Current antimicrobial susceptibility testing for beta-lactamase-producing Enterobacteriaceae in clinical settings

Pereckaitė, Laura; Tatarūnas, Vacis; Giedraitienė, Agnė

doi:10.1016/j.mimet.2018.07.014

Cited by 24 publications

(13 citation statements)

References 109 publications

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“…Secondly, the molecular analysis of antibiotic resistance genes could not be performed due to insufficient financial resources. In order to detect resistance by phenotypic tests, the standard two-step algorithm was performed consisting of (i) initial screening with antibiotic containing media, and (ii) further evaluation using a confirmatory test [44]. This strategy generally gives accurate results.…”

Section: Discussionmentioning

confidence: 99%

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Ruh

Zakka

Hoti

et al. 2019

Antimicrob Resist Infect Control

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Background Antibiotic-resistant Enterobacteriaceae in the gastrointestinal flora can lead to infections with limited therapeutic options. Also, the resistant bacteria can be transferred from colonized persons to others. The present study was conducted to search the fecal carriage rates of (i) Enterobacteriaceae that produce extended-spectrum β-lactamase (ESBL-E) and/or (ii) plasmid-mediated AmpC β-lactamase (pAmpC-E), (iii) ciprofloxacin-resistant Enterobacteriaceae (CIP-RE), and (iv) carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE) in Northern Cyprus. Methods A total of 500 community-dwellers were recruited from consecutive admissions to the clinical laboratories of four hospitals. One rectal swab or stool sample was collected from each participant. A questionnaire was applied to evaluate possible risk factors associated with intestinal colonization of resistant bacteria. The samples were cultured on antibiotic containing media to screen for resistant bacteria colonization. The bacterial colonies that grew on the plates were subjected to further phenotypic tests to confirm the resistance. Results Of 500 volunteers, ESBL-E, pAmpC-E, CIP-RE and CIRE carriage were detected in 107 (21.4%), 15 (3.0%), 51 (10.2%) and six (1.2%) participants, respectively. Escherichia coli was the most commonly recovered species among Enterobacteriaceae isolates. A significant proportion of ESBL-producing E. coli isolates ( n = 22/107; 20.6%) was found to be co-resistant to CIP ( p = 0.000, OR 3.21, 95% CI 1.76–5.87). In this study, higher socioeconomic status (CIP-RE: p = 0.024, OR 1.96, 95% CI 1.09–3.53), presence of gastrointestinal symptoms (CIRE: p = 0.033; OR 6.79, 95% CI 1.34–34.39), antibiotic use (ESBL-E: p = 0.031; OR 1.67, 95% CI 1.04–2.67; and CIRE: p = 0.033; OR 6.40, 95% CI 1.16–35.39), and travelling abroad (pAmpC-E: p = 0.010; OR 4.12, 95% CI 1.45–11.66) were indentified as risk factors. Conclusion The study indicates that resistant Enterobacteriaceae isolates are carried by humans in the community. To prevent further spread of resistance, rational use of antibiotics should be encouraged, and antibiotic resistance should be carefully monitored in Northern Cyprus.

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Section: Discussionmentioning

confidence: 99%

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Ruh

Zakka

Hoti

et al. 2019

Antimicrob Resist Infect Control

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“…Amoxicillin + Clavulanic acid (Augmentin), Cefotaxime, Ceftazidime, Ceftriaxone and Aztreonam were the antibiotic discs utilized. All Augmentin resistant enterobacteria and one third generation cephalosporin were seen in this study as the producers of ESBL (Pereckaite et al, 2018).…”

Section: Antimicrobial Assaysmentioning

confidence: 59%

Coexistence between (TOHO-type and BES-type) extended-spectrum -lactamase genes of identified enterobacteria at Saint Camille Hospital, Ouagadougou, West Africa

Amana¹,

Serge²,

Wend-Kuni³

et al. 2019

Int. J. Genet. Mol. Biol.

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Coexistence between the TOHO-type and Brazilian extended-spectrum (BES)-type of extendedspectrum β-lactamase (ESBL)-produced by bacteria caused public health issue. Several studies have been reported on the coexistence between blaTEM, blaCTX-M and blaSHV genes in ESBL in broad spectrum enterobacteria. The present study involved the prevalence of coexistence of blaTOHO and blaBES genes in enterobacteria identified in hospitalized and outpatients at Saint Camille Hospital in Ouagadougou (Burkina Faso). Firstly, the study was led by microbiological identification of enterobacteria, secondly antibiogram was performed by diffusion method and finally the molecular characterization was done by conventional polymerase chain reaction (PCR) to search for antibiotic resistance genes blaTOHO and blaBES. The ultraviolet (UV) lamp (Gene Flash) for the photography of gels allowed the visualization of specific bands of TOHO and BES genes. Among 250 strains of Gram negative bacilli collected, 60 strains (24.1%) showed resistance profile to antibiotics used. Molecular characterization showed the coexistence between blaTOHO and blaBES genes in 53.3% in bacteria strains carried by the patients. The highest prevalence was observed in Escherichia coli (34.4%) and Klebsiella pneumoniae (21.9%) strains. For the first time in Ouagadougou, Burkina Faso, this study therefore established the coexistence between blaTOHO and blaBES genes in ESBL produced enterobacteria at Saint Camille Hospital.

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“…Thus, optimal use of these new and expensive anti-infective agents requires knowledge of the mechanism of carbapenem resistance in the target organism. Yet, published data suggest that differentiation among beta-lactamase classes in CPOs often is not performed ( Lutgring and Limbago, 2016 ; Miller et al., 2017 ; Burnham et al., 2017 ; Pereckaite et al., 2018 ). The underutilization of these tests is a critical problem for optimal use of the newer antimicrobial agents globally.…”

Section: Differentiating Among Ambler Classes Of Carbapenem-resistance Genesmentioning

confidence: 99%

“…There are several reasons why laboratories may be reluctant to use molecular tests to detect CPOs and differentiate among CRG classes in resistant bacterial isolates. The cost of the tests is often cited as an issue, especially for the genotypic assays ( Burnham et al., 2017 ; Pereckaite et al., 2018 ) but the reluctance to use molecular tests clearly goes beyond this issue as syndromic test panels are broadly used in clinical microbiology laboratories despite their increased costs over traditional identification methods ( Dien Bard and McElvania, 2020 ). For many laboratories in the United States, there is a sense that differentiation among CRG is simply unnecessary, as it is presumed that CPOs are likely to be KPC-producers ( Miller et al., 2017 ).…”

Section: Reluctance To Using Molecular Diagnostic Tests For Cpo Detectionmentioning

confidence: 99%

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Using Molecular Diagnostics to Develop Therapeutic Strategies for Carbapenem-Resistant Gram-Negative Infections

Tenover¹

2021

Front. Cell. Infect. Microbiol.

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Infections caused by multidrug-resistant Gram-negative organisms have become a global threat. Such infections can be very difficult to treat, especially when they are caused by carbapenemase-producing organisms (CPO). Since infections caused by CPO tend to have worse outcomes than non-CPO infections, it is important to identify the type of carbapenemase present in the isolate or at least the Ambler Class (i.e., A, B, or D), to optimize therapy. Many of the newer beta-lactam/beta-lactamase inhibitor combinations are not active against organisms carrying Class B metallo-enzymes, so differentiating organisms with Class A or D carbapenemases from those with Class B enzymes rapidly is critical. Using molecular tests to detect and differentiate carbapenem-resistance genes (CRG) in bacterial isolates provides fast and actionable results, but utilization of these tests globally appears to be low. Detecting CRG directly in positive blood culture bottles or in syndromic panels coupled with bacterial identification are helpful when results are positive, however, even negative results can provide guidance for anti-infective therapy for key organism-drug combinations when linked to local epidemiology. This perspective will focus on the reluctance of laboratories to use molecular tests as aids to developing therapeutic strategies for infections caused by carbapenem-resistant organisms and how to overcome that reluctance.

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Current antimicrobial susceptibility testing for beta-lactamase-producing Enterobacteriaceae in clinical settings

Cited by 24 publications

References 109 publications

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Extended-spectrum β-lactamase, plasmid-mediated AmpC β-lactamase, fluoroquinolone resistance, and decreased susceptibility to carbapenems in Enterobacteriaceae: fecal carriage rates and associated risk factors in the community of Northern Cyprus

Coexistence between (TOHO-type and BES-type) extended-spectrum -lactamase genes of identified enterobacteria at Saint Camille Hospital, Ouagadougou, West Africa

Using Molecular Diagnostics to Develop Therapeutic Strategies for Carbapenem-Resistant Gram-Negative Infections

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