Archive for October 2, 2015

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections: are carbapenem alternatives achievable in daily practice?

Int J Infect Dis. 2015 Sep 12;39:62-67.

Pilmis B1, Delory T2, Groh M3, Weiss E4, Emirian A5, Lecuyer H6, Lesprit P2, Zahar JR7.

Author information

1Université Paris Descartes, Hôpital Necker Enfants Malades, Service de Maladies Infectieuses et Tropicales, Paris, France; Groupe Hospitalier Paris Saint-Joseph, Equipe Mobile de Microbiologie Clinique, Paris, France.

2Université Paris XII, Hôpital Henri Mondor, Unité de Contrôle Épidémiologique et Prévention de l’Infection, Créteil, France.

3Université Paris Descartes, Hôpital Cochin, Service de Médecine Interne, Paris, France.

4Université Paris Diderot, Hôpital Beaujon, Département d’Anesthésie-Réanimation, Clichy, France.

5Université Paris XII, Hôpital Henri Mondor, Laboratoire de Bactériologie-Hygiène, Département de Virologie, Bactériologie-Hygiène, Parasitologie-Mycologie, Créteil, France.

6Université Paris Descartes, Hôpital Necker Enfants Malades, Laboratoire de Microbiologie, Paris, France.

7Université d’Angers, Unité de Prévention et de Lutte Contre les Infections Nosocomiales, CHU d’Angers, 4 rue Larrey, 49000 Angers, France. Electronic address: JeanRalph.ZAHAR@chu-angers.fr

Abstract

OBJECTIVES:

To avoid the use of carbapenems, alternatives such as cephamycin, piperacillin-tazobactam, and others are suggested for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) infections. The aim of this study was to evaluate the frequency and the feasibility of antimicrobial de-escalation for ESBL-PE-related infections.

METHODS:

A prospective observational, bi centric cohort study was conducted. All patients with ESBL-PE infections were included. De-escalation was systematically suggested if patients were clinically stable and the isolate was susceptible to possible alternatives.

RESULTS:

Seventy-nine patients were included: 36 (45.6%) were children, 27 (34.1%) were hospitalized in intensive care units, and 37 (47%) were immunocompromised. Urinary tract infections, pneumonia, and catheter-related bloodstream infections accounted for 45.6%, 19%, and 10%, respectively, of the cohort. Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae were the three most frequent causative organisms isolated. On day 5, 47 (59.2%) of the patients were still receiving carbapenems. Antimicrobial resistance (44.7%), infection relapse (26.9%), and clinical instability (19.2%) were the most important reasons for not prescribing alternatives. E. coli-related infections appeared to be a protective factor against maintaining the carbapenem prescription (odds ratio 0.11, 95% confidence interval 0.041-0.324; p=0.0013).

CONCLUSIONS:

In clinical practice, less than 50% of patients with ESBL-PE-related infections were de-escalated after empirical treatment with carbapenems.

PDF

http://www.ijidonline.com/article/S1201-9712(15)00206-4/pdf

 

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October 2, 2015 at 9:10 am

New Delhi Metallo-β-Lactamase 1(NDM-1), the Dominant Carbapenemase Detected in Carbapenem-Resistant Enterobacter cloacae from Henan Province, China.

PLoS One. 2015 Aug 11;10(8):e0135044.

Liu C1, Qin S2, Xu H1, Xu L1, Zhao D2, Liu X3, Lang S4, Feng X1, Liu HM2.

Author information

1Department of clinical laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China; Henan province Key Laboratory of Medicine, Zhengzhou, PR China.

2School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, PR China.

3Department of clinical laboratory, The central hospital of Zhumadian city, Zhumadian, PR China.

4Department of clinical laboratory, The central hospital of Sanmenxia city, Sanmenxia, PR China.

Abstract

The emergence of New Delhi metallo-β-lactamase 1 (NDM-1) has become established as a major public health threat and represents a new challenge in the treatment of infectious diseases.

In this study, we report a high incidence and endemic spread of NDM-1-producing carbapenem-resistant Enterobacter cloacae isolates in Henan province, China.

Eight (72.7%) out of eleven non-duplicated carbapenem-resistant E. cloacae isolates collected between June 2011 and May 2013 were identified as NDM-1 positive.

The blaNDM-1 gene surrounded by an entire ISAba125 element and a bleomycin resistance gene bleMBL in these isolates were carried by diverse conjugatable plasmids (IncA/C, IncN, IncHI2 and untypeable) ranging from ~55 to ~360 kb.

Molecular epidemiology analysis revealed that three NDM-1-producing E. cloacae belonged to the same multilocus sequence type (ST), ST120, two of which were classified as extensively drug-resistant (XDR) isolates susceptible only to tigecycline and colistin.

The two XDR ST120 E. cloacae isolates co-harbored blaNDM-1, armA and fosA3 genes and could transfer resistance to carbapenems, fosfomycin and aminoglycosides simultaneously via a conjugation experiment.

Our study demonstrated NDM-1 was the most prevalent metallo-β-lactamase (MBL) among carbapenem-resistant E. cloacae isolates and identified a potential endemic clone of ST120 in Henan province.

These findings highlight the need for enhanced efforts to monitor the further spread of NDM-1 and XDR ST120 E. cloacae in this region.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4532496/pdf/pone.0135044.pdf

October 2, 2015 at 9:07 am


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