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Healthcare (Basel, Switzerland) Apr 2024fungemia is rare and highly resistant to antifungal therapy. We herein report a case involving a 31-year-old male admitted after a high-velocity road traffic accident....
fungemia is rare and highly resistant to antifungal therapy. We herein report a case involving a 31-year-old male admitted after a high-velocity road traffic accident. He sustained a grade IV liver injury with right hepatic vein thrombosis, which necessitated an urgent laparotomy. Post-operatively, repeated imaging of the abdomen revealed the presence of a biloma. Percutaneous subdiaphragmatic drainage was carried out but appeared ineffective, prompting a second surgery for an urgent hemi-hepatectomy. The patient was then nursed in the intensive care unit (ICU); however, during his stay in the ICU, he became more sepsis, which was evident by worsening ventilatory support and a rise in septic parameters from the biochemistry parameters. Despite intravenous piperacillin-tazobactam and fluconazole, his septic parameters did not improve and a full septic workup was conducted and was found to be positive for from the blood cultures. After discussion with the infectious disease physicians and clinical microbiologists, it was decided to initiate a course of intravenous meropenem and amphotericin B based on minimum inhibitory concentration (MIC) values, considering the patient's extended ICU stay and catheter use. Eventually, after successfully weaning off mechanical ventilation, the patient was discharged from ICU care. This case underscores the necessity of individualized approaches, combining timely imaging, appropriate drainage techniques, and tailored treatments to optimize outcomes for such intricate post-traumatic complications.
PubMed: 38727437
DOI: 10.3390/healthcare12090880 -
Journal of Global Antimicrobial... May 2024The aim of this study is to characterize an NDM-1-producing Acinetobacter seifertii isolates from a patient in South Korea.
OBJECTIVES
The aim of this study is to characterize an NDM-1-producing Acinetobacter seifertii isolates from a patient in South Korea.
METHODS
Antibiotic susceptibility testing and genotyping using multigene sequencing were performed and whole plasmid sequences were determined.
RESULTS
The genotype of A. seifertii was ST1899, and was resistant to ceftazidime, trimethoprim-sulfamethoxazole, and piperacillin-tazobactam, in addition to carbapenem. bla was surrounded by ISAba125 insertion sequence within the structure of Tn125 in the 47 kb-sized plasmid. The plasmid exhibited a structure similar to that of other plasmids of diverse Acinetobacter species found worldwide. Transconjugation and growth curve indicated that the plasmid was adapted to A. seifertii rather than other closely related Acinetobacter species.
CONCLUSION
Acquisition of the carbapenem resistance by horizontal transfer of the bla-carrying plasmid from another Acinetobacter species with no growth defect.
PubMed: 38723713
DOI: 10.1016/j.jgar.2024.05.003 -
Journal of Global Antimicrobial... May 2024This study was performed to investigate the activity of the novel ß-lactam/ß-lactamase inhibitor combination cefepime/enmetazobactam, against recently circulating...
Evaluation of the activity of cefepime/enmetazobactam against Enterobacterales bacteria collected in Europe from 2019 to 2021, including third-generation cephalosporin-resistant isolates.
OBJECTIVES
This study was performed to investigate the activity of the novel ß-lactam/ß-lactamase inhibitor combination cefepime/enmetazobactam, against recently circulating Enterobacterales isolates from Europe from 2019 to 2021.
METHODS
A total of 2627 isolates were collected, and antimicrobial susceptibility was determined according to the European Committee on Antimicrobial Susceptibility Testing guidelines. Isolates with phenotypic resistance to ceftriaxone and ceftazidime (but susceptible to meropenem) and isolates nonsusceptible to meropenem were screened for the presence of ß-lactamases.
RESULTS
Overall, susceptibility to third-generation cephalosporins was 77%, and 97.3% were susceptible to meropenem. Cefepime/enmetazobactam susceptibility was 97.9% (72% of these isolates were Klebsiella pneumoniae from Italy), compared with 80.0% susceptibility to piperacillin/tazobactam and 99.4% to ceftazidime/avibactam. A total of 320 isolates (12.2%) were resistant to third-generation cephalosporins but susceptible to meropenem, and virtually all (96.3%) carried an extended-spectrum ß-lactamase with or without an AmpC and these were all susceptible to cefepime/enmetazobactam. Most meropenem-nonsusceptible isolates carried a KPC (68%), which were not inhibited by cefepime/enmetazobactam but were inhibited by ceftazidime/avibactam. Additionally, most meropenem-nonsusceptible isolates carrying OXA-48 (9/12 isolates) were susceptible to cefepime/enmetazobactam.
CONCLUSIONS
Cefepime/enmetazobactam was highly active against Enterobacterales isolates, especially those resistant to third-generation cephalosporins. These data suggest that cefepime/enmetazobactam could be used as a carbapenem-sparing agent to replace piperacillin/tazobactam.
PubMed: 38723712
DOI: 10.1016/j.jgar.2024.04.014 -
Emerging Microbes & Infections Dec 2024OXA-48-like enzymes represent the most frequently detected carbapenemases in Enterobacterales in Western Europe, North Africa and the Middle East. In contrast to other...
OXA-48-like enzymes represent the most frequently detected carbapenemases in Enterobacterales in Western Europe, North Africa and the Middle East. In contrast to other species, the presence of OXA-48-like in leads to an unusually susceptible phenotype with low MICs for carbapenems and piperacillin-tazobactam, which is easily missed in the diagnostic laboratory. So far, there is little data available on the genetic environments of the corresponding genes, -like, in In this study susceptibility phenotypes and genomic data of 13 OXA-48-like-producing were investigated (OXA-48, = 9; OXA-181, = 3; OXA-162, = 1). Ten isolates were susceptible to meropenem and ertapenem and three isolates were susceptible to piperacillin-tazobactam. The gene was chromosomally located in 7/9 isolates. Thereof, in three isolates was inserted into a genomic island. Of the three isolates harbouring one was located on an IncX3 plasmid and two were located on a novel MOB plasmid, pOXA-P12, within the new transposon Tn. In 5/6 isolates with plasmidic location of like, the plasmids could conjugate to recipients . , -carrying plasmids could conjugate from other Enterobacterales into a recipient. These data show a high diversity of -like genetic environments compared to other Enterobacterales, where genetic environments are quite homogenous. Given the difficult-to-detect phenotype of OXA-48-like-producing and the location of -like on mobile genetic elements it is likely that OXA-48-like-producing can disseminate, escape most surveillance systems, and contribute to a hidden spread of OXA-48-like.
Topics: Proteus mirabilis; beta-Lactamases; Bacterial Proteins; Anti-Bacterial Agents; Microbial Sensitivity Tests; Humans; Proteus Infections; Plasmids; Genomic Islands; Carbapenems
PubMed: 38712879
DOI: 10.1080/22221751.2024.2353310 -
PloS One 2024Urinary tract infections (UTI) are common in under-five children, with significant consequences leading to bacteremia, dehydration, kidney scarring, and renal failure....
Bacterial aetiology, antimicrobial susceptibility patterns, and factors associated with urinary tract infection among under-five children at primary health facility, North-Western Tanzania.
BACKGROUND
Urinary tract infections (UTI) are common in under-five children, with significant consequences leading to bacteremia, dehydration, kidney scarring, and renal failure. The incidence of UTI varies with patients' demographics and geographic location. Limited studies have addressed UTI issues, particularly in children. We determined the proportion of UTI, bacterial aetiology, and antimicrobial susceptibility patterns and associated factors among under-five children at the district hospital between March and April 2023.
METHODS
We conducted a cross-sectional study using a convenient non-probability sampling technique to collect urine samples from participants with signs and symptoms of UTI. Written informed consent was obtained from parents or guardians. We collected Participants' information using a pretested structured questionnaire. Urine samples were processed at the Regional Referral Hospital. All analyses were conducted using STATA version 15.0. We determined the factors associated with UTI using a modified Poisson model multivariable analysis of the modified Poisson model. The results were presented as a prevalence ratio and 95% confidence interval. The level of significance was specified at 0.05.
RESULT
The study recruited 368 under-five children; 194 (52.7%) were males, and the median age (interquartile range) was 24 (13-36) months. Of all, 28.8% (95% CI-24.3-33.6) had culture-confirmed UTI. One hundred and six pathogens were isolated, the majority being Escherichia coli (E. coli), 37 (34.9%), and Staphylococcus aureus (S. aureus), 26 (24.5%). The susceptibility of E. coli to cefepime, piperacillin-tazobactam, nitrofurantoin, and meropenem ranged from 81.1% to 97.3%. S. aureus was most susceptible to nitrofurantoin (96.2%) and ciprofloxacin (92.3%). Multidrug resistance was observed in 33.0% of isolates. The proportion of Methicillin-resistant S. aureus and extended-spectrum beta-lactamases was 23.1% and 25%, respectively. UTI was observed more in patients presenting with vomiting, dysuria, and abdominal pain, patients below 24 months of age, nappy users, and uncircumcised males.
CONCLUSION
Our study found a relatively high proportion of UTI among under-five children associated with vomiting, dysuria, abdominal pain, nappy use, and uncircumcision in males. The pathogens were least susceptible to (trimethoprim-sulfamethoxazole, gentamycin, ampicillin, and penicillin) the commonly used antibiotic. We advocate a thorough clinical analysis to detect the predictors of UTI and a periodic review of empirical treatment of UTI based on the antibiotic susceptibility pattern.
Topics: Humans; Urinary Tract Infections; Male; Female; Tanzania; Infant; Child, Preschool; Cross-Sectional Studies; Anti-Bacterial Agents; Microbial Sensitivity Tests
PubMed: 38709815
DOI: 10.1371/journal.pone.0303369 -
Briefings in Bioinformatics Mar 2024The advent of rapid whole-genome sequencing has created new opportunities for computational prediction of antimicrobial resistance (AMR) phenotypes from genomic data....
The advent of rapid whole-genome sequencing has created new opportunities for computational prediction of antimicrobial resistance (AMR) phenotypes from genomic data. Both rule-based and machine learning (ML) approaches have been explored for this task, but systematic benchmarking is still needed. Here, we evaluated four state-of-the-art ML methods (Kover, PhenotypeSeeker, Seq2Geno2Pheno and Aytan-Aktug), an ML baseline and the rule-based ResFinder by training and testing each of them across 78 species-antibiotic datasets, using a rigorous benchmarking workflow that integrates three evaluation approaches, each paired with three distinct sample splitting methods. Our analysis revealed considerable variation in the performance across techniques and datasets. Whereas ML methods generally excelled for closely related strains, ResFinder excelled for handling divergent genomes. Overall, Kover most frequently ranked top among the ML approaches, followed by PhenotypeSeeker and Seq2Geno2Pheno. AMR phenotypes for antibiotic classes such as macrolides and sulfonamides were predicted with the highest accuracies. The quality of predictions varied substantially across species-antibiotic combinations, particularly for beta-lactams; across species, resistance phenotyping of the beta-lactams compound, aztreonam, amoxicillin/clavulanic acid, cefoxitin, ceftazidime and piperacillin/tazobactam, alongside tetracyclines demonstrated more variable performance than the other benchmarked antibiotics. By organism, Campylobacter jejuni and Enterococcus faecium phenotypes were more robustly predicted than those of Escherichia coli, Staphylococcus aureus, Salmonella enterica, Neisseria gonorrhoeae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Streptococcus pneumoniae and Mycobacterium tuberculosis. In addition, our study provides software recommendations for each species-antibiotic combination. It furthermore highlights the need for optimization for robust clinical applications, particularly for strains that diverge substantially from those used for training.
Topics: Phenotype; Anti-Bacterial Agents; Machine Learning; Drug Resistance, Bacterial; Computational Biology; Genome, Bacterial; Genome, Microbial; Humans; Bacteria
PubMed: 38706320
DOI: 10.1093/bib/bbae206 -
Antimicrobial Stewardship & Healthcare... 2024To investigate the factors associated with isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.
OBJECTIVES
To investigate the factors associated with isolates in intensive care unit (ICU) before and after an antimicrobial stewardship program.
MATERIALS
Monocentric retrospective cohort study. Patients admitted to the ICU in 2007-2014 were included. Characteristics of patients were compared to overall ICU population. Clinical and microbiological characteristics of patients before (2007-2010) and after (2011-2014) the beginning of the AMP were compared.
RESULTS
Overall, 5,263 patients were admitted to the ICU, 274/5,263 (5%) had a isolate during their staying. In 2011-2014, the percentage isolates reduced (7% vs 4%, ≤ .0001). Patients with had higher rates of in-hospital death (43% 20%, < .0001) than overall ICU population. In 2011-2014, rates of multidrug-resistant (11% 2%, = .0020), fluoroquinolone-resistant (35% vs 12%, < .0001), and ceftazidime-resistant (23% vs 8%, = .0009) reduced. Treatments by fluoroquinolones (36% vs 4%, ≤ .0001), carbapenems (27% vs 9%, = .0002), and third-generation cephalosporins (49% vs 12, ≤ .0001) before isolation reduced while piperacillin (0% vs 13%, < .0001) and trimethoprim-sulfamethoxazole (8% vs 26%, = .0023) increased. Endotracheal intubation reduced in 2011-2014 (61% vs 35%, < .0001). Fluoroquinolone-resistance was higher in patients who received endotracheal intubation (29% vs 17%, = .0197). Previous treatment by fluoroquinolones (OR = 2.94, = .0020) and study period (2007-2010) (OR = 2.07, = .0462) were the factors associated with fluoroquinolone-resistance at the multivariate analysis.
CONCLUSIONS
Antibiotic susceptibility in isolates was restored after the reduction of endotracheal intubation, fluoroquinolones, carbapenems, and third-generation cephalosporins and the increased use of molecules with a low ecological footprint, as piperacillin and trimethoprim-sulfamethoxazole.
PubMed: 38698949
DOI: 10.1017/ash.2024.53 -
Frontiers in Microbiology 2024We investigated antibiotic resistance pattern in clinical bacterial pathogens isolated from in-patients and out-patients, and compared it with non-clinical bacterial...
We investigated antibiotic resistance pattern in clinical bacterial pathogens isolated from in-patients and out-patients, and compared it with non-clinical bacterial isolates. 475 bacterial strains isolated from patients were examined for antibiotic resistance. spp. (148; 31.1%) were found to be the most prevalent, followed by (135; 28.4%), (74; 15.5%), (65; 13.6%), spp. (28; 5.8%), and spp. (25; 5.2%). Drug-resistant bacteria isolated were extended spectrum-β-lactamase . (8.8%), . (20%), metallo-β-lactamase . (14; 2.9%), erythromycin-inducing clindamycin resistant (7.4%), and methicillin-resistant species (21.6%). Pathogens belonging to the Enterobacteriaceae family were observed to undergo directional selection developing resistance against antibiotics ciprofloxacin, piperacillin-tazobactam, cefepime, and cefuroxime. Pathogens in the surgical ward exhibited higher levels of antibiotic resistance, while non-clinical . and . strains were more antibiotic-susceptible. Our research assisted in identifying the drugs that can be used to control infections caused by antimicrobial resistant bacteria in the population and in monitoring the prevalence of drug-resistant bacterial pathogens.
PubMed: 38694800
DOI: 10.3389/fmicb.2024.1383989 -
World Journal of Hepatology Apr 2024Liver transplantation (LT) is the only curative treatment for end-stage liver disease. However, LT recipients are susceptible to infection, which is the leading cause of...
BACKGROUND
Liver transplantation (LT) is the only curative treatment for end-stage liver disease. However, LT recipients are susceptible to infection, which is the leading cause of early mortality after LT. infections (KPIs) in the bloodstream are common in LT recipients. We hypothesized that KPIs and carbapenem-resistant (CRKP) infections may affect the outcomes of LT recipients.
AIM
To assess KPI incidence, timing, distribution, drug resistance, and risk factors following LT and its association with outcomes.
METHODS
This retrospective study included 406 patients undergoing LT at The Third Xiangya Hospital of Central South University, a tertiary hospital, from January 2015 to January 2023. We investigated the risk factors for KPIs and assessed the impact of KPIs and CRKP infections on the prognosis of LT recipients using logistic regression analysis.
RESULTS
KPI incidence was 7.9% ( = 32), with lung/thoracic cavity the most frequent site of infection; the median time from LT to KPI onset was 7.5 d. Of 44 isolates, 43 (97.7%) and 34 (77.3%) were susceptible to polymyxin B or ceftazidime/avibactam and tigecycline, respectively; > 70% were resistant to piperacillin/ tazobactam, ceftazidime, cefepime, aztreonam, meropenem, and levofloxacin. Female sex [odds ratio (OR) = 2.827, 95% confidence interval (CI): 1.256-6.364; = 0.012], pre-LT diabetes (OR = 2.794, 95%CI: 1.070-7.294; = 0.036), day 1 post-LT alanine aminotransferase (ALT) levels ≥ 1500 U/L (OR = 3.645, 95%CI: 1.671-7.950; = 0.001), and post-LT urethral catheter duration over 4 d (OR = 2.266, 95%CI: 1.016-5.054; = 0.046) were risk factors for KPI. CRKP infections, but not KPIs, were risk factors for 6-month all-cause mortality post-LT.
CONCLUSION
KPIs occur frequently and rapidly after LT. Risk factors include female sex, pre-LT diabetes, increased post-LT ALT levels, and urethral catheter duration. CRKP infections, and not KPIs, affect mortality.
PubMed: 38689752
DOI: 10.4254/wjh.v16.i4.612 -
In Vivo (Athens, Greece) 2024Pharmacovigilance data and clinical studies have indicated a risk of acute kidney injury (AKI) associated with concomitant administration of vancomycin and...
BACKGROUND/AIM
Pharmacovigilance data and clinical studies have indicated a risk of acute kidney injury (AKI) associated with concomitant administration of vancomycin and piperacillin-tazobactam. However, no pharmacovigilance studies have evaluated time-to-onset and outcomes of AKI related to this combination. Therefore, this study used a pharmacovigilance database to investigate the incidence, time-to-onset, and outcomes of AKI in patients treated with intravenous vancomycin plus piperacillin-tazobactam or other antipseudomonal antibiotics.
PATIENTS AND METHODS
From data in the Japanese Adverse Drug Event Report (JADER) database, we calculated the reporting odds ratios (RORs) and 95% confidence intervals (CIs), time-to-onset, and outcomes of AKI following intravenous administration of vancomycin plus piperacillin-tazobactam or other antipseudomonal antibiotics and with other vancomycin regimens, including monotherapy.
RESULTS
The JADER database contained 4,471 reports of intravenous vancomycin treatment, including 517 reports of AKI. The adjusted RORs (95%CIs) of AKI in cases with co-administration of intravenous vancomycin and piperacillin-tazobactam was 2.58 (2.06-3.24). The median time-to-onset for AKI in vancomycin plus piperacillin-tazobactam was 6.0 (interquartile range=3.0-10.3). Weibull shape parameter analysis showed that the pattern of onset of AKI in vancomycin plus piperacillin-tazobactam represented a wear out failure, predicting an increasing hazard with time. For the outcome of AKI, there was no significant difference between all vancomycin regimen and the piperacillin-tazobactam combination groups.
CONCLUSION
Concomitant use of intravenous vancomycin and piperacillin-tazobactam may increase the incidence of AKI but may not affect the outcome. This combination does not necessarily have to be avoided, but long-term use is not advisable.
Topics: Vancomycin; Acute Kidney Injury; Humans; Piperacillin, Tazobactam Drug Combination; Male; Female; Anti-Bacterial Agents; Middle Aged; Aged; Drug Therapy, Combination; Adult; Incidence; Pharmacovigilance; Databases, Factual; Aged, 80 and over; Risk Factors
PubMed: 38688650
DOI: 10.21873/invivo.13586