran, Morocco, Russia, Serbia, Tunisia and Turkey. These findings highlight the benefit of European whole genome sequencing-based surveillance and data sharing for control of antimicrobial resistance.
We describe the characterization of a new isolated in Spain of Klebsiella pneumoniae ST258 producing KPC-3, carbapenems non-susceptible, recovered from a sample of urine from a patient with urinary ...tract infection and no history of carbapenems exposure.
After the isolation, identification of K. pneumoniae was performed by biochemical tests and mass spectrometry. The carbapenems susceptibility testing was performed by microdilution and E-test in cation-adjusted Mueller-Hinton. The study was completed by Rapidec® Carba NP. In order to determine the genetic basis of resistance to carbapenems we used Xpert® Carba-R for carbapenemase type and subtype was subsequently analyzed by amplification by PCR and sequencing.
We demonstrated by MLST that the strain belonged to the clone of high-risk ST258.
This is the first characterization, in our media, of a clinical isolated of K. pneumoniae ST258 producing KPC-3 and no history of carbapenems exposure.
Clinical and epidemiological description of an outbreak in an intensive care unit (ICU) caused by a strain of multidrug-resistant Enterobacter cloacae complex carrying a CTX-M-9-type ...extended-spectrum β-lactamase (ESBL).
A retrospective study of the clinical and epidemiological features of the outbreak caused by E.cloacae complex was performed. Identifying and studying the sensitivity of the strains were performed using the semi-automated system BD Phoenix™, and the characterisation of ESBL using PCR and sequencing. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE).
During February 2014, 6 patients (50% women; mean age: 61.5 years; age range: 44-76 years) admitted to the ICU of the Hospital of Pontevedra (CHOP) presented resistant E.cloacae complex isolates to extended-spectrum cephalosporins. Three patients developed infection; one had primary bacteraemia and septic shock, and 2 with ventilator-associated pneumonia. In the remaining three cases E.cloacae complex isolates were considered as colonisation. Phenotypic and genotypic analysis revealed that all isolates had the same PFGE profile and carried the same CTX-M-9 ESBL. The outbreak was controlled by improving universal precautions and contact isolation of patients infected and/or colonized.
The clinical and epidemiological features of an outbreak in an ICU caused by E.cloacae complex carrying CTX-M-9 are described.
Background: Despite its great ubiquity and
morbidity and mortality, the scientific evidence on
the hospital control of multiresistant Acinetobacter
baumanii (ABMR) outside the Intensive Care Units
in ...Spain is scarce. The objective was to describe
an epidemic outbreak by MRAB and analyze the
effectiveness of the actions carried out.
Methods: Prospective observational study
of admitted-rotated patients in a multipathological
control at the University Hospital of
Guadalajara, Spain, during the outbreak (September
20-November 3, 2017); using Mambrino Electronic
Health Record. A genetic study of the resistance
mechanism and molecular characterization of
the strains were carried out. Frequency measurements
were estimated, with subsequent comparative
analysis of cases vs controls.
Results: The median age of the study population
(N=138) was 83.2 years (Interquartile Range
IR=69.7-90.1). There were 3 cases of ABMR infection
among them. Thirteen percent required issolation,
17% because of MRAB. The MRAB
incidence was 2.2 cases/100 admitted-rotated (mortality
rate=33%). The excess stay for cases was
17±4.3 (95%CI=8.5-25.6), with an incidence density
of 3 cases/10³ days. The responsible strain was
carbapenemase OXA-23. We found a single case in
the colonization study of contacts. No MRAB was
isolated from environmental samples.
Conclusions: Along with epidemiological research,
coordination and compliance with precautions;
prompt identification and management of an
outbreak are crucial to minimize the colonization
pressure and to stop dissemination.
Fundamentos: Pese a su gran ubicuidad y
morbimortalidad, la evidencia científica sobre el
control hospitalario de Acinetobacter baumanii
multirresistente (ABMR) fuera de las Unidades de
Cuidados Intensivos en España es escasa. El objetivo
fue describir un brote epidémico por ABMR y
analizar la efectividad del manejo.
Métodos: Se realizó un estudio observacional
retrospectivo de los ingresados-rotados (N=138)
en un control de pluripatológicos del Hospital
Universitario de Guadalajara (España), durante el
brote (20 septiembre-3 noviembre de 2017), utilizando
la Historia Clínica Electrónica Mambrino. Se
realizó un estudio genético del mecanismo de resistencia
y caracterización molecular de cepas. Se
estimaron medidas de frecuencia y análisis comparativo
de casos respecto a controles.
Resultados: La mediana de edad de la población
expuesta fue de 83,2 años (Rango
Intercuartílico RI=69,7-90,1). Hubo entre ellos
tres casos de infección por ABMR. Requirieron
aislamiento un 13% de los ingresados-rotados, el
17% por ABMR. La incidencia de ABMR fue de
2,2 por cada 100 ingresados-rotados (tasa de mortalidad=
33%). El exceso de estancia de los casos fue
de 17±4,3 días (IC95%=8,5-25,6), con una densidad
de incidencia de 3/10³ días. La cepa responsable
fue carbapenemasa OXA-23. En el estudio de
colonización de contactos se evidenció un caso. El
estudio ambiental resultó negativo.
Conclusiones: Junto a la investigación epidemiológica,
la coordinación y el cumplimiento
de precauciones, la prontitud en la identificación y
gestión del brote son determinantes para minimizar
la presión de colonización y frenar la cadena de diseminación.
Infections caused by carbapenem-resistant Acinetobacter baumannii are a global threat causing a high number of fatal infections. This microorganism can also easily acquire antibiotic resistance ...determinants, making the treatment of infections a big challenge, and has the ability to persist in the hospital environment under a wide range of conditions. The objective of this work was to study the molecular epidemiology and genetic characteristics of two blasub.OXA24/40Acinetobacter baumannii outbreaks (2009 and 2020-21) at a tertiary hospital in Northern Spain. Thirty-six isolates were investigated and genotypically screened by Whole Genome Sequencing to analyse the resistome and virulome. Isolates were resistant to carbapenems, aminoglycosides and fluoroquinolones. Multi-Locus Sequence Typing analysis identified that Outbreak 1 was mainly produced by isolates belonging to ST3sup.Pas/ST106sup.Oxf (IC3) containing blasub.OXA24/40, blasub.OXA71 and blasub.ADC119. Outbreak 2 isolates were exclusively ST2sup.Pas/ST801sup.Oxf (IC2) blasub.OXA24/40, blasub.OXA66 and blasub.ADC30, the same genotype seen in two isolates from 2009. Virulome analysis showed that IC2 isolates contained genes for capsular polysaccharide KL32 and lipooligosacharide OCL5. A 8.9 Kb plasmid encoding the blasub.OXA24/40 gene was common in all isolates. The persistance over time of a virulent IC2 clone highlights the need of active surveillance to control its spread.
Acquisition of reduced susceptibility to biocides may contribute to the dissemination of high-risk (HR) clones of carbapenemase-producing Klebsiella pneumoniae (CP-Kp). The aim of this study was (a) ...to determinate the activity of biocides against CP-Kp, and (b) to analyse the relationship between biocide activity and the presence of efflux pumps.
The minimal inhibitory concentrations (MICs) of 6 biocides (sodium hypochlorite, chlorhexidine digluconate, benzalkonium chloride, povidone-iodine, ethanol and triclosan) were determined in triplicate at 25°C and 37°C in Mueller-Hinton broth (MHB) and M9 minimum medium, against 17 CP-Kp isolates representing different clones (HR and no-HR), sequence-types (STs) and carbapenemases. Efflux pumps genes were detected by whole genome sequencing (MiSeq).
Median MICs were slightly higher at 37°C than at 25°C (p≤0.05), except for benzalkonium chloride, triclosan and ethanol. MIC medians were much higher in MHB than in M9, except for triclosan. No significant differences were observed in the median MICs, regarding the type of clone, ST or carbapenemase; cepA, acrAB, kpnEF and oqxAB genes were detected in all isolates, whereas qacE and qacA were not detected; smvAR, and qacΔE genes were detected in 94%and 47% of isolates, respectively.
Triclosan, chlorhexidine digluconate, benzalkonium chloride and ethanol were the most active biocides. The activity of some biocides is affected by temperature and growth media, suggesting that standardised procedures for biocide susceptibility testing based on MIC determination are required. This activity, in terms of MICs, are not related to the type of clone, ST, carbapenemase or the presence of the efflux pump genes.
Pseudomonas aeruginosa, a ubiquitous opportunistic pathogen considered one of the paradigms of antimicrobial resistance, is among the main causes of hospital-acquired and chronic infections ...associated with significant morbidity and mortality. This growing threat results from the extraordinary capacity of P. aeruginosa to develop antimicrobial resistance through chromosomal mutations, the increasing prevalence of transferable resistance determinants (such as the carbapenemases and the extended-spectrum β-lactamases), and the global expansion of epidemic lineages. The general objective of this initiative is to provide a comprehensive update of P. aeruginosa resistance mechanisms, especially for the extensively drug-resistant (XDR)/difficult-to-treat resistance (DTR) international high-risk epidemic lineages, and how the recently approved β-lactams and β-lactam/β-lactamase inhibitor combinations may affect resistance mechanisms and the definition of susceptibility profiles.
To address this challenge, the European Study Group for Antimicrobial Resistance Surveillance (ESGARS) from the European Society of Clinical Microbiology and Infectious Diseases launched the ‘Improving Surveillance of Antibiotic-Resistant Pseudomonas aeruginosa in Europe (ISARPAE)’ initiative in 2022, supported by the Joint programming initiative on antimicrobial resistance network call and included a panel of over 40 researchers from 18 European Countries. Thus, a ESGARS-ISARPAE position paper was designed and the final version agreed after four rounds of revision and discussion by all panel members.
To provide an update on (a) the emerging resistance mechanisms to classical and novel anti-pseudomonal agents, with a particular focus on β-lactams, (b) the susceptibility profiles associated with the most relevant β-lactam resistance mechanisms, (c) the impact of the novel agents and resistance mechanisms on the definitions of resistance profiles, and (d) the globally expanding XDR/DTR high-risk lineages and their association with transferable resistance mechanisms.
The evidence presented herein can be used for coordinated epidemiological surveillance and decision making at the European and global level.
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