Evolution of Antimicrobial Resistance Levels of ESKAPE Microorganisms in a Peruvian IV-Level Hospital

Abstract

Backgound The members of the so-called ESKAPE group ( Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa and Enterobacter spp.) are a frequent cause of severe infection, ranking among the most relevant causes of hospital infections. In Peru, few studies, often focused in a single ESKAPE microorganism, have been performed, but none providing an overall and comprehensive long-time analysis of the antibiotic resistance of ESKAPE microorganisms. In the present study, the evolution of antimicrobial resistance levels of ESKAPE microorganisms isolated during 2009 - 2010 (Period 1) and 2012 - 2014 (Period 2) in a IV-level hospital in Lima was analyzed. Materials and Methods ESKAPE microorganisms were isolated from inpatients clinical samples. Bacterial identification, as well as antimicrobial susceptibility levels for up to 29 antimicrobial agents and presence of Extended-Spectrum β-Lactamases (only established in K. pneumoniae ) were determined using automatic methods. Results Of 9,918 clinical isolates, 1,917/3,777 (50.8%) [JAN/2009-JUN/2010 (Period 1)] and 4764/6141 (46.4%) [JAN/2012-DEC/2014 (Period 2)] belonged to the ESKAPE group ( P <0.0001). ESKAPE were more frequent in the intensive care unit (ICU) ( P <0.0001). E. faecium decreased from 5.1% to 4.1% ( P <0.5), S. aureus from 10.5% to 7.0% ( P <0.05), and P. aeruginosa from 12.9% to 11.6% ( P <0.05), while, A. baumannii increased from 5.0% to 6.7% ( P <0.05), mainly related to an increase in ICU isolates (8.4% vs. 17.1%; P <0.05). Overall, high levels of antimicrobial resistance were detected, but with few exceptions ( e.g. vancomycin in E. faecium ), antibiotic resistance levels remained stable or lower in Period 2. Contrarily, A. baumannii showed significantly increased resistance to different cephalosporins, carbapenems and amoxicillin plus sulbactam. Conclusion The introduction of a successful extensively drug-resistant A. baumannii clone in the ICU is suspected. The isolation of ESKAPE and levels of antibiotic resistance levels have reduced over time.

Risk Factors for E2SKAPE Infections and Mortality among Liver Transplant Recipients

“…The median (IQR) length of hospital stay and preoperative Model for End-Stage Liver Disease (MELD) score prior to LT were 9 (1-24) days and 24 (16-30), respectively. Eighty-one (35.4%) patients received antibiotics within 2 weeks prior to LT. One hundred (43.7%) patients were infected within 2 months but not within 2 weeks before LT. [19,20]. Seventy-ve (90.4%) of 83 E 2 SKAPE isolates were MDR which was higher than another Chinese study performed on burn patients with the rate being 55% [21].…”

In vitro Investigation of Antibiotic Combinations against Multi- and Extensively Drug-Resistant Klebsiella pneumoniae

“…Although the in vitro activity of most combinations may be scored as synergistic, their in vivo effectiveness remains uncertain due to the complexity of the infections such as infection site, pharmacokinetic, and pharmacodynamics characteristics of the drugs [13]. The results from genome sequences and epidemiological data of more than 1700 K. pneumoniae samples isolated from patients in 244 hospitals in 32 countries during the European Survey of Carbapenemase-Producing Enterobacteriaceae demonstrate that carbapenemase acquisition is the main cause of CR and 477 of 682 (69.9%) carbapenemase-positive isolates are concentrated in four clonal lineages (11,15, 101, 258/512) and their derivates [36], [37]. In this study, we focused on evaluating the interaction effect of certain combinations on twelve K. pneumoniae nosocomial strains belonging to the most prevalent sequence types in Bulgaria (ST11, ST15, and ST258).…”

“…Highly resistant K. pneumonia strains are a significant burden to the healthcare systems and have an important global economic impact. Effects include high mortality and morbidity rates, and recent data on the impact of AMR in the European Union (EU) have shown that >33,000 deaths and 874,541 disability-adjusted life-years [9], [11]. The most recent emergence of extensive-drug resistant (XDR, resistant to all drugs except cefepime, tigecycline (TGC), and ceftazidime-avibactam) and pandrug resistant (PDR, resistant to all drugs) K. pneumoniae is a wake-up call for us to contemplate more strategic measures to control their spread.…”

The Antibacterial, Antitumor Activities, and Bioactive Constituents’ Identification of Alectra sessiliflora Bacterial Endophytes

“…Care was taken to include methicillin-resistant Staphylococcus saprophyticus ( Higashide et al, 2008 ), members of the ESKAPE group ( Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , and Enterobacter spp.) ( Flores-Paredes et al, 2021 ), with the exception of Acinetobacter baumannii and Enterobacter spp. ; and methicillin-susceptible S. aureus (MSSA) ( Ham et al, 2010 ): The test strains included, Bacillus cereus (ATCC 10876), Escherichia coli (ATCC 10536), Klebsiella pneumoniae (ATCC 10031), Klebsiella oxytoca (ATCC 13182), Mycobacterium smegmatis (ATCC 21293), Pseudomonas aeruginosa (NCTC 10662), Staphylococcus aureus (ATCC 25923), S. saprophyticus (ATCC 15305), Staphylococcus epidermidis (ATCC 14990), Veillonella parvula (ATCC 10790), and Enterococcus faecium (ATCC 13048).…”