Nosocomial infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: molecular epidemiology, risk factors, clinical features and outcomes

Lucena, A.; Costa, Libera Maria Dalla; Nogueira, Keite da Silva; Matos, Adriana Pereira; Gales, Ana Cristina; Paganini, Maria Cristina; Castro, Marisa; Raboni, Sônia Mara

doi:10.1016/j.jhin.2014.05.007

Cited by 47 publications

(38 citation statements)

References 29 publications

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“…With respect to the baseline disease, the chronic pulmonary disease showed a low incidence rate in the case group compared to that in the control group with the OR value 0.256 (95% CI 0.072–0.908). Interestingly, if the pulmonary disease emerged as the underlying illness, it would be a protective factor for CRKP infection while if it occurred as a comorbidity disease, the opposite effect would occur (Lucena et al, 2014). In addition, ICU stays, various invasive manipulations, and prior medical history including admission to the hospital or exposure to antibiotics 90 days before the outcome of interest, were strongly correlated with CKPN infections, which has also been identified by other studies (Lucena et al, 2014; Hoxha et al, 2016; Lee et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

et al. 2017

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Background: The increasing prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses an immediate threat to treatment worldwide. This retrospective study assessed the molecular epidemiology and determined the risk factors for and outcomes of CRKP infections in a general teaching hospital in Shanghai, China.Methods: From January 2013 to July 2015, 100 consecutive unique CRKP isolates isolated from hospitalized patients were collected. Isolates were screened for antibiotic resistance genes by polymerase chain reaction and molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Patients infected with CRKP comprised the case group and were compared to the control group of patients infected with carbapenem-susceptible Klebsiella pneumoniae. Therapeutic effects were compared in the CRKP infection group.Results: Among the 100 CRKP isolates, the percentages of multidrug-resistant, extensively drug-resistant (XDR), and pandrug-resistant were 50.0, 50.0, and 0%, respectively. All the CRKP isolates produced KPC-2 and could be divided into 18 PFGE clusters (A–O) and 70 subtypes. No dominant intra-hospital PFGE type was detected using a cutoff of 80% similarity. The ratio of CRKP infection to colonization was 51 to 49. Risk factors correlated with CRKP infection included pulmonary disease (p = 0.038), ICU stay (p = 0.002), invasive ventilation (p = 0.009), blood transfusion (p = 0.028), parenteral nutrition (p = 0.004), sputum suction (p = 0.006), medical history of previous hospitalization (p = 0.022), exposure to antibiotics 90 days before infection (p = 0.030), and antibiotic exposure during hospital stay including carbapenems (p = 0.013), enzyme inhibitors (p = 0.021), nitroimidazoles (p = 0.029), and glycopeptides (p = 0.000). Multivariable analysis showed that sputum suction (odds ratio 3.090, 95% confidence intervals 1.004–9.518, p = 0.049) was an independent risk factor for CRKP infections. Patients infected with CRKP with longer carbapenems treatment course (p = 0.002) showed better outcome.Conclusion: This study showed the severity of CRKP infection in eastern China. Sputum suction was an independent risk factor for CRKP infection. Prolonged duration of treatment with carbapenems benefited the patients infected with CRKP.

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Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

et al. 2017

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“…; Lucena et al . ) and Japan (1·9%) and Saudi Arabia (30·2%) among the Acinetobacter spp. (Nishio et al .…”

Section: Discussionmentioning

confidence: 99%

“…Varying rate of MBLs in nonfermenters has been reported, Japan (2Á5%), Kenya (13Á7%), Netherlands (40%) and Brazil (69%) among the Pseudomonas spp. (Pitout et al 2008;Van der Bij et al 2012;Watanabe et al 2012;Lucena et al 2014) and Japan (1Á9%) and Saudi Arabia (30Á2%) among the Acinetobacter spp. (Nishio et al 2004;El-Ageery and Al-Hazmi 2014).…”

Section: Discussionmentioning

confidence: 99%

Dual-tubed multiplex-PCR for molecular characterization of carbapenemases isolated amongAcinetobacterspp. andPseudomonasspp.

et al. 2015

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“…In P. aeruginosa , we highlight the presence of bla SPM-like gene (15.8% for isolates from patients) which highly accounted to define the phenotypic MDR profile. Previous studies with P. aeruginosa reported bla SPM-like frequencies close to 6.0% (33, 36), while studies with P. aeruginosa with a MDR or carbapenem resistant profile reported higher and more variable frequencies, ranging from 17.8% to 64.1% (59, 60).…”

Section: Discussionmentioning

confidence: 87%

Multidrug-resistant Gram-negative bacteria from patients, hospital environment and healthcare workers: a six-month cross-sectional study

Sereia

Cunha

Tartari

et al. 2018

Preprint

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19Healthcare-associated infections (HAI) are an important public health threat with the 20 multidrug-resistant (MDR) gram-negative bacteria (GNB) being of particular concern. Here 21 we present the antimicrobial resistance profile of HAI-related GNB (HAIrB) isolated from 22 patients (PT), healthcare workers (HCW) and hospital environment (HE) in a six-month 23 screening program. From the 180 sampling points distributed in six hospital units, a total of 24 1,080 swabs were collected allowing the isolation of 390 HAIrB: 50.5% from HE, 42.6% 25 2 from PT and 6.9% from HCW. Among the HAIrB, 32.6% were characterized as MDR and 26 38.7% as extended-spectrum cephalosporins resistant (ESC-R), showing no differences in the 27 distribution between PT, HE and HCW. Carbapenem resistance (CARB-R) was detected for 28 17.7% of all HAIrB, being higher among Acinetobacter spp. isolates (36.5%), followed by 29 Enterobacteriaceae (14.5%) and Pseudomonas spp. (11.8%). Except for the ICU, that 30 revealed higher MDR, CARB-R and ESC-R rates, HAIrB-resistant profiles were similarly 31 detected within the hospital units. Prevalence of bla KPC-like and bla CTX-M-1 β-lactamases-32 resistance genes was higher in K. pneumoniae and E. cloacae complex, while bla OXA-23-like 33 and bla SPM-like were higher in A. baumannii and P. aeruginosa, respectively. This study 34 reveals that the spreading of HAIrB within a hospital environment is higher than predicted, 35indicating that healthcare workers, hospital areas and equipment are key players on 36 dissemination of MDR gram-negative bacteria and shows that an active surveillance program 37 can provide precise understanding and direct actions towards control of HAI. 38 39 3 14). In this scenario, adoption of surveillance programs based on new technologies associated 51 with the rational management of antimicrobials and the continuous training for healthcare 52 workers can allow an effective control of HAI transmission, ensuring the patient safety and a 53 consequent reduction of direct and indirect healthcare costs (5,(15)(16). 54To better understand the antimicrobial resistance profile and the dissemination of HAI-related 55 GNB in the healthcare setting we carried out a six-month surveillance program targeting 56 patients, hospital environment and healthcare workers. 57 58 Material and Methods 59 Study design 60The Healthcare-associated Infections Microbiome Project (HAIMP) was carried out at the 61 Professor Polydoro Ernani

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Nosocomial infections with metallo-beta-lactamase-producing Pseudomonas aeruginosa: molecular epidemiology, risk factors, clinical features and outcomes

Cited by 47 publications

References 29 publications

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China

Dual-tubed multiplex-PCR for molecular characterization of carbapenemases isolated amongAcinetobacterspp. andPseudomonasspp.

Multidrug-resistant Gram-negative bacteria from patients, hospital environment and healthcare workers: a six-month cross-sectional study

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