Clinical, Epidemiologic and Microbiologic Features of a Persistent Outbreak of Amikacin-Resistant Serratia marcescens

1981 ◽  
Vol 2 (5) ◽  
pp. 367-372 ◽  
Author(s):  
Julio C. Arroyo ◽  
W. Lloyd Milligan ◽  
Bosko Postic ◽  
Jimmie Northey ◽  
Ellen Parker ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Serratia Marcescens ◽  
Major Change ◽  
Control Measures ◽  
Third Generation ◽  
Urinary Infections ◽  
Tract Infections ◽  
Third Generation Cephalosporins ◽  
Prior Administration ◽  
Significant Factors

AbstractThis article describes a prolonged outbreak (January 1977 to February 1980) of amikacin-resistant Serratia marcescens (ARSM) urinary infections and the methods used for its control. Significant factors predisposing to ARSM urinary tract infection included an extended hospital stay, being in the urology ward, and undergoing urologie surgery. There had been no prior administration of amikacin or of other aminoglycosides in 20 of 27 patients with ARSM urinary tract infections. Chronically infected patients who required multiple hospitalizations represented a major reservoir for the perpetuation of the outbreak, overshadowing the importance of aminoglycoside use. Traditional control measures and even a major change in the inanimate environment were only partially effective in controlling the outbreak, but treatment of bacteriuric patients in the urology unit with “second and third generation” cephalosporins interrupted patient-to-patient transmission. No new cases of ARSM bacteriuria appeared in the urology unit in the ensuing 12 months [Infect Control 1981; 2(5):367-372.]

scholarly journals Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

2021 ◽  
Vol 11 (1) ◽  
pp. e2-e2
Author(s):  
Manijeh Kahbazi ◽  
Parsa Yousefichaijan ◽  
Danial Habibi ◽  
Somaie Nejabat ◽  
Amirreza Najmi ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Recurrence Rate ◽  
Urine Analysis ◽  
Third Generation ◽  
Extended Spectrum ◽  
First Choice ◽  
Febrile Uti ◽  
History Of ◽  
Tract Infections ◽  
Third Generation Cephalosporins

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems. Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment. Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months). Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group. Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.

scholarly journals Community acquired urinary tract infection: etiology and bacterial susceptibility

2003 ◽  
Vol 18 (suppl 5) ◽  
pp. 33-36 ◽  
Author(s):  
José Anastácio Dias Neto ◽  
Antonio Carlos Pereira Martins ◽  
Leonardo Dias Magalhães da Silva ◽  
Ricardo Brianezi Tiraboschi ◽  
André Luis Alonso Domingos ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Severe Disease ◽  
Antibacterial Drug ◽  
Third Generation ◽  
Antibacterial Susceptibility ◽  
Tract Infections ◽  
Epidemiological Characteristics ◽  
Third Generation Cephalosporins

PURPOSE: Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed. UTI account for a large proportion of antibacterial drug consumption and have large socio-economic impacts. Since the majority of the treatments begins or is done completely empirically, the knowledge of the organisms, their epidemiological characteristics and their antibacterial susceptibility that may vary with time is mandatory. OBJECTIVE: The aim of this study was to report the prevalence of uropathogens and their antibiotic susceptibility of the community acquired UTI diagnosed in our institution and to provide a national data. METHODS: We analyzed retrospectively the results of urine cultures of 402 patients that had community acquired urinary tract infection in the year of 2003. RESULTS: The mean age of the patients in this study was 45.34 ± 23.56 (SD) years. There were 242 (60.2%) females and 160 (39.8%) males. The most commonly isolated organism was Escherichia coli (58%). Klebsiella sp. (8.4%) and Enterococcus sp.(7.9%) were reported as the next most common organisms. Of all bacteria isolated from community acquired UTI, only 37% were sensitive to ampicillin, 51% to cefalothin and 52% to trimethoprim/sulfamethoxazole. The highest levels of susceptibility were to imipenem (96%), ceftriaxone (90%), amikacin (90%), gentamicin (88%), levofloxacin (86%), ciprofloxacin (73%), nitrofurantoin (77%) and norfloxacin (75%). CONCLUSION: Gram-negative agents are the most common cause of UTI. Fluoroquinolones remains the choice among the orally administered antibiotics, followed by nitrofurantoin, second and third generation cephalosporins. For severe disease that require parenteral antibiotics the choice should be aminoglycosides, third generation cephalosporins, fluoroquinolones or imipenem, which were the most effective.

Carriage of Staphylococcus aureus and of Gram-Negative Bacilli Resistant to Third-Generation Cephalosporins in Cirrhotic Patients A Prospective Assessment of Hospital-Acquired Infections

2001 ◽  
Vol 22 (7) ◽  
pp. 427-432 ◽  
Author(s):  
Catherine Dupeyron ◽  
Bernard Campillo ◽  
Nicole Mangeney ◽  
Muriel Bordes ◽  
Jean-Philippe Richardet ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Third Generation ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Prospective Assessment ◽  
Cirrhotic Patients ◽  
Tract Infections ◽  
Third Generation Cephalosporins

AbstractObjective:To study the relation between Staphylococcus aureus nasal and stool colonization, stool carriage of gram-negative bacilli resistant to third-generation cephalosporins (CephR), and subsequent infections during hospitalization.Design:Prospective study.Patients:551 cirrhotic patients with 589 consecutive hospital stays. All patients were screened within 48 hours of admission; 589 nasal swabs, 417 stool specimens, and 589 urine samples were analyzed.Results:Carriage rates were 18.8% for methicillin-sensitive S aureus (MSSA), 16.3% for methicillin-resistant S aureus (MRSA), and 13.7% for CephR. We observed 87 episodes of spontaneous bacterial peritonitis, 63 cases of bacteremia, and 167 urinary tract infections occurred. Only 1 case of bacteremia and 4 urinary tract infections due to CephR occurred in patients carrying the same organism in their stools. The risk of MRSA ascitic fluid infections, bacteremia, and urinary tract infections was 3.1% versus 1% (not significant), 8.3% versus 0.8% (P<.001), and 11.4% versus 0.6% (P<.001) in carriers and noncarriers, respectively. Pulsed-field gel electrophoresis (PFGE) of isolates from 16 patients infected by MSSA (3 cases) and MRSA (13 cases) demonstrated that the colonizing strains matched the invasive strains in the 3 MSSA cases and in 8 of 13 MRSA cases.Conclusion:Carriage of CephR strains is not associated with subsequent infection by these organisms in hospitalized cirrhotic patients. In contrast, MRSA carriage was an important risk factor for MRSA bacteremia and urinary tract infection.

scholarly journals 1435. Urinary Tract Infections Due to Extended-Spectrum Β-Lactamase-Producing Bacteria in Hospitalized Children: Demographics, Risk Factors, Clinical Characteristics, Imaging and Treatment

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S524-S524
Author(s):  
Areej Bukhari ◽  
Diana S Villacis Nunez ◽  
Veronica Etinger ◽  
Melissa Clemente ◽  
Joshua Gruber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urinary Tract ◽  
Clinical Characteristics ◽  
Antibiotic Use ◽  
Third Generation ◽  
High Grade ◽  
History Of ◽  
Tract Infections ◽  
Third Generation Cephalosporins ◽  
Urinary Tract Anomalies

Abstract Background Urinary tract infections (UTIs) are a common cause for hospitalization in children. Inadequate treatment can lead to long-term renal damage. AAP guidelines recommend third-generation cephalosporins as empiric therapy. However, the incidence of community-acquired multiresistant, extended-spectrum β-lactamase (ESBL)-producing pathogens is rising. More research is needed to evaluate risk factors and management of ESBL UTI in children. Methods A case–control retrospective study was conducted at a tertiary care children’s hospital from July 2014 to December 2017. Hospitalized, non-ICU patients aged 0–18 years with UTI and urine culture positive for potentially ESBL-producing organisms were retrieved. Of the 1301 cultures reviewed, 106 cases (UTI+ESBL) were identified and 208 controls (UTI+non-ESBL) were randomly selected. We compared demographics, risk factors, clinical characteristics and treatment between both groups. Results Both groups had similar demographics, except for a higher median age for ESBL patients (3 vs. 0 years). ESBL patients were significantly more likely (P < 0.001) to have recent antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities. Both groups had similar clinical presentations and laboratory results. ESBL patients had more VCUGs performed (59.4% vs. 38%), but the prevalence of high-grade VUR was similar in both groups. ESBL patients had longer course of IV antibiotics and length of stay (mean 6 vs. 3 days). Although 59.4% of ESBL patients received inappropriate initial antibiotics based on culture susceptibilities, 77.4% of these patients clinically improved with initial therapy. Conclusion Our results support previous studies demonstrating that prior antibiotic use, history of UTI, urinary tract anomalies or non-renal comorbidities are risk factors for ESBL UTI. When these are encountered, the suspicion for ESBL should be higher and may guide antibiotic therapy pending culture results. Given the similar prevalence of high-grade VUR in both groups, the presence of ESBL UTI alone should not be an indication to obtain a VCUG. Finally, a subgroup of patients with ESBL UTI might be clinically responsive to third-generation cephalosporins, despite in vitro resistance. Disclosures All authors: No reported disclosures.

Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013–15: a retrospective observational study

2018 ◽  
Vol 36 (4) ◽  
pp. 402-409 ◽  
Author(s):  
Yusuke Teratani ◽  
Hideharu Hagiya ◽  
Toshihiro Koyama ◽  
Mayu Adachi ◽  
Ayako Ohshima ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Oral Antibiotic ◽  
Third Generation ◽  
Acute Respiratory Tract Infections ◽  
Inappropriate Use ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Tract Infections ◽  
Third Generation Cephalosporins

Abstract Background In this age of antimicrobial resistance, unnecessary use of antibiotics to treat non-bacterial acute respiratory tract infections (ARTIs) and inappropriate use of antibiotics in treating bacterial ARTIs are public health concerns. Purpose Our aim is to identify the pattern of oral antibiotic prescriptions for outpatients with ARTIs in Japan. Methods We analysed health insurance claims data of patients (aged ≤74 years) from 2013 to 2015, to determine the pattern of antibiotic prescriptions for outpatient ARTIs and calculated the proportion of each antibiotic. Results Data on 4.6 million antibiotic prescriptions among 1559394 outpatients with ARTIs were analysed. The most commonly prescribed classes of antibiotics included cephalosporins (41.9%), macrolides (32.8%) and fluoroquinolones (14.7%). The proportion of first-, second- and third-generation cephalosporins was 1.0%, 1.7% and 97.3%, respectively. Fluoroquinolones accounted for a quarter of the prescriptions for ARTIs in patients aged >20 years. In contrast, penicillins accounted for just 8.0% of the total number of antibiotic prescriptions for ARTIs. Conclusions According to clinical guidelines, penicillins are first-line antibiotics against ARTIs. However, third-generation cephalosporins, macrolides and fluoroquinolones are more frequently prescribed in Japan. Although we could not assess the extent to which appropriate antibiotics are selected, our results support the necessity of improving antibiotic choices in the treatment of ARTIs.

scholarly journals PREVALÊNCIA DE INFECÇÃO URINÁRIA E DE Actinomyces suis EM PORCAS GESTANTES E SUA CORRELAÇÃO COM ALGUNS PARÂMETROS FÍSICOS E QUÍMICOS DA URINA

2000 ◽  
Vol 5 (1) ◽  
Author(s):  
G.C. ALBERTON ◽  
P.R. WERNER ◽  
J. SOBESTIANSKY ◽  
O.D. COSTA ◽  
W. BARIONI JÚNIOR
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urinary Infection ◽  
Urine Samples ◽  
Chemical Parameters ◽  
Presumptive Diagnosis ◽  
Urinary Infections ◽  
Physical And Chemical Parameters ◽  
Tract Infections ◽  
Physical And Chemical

O presente trabalho teve como objetivo determinar a prevalência de infecção urinária e da bactéria Actinomyces suis na urina de 1745 porcas gestantes da região Sul do Brasil e correlacionar essa prevalência com parâmetros físicos e químicos da urina. A prevalência de infecção urinária e de A. suis foi de 28,31% e 20,63%, respectivamente. Observou-se correlação negativa entre infecção urinária e A. suis, ou seja, as porcas que apresentaram infecção urinária tinham menor prevalência de A. suis (13,67%) do que as que não a apresentaram (23,12%). Da mesma forma, as porcas portadoras de A. suis, tinham menor prevalência de infecção urinária (17,43%) do que as não portadoras (28,62%). Apenas 3,60% das porcas examinadas eram positivas para infecção urinária e A. suis simultaneamente. A cor predominante da urina foi a amarelo claro, tanto para as porcas portadoras ou não portadoras de infecção urinária ou de A. suis. Constatou-se a presença de turbidez em 83,15% das amostras, sendo que em 96,18% das amostras turvas observou-se a presença de cristais. Finalmente, a cor, aspecto, densidade, pH e presença de cristais, foram considerados como parâmetros sem valor para o diagnóstico presuntivo de infecção urinária em porcas gestantes. Prevalence of urinary tract infections and of Actinomyces suis in urine from pregnant sows. Correlation with some urine’s physical and chemical parameters Abstract A survey has been carried out in urine samples from 1745 pregnant sows from Southern Brazil, in regard to the prevalence of urinary infections and of Actinomyces suis and its correlation with some of the urine physical and chemical parameters. Prevalence of urinary infections was of 28.31% and that of A. suis, 20.63%. However, a negative correlation has been found between the incidence of urinary infection and the presence of A. suis, the prevalence of the latter being lower in sows which are positive for urinary infections (13.67%) than in those without urinary infection (23.12%). At the same time, sows positive for A. suis display a lesser number of urinary infection (17.43%) than those negative for the bacteria (28.62%). Only in 3.60% of the sows, urinary infection and A. suis occurred simultaneously. Due to the presence of crystals, turbidity was frequently observed in sow’s urine (83.15%). Crystals were present in 96.18% of sow’s turbid urine samples. Furthermore, color, turbidity, density, pH and the presence of crystals were not considered of value for the presumptive diagnosis of urinary tract infections in pregnant sows.

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