Archive for November 8, 2016

Ceftaroline fosamil: A super-cephalosporin?

Cleve Clin J Med. 2015 Jul;82(7):437-44.

Ghamrawi RJ1, Neuner E2, Rehm SJ3,4.

Author information

1Clinical Pharmacist Specialist, Adult Antimicrobial Stewardship Department of Pharmacy, University Hospitals Case Medical Center, Cleveland, OH, USA.

2Infectious Diseases Clinical Specialist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA. E-mail:

3Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.

4Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.


Ceftaroline is a broad-spectrum cephalosporin used to treat infections caused by a variety of microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Streptococcus pneumoniae.

However, it is not active against Pseudomonas aeruginosa, Bacteroides fragilis, and carbapenem-resistant Enterobacteriaceae.

Its approved indications include community-acquired bacterial pneumonia and bacterial infections of skin and skin structures.

It has also been used off-label to treat osteomyelitis, endocarditis, and meningitis caused by ceftaroline-susceptible organisms.



November 8, 2016 at 8:24 am

Superbugs on Duodenoscopes: the Challenge of Cleaning and Disinfection of Reusable Devices.

J Clin Microbiol. 2015 Oct;53(10):3118-25.

Humphries RM1, McDonnell G2.

Author information

1Department of Pathology & Laboratory Medicine, University of California, Los Angeles, California, USA

2STERIS Corporation, Mentor, Ohio, USA.


Inadequate flexible endoscope reprocessing has been associated with infection outbreaks, most recently caused by carbapenem-resistant Enterobacteriaceae.

Lapses in essential device reprocessing steps such as cleaning, disinfection/sterilization, and storage have been reported, but some outbreaks have occurred despite claimed adherence to established guidelines.

Recommended changes in these guidelines include the use of sterilization instead of high-level disinfection or the use of routine microbial culturing to monitor efficacy of reprocessing.

This review describes the current standards for endoscope reprocessing, associated outbreaks, and the complexities associated with both microbiological culture and sterilization approaches to mitigating the risk of infection associated with endoscopy.


November 8, 2016 at 8:22 am

Role of Clinical Endoscopy in Emphasizing Endoscope Disinfection.

Clin Endosc. 2015 Sep;48(5):351-5.

Ryu JK1, Kim EY2, Kwon KA3, Choi IJ4, Hahm KB5.

Author information

1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

3Department of Gastroenterology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.

4Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

5Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.


Based on the unexpected Middle East respiratory syndrome (MERS) outbreak in Korea, it was established that the virus can spread easily, MERS exposure in hospitals carries an extreme risk for infection as well as mortality, and the sharing of information was essential for infection control. Although the incidence of exogenous infections related to contaminated endoscopes is very low, the majority of published outbreaks have been caused by various shortcomings in reprocessing procedures, including insufficient training or awareness. Ever since the inauguration of “Clinical Endoscopy” as an English-language journal of the Korean Society of Gastrointestinal Endoscopy in 2011, it has published several articles on disinfection of the endoscope and its accessories. Many Science Citation Index journals have also emphasized high-level disinfection of the gastrointestinal endoscope. Many papers have been produced specifically, since the outbreak of carbapenem-resistant Enterobacteriaceae in 2013. The recent review papers concluded that quality control is the most important issue among all the aspects of procedural care, including the efficiency of the gastrointestinal endoscopy unit and reprocessing room. Thorough reprocessing of endoscopes using high-level disinfection and sterilization methods may be essential for reducing the risk of infection.


November 8, 2016 at 8:21 am

Current Issues in Duodenoscope-Associated Infections: Now Is the Time to Take Action.

Clin Endosc. 2015 Sep;48(5):361-3.

Ha J1, Son BK1.

Author information

1Division of Gastroenterology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.


A duodenoscope has a very complex structure that contains many small parts which make reprocessing more challenging. The difficulty in cleaning duodenoscopes contributes to a higher risk of infection than that of conventional gastrointestinal endoscopes. However, a duodenoscope shares similar disinfection process with other gastrointestinal endoscopes. Recent outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography procedures have raised many concerns worldwide. Duodenoscope-associated infections involving CRE or other multidrug-resistant bacteria pose a great threat to patients undergoing procedures using duodenoscopes and should be dealt with a great concern. Updated guidelines regarding cleaning and disinfection of duodenoscope needs to be developed urgently to prevent transmission of infection and ensure patient safety. Meanwhile, healthcare staff should pay special attention to thorough cleaning and disinfection of duodenoscopes


November 8, 2016 at 8:20 am

Tigecycline Treatment for Carbapenem-Resistant Enterobacteriaceae Infections: A Systematic Review and Meta-Analysis.

Medicine (Baltimore). 2016 Mar;95(11):e3126.

Ni W1, Han Y, Liu J, Wei C, Zhao J, Cui J, Wang R, Liu Y.

Author information

1From the Department of Respiratory Diseases (WN, CW, JZ, JC, YL), Chinese PLA General Hospital; Department of Neurology (YH), Chinese PLA 305 Hospital; Department of Vascular and Endovascular Surgery (JL); and Department of Clinical Pharmacology (RW), Chinese PLA General Hospital, Beijing, China.


Carbapenem-resistant Enterobacteriaceae (CRE) infections are prevalent worldwide; they have few effective treatments and this jeopardizes public health. Clinicians often use tigecycline to combat CRE, but its clinical efficacy remains controversial. Therefore, to compare the efficacy and safety of tigecycline in treating CRE infections compared with that of other antimicrobial agents, and to evaluate whether combination therapy and high-dose regimens are beneficial, we performed a systematic review and meta-analysis.PubMed and Embase were searched for controlled trials or cohort studies reporting the efficacy and/or safety of tigecycline-based regimens to treat CRE infections. Statistical analyses were performed using the Comprehensive Meta-Analysis V2.2. All meta-analyses were performed based on fixed- or random-effects model, and the I method was used to assess heterogeneity.Twenty-one controlled studies and 5 single-arm studies were included in this systematic review. With regard to the controlled studies, the tigecycline groups did not differ significantly from the control groups in terms of overall mortality (Odds ratio (OR) = 0.96 [95% confidence interval (CI) = 0.75-1.22; P = 0.73]), clinical response rate (OR = 0.58 [95% CI = 0.31-1.09; P = 0.09]), or microbiological response rate (OR = 0.46 [95% CI = 0.15-1.44; P = 0.18]). Subgroup analyses showed that 30-day mortality was significantly lower in patients who received tigecycline combination therapy than in those who received monotherapy (OR = 1.83 [95% CI = 1.07-3.12; P = 0.03]) and other antibiotic regimens (OR = 0.59 [95% CI = 0.39-0.88; P = 0.01]), respectively. In addition, high-dose tigecycline regimens differed significantly from standard dose schedules in terms of ICU mortality (OR = 12.48 [95% CI = 2.06-75.43; P = 0.006]). The results of the 5 single-arm studies corroborated the findings of the controlled studies.Our results indicated that the efficacy of tigecycline in treating CRE infections is similar to that of other antibiotics. Tigecycline combination therapy and high-dose regimens may be more effective than monotherapy and standard-dose regimens, respectively. Nonetheless, considering that the current available evidence is limited, well-designed randomized controlled trials are urgently needed to clarify the comparative efficacy of tigecycline in treating CRE infections.


November 8, 2016 at 8:18 am

Performance evaluation of three automated identification systems in detecting carbapenem-resistant Enterobacteriaceae.

Ann Clin Microbiol Antimicrob. 2016 Jun 21;15(1):40.

He Q1, Chen W2, Huang L2, Lin Q2, Zhang J2, Liu R2, Li B3.

Author information

1Department of Clinical Laboratory, Fujian Medical University Union Hospital, 29 Xinquan Rd., Fuzhou, 350001, Fujian, People’s Republic of China.

2Medical Technology and Engineering College, Fujian Medical University, Fuzhou, 350004, Fujian, People’s Republic of China.

3Department of Clinical Laboratory, Fujian Medical University Union Hospital, 29 Xinquan Rd., Fuzhou, 350001, Fujian, People’s Republic of China.



Carbapenem-resistant Enterobacteriaceae (CRE) is prevalent around the world. Rapid and accurate detection of CRE is urgently needed to provide effective treatment. Automated identification systems have been widely used in clinical microbiology laboratories for rapid and high-efficient identification of pathogenic bacteria. However, critical evaluation and comparison are needed to determine the specificity and accuracy of different systems. The aim of this study was to evaluate the performance of three commonly used automated identification systems on the detection of CRE.


A total of 81 non-repetitive clinical CRE isolates were collected from August 2011 to August 2012 in a Chinese university hospital, and all the isolates were confirmed to be resistant to carbapenems by the agar dilution method. The potential presence of carbapenemase genotypes of the 81 isolates was detected by PCR and sequencing. Using 81 clinical CRE isolates, we evaluated and compared the performance of three automated identification systems, MicroScan WalkAway 96 Plus, Phoenix 100, and Vitek 2 Compact, which are commonly used in China. To identify CRE, the comparator methodology was agar dilution method, while the PCR and sequencing was the comparator one to identify CPE.


PCR and sequencing analysis showed that 48 of the 81 CRE isolates carried carbapenemase genes, including 23 (28.4 %) IMP-4, 14 (17.3 %) IMP-8, 5 (6.2 %) NDM-1, and 8 (9.9 %) KPC-2. Notably, one Klebsiella pneumoniae isolate produced both IMP-4 and NDM-1. One Klebsiella oxytoca isolate produced both KPC-2 and IMP-8. Of the 81 clinical CRE isolates, 56 (69.1 %), 33 (40.7 %) and 77 (95.1 %) were identified as CRE by MicroScan WalkAway 96 Plus, Phoenix 100, and Vitek 2 Compact, respectively. The sensitivities/specificities of MicroScan WalkAway, Phoenix 100 and Vitek 2 were 93.8/42.4 %, 54.2/66.7 %, and 75.0/36.4 %, respectively.


The MicroScan WalkAway and Viteck2 systems are more reliable in clinical identification of CRE, whereas additional tests are required for the Pheonix 100 system. Our study provides a useful guideline for using automated identification systems for CRE identification.


November 8, 2016 at 8:17 am

Boronic acid disk diffusion for the phenotypic detection of polymerase chain reaction-confirmed, carbapenem-resistant, gram-negative bacilli isolates.

BMC Microbiol. 2016 Jul 1;16(1):135.

Elsherif R1, Ismail D1, Elawady S1, Jastaniah S2, Al-Masaudi S2, Harakeh S3, Karrouf G4,5.

Author information

1Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Giza, Egypt.

2Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.

3Special Infectious Agents Unit-Biosafety Level 3, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.

4Medical Physics Department, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.

5Surgery, Anesthesiology and Radiology Department, Faculty of Veterinary Medicine, Mansoura University, Mansoura, 35516, Dakahlia, Egypt.



The Middle East is regarded as a secondary reservoir for OXA-48 and New Delhi metallo-β-lactamase (NDM) carbapenemases. One of the main challenges in clinical microbiology diagnostics is the detection of carbapenemases. For this reason simple screening methods have been sought to detect carbapenemase producers to determine appropriate therapeutic measures and implement infection control interventions. The present study aimed to evaluate the efficacy of the modified Hodge test (MHT) and a boronic acid-based combined disk test using carbapenems as substrates for the phenotypic determination of OXA-48 and NDM type carbapenemases in 45 epidemiologically unrelated carbapenem-resistant clinical isolates of Klebsiella pneumoniae (13 isolates), Acinetobacter baumanii (20 isolates), and Pseudomonas aeruginosa (12 isolates).


Boronic acid disk test using meropenem as substrate and 600 µg of 3- aminophenylboronic acid (APB) was the most sensitive method (83.33 %) for detection of OXA-48, while the most specific method was MHT (100 %). As regards NDM carbapenemase, boronic acid disk tests using imipenem and 600 µg of APB per disk, and meropenem with 300 or 600 µg of APB were the most  sensitive methods (87.50 %), while the most specific method was the MHT (100 %).


The results of the present study indicate that phenotypic screening with the MHT and the boronic acid disk test may be used to detect OXA-48 and NDM carbapenemases in Gram-negative bacilli clinical isolates, and that these tests can be easily applied in tertiary care settings with minimal infrastructure.


November 8, 2016 at 8:16 am


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