Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis

Peng, Dan; Li, Xuan; Pin, Liu; Luo, Mei; Chen, Shuai; Su, Kewen; Zhang, Zhongshuang; He, Qiang; Qiu, Jingfu; Li, Yingli

doi:10.1016/j.ajic.2018.07.012

Cited by 46 publications

(39 citation statements)

References 32 publications

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“…High rates of resistance in intensive care is not surprising as ICU usually has the most critically ill patients with an urgent need for antibiotics [30]. Several studies have shown high rates of resistance in ICUs, and multi-drug resistant organisms like Acinetobacter, Klebsiella and Pseudomonas aeruginosa are commonly seen in ICU patients [31, 32]. These bacteria had an increased trend in this study.…”

Section: Discussionmentioning

confidence: 55%

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

Wang

Little

et al. 2019

Antimicrob Resist Infect Control

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BackgroundWe sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China.MethodsCross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance.ResultsIn total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96–5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22–10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71–0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance.ConclusionsAntibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.

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Section: Discussionmentioning

confidence: 55%

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

Wang

Little

et al. 2019

Antimicrob Resist Infect Control

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“…CA-bacteriuria is correlated with the duration, mainly 6 days, of catheterization [1,6]. The risk of CA-UTI increases in the intensive care unit (ICU), where incidence rates range between 3.6 and 14.71 per 1000 urine catheter days [1,3,5,7,8]. The first step in the pathogenesis of CA-UTI is the endoluminal or exoluminal colonization of the urinary catheter, which is more frequently involved than the blood-borne pathway [1,6,9].…”

Section: Introductionmentioning

confidence: 99%

A prospective study on the pathogenesis of catheter-associated bacteriuria in critically ill patients

et al. 2021

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Background Updating the pathogenesis of catheter-associated bacteriuria (CA-bacteriuria) in the intensive care unit (ICU) is needed to adapt prevention strategies. Our aim was to determine whether the main pathway of CA-bacteriuria in ICU patients was endoluminal or exoluminal. In a prospective study, quantitative urine cultures were sampled from catheter sampling sites, collector bags and the catheter outer surface near the meatus from days 1 to 15 after catheterization. The endoluminal pathway was CA-bacteriuria (defined as 102 CFU/mL) first in collector bags and then in catheters. The exoluminal pathway was CA-bacteriuria first in catheters, on day 1 in early cases and after day 1 in late cases. Results Of 64 included patients, 20 had CA-bacteriuria. Means of catheterization days and incidence density were 6.81 days and 55.2/1000 catheter-days. Of 26 microorganisms identified, 12 (46.2%) were Gram positive cocci, 8 (30.8%) Gram negative bacilli and 6 yeasts. Three (11.5%) CA-bacteriuria were endoluminal and 23 (88.5%) exoluminal, of which 10 (38.5%) were early and 13 (50%) late. Molecular comparison confirmed culture findings. A quality audit showed good compliance with guidelines. Conclusion The exoluminal pathway of CA-bacteriuria in ICU patients predominated and surprisingly occurred early despite good implementation of guidelines. This finding should be considered in guidelines for prevention of CA-bacteriuria.

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“…The Gram-positive bacterium Enterococcus faecalis is an important foodborne pathogen [ 1 ] capable of causing endocarditis, sepsis, and meningitis in both animals and humans [ 2 , 3 , 4 ]. Reports suggest that E. faecalis is the third-most common cause of hospital-acquired bacterial infection, accounting for 15% of catheter-associated urinary tract infections and 5%–15% of infective endocarditis cases [ 5 , 6 , 7 ]. E. faecalis strains also play a role in periodontal disease and are closely associated with hard-to-treat persistent intra-articular infections [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Characterization of a Lytic Bacteriophage vB_EfaS_PHB08 Harboring Endolysin Lys08 against Enterococcus faecalis Biofilms

et al. 2020

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Enterococcus faecalis is an opportunistic pathogen that causes illnesses ranging from urinary tract infections to sepsis in humans and animals. However, the overuse of antibiotics has increased rates of drug resistance among E. faecalis isolates. Bacteriophages and their derivatives have recently been identified as good candidates for the treatment of drug-resistant bacterial infections. Here, we isolated a virulent E. faecalis phage, PHB08, using the double-layer plate method. The bioactivity of the phage was determined via one-step growth curve testing and bacterial killing assays, and whole-genome sequencing was performed using the Illumina HiSeq platform. In addition, protein expression and antibiofilm assays were performed to investigate the activity of the phage lysin. Results showed that PHB08 has a 55,244-bp linear double-stranded DNA genome encoding 91 putative coding sequences. PHB08 inhibited the growth of host strain EF3964 at 37 °C in tryptic soy broth (TSB) medium, while in vegetable models, PHB08 caused a 4.69-log decrease in viable E. faecalis cells after 24 h. Both PHB08 and its endolysin lys08 showed antibiofilm activity against E. faecalis biofilms, which was enhanced by Mn2+ ions. Thus, virulent phage PHB08 and endolysin lys08 may be good candidates for reducing and/or eradicating E. faecalis infections.

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Epidemiology of pathogens and antimicrobial resistanceof catheter-associated urinary tract infections in intensivecare units: A systematic review and meta-analysis

Cited by 46 publications

References 32 publications

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018

A prospective study on the pathogenesis of catheter-associated bacteriuria in critically ill patients

Characterization of a Lytic Bacteriophage vB_EfaS_PHB08 Harboring Endolysin Lys08 against Enterococcus faecalis Biofilms

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