scholarly journals THE FIRST INVESTIGATION OF AAC(6’)-Ib ENZYME IN CARBAPENEM-RESISTANT ENTEROBACTERIACEAE ISOLATED FROM INDONESIAN PATIENTS

2019 ◽  
Vol 2 (1) ◽  
pp. 8-14
Author(s):  
Beauty Novianty ◽  
Ella Amalia ◽  
Ziske Maritska ◽  
Yuwono Yuwono ◽  
Lusia Hayati
Keyword(s):  
Resistance Mechanism ◽  
Test Results ◽  
Gram Negative ◽  
Therapy Options ◽  
The Past ◽  
Carbapenem Resistant ◽  
Long Time ◽  
Pcr Method ◽  
Vitek 2 ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Over the past decade, numbers of Carbapenemase Producing-Carbapenem Resistant Enterobacteriaceae (CP-CRE) has been increasing worldwide and it has been becoming a threat because of its resistance against carbapenem which is considered as the “last resort” antibiotic. Therapy options for its infection are still limited. Aminoglycoside serves as one of the most commonly used antibiotics, but the resistance against it has already been presented for a long time. Aminoglycoside Modifying Enzyme (AME) is the most important resistance mechanism against aminoglycoside. AAC(6’)-Ib enzyme is one of the most common AME produced by the gram-negative bacteria.Objectives: This study wished to identify the gene of this enzyme among CRE isolated from infected Indonesian patients in Dr. Mohammad Hoesin Hospital Palembang.Methods: Twenty-eight isolates collected from CRE-infected patients identified by Vitek 2 Compact (bioMerieux, USA) in dr. Mohammad Hoesin Hospital Palembang during September—November 2017. AAC(6’)-Ib gene was identified using PCR method, then visualize by electrophoresis. The result is then analyzed by comparing it with a susceptibility test.  Results: Out of 28 samples, AAC(6’)-Ib is identified in 22 (78.57%) samples. Samples with AAC(6’)-Ib showed to be less resistant to various antibiotics, significantly to amikacin (p=0.023).Conclusion: AAC(6’)-Ib gene is found in most of samples implying its frequent occurrence in Indonesian patients.

scholarly journals 490. High Prevalence of Rectal Carriage of blaKPC –Mediated Carbapenem-Resistant Enterobacteriaceae Among Community Food Handlers in Kuwait

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S239-S239
Author(s):  
Noura Al-Sweih ◽  
Ola Moghnai ◽  
Vincent O Rotimi
Keyword(s):  
Healthy Food ◽  
Food Handlers ◽  
Carbapenem Resistant ◽  
Gcc Countries ◽  
High Prevalence ◽  
The World ◽  
Genes Encoding ◽  
Vitek 2 ◽  
Very High ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenemases are diverse enzymes which inactivate the carbapenems. KPC-producing carbapenemase-producing Enterobacteriaceae have disseminated to many regions in the world, however, anecdotal reports of KPC-producing CPE in some GCC countries excluding Kuwait. In this study we report the first emergence of the KPC producing CPE isolated from healthy food handlers in our community. Methods Rectal swabs were collected from 405 food handlers. Isolates were identified by VITEK 2 and their susceptibility to 21 antibiotics performed by MIC determination using Etest. Genes encoding carbapenemase production were characterized by PCR and clonality of isolates was determined by MLST. Results A total of 36 CPE were isolated from 31 participants, of which 15 (41.7%) were Escherichia coli and 8 (22.2%) Klebsiella pneumoniae. All isolates were susceptible to amikacin and tigecycline but an alarmingly high percentage (38.9%) were non-susceptible to colistin. A very high proportion of the CPE harbored blaKPC (58.3%), followed by blaOXA-48 (25%), blaNDM (5.6%) and blaVIM (2.8%). Carbapenemases were co-produced with ESBLs in 30.6% of the isolates. Sequencing of the KPC revealed that KPC-18 represented 45%, KPC-2 36% and KPC-29 18%. Considerable genetic diversity among the isolates was identified by MLST assays demonstrating the emergence of new clones. Five diverse new CPE clones were detected from three Bangladeshi citizens and 2 Indians. Conclusion Our finding demonstrates a relatively high colonization rate (8.9%) of healthy food handlers by CPE of which KPC-producing CPE were predominant; this is an unusual finding in Kuwait representing the first of such findings in our country and GCC. Disclosures All authors: No reported disclosures.

scholarly journals Activity of Meropenem-Vaborbactam in Mouse Models of Infection Due to KPC-Producing Carbapenem-Resistant Enterobacteriaceae

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
Mojgan Sabet ◽  
Ziad Tarazi ◽  
Thomas Nolan ◽  
Jonathan Parkinson ◽  
Debora Rubio-Aparicio ◽  
...  
Keyword(s):  
Body Weight ◽  
Lung Infection ◽  
Infection Model ◽  
Bacterial Killing ◽  
Gram Negative ◽  
Content Type ◽  
Highly Active ◽  
Carbapenem Resistant ◽  
Infection Models ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT Meropenem-vaborbactam (Vabomere) is highly active against Gram-negative pathogens, especially Klebsiella pneumoniae carbapenemase (KPC)-producing, carbapenem-resistant Enterobacteriaceae. The objective of these studies was to evaluate the efficacy of meropenem alone and in combination with vaborbactam in mouse thigh and lung infection models. Thighs or lungs of neutropenic mice were infected with KPC-producing carbapenem-resistant Enterobacteriaceae, with meropenem MICs ranging from ≤0.06 to 8 mg/liter in the presence of 8 mg/liter vaborbactam. Mice were treated with meropenem alone or meropenem in combination with vaborbactam every 2 h for 24 h to provide exposures comparable to 2-g doses of each component in humans. Meropenem administered in combination with vaborbactam produced bacterial killing in all strains tested, while treatment with meropenem alone either produced less than 0.5 log CFU/tissue of bacterial killing or none at all. In the thigh model, 11 strains were treated with the combination of meropenem plus vaborbactam (300 plus 50 mg/kg of body weight). This combination produced from 0.8 to 2.89 logs of bacterial killing compared to untreated controls at the start of treatment. In the lung infection model, two strains were treated with the same dosage regimen of meropenem and vaborbactam. The combination produced more than 1.83 logs of bacterial killing against both strains tested compared to untreated controls at the start of treatment. Overall, these data suggest that meropenem-vaborbactam may have utility in the treatment of infections due to KPC-producing carbapenem-resistant Enterobacteriaceae.

scholarly journals 532. Can Saccharomyces boulardii Therapy Be Effective in Decolonizing Rectal Carbapenem-Resistant Enterobacteriaceae (CRE) Colonization?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S255-S256
Author(s):  
Oguz Resat Sipahi ◽  
Gunel Quliyeva ◽  
Feriha Cilli ◽  
Nilgun Deniz Kucukler ◽  
Demet Dikis ◽  
...  
Keyword(s):  
Susceptibility Testing ◽  
Rectal Swab ◽  
Saccharomyces Boulardii ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Promising Tool ◽  
Carbapenem Resistant ◽  
History Of ◽  
Vitek 2 ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background CRE are globally important pathogens associated with significant morbidity and mortality. The problem of carrying CRE may continue to create a problem in discharged cases in the community. Saccharomyces boulardii sachet therapy (SBST) is reported to cause decolonization in several MDR bacteria carriers. Herein, it is aimed to present the decolonizing rates of rectal CRE colonized cases after SBST treatment. Methods The study period was August 2018–March 2019. Inclusion criteria were: (i) age >18, (ii) receiving Saccharomyces boulardii 250 mg sachets q12h for 7 days, (iii) being proven CRE carrier on rectal swab culture (RSC) up to 5 days period before SBST. The first repeated RSC was performed 3–5 days after the end of SBST. Data were retrieved from the hospital electronic database. Cases with three consecutive weekly performed negative RSC were considered to be decolonized. RSC were processed according to CDC protocol; briefly, the swab was inoculated into 10 mL of trypticase soy broth (bioMérieux Inc., Marcy-l’Étoile, France) with the addition of one 10-μg ertapenem disk (Oxoid, Altrincham, UK) and incubated at 35°C for 18–20 h. The next day, after vortexing, 100 μL of the inoculum was subcultured (8) onto chromID CARBA agar plates (bioMérieux) and incubated at 35°C for 18–20 h. Suspected CRE colonies on chromID CARBA (blue/green to blue/gray in color) were identified by the VITEK MS system (bioMérieux). Susceptibility testing of the isolates was performed with the VITEK 2 system (bioMérieux). Isolates were tested for their resistance phenotypes to imipenem, ertapenem, and meropenem by E-test (bioMérieux). The results were interpreted according to the EUCAST criteria. Results Fifteen cases [2 women, mean age 60.6 ± 18.3 (min. 18–max. 83)] fulfilled the inclusion criteria. All had a history of carbapenem usage. Five cases (33%) had three consequent negative RSC after SBST and were considered to be decolonized. Twelve cases were receiving concomitant antibiotic during SBST (10 carbapenem based regimens). Three cases who received no concomitant antibiotic were decolonized. Conclusion SBST may be a promising tool for decolonizing CRE carriers. These data need to be validated in larger cohorts preferably via randomized-controlled trials. Disclosures All authors: No reported disclosures.

scholarly journals NDM Production as a Dominant Feature in Carbapenem-Resistant Enterobacteriaceae Isolates from a Tertiary Care Hospital

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 48
Author(s):  
Fakhur Uddin ◽  
Syed Hadi Imam ◽  
Saeed Khan ◽  
Taseer Ahmed Khan ◽  
Zulfiqar Ahmed ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Resistance Mechanism ◽  
Enterobacter Cloacae ◽  
Care Hospital ◽  
Healthcare Settings ◽  
Carbapenem Resistant ◽  
Potential Source ◽  
Dominant Feature ◽  
Carbapenem Resistant Enterobacteriaceae

The worldwide spread and increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is of utmost concern and a problem for public health. This resistance is mainly conferred by carbapenemase production. Such strains are a potential source of outbreaks in healthcare settings and are associated with high rates of morbidity and mortality. In this study, we aimed to determine the dominance of NDM-producing Enterobacteriaceae at a teaching hospital in Karachi. A total of 238 Enterobacteriaceae isolates were collected from patients admitted to Jinnah Postgraduate Medical Centre (Unit 4) in Karachi, Pakistan, a tertiary care hospital. Phenotypic and genotypic methods were used for detection of metallo-β-lactamase. Out of 238 isolates, 52 (21.8%) were CRE and 50 isolates were carbapenemase producers, as determined by the CARBA NP test; two isolates were found negative for carbapenemase production by CARB NP and PCR. Four carbapenemase-producing isolates phenotypically appeared negative for metallo-β-lactamase (MBL). Of the 52 CRE isolates, 46 (88.46%) were blaNDM positive. Most of the NDM producers were Klebsiella pneumoniae, followed by Enterobacter cloacae and Escherichia coli. In all the NDM-positive isolates, the blaNDM gene was found on plasmid. These isolates were found negative for the VIM and IPM MBLs. All the CRE and carbapenem-sensitive isolates were sensitive to colistin. It is concluded that the NDM is the main resistance mechanism against carbapenems and is dominant in this region.

scholarly journals Phenotypic and molecular identification of carbapenemase-producing Enterobacteriaceae - challenges in diagnosis and treatment

2018 ◽  
Vol 26 (2) ◽  
pp. 221-230
Author(s):  
Annamária Főldes ◽  
Doina-Veronica Bilca ◽  
Edit Székely
Keyword(s):  
Global Public Health ◽  
Bronchial Secretions ◽  
Carbapenem Resistant ◽  
Multiplex Pcr Assay ◽  
Baia Mare ◽  
Antimicrobial Susceptibility Tests ◽  
Vitek 2 ◽  
Providencia Stuartii ◽  
Susceptibility Tests ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Introduction: Infections due to carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CPCRE) are an emerging global public health threat. The purpose of this study was to investigate phenotypic and genotypic features of CP-CRE strains isolated from hospitalized patients. Material and methods: Between 1st of January - 1st of July 2017, in the Department of Microbiology, “Dr. Constantin Opriş” County Emergency Hospital Baia Mare, Romania, 1110 strains of Enterobacteriaceae were isolated from bronchial secretions, urine, wounds and blood cultures. Bacterial identification and antimicrobial susceptibility tests were performed by conventional methods, Vitek 2 Compact and M.I.C.E. strips. We analysed all Enterobacteriaceae strains non-susceptible to carbapenems according to CLSI 2017 criteria. The modified Hodge test (MHT), the modified carbapenem inactivation method (mCIM) and the combination disks test (KPC, MBL, OXA-48 Confirm kit, Rosco Diagnostica) were used for phenotypic confirmation, whereas a multiplex PCR assay for genes blaKPC, blaNDM and blaOXA-48 was used for genetic confirmation. Results: 19 non-duplicate strains isolated from 16 patients were phenotypically identified as CP-CRE: Klebsiella pneumoniae (n=14), Escherichia coli (n=2), Providencia stuartii (n=2) and Serratia marcescens (n=1). Most strains were isolated from bronchial secretions (n=9). The carbapenem-hydrolizing enzymes were identified by the combination disks test as: KPC (n=9), OXA-48-like (n=5) and MBL (n=5). Molecular confirmation was performed in 18 phenotypically positive isolates with 100% concordant results with mCIM and combination disks test. Discrepant results were noticed with the MHT in case of 4 NDM-producers confirmed by PCR. All CP-CRE strains were resistant to all tested cephems. Three out of 9 K. pneumoniae strains tested against colistin were found resistant. Conclusions: The most common carbapenemase detected was KPC. Therapeutic options were limited in all positive cases. Rapid and reliable detection of CP-CRE is critical for preventing the spread of these pathogens

scholarly journals Ability of the VITEK 2 Advanced Expert System To Identify β-Lactam Phenotypes in Isolates of Enterobacteriaceae andPseudomonas aeruginosa

2000 ◽  
Vol 38 (2) ◽  
pp. 570-574 ◽  
Author(s):  
Christine C. Sanders ◽  
Michel Peyret ◽  
Ellen Smith Moland ◽  
Carole Shubert ◽  
Kenneth S. Thomson ◽  
...  
Keyword(s):  
Expert System ◽  
Antimicrobial Susceptibility ◽  
Resistance Mechanism ◽  
Test System ◽  
Molecular Techniques ◽  
Antimicrobial Susceptibility Test ◽  
Accurate Identification ◽  
Gram Negative ◽  
The Family ◽  
Vitek 2

The Advanced Expert System (AES) was used in conjunction with the VITEK 2 automated antimicrobial susceptibility test system to ascertain the β-lactam phenotypes of 196 isolates of the familyEnterobacteriaceae and the species Pseudomonas aeruginosa. These isolates represented a panel of strains that had been collected from laboratories worldwide and whose β-lactam phenotypes had been characterized by biochemical and molecular techniques. The antimicrobial susceptibility of each isolate was determined with the VITEK 2 instrument, and the results were analyzed with the AES to ascertain the β-lactam phenotype. The results were then compared to the β-lactam resistance mechanism determined by biochemical and molecular techniques. Overall, the AES was able to ascertain a β-lactam phenotype for 183 of the 196 (93.4%) isolates tested. For 111 of these 183 (60.7%) isolates, the correct β-lactam phenotype was identified definitively in a single choice by the AES, while for an additional 46 isolates (25.1%), the AES identified the correct β-lactam phenotype provisionally within two or more choices. For the remaining 26 isolates (14.2%), the β-lactam phenotype identified by the AES was incorrect. However, for a number of these isolates, the error was due to remediable problems. These results suggest that the AES is capable of accurate identification of the β-lactam phenotypes of gram-negative isolates and that certain modifications can improve its performance even further.

scholarly journals IS26 mediate the acquisition of tigecycline resistance gene cluster tmexCD1-toprJ1 by IncHI1B-FIB plasmids in Klebsiella pneumoniae and Klebsiella quasipneumoniae from food market sewage

2020 ◽  
Author(s):  
Miao Wan ◽  
Xun Gao ◽  
Luchao Lv ◽  
Zhongpeng Cai ◽  
Jian-Hua Liu
Keyword(s):  
Klebsiella Pneumoniae ◽  
Gene Cluster ◽  
Resistance Gene ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Resistance Gene Cluster ◽  
Carbapenem Resistant ◽  
Food Market ◽  
Carbapenem Resistant Enterobacteriaceae

Tigecycline and colistin are considered 20 as the final options for the treatment of infections caused by multidrug-resistant (MDR) gram-negative bacteria, especially carbapenem-resistant Enterobacteriaceae (1).…

scholarly journals Risk Factors for Carbapenemase Producing-Carbapenem Resistant Enterobacteriaceae in Those With CRE Positive Cultures

2020 ◽  
Vol 41 (S1) ◽  
pp. s376-s377
Author(s):  
Geneva Wilson ◽  
Christopher Pfeiffer ◽  
Margaret Fitzpatrick ◽  
Katie Suda ◽  
Brian Bartle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Geographic Region ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Factors Associated ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are gram-negative bacteria resistant to at least 1 carbapenem and are associated with high mortality (50%). Carbapenemase-producing CRE (CP-CRE) are particularly serious because they are more likely to transmit carbapenem resistance genes to other gram-negative bacteria and they are resistant to all carbapenem antibiotics. Few studies have evaluated risk factors associated with CP-CRE colonization. The goal of this study was to determine the risk factors associated with CP-CRE colonization in a cohort of US veterans. Methods: We conducted a retrospective cohort study of patients seen at VA medical centers between 2013 and 2018 who had positive cultures for CRE from any site, defined by resistance to at least 1 of the following carbapenems: imipenem, meropenem, doripenem, or ertapenem. CP-CRE was defined via antibiotic sensitivity data that coded the culture as being ‘carbapenemase producing,’ being ‘Hodge test positive,’ or ‘KPC producing.’ Only the first positive culture for CRE was included. Patient demographics (year of culture, age, sex, race, major comorbidities, infectious organism, culture site, inpatient status, and CP-CRE status) and facility demographics (rurality, geographic region, and facility complexity) were collected. Bivariate analysis and multiple logistic regression were performed to determine variables associated with CP-CRE versus non–CP-CRE. Results: In total, 3,322 patients were identified with a positive CRE culture: 546 (16.4%) with CP-CRE and 2,776 (83.63%) with non–CP-CRE. Most patients were men (95%) and were older (mean age, 71; SD, 12.5) and were diagnosed at a high-complexity VA medical center (65%). Most of the cultures were urine (63%), followed by sputum (13%), and blood (7%). Most were from inpatients (46%), followed by outpatients (42%), and long-term care facilities (12%). Multivariable analysis showed the following variables to be associated with CP-CRE positive cultures: congestive heart failure (P = .0136), African American (P = .0760), Klebsiella spp (P < .0001), GI cancers (P = .0087), culture collected in 2017 (P = .0004), and culture collected in 2018 (P < .0001). There were also significant differences CP-CRE frequencies by geographic region (P < .001). Discussion: CP-CRE diagnoses are relatively rare; however, the serious complications associated make them important infections to investigate. In our analysis, we found that congestive heart failure and gastric cancer were comorbidities strongly associated with CP-CRE. In 2017, the VA formalized their CP-CRE definition, which led to more accurate reporting. Conclusions: After the guideline was implemented, CP-CRE detection dramatically increased in noncontinental US facilities. More work should be done in the future to determine the different risk factors between non–CP-CRE and CP-CRE infections.Funding: NoneDisclosures: None

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