Betalactamasas de espectro extendido en las infecciones del tracto urinario causadas por enterobacterias: aproximación a su conocimiento y pautas de actuación

García-Tello, A.; Gimbernat, H.; Redondo, C.; Arana, David M.; Cacho, J.; Angulo, Javier C.

doi:10.1016/j.acuro.2014.05.004

Cited by 20 publications

(23 citation statements)

References 22 publications

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“…The region has four distinct ecosystems inhabited by diverse communities of miners, pastoralists, agrarians, and fishermen. Given the public health importance of ESBL-producing gram-negative bacteria, the role that KCMC plays in guiding empirical treatment, and the need for therapeutic decisions to be based on guidelines which are derived from local epidemiological data [ 33 ], a study on ESBL-producing gram-negative bacteria in KCMC was found to be imperative. In our setting, little attention is paid to gram-negative bacteria, although they have been reported in east Africa and elsewhere to be causes of outbreaks and to be main contributors of ESBL resistance due to production of CTX-M [ 13 , 34 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Sonda

Kumburu

Zwetselaar

et al. 2018

Eur J Clin Microbiol Infect Dis

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Emergence and spread of extended spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, mainly due to CTX-M, is a major global public health problem. Patients infected with ESBL-producing gram-negative bacteria have an increased risk of treatment failure and death. We investigated the prevalence and risk factors for CTX-M gram-negative bacteria isolated from clinical specimens of patients hospitalized at a tertiary care hospital in Kilimanjaro, Tanzania. Isolated gram-negative bacteria from inpatients admitted at Kilimanjaro Christian Medical Centre (KCMC) between August 2013 and August 2015 were fully genome sequenced. The prevalence of ESBL-producing gram-negative bacteria was determined based on the presence of blaCTX-M. The odds ratio (OR) and risk factors for ESBL-producing gram-negative bacteria due to CTX-M were assessed using logistic regression models. The overall CTX-M prevalence (95% CI) was 13.6% (10.1–18.1). Adjusted for other factors, the OR of CTX-M gram-negative bacteria for patients previously hospitalized was 0.26 (0.08–0.88), p = 0.031; the OR for patients currently on antibiotics was 4.02 (1.29–12.58), p = 0.017; the OR for patients currently on ceftriaxone was 0.14 (0.04–0.46), p = 0.001; and the OR for patients with wound infections was 0.24 (0.09–0.61), p = 0.003. The prevalence of ESBL-producing gram-negative bacteria due to CTX-M in this setting is relatively low compared to other previous reports in similar settings. However, to properly stop further spread in the hospital, we recommend setting up a hospital surveillance system that takes full advantage of the available next-generation sequencing facility to routinely screen for all types of bacterial resistance genes.

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Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Sonda

Kumburu

Zwetselaar

et al. 2018

Eur J Clin Microbiol Infect Dis

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“…Approaches to dosing vary: NICE guidelines suggest a single dose of 3 g in women and two 3 g doses (at an interval of 3 days) in men [ 14 ], but the UK product licence is for a single dose only and European guidelines produced by the European Association of Urology do not recommend fosfomycin for use in men at all [ 16 ]. Although the UK recommendation is restricted to uncomplicated lower UTI [ 3 , 14 , 17 , 18 ], and the focus of existing guidance is for out-patient treatment, fosfomycin has also been used with some success in patients with risk factors for persistent or recurrent UTI [ 11 , 12 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Oral fosfomycin for treatment of urinary tract infection: a retrospective cohort study

et al. 2016

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BackgroundFosfomycin is increasingly called upon for the treatment of multi drug-resistant (MDR) organisms causing urinary tract infection (UTI). We reviewed oral fosfomycin use for UTI treatment in a large UK hospital. The primary goal was to audit our clinical practice against current national guidelines. Secondary aims were to identify factors associated with treatment failure, and to investigate the potential for using fosfomycin in patients with co-morbidities.MethodsWe retrospectively studied 75 adult patients with UTI who received 151 episodes of treatment with fosfomycin from March 2013 to June 2015. We collected clinical data from our electronic patient record, and microbiology data pre- and post- fosfomycin treatment. We recorded additional data for patients receiving prolonged courses in order to make a preliminary assessment of safety and efficacy. We also reviewed >18,000 urinary tract isolates of Escherichia coli and Klebsiella spp. processed by our laboratory over the final year of our study period to determine the prevalence of fosfomycin resistance.ResultsThere was a significant increase in fosfomycin treatment episodes over the course of the study period. Co-morbidities were present in 71 % of patients. The majority had E. coli infection (69 %), of which 59 % were extended spectrum beta-lactamase (ESBL)-producers. Klebsiella infections were more likely than E. coli to fail treatment, and more likely to be reported as fosfomycin resistant in cases of relapse following treatment. There were no adverse events in five patients treated with prolonged fosfomycin. Among all urinary isolates collected over a year, fosfomycin resistance was documented in 1 % of E. coli vs. 19 % of Klebsiella spp. (p < 0.0001).ConclusionsWe report an important role for oral fosfomycin for MDR UTI treatment in a UK hospital population, and based on the findings from this study, we present our own local guidelines for its use. We present preliminary data suggesting that fosfomycin is safe and effective for use in patients with complex comorbidities and over prolonged time periods, but may be less effective against Klebsiella than E. coli.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1888-1) contains supplementary material, which is available to authorized users.

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“…Advanced age, male sex, diabetes, use of indwelling catheters or nasogastric tubes, previous hospitalisation or nursing home residence and previous antibiotic have been proposed as risk factors for ESBL-producing bacteria [7,11,13,14]. According to our data, immunosuppression and urinary stone were risk factors for ESBL-producing bacteria, in both uni- and multivariate analysis.…”

Section: Discussionmentioning

confidence: 82%

“…There are also high resistance rates to quinolones among ESBL-producing bacteria, 83-90% in studies from Spain [13,21], and up to 84% in some reviews conducted in some European countries [19,22]. The resistance to these drugs has been related to the presence of a conjugative plasmid associated with the ESBL phenotype [12].…”

Section: Discussionmentioning

confidence: 99%

Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns

et al. 2015

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Introduction: Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward. Material and Methods: We carried out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae. Results: The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems. Conclusions: ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.

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Betalactamasas de espectro extendido en las infecciones del tracto urinario causadas por enterobacterias: aproximación a su conocimiento y pautas de actuación

Cited by 20 publications

References 22 publications

Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Prevalence and risk factors for CTX-M gram-negative bacteria in hospitalized patients at a tertiary care hospital in Kilimanjaro, Tanzania

Oral fosfomycin for treatment of urinary tract infection: a retrospective cohort study

Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns

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