Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit

Robustillo-Rodela, A.; Pérez-Blanco, Verónica; Ruiz, M.A. Espinel; Ruiz-Carrascoso, Guillermo; Iglesias, J.C. Figueira; Martin, Dünser

doi:10.1016/j.ajic.2017.07.018

Cited by 22 publications

(17 citation statements)

References 19 publications

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“…In relation to our study of carbapenemase-producing Enterobacterales, we highlight that they included a large number of K. pneumoniae isolates (57.9%), mainly carriers of β-lactamase OXA-48. This is attributable to the frequency of this enzyme in K. pneumoniae, which produces endemic infections in North African countries [ 30 ] and nosocomial outbreaks in Spain, among other countries [ 31 , 32 ]. Other E. coli and C. freundii isolates also showed this type of enzyme.…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

et al. 2020

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The increasing resistance to antibiotics is compromising the empirical treatment of infections caused by resistant bacteria. Rapid, efficient, and clinically applicable phenotypic methods are needed for their detection. This study examines the phenotypic behavior of β-lactam-resistant Gram-negative bacteria grown on ChromID ESBL medium with ertapenem, cefoxitin, and cefepime disks, reports on the coloration of colonies, and establishes a halo diameter breakpoint for the detection of carbapenemase-producing bacteria. We studied 186 β-lactam-resistant Gram-negative microorganisms (77 with extended spectrum beta lactamase (ESBL), 97 with carbapenemases, and 12 with AmpC β-lactamases (AmpC)). Susceptibility profiles of Gram-negative bacteria that produced ESBL, AmpC, and carbapenemases were similar to the expected profiles, with some differences in the response to cefepime of ESBL-producing microorganisms. Coloration values did not differ from those described by the manufacturer of ChromID ESBL medium. In the screening of carbapenemase production, inhibition halo diameter breakpoints for antibiotic resistance were 18 mm for Enterobacterales and ertapenem, 18 mm for Pseudomonas and cefepime, and 16 mm for Acinetobacter baumannii and cefepime. This innovative phenotypic approach is highly relevant to clinical laboratories, combining susceptibility profiles with detection by coloration of high-priority resistant microorganisms such as carbapenemase-producing A. baumannii, carbapenemase-producing Pseudomonas spp., and ESBL and/or carbapenemase-producing Enterobacterales.

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Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

et al. 2020

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“…A color change from yellow to orange-red or purple is indicative of the presence of carbapenem-hydrolyzing activity. A validation study found that overall sensitivity and specificity of the ␤-CARBA test for the detection of CPEs (e.g., 85.1% and 92.7%, respectively) were lower than with the Carba NP test (254). OXA-48-like enzymes were detected in only 80.5% of isolates (254).…”

Section: Phenotypic Confirmation Methodsmentioning

confidence: 99%

“…3). Health care-associated outbreaks have also been described in various other countries, including Greece (70,71), Australia (72), Israel (73,74), the United Kingdom (75,76), the Netherlands (77,78), Ireland (79,80), Spain (81)(82)(83)(84)(85), France (86)(87)(88), Germany (89,90), Mexico (91), China (92), Belgium (93), Norway (94), Poland (95), Taiwan (96), South Africa (97), Croatia (98), and Slovenia (99).…”

Section: Geographical Distribution Of Oxa-48mentioning

confidence: 99%

The Global Ascendency of OXA-48-Type Carbapenemases

et al. 2019

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SUMMARY Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of blaOXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with blaOXA-48, blaOXA-181, and blaOXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.

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“…Molecular analysis revealed diversity in the clones of A. baumannii, which suggested an ongoing evolution of the isolates and suggests that outbreak strains can quickly adapt over a short time period of 2-3 months [36]. In the second ICU outbreak investigation involving both OXA-48-producing Enterobacteriaceae and MDR A. baumannii [37], 13 OXA-48-producing Enterobacteriaceae carriers and 18 MDR A. baumannii carriers were identified. Initial outbreak response included in-depth bleach cleaning of the environment and a review of device disinfection protocols.…”

Section: Outbreak Reportsmentioning

confidence: 95%

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Chia

Sengupta

Kukreja

et al. 2020

Antimicrob Resist Infect Control

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Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.

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Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit

Cited by 22 publications

References 19 publications

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

The Global Ascendency of OXA-48-Type Carbapenemases

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

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