A carbapenem-resistant Escherichia coli strain (DVR22) was recovered from a stool specimen from a patient with traveler's diarrhea who had traveled to India. Molecular screening led to the first ...identification of NDM-1 in Spain. The blaNDM-1 gene was located in a conjugative plasmid of ca. 300 kb that also contained the blaCTX-M-15, blaTEM-1, ΔblaDHA-1, and armA genes. In addition, blaNDM-1 was preceded by an ISAba125 insertion element only found in Acinetobacter spp.
Background
Knowledge of resistance patterns is essential to choose empirical treatment. We aimed to determine the risk factors for antibiotic-resistant microorganisms (ARM) in intraabdominal ...infections (IAI) and their impact on mortality.
Methods
Retrospective cohort study of patients with bacteremia from IAI origin in a single hospital between January 2006 and July 2017.
Results
A total of 1485 episodes were recorded, including 381 (25.6%) due to ARM. Independent predictors of ARM were cirrhosis (OR 2; 95% CI 1.15–3.48), immunosuppression (OR 1.49; 1.12–1.97), prior ceftazidime exposure (OR 3.7; 1.14–11.9), number of prior antibiotics (OR 2.33; 1.61–3.35 for 1 antibiotic), biliary manipulation (OR 1.53; 1.02–2.96), hospital-acquisition (OR 2.77; 1.89–4) and shock (OR 1.48; 1.07–2). Mortality rate of the whole cohort was 11.1%. Age (OR 1.03; 1.01–1.04), cirrhosis (OR 2.32; 1.07–4.38), urinary catheter (OR 1.99; 1.17–3.38), ultimately (OR 2.28; 1.47–3.51) or rapidly (OR 13.3; 7.12–24.9) fatal underlying disease, nosocomial infection (OR 2.76; 1.6–4.75), peritonitis (OR 1.95, 1.1–3.45), absence of fever (OR 2.17; 1.25–3.77), shock (OR 5.96; 3.89–9.13), and an ARM in non-biliary infections (OR 2.14; 1.19–3.83) were independent predictors of 30-day mortality. Source control (OR 0.24; 0.13–0.44) and 2015–2017 period (OR 0.29; 0.14–0.6) were protective.
Conclusion
Biliary manipulation and septic shock are predictors of ARM. The presence of an ARM from a non-biliary focus is a poor-prognosis indicator. Source control continues to be of paramount importance.
Background: The direct identification of uropathogens from urine samples, in combination with the rapid detection of resistance, would allow early adjustment of empirical antimicrobial treatment. ...Methods: Two hundred and ninety-eight urine samples processed between 1 June and 31 December 2020, selected with flow cytometry, with direct identification by MALDI-TOF mass spectrometry, and rapid detection of extended-spectrum beta-lactamase (ESBL) and carbapenemases-producing strains by lateral flow were analyzed. Results: The positive predictive value of the direct identification of the 86 samples that met the flow cytometry criterion (>5000 bacteria/µL) was 96.4%. Reliable direct identification was obtained in 14 of the 27 (51.8%) urinary source bacteraemias. There was 100% agreement between the lateral flow and antibiogram in the detection of ESBL and carbapenemases. Conclusion: the protocol for the direct identification and rapid detection of ESBL and carbapenemases-producing strains from urine samples is a reliable and useful tool.
We describe four cases of a novel carbapenem-resistant
ST179 clone carrying the
or
gene together with
, imported from Peru to Spain and isolated from leukemia patients. All isolates were ...multidrug-resistant but remained susceptible to fosfomycin, cefiderocol, and colistin. Whole-genome sequencing revealed that
and
were located in an IncP6 plasmid, whereas
was in a chromosomal type 1 integron. This study highlights the global threat of multidrug-resistant
clones and underscores the importance of monitoring and early detection of emerging resistance mechanisms to guide appropriate treatment strategies. The importation and spread of such clones emphasize the urgent need to implement strict infection control measures to prevent the dissemination of carbapenem-resistant bacteria.
This is the first documented case of a
ST179 strain carrying the blaKPC-35 gene, and it represents the first report of a
co-harboring blaIMP-16 and either blaKPC-2 or blaKPC-35, which wre imported from Peru to Spain, highlighting a threat due to the capacity of spreading carbapenem-resistance via plasmid conjugation.
Introduction
Real-life data about cefiderocol use to treat extensively drug-resistant bacteria are scarce. We aim to report our early experience in patients with difficult-to-treat infections and ...limited therapeutic options.
Methods
Patients treated with cefiderocol from March 2018 to April 2022 in a tertiary-care hospital in Spain were included. Demographic, clinical, and microbiological data were collected up to 90 days after the end of treatment or until death. Survival status was recorded at 30 and 90 days.
Results
Ten patients were included, seven of them critically ill. Ventilator-associated pneumonia (40%) and bacteremia (40%) were the main infections. Multidrug-resistant or extensively drug-resistant
P. aeruginosa
was the most frequently isolated pathogen (70%, of which six patients were infected with bacteria with difficult-to-treat resistance), followed by
A. baumannii
,
E. coli
, and
A. xylosoxidans
(10% each). Seven patients received combination therapy. Clinical and microbiological cures were achieved in 90% and 80% of patients, respectively. Two previously susceptible strains (20%) developed resistance to cefiderocol. Overall, 30-day and 90-day mortality rates were 10% and 50%, respectively, although two out of five patients died due to the infection. No serious adverse events were reported, except for one patient who developed thrombocytopenia.
Conclusion
Cefiderocol seems to be an effective and safe rescue therapy for patients infected with difficult-to-treat pathogens, although there is a definite risk of the emergence of resistance.
Objectives:
The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in ...Catalonia, Spain.
Methods:
Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of
bla
genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids.
Results:
From July 2018 to February 2019, 125
Klebsiella pneumoniae
carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of
Klebsiella pneumoniae
belonging to sequence type ST15 and additional isolates of
K. pneumoniae
,
Escherichia coli
and
Enterobacter
sp. from different STs. All isolates but one carried the
bla
KPC–2
allelic variant. The
bla
KPC–2
gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn
4401
element designated NTE
KPC
-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTE
KPC
-pMC-2-1 module was highly conserved.
Conclusion:
We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15
K. pneumoniae
but also the intra- and inter-species transmission of the
bla
KPC–2
gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.
Several analogues of baringolin (1) were prepared to evaluate the role of its characteristic thiazoline ring and pentapeptidic tail with the aim of defining structure–activity relationships for these ...moieties. The thiazoline ring appeared as a crucial moiety to maintain a broad scope of activities against different Gram-positive bacteria. Further modifications were performed to simplify the structure of the natural product and assess the role of its tail, resulting in an enhanced in vitro performance. Analogue 25, with the thiazole-containing macrocycle and a 4-aminocyclohexane-1-carboxylic acid moiety in place of the pentapeptidic tail, was identified as a much more potent analogue, capable of overcoming the absence of the thiazoline ring and performing extraordinarily well against all strains tested. This is the first library of thiopeptide analogues produced by chemical synthesis alone, which demonstrates the robustness and convenience of the synthetic strategy used.
n
-Butyl-2-cyanoacrylate (NCBA) is an effective therapeutic option for bleeding gastric varices but can sometimes be associated with adverse effects. Persistent bacteraemia is an unusual complication ...with a high mortality rate. We report the case of a 34-year-old man with history of cirrhosis due to Wilson’s disease and severe portal hypertension who was hospitalized as a result of upper gastrointestinal bleeding secondary to fundic varices that were treated with NCBA. Eight weeks after the bleeding episode he was readmitted with a 14-day history of fever and chills.
Pseudomonas aeruginosa
was isolated from blood cultures. He presented with persistent
P. aeruginosa
bacteraemia despite correct antibiotic treatment. A PET-CT scan was performed to rule out infection source, and inflammatory changes at the NCBA site plug were found. A presumptive diagnosis of NCBA plug infection was considered. The case was evaluated by multidisciplinary board and indicated liver transplantation as treatment. However, the patient’s bacteraemia persisted and therefore a vertical gastrectomy to remove the NCBA plug was performed.
P. aeruginosa
was also isolated from the plug. The patient was discharged with ceftazidime plus ciprofloxacin to complete 6 weeks after surgery and he remained asymptomatic. Any foreign material such as NCBA is susceptible to being infected and should be considered in patients with persistent breakthrough bloodstream infections. The individualized treatment is recommended in this complex scenario.
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