Archive for September 15, 2015

Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

Antimicrob Resist Infect Control. 2015 Jul 25;4:31.

Kaspar T1, Schweiger A2, Droz S3, Marschall J1.

1Department of Infectious Diseases and Prevention, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

2Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.

3Institute for Infectious Diseases, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk.

METHODS:

This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA).

RESULTS:

A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p<0.001), surgical procedure in a hospital abroad (p=0.007), and – on admission to our hospital – active infection (p=0.002), antibiotic treatment (p=0.014) and presence of skin lesions (p=0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization.

CONCLUSION:

Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4514935/pdf/13756_2015_Article_71.pdf

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September 15, 2015 at 3:35 pm

Carbapenem-resistant and carbapenem-susceptible isogenic isolates of Klebsiella pneumoniae ST101 causing infection in a tertiary hospital.

BMC Microbiol. 2015 Sep 3;15(1):177.

Cubero M1,2, Cuervo G3, Dominguez MÁ4,5, Tubau F6,7, Martí S8,9, Sevillano E10, Gallego L11, Ayats J12,13, Peña C14,15, Pujol M16,17, Liñares J18,19, Ardanuy C20,21.

1Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. mcubero@bellvitgehospital.cat.

2Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. mcubero@bellvitgehospital.cat.

3Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. guillermo.cuervos@bellvitgehospital.cat.

4Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. adominguez@bellvitgehospital.cat.

5Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. adominguez@bellvitgehospital.cat.

6Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. f.tubau@bellvitgehospital.cat.

7Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. f.tubau@bellvitgehospital.cat.

8Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. smartinm@bellvitgehospital.cat.

9Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. smartinm@bellvitgehospital.cat.

10Department of Immunology, Microbiology, and Parasitology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Bizkaia, Spain. elena.sevillano@ehu.es.

11Department of Immunology, Microbiology, and Parasitology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Bizkaia, Spain. lucia.gallego@ehu.es.

12Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. jayats@bellvitgehospital.cat.

13Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. jayats@bellvitgehospital.cat.

14Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. cpena@bellvitgehospital.cat.

15Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. cpena@bellvitgehospital.cat.

16Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. mpujol@bellvitgehospital.cat.

17Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. mpujol@bellvitgehospital.cat.

18Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. fina.linares@bellvitgehospital.cat.

19Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. fina.linares@bellvitgehospital.cat.

20Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. c.ardanuy@bellvitgehospital.cat.

21Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. c.ardanuy@bellvitgehospital.cat.

Abstract

BACKGROUND:

In this study we describe the clinical and molecular characteristics of an outbreak due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) producing CTX-M-15 and OXA-48 carbapenemase. Isogenic strains, carbapenem-susceptible K. pneumoniae (CS-KP) producing CTX-M-15, were also involved in the outbreak.

RESULTS:

From October 2010 to December 2012 a total of 62 CR-KP and 23 CS-KP were isolated from clinical samples of 42 patients (22 had resistant isolates, 14 had susceptible isolates, and 6 had both CR and CS isolates). All patients had underlying diseases and 17 of them (14 patients with CR-KP and 3 with CS-KP) had received carbapenems previously. The range of carbapenem MICs for total isolates were: imipenem: 2 to >32 μg/ml vs. <2 μg/ml; meropenem: 4 to >32 μg/ml vs. <2 μg/ml; and ertapenem: 8 to >32 μg/ml vs. <2 μg/ml. All the isolates were also resistant to gentamicin, ciprofloxacin, and cotrimoxazole. Both types of isolates shared a common PFGE pattern associated with the multilocus sequence type 101 (ST101). The bla CTX-M-15 gene was detected in all the isolates, whereas the bla OXA-48 gene was only detected in CR-KP isolates on a 70 kb plasmid.

CONCLUSIONS:

The clonal spread of K. pneumoniae ST101 expressing the OXA-48 and CTX-M-15 beta-lactamases was the cause of an outbreak of CR-KP infections. CTX-M-15-producing isolates lacking the bla OXA-48 gene coexisted during the outbreak.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559076/pdf/12866_2015_Article_510.pdf

September 15, 2015 at 3:33 pm

Complete Genome Sequence of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Siphophage Sushi.

Genome Announc. 2015 Sep 3;3(5). pii: e00994-15.

Nguyen DT1, Lessor LE1, Cahill JL1, Rasche ES1, Kuty Everett GF2.

1Center for Phage Technology, Texas A&M University, College Station, Texas, USA.

2Center for Phage Technology, Texas A&M University, College Station, Texas, USA cpt@tamu.edu.

Abstract

Klebsiella pneumoniae is a Gram-negative bacterium in the family Enterobacteriaceae.

It is associated with numerous nosocomial infections, including respiratory and urinary tract infections in humans.

The following reports the complete genome sequence of K. pneumoniae carbapenemase-producing K. pneumoniae T1-like siphophage Sushi and describes its major features.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559738/pdf/e00994-15.pdf

September 15, 2015 at 3:31 pm


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