Antimicrobial resistance patterns of uropathogens among children in Istanbul, Turkey

Urinary tract infections are a common cause of end-stage renal disease in Turkey. This prospective study investigated the antibiotic resistance patterns of uropathogens in order to recommend appropriate therapeutic protocols for children with urinary tract infections in Istanbul, Turkey. Between October 2007 and October 2008, children presenting with a first episode of urinary tract infection to a pediatric outpatient clinic were enrolled in the study. Urine samples were cultured, and antimicrobial susceptibility testing was performed. Children with proven urinary tract infections underwent imaging studies where available. A total of 126 children with a first episode of community-acquired urinary tract infection were enrolled in the study. The median age was 60.6 months; 84.1% of the children were female. Of the 126 urine samples, Escherichia coli was the leading uropathogen (81.7%), followed by Proteus spp (7.1%), Klebsiella spp (4.0%), Enterococcus spp (3.2%), Enterobacter spp (2.4%), and Pseudomonas spp (1.6%). Among the isolated uropathogens, resistance to ampicillin (85.0%), amoxicillin-clavulanate (73.8%), cefazolin (37.3%) and trimethoprim-sulfamethoxazole (42.9%) was remarkable. A large number of Enterococcus species were resistant to all antimicrobial agents except vancomycin. A country-based evaluation of antibiotic susceptibility is needed to modify antibiotic treatment. Resistance to antimicrobial agents commonly used to treat urinary tract infections (nitrofurantoin, cefixime) is less a problem than resistance to other antimicrobials (aminopenicillins, cephalosporins, trimethoprim-sulfamethoxazole) frequently prescribed for other indications.     

Increasing antimicrobial resistance in gram-negative bacilli isolated from patients in intensive care units

BACKGROUND: We investigated gram-negative bacilli from patients in intensive care units to determine whether antimicrobial resistance was increasing. METHODS: Minimal inhibitory concentrations were determined by broth microdilution on 334 gram-negative bacilli collected in 1990, 1995, and 1998. RESULTS: During the 3 study years, the types of gram-negative bacilli encountered in our intensive care units changed with proportional increases of Pseudomonas sp and decreases of inducible enterics. Dramatic increases in resistance for ceftazidime, cefotaxime, and piperacillin were paralleled between respiratory-tract isolates and inducible enterics. By 1998, ticarcillin was more active than piperacillin against most isolates except Escherichia coli and Klebsiella sp, and most isolates became more resistant to gentamicin and tobramycin. CONCLUSIONS: Continuous changes in the types of gram-negative bacilli and antimicrobial resistance complicate empirical selection of antimicrobials in the intensive care units. These complications will place more emphasis on communication and strategy formations among health care workers (nurses, physicians, laboratorians, and pharmacists) in an effort to treat infections in a timely and effective manner.     

重症监护病房与普通病房细菌分布及耐药性比较

目的：比较呼吸科重症监护病房（RICU）、外科重症监护病房（SICU）以及普通呼吸科病房检出细菌流行病学分布及耐药特点。方法：采用纸片扩散法（K—B法）,对我院RICU、普通呼吸科病房、SICU患者中1523株分离细菌进行药敏试验,并用WHONET软件5-4进行分析。结果：1523株细菌中革兰阴性菌1112株（73．0％）：革兰阳性菌411株（27．0％）。RICU、普通呼吸科病房和SICU分别检出细菌383、441和699株．三大病房金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）流行率分别占96．7％、64.3％和98．4％,未检出对万古霉素或替考拉宁耐药株．SICU检出耐万古霉素屎肠球菌4株。肺炎克雷伯菌产超广谱B内酰胺酶（ESBLs）菌株在RICU、普通呼吸科病房和SICU的流行率分别为21．6％、10．6％和45．9％;非发酵菌分别占革兰阴性菌的75．0％、53．0％和54．0％。三大病房比较,普通病房各细菌耐药率均较低;RICU和SICU鲍曼不动杆菌仅对头孢哌酮-舒巴坦耐药率低（〈20％）,对其余临床常用抗生素耐药率均高于50．0％;SICU检出铜绿假单胞菌对临床常用抗假单胞菌药物耐药率均高于40．0％。结论：三大病房检出细菌均以革兰阴性菌为主,多重耐药非发酵菌是常见细菌。葡萄球菌属在革兰阳性菌检出中占主导．已发现耐万古霉素屎肠球菌菌株。     

Antimicrobial resistance and antibiotic consumption in intensive care units,Switzerland, 2009 to 2018

BackgroundIntensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR).AimWe aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA.MethodsWe analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009–2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA.ResultsAmong 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0–1.02; p = 0.004).DiscussionIn Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.     

Drug resistance in intensive care units

Intensive care units (ICUs) are generally considered epicenters of antibiotic resistance and the principal sources of outbreaks of multi-resistant bacteria. The most important risk factors are obvious, such as excessive consumption of antibiotics exerting selective pressure on bacteria, the frequent use of invasive devices and relative density of a susceptible patient population with severe underlying diseases. Infections due to antibiotic-resistant bacteria have a major impact on morbidity and health-care costs. Increased mortality is not uniformly shown for all of these organisms: Methicillin-resistant Staphylococcus aureus (MRSA) seems to cause significantly higher mortality, in contrast to vancomycin-resistant enterococci (VRE). Therefore it is essential to diminish these potential risk factors, especially by providing locally adapted guidelines for the prudent use of antibiotic therapy. A quality control of antimicrobial therapy within a hospital, and especially within the ICU, might help to minimize the selection of multidrug-resistant bacteria. The restricted use of antimicrobial agents in prophylaxis and therapy has also been shown to have at least temporal effects on local resistance patterns. New approaches to the problem of drug resistance in ICUs are badly needed.     

Antimicrobial resistance in the intensive care unit

Antimicrobial resistance remains a major clinical problem in the intensive care unit despite the introduction of potent new antibiotics and the application of infection control measures. Impaired antibiotic permeability, antibiotic inactivation and alteration of antibiotic target sites, typically in concert, are mechanisms by which this resistance occurs. Resistance traits may be chromosomally mediated, in which case they may be expressed constitutively or inducibly, or may be mediated by plasmids and/or transposons that may confer resistance to multiple drugs and facilitate spread to other organisms. Bacteria in which clinically significant resistance has now become a potential problem include methicillin-resistant staphylococci, enterococci, a wide variety of Enterobacteriaceae, Pseudomonas aeruginosa, Pseudomonas cepacia, and Xanthomonas (Pseudomonas) maltophilia. Judicious limitation in the use of antimicrobials, especially in prophylactic regimens; use of antibiotics in appropriate doses; and, where possible, avoidance of drugs to which resistance has been shown to emerge rapidly in a specific clinical setting will help to minimize the evolution and spread of resistant bacterial isolates.     

Antimicrobial resistance among Clostridium perfringens isolated from various sources in Thailand

Antimicrobial resistance among Clostnridium perfringens isolated from feces of humans and pigs, food and other environmental sources was examined by testing of 201 PCR-confirmed strains for resistance to 7 antimicrobial agents. The minimal inhibitory concentrations (MICs) were determined by the agar dilution method. Overall, C. perfringens showed the highest resistance to tetracycline (56.2%), followed by imipenem (24.9%), metronidazole (9.5%), penicillin G (9%), vancomycin (4.5%), chloramphenicol (3%) and ceftriaxone (1%). The majority of the isolated strains from pig feces (77.8%), environment (72.7%), human feces (44.9%) and food (28%) showed resistance to tetracycline. Strains isolated from human feces only showed low resistance to ceftriaxone (2.5%) and vancomycin (10.1%). Penicillin G had high activity, with overall MIC50 and MIC90 of 0.06 and 1.0 microg/ml, respectively, and low rate of resistance (10-12% for strains isolated from humans, animals and food). Among 62.7% of antimicrobial resistant strains, 39.3% were resistant to a single drug and 23.4% were multiple-drug resistant (MDR). Of overall 47 MDR strains, 63.8% were derived from human feces and were resistant to two to six drugs.     

Carbapenem-resistant Gram-negative bacteria isolated from poultry samples: a cross-sectional study

Background

Gram-negative bacteria are a common cause of human infections and can be transmitted through food handling and food consumption. Infection with carbapenemase-producing Gram-negative bacteria is becoming a worldwide threat, and is hard to cure because the broad-spectrum carbapenem antibiotics are considered a last resort for treatment. This research aimed to determine carbapenem resistance among Gram-negative bacteria from poultry samples.

Evaluation of risk factors for mortality in intensive care units: a prospective study from a referral hospital in Turkey

BACKGROUND: The aim of the clinical practice is to decrease the mortality rate in intensive care units. Determination of the risk factors for mortality may provide useful guidance for intensive care patients. This study sought to find mortality-related risk factors in intensive care units. OBJECTIVE: To investigate risk factors for mortality in intensive care units (ICUs). METHODS: The prospective study was performed from May 2002 to November 2002 in the surgical and medical ICUs of the Ankara Numune Education and Research Hospital. Three hundred thirty-four patients who were followed in the ICUs for at least 48 hours were enrolled in this study. Those patients who died within 48 hours of ICU discharge were included in the mortality analysis. RESULTS: The overall mortality rate in the ICUs was 46.7%. Among the 334 patients, 104 (31.1%) had ICU-acquired infections. The mortality rate was significantly higher in the patients with nosocomial infections (66.3%) than in the patients without nosocomial infections (37.8%) ( P < .001). The mean age, sex, acute physiology and chronic health evaluation (APACHE) II score, trauma and intraabdominal pathology, nosocomial infection, stay in the medical/surgical ICU, coma, TISS score, use of steroid or chemotherapy, use of antibiotic, and serum urea >50 mg/dL and creatinine >1.2 mg/dL levels were associated with mortality in the univariate analysis. Eight variables were determined as independent risk factors: presence of nosocomial infection (hazard ratio (HR) 0.40; 95% confidence interval (CI), 0.27-0.61), mean age (HR, 1.01; 95% CI, 1.00-1.02), mean APACHE II score (HR, 1.99; 95% CI, 1.50-2.64), mechanical ventilation (HR, 1.98; 95% CI, 1.33-2.95), stay in the medical/surgical ICU (HR, 0.41; 95% CI, 0.27-0.61), enteral nutrition (HR, 0.43; 95% CI, 0.29-0.65), tracheostomy (HR, 0.26; 95% CI, 0.094-0.75), and use of steroid or chemotherapy (HR, 1.61; 95% CI, 1.13-2.29). Nosocomial pneumonia (HR, 0.59; 95% CI, 0.38-0.92) and sepsis (HR, 0.29; 95% CI, 0.16-0.51) were related with mortality. CONCLUSION: The most important risk factors of mortality were observed as nosocomial infection, older age, high APACHE II score, mechanical ventilation, enteral nutrition, tracheostomy, and use of steroids or chemotherapy.     

Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

ObjectivThisobservational study described the characterization of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units. The demonstration of isolated microorganism resistance to antibiotics and a time-trend analysis of infection comparing a 48-month period were also other objectives.MethodSemi-quantitative assays of 1254 samples taken from 741 ventilated patients were performed, while pathogens were identified using the Enterotube II assay and VITEK 2 Compact equipment. Bacterial resistance to antibiotics was assessed by the Kirby-Bauer disc diffusion method and time-trend analysis of infection was based on data recorded by hospital microbiology laboratories.ResultsThe most prevalent isolated bacteria from the patient's lower respiratory tract were with Gram-negative bacteria (67.8%) mostly represented by: Acinetobacter spp. (25.2%), Pseudomonas spp. (18.3%) and Klebsiellas spp. (9.4%). Acinetobacter spp. showed moderate high to very high resistance to ceftriaxone (CRO), gentamicin (CN), amikacin (AK), meropenem (MRP), aztreonam (ATM) and piperacillin/tazobactam (TZP). Some isolates of Acinetobacter spp. resistant to colistin (CS) were identified in this patient population. Pseudomonas spp. and Klebsiella spp. were very highly resistant to ampicillin/sublactam (AMS) and with moderate or low resistance to CRO, ATM, MRP, AK, CN and TZP. A decrease in the Pseudomonas spp. prevalence rate was observed, whereas an increase in Acinetobacter spp. and Klebsiella spp. prevalence rates were observed in a 48-month period.ConclusionThis research corroborated that these nosocomial infections are a relevant medical problem in our context. The most prevalent bacterial infections in the lower respiratory tract of ventilated patients were by Acinetobacter spp., Pseudomonas spp. and Klebsiella spp. The panel of antibiotics used as preventive therapy was not the solution of infections and probably induced drug-resistance mechanisms in these isolated microorganisms.     

下呼吸道感染革兰阴性杆菌分布及耐药情况分析

目的了解近两年我院下呼吸道感染患者革兰阴性杆菌的菌群分布及耐药情况。方法对我院下呼吸道感染住院患者的痰标本所分离的病原菌的菌群分布和耐药性进行统计分析。结果共收集2026株病原菌,其中革兰阴性杆菌1494株（73.9%）,革兰阴性杆菌前五位分别是鲍曼不动杆菌344株（23.03%）,铜绿假单胞菌334株（22.36%）,肺炎克雷伯菌316株（21.15%）,大肠埃希菌178株（11.91%）及阴沟肠杆菌90株（6.02%）。各类病原菌均存在不同程度的多药耐药现象。结论我院下呼吸道感染的革兰阴性杆菌均存在严重耐药问题,及时监测病原菌变化及耐药趋势对指导临床用药至关重要。     

云南大理医院ICU产ESBLs细菌基因型及耐药性分析

目的了解2010年大理学院附属医院重症监护病房(ICU)产超广谱β-内酰胺酶(ESBLs)细菌基因型及耐药情况。方法 2010年1～12月ICU分离的大肠埃希菌43株,肺炎克雷伯菌27株,采用CLSI(2009)推荐的纸片扩散法进行ESBLs表型检测,基因型检测采用PCR法,药敏试验采用MIC法。结果 70株细菌中检出32株产ESBLs细菌,检出率为45.71%;PCR结果显示CTX-M、SHV、TEM-1基因型分别有21株、14株和5株,6株细菌携带2种以上基因型;产酶株对亚胺培南均敏感,对氨苄西林耐药率达100%,对头孢菌素和环丙沙星的耐药率亦较高(50%～85%),而对氨苄西林/舒巴坦、哌拉西林/舒巴坦和丁胺卡那耐药率较低(<25%)。结论 ICU产ESBLs菌检出率较高,耐药情况严重,临床医疗过程中应合理使用抗生素,同时加强产酶株的监测。     

Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey

Background  

Several studies have reported higher rates of antimicrobial resistance among isolates from intensive care units than among isolates from general patient-care areas. The aims of this study were to review the pathogens associated with nosocomial infections in a surgical intensive care unit of a university hospital in Turkey and to summarize rates of antimicrobial resistance in the most common pathogens. The survey was conducted over a period of twelve months in a tertiary-care teaching hospital located in the south-eastern part of Turkey, Gaziantep. A total of 871 clinical specimens from 615 adult patients were collected. From 871 clinical specimens 771 bacterial and fungal isolates were identified.