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1.
J Korean Med Sci ; 39(17): e157, 2024 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-38711319

RESUMEN

This study assessed the performance of the BioFire Blood Culture Identification 2 (BCID2) panel in identifying microorganisms and antimicrobial resistance (AMR) profiles in positive blood cultures (BCs) and its influence on turnaround time (TAT) compared with conventional culture methods. We obtained 117 positive BCs, of these, 102 (87.2%) were correctly identified using BCID2. The discordance was due to off-panel pathogens detected by culture (n = 13), and additional pathogens identified by BCID2 (n = 2). On-panel pathogen concordance between the conventional culture and BCID2 methods was 98.1% (102/104). The conventional method detected 19 carbapenemase-producing organisms, 14 extended-spectrum beta-lactamase-producing Enterobacterales, 18 methicillin-resistant Staphylococcus spp., and four vancomycin-resistant Enterococcus faecium. BCID2 correctly predicted 53 (96.4%) of 55 phenotypic resistance patterns by detecting AMR genes. The TAT for BCID2 was significantly lower than that for the conventional method. BCID2 rapidly identifies pathogens and AMR genes in positive BCs.


Asunto(s)
Cultivo de Sangre , Reacción en Cadena de la Polimerasa Multiplex , Reacción en Cadena de la Polimerasa Multiplex/métodos , Humanos , Pruebas de Sensibilidad Microbiana , Farmacorresistencia Bacteriana/genética , Proteínas Bacterianas/genética , beta-Lactamasas/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Enterococcus faecium/genética , Enterococcus faecium/aislamiento & purificación , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Bacteriemia/microbiología , Bacteriemia/diagnóstico
2.
J Hosp Infect ; 147: 77-82, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38492645

RESUMEN

OBJECTIVES: There is limited data on the effects of discontinuing single-room isolation while maintaining contact precautions, such as the use of gowns and gloves. In April 2021, our hospital ceased single-room isolation for patients with vancomycin-resistant enterococci (VRE) because of single-room unavailability. This study assessed the impact of this policy by examining the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). METHODS: This retrospective quasi-experimental study was conducted at a tertiary-care hospital in Seoul, South Korea. Time-series analysis was used to evaluate HA-VRE BSI incidence at the hospital level and in the haematology unit before (phase 1) and after (phase 2) the policy change. RESULTS: At the hospital level, HA-VRE BSI incidence level (VRE BSI per 1000 patient-days per month) and trend did not change significantly between phase 1 and phase 2 (coefficient -0.015, 95% confidence interval (CI): -0.053 to 0.023, P=0.45 and 0.000, 95% CI: -0.002 to 0.002, P=0.84, respectively). Similarly, HA-VRE BSI incidence level and trend in the haematology unit (-0.285, 95% CI: -0.618 to 0.048, P=0.09 and -0.018, 95% CI: -0.036 to 0.000, P = 0.054, respectively) did not change significantly across the two phases. CONCLUSIONS: Discontinuing single-room isolation of VRE-colonized or infected patients was not associated with an increase in the incidence of VRE BSI at the hospital level or among high-risk patients in the haematology unit. Horizontal intervention for multi-drug-resistant organisms, including measures such as enhanced hand hygiene and environmental cleaning, may be more effective at preventing VRE transmission.


Asunto(s)
Infección Hospitalaria , Infecciones por Bacterias Grampositivas , Aislamiento de Pacientes , Centros de Atención Terciaria , Enterococos Resistentes a la Vancomicina , Humanos , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Estudios Retrospectivos , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/prevención & control , Incidencia , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/microbiología , República de Corea/epidemiología , Control de Infecciones/métodos , Habitaciones de Pacientes , Bacteriemia/epidemiología , Bacteriemia/microbiología , Seúl/epidemiología , Masculino
3.
Antimicrob Agents Chemother ; 68(5): e0171623, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38506550

RESUMEN

Outbreaks caused by vancomycin-resistant enterococci that transcend jurisdictional boundaries are occurring worldwide. This study focused on a vancomycin-resistant enterococcus outbreak that occurred between 2018 and 2021 across two cities in Hiroshima, Japan. The study involved genetic and phylogenetic analyses using whole-genome sequencing of 103 isolates of vancomycin-resistant enterococci to identify the source and transmission routes of the outbreak. Phylogenetic analysis was performed using core genome multilocus sequence typing and core single-nucleotide polymorphisms; infection routes between hospitals were inferred using BadTrIP. The outbreak was caused by Enterococcus faecium sequence type (ST) 80 carrying the vanA plasmid, which was derived from strain A10290 isolated in India. Of the 103 isolates, 93 were E. faecium ST80 transmitted across hospitals. The circular vanA plasmid of the Hiroshima isolates was similar to the vanA plasmid of strain A10290 and transferred from E. faecium ST80 to other STs of E. faecium and other Enterococcus species by conjugation. The inferred transmission routes across hospitals suggest the existence of a central hospital serving as a hub, propagating vancomycin-resistant enterococci to multiple hospitals. Our study highlights the importance of early intervention at the key central hospital to prevent the spread of the infection to small medical facilities, such as nursing homes, with limited medical resources and a high number of vulnerable individuals.


Asunto(s)
Brotes de Enfermedades , Enterococcus faecium , Infecciones por Bacterias Grampositivas , Tipificación de Secuencias Multilocus , Filogenia , Plásmidos , Enterococos Resistentes a la Vancomicina , Secuenciación Completa del Genoma , Enterococcus faecium/genética , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/aislamiento & purificación , Japón/epidemiología , Humanos , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Plásmidos/genética , Infecciones por Bacterias Grampositivas/transmisión , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Infección Hospitalaria/epidemiología , Proteínas Bacterianas/genética , Antibacterianos/farmacología , Ligasas de Carbono-Oxígeno/genética , Pruebas de Sensibilidad Microbiana , Polimorfismo de Nucleótido Simple , Hospitales , Vancomicina/farmacología , Genoma Bacteriano/genética
5.
J Antimicrob Chemother ; 79(5): 997-1005, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38501366

RESUMEN

BACKGROUND: VRE are increasingly described worldwide. Screening of hospitalized patients at risk for VRE carriage is mandatory to control their dissemination. Here, we have developed the Bfast [VRE Panel] PCR kit, a rapid and reliable quantitative PCR assay for detection of vanA, vanB, vanD and vanM genes, from solid and liquid cultures adaptable to classical and ultrafast real-time PCR platforms. METHODS: Validation was carried out on 133 well characterized bacterial strains, including 108 enterococci of which 64 were VRE. Analytical performances were determined on the CFX96 Touch (Bio-Rad) and Chronos Dx (BforCure), an ultrafast qPCR machine. Widely used culture plates and broths for enterococci selection/growth were tested. RESULTS: All targeted van alleles (A, B, D and M) were correctly detected without cross-reactivity with other van genes (C, E, G, L and N) and no interference with the different routinely used culture media. A specificity and sensitivity of 100% and 99.7%, respectively, were determined, with limits of detection ranging from 21 to 238 cfu/reaction depending on the targets. The Bfast [VRE Panel] PCR kit worked equally well on the CFX and Chronos Dx platforms, with differences in multiplexing capacities (five and four optical channels, respectively) and in turnaround time (45 and 16 minutes, respectively). CONCLUSIONS: The Bfast [VRE Panel] PCR kit is robust, easy to use, rapid and easily implementable in clinical microbiology laboratories for ultra-rapid confirmation of the four main acquired van genes. Its features, especially on Chronos Dx, seem to be unmatched compared to other tools for screening of VRE.


Asunto(s)
Reacción en Cadena en Tiempo Real de la Polimerasa , Sensibilidad y Especificidad , Resistencia a la Vancomicina , Enterococos Resistentes a la Vancomicina , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Resistencia a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococcus/genética , Enterococcus/efectos de los fármacos , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Proteínas Bacterianas/genética , Factores de Tiempo , Genes Bacterianos/genética
6.
PLoS One ; 17(1): e0261588, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35025906

RESUMEN

Results from sampling healthcare surfaces for pathogens are difficult to interpret without understanding the factors that influence pathogen detection. We investigated the recovery of four healthcare-associated pathogens from three common surface materials, and how a body fluid simulant (artificial test soil, ATS), deposition method, and contamination levels influence the percent of organisms recovered (%R). Known quantities of carbapenemase-producing KPC+ Klebsiella pneumoniae (KPC), Acinetobacter baumannii, vancomycin-resistant Enterococcus faecalis, and Clostridioides difficile spores (CD) were suspended in Butterfield's buffer or ATS, deposited on 323cm2 steel, plastic, and laminate surfaces, allowed to dry 1h, then sampled with a cellulose sponge wipe. Bacteria were eluted, cultured, CFU counted and %R determined relative to the inoculum. The %R varied by organism, from <1% (KPC) to almost 60% (CD) and was more dependent upon the organism's characteristics and presence of ATS than on surface type. KPC persistence as determined by culture also declined by >1 log10 within the 60 min drying time. For all organisms, the %R was significantly greater if suspended in ATS than if suspended in Butterfield's buffer (p<0.05), and for most organisms the %R was not significantly different when sampled from any of the three surfaces. Organisms deposited in multiple droplets were recovered at equal or higher %R than if spread evenly on the surface. This work assists in interpreting data collected while investigating a healthcare infection outbreak or while conducting infection intervention studies.


Asunto(s)
Bacterias/aislamiento & purificación , Vendajes/microbiología , Celulosa/química , Manejo de Especímenes/métodos , Acinetobacter baumannii/aislamiento & purificación , Clostridioides difficile/aislamiento & purificación , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Plásticos/química , Acero/química , Propiedades de Superficie , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
7.
Nat Commun ; 13(1): 509, 2022 01 26.
Artículo en Inglés | MEDLINE | ID: mdl-35082278

RESUMEN

Vancomycin-resistant Enterococcus faecium (VREfm) is a major nosocomial pathogen. Identifying VREfm transmission dynamics permits targeted interventions, and while genomics is increasingly being utilised, methods are not yet standardised or optimised for accuracy. We aimed to develop a standardized genomic method for identifying putative VREfm transmission links. Using comprehensive genomic and epidemiological data from a cohort of 308 VREfm infection or colonization cases, we compared multiple approaches for quantifying genetic relatedness. We showed that clustering by core genome multilocus sequence type (cgMLST) was more informative of population structure than traditional MLST. Pairwise genome comparisons using split k-mer analysis (SKA) provided the high-level resolution needed to infer patient-to-patient transmission. The more common mapping to a reference genome was not sufficiently discriminatory, defining more than three times more genomic transmission events than SKA (3729 compared to 1079 events). Here, we show a standardized genomic framework for inferring VREfm transmission that can be the basis for global deployment of VREfm genomics into routine outbreak detection and investigation.


Asunto(s)
Infección Hospitalaria/transmisión , Atención a la Salud , Enterococcus faecium/genética , Genoma Bacteriano , Infecciones por Bacterias Grampositivas/transmisión , Enterococos Resistentes a la Vancomicina/genética , Antibacterianos , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana , Ligasas de Carbono-Oxígeno/genética , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Enterococcus faecium/clasificación , Enterococcus faecium/aislamiento & purificación , Genómica , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Tipificación de Secuencias Multilocus , Filogenia , Vancomicina , Enterococos Resistentes a la Vancomicina/clasificación , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Secuenciación Completa del Genoma
8.
Infect Control Hosp Epidemiol ; 43(8): 1063-1066, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-34016196

RESUMEN

Perianal screening can be intrusive. The sensitivities of multianatomical, nonperianal surveillance were 92.3% for methicillin-resistant Staphylococcus aureus (MRSA), 58.7% for vancomycin-resistant enterococci (VRE), and 54.9% for resistant Gram-negative bacilli (R-GNB). Sensitivities improved upon adding environmental surveillance (95.5%, 82.9%, and 67.9%, respectively). Multianatomical, nonperianal screening and room environment surveillance may replace perianal screening and reduce healthy participant bias in nursing homes.


Asunto(s)
Infecciones Bacterianas , Farmacorresistencia Bacteriana Múltiple , Monitoreo del Ambiente , Control de Infecciones , Tamizaje Masivo , Casas de Salud , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/prevención & control , Monitoreo Biológico/métodos , Resistencia a Múltiples Medicamentos , Monitoreo del Ambiente/métodos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/prevención & control , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/prevención & control , Humanos , Control de Infecciones/métodos , Tamizaje Masivo/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Estudios Prospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
9.
Microb Drug Resist ; 28(3): 382-385, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34918959

RESUMEN

Vancomycin-resistant enterococcal (VRE) bacteremia is associated with higher mortality rates and longer hospitalizations than vancomycin-sensitive enterococcal (VSE) bacteremia. A 67-year-old man with a right psoas abscess and pacemaker-associated tricuspid valve endocarditis in September 2020 grew VSE Enterococcus faecium from blood cultures that cleared after administration of intravenous vancomycin and gentamicin. Subsequently, he underwent tricuspid valve repair, pacemaker removal, and partial lead extraction. Valve and postoperative blood cultures grew VRE E. faecium, which cleared after administration of intravenous daptomycin. One VSE and two VRE isolates were collected and sequenced. All isolates belonged to E. faecium multilocus sequence type ST17 and were closely related, having <20 mutations in pairwise genome comparisons. Vancomycin resistance was due to the acquisition of a plasmid-encoded VanA operon. None of the isolates encoded the virulence factors asa1, gelE, cylA, or hyl; all encoded a homologue of efaAfm. VSE E. faecium, but not VRE E. faecium isolates, encoded a glucose transporter gene mutation. Two VRE E. faecium isolates formed more robust biofilms than the VSE E. faecium isolate (p < 0.001). The VRE E. faecium isolates, which generated larger biofilms than the VSE E. faecium isolate, could have remained protected in the heart valve and only caused bacteremia when disrupted during cardiac surgery. This study demonstrates that bacteria detected in the bloodstream of patients with endocarditis may not fully represent the organisms adherent to the cardiac valves or indwelling devices.


Asunto(s)
Bacteriemia/microbiología , Endocarditis Bacteriana/microbiología , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Anciano , Antibacterianos/farmacología , Bacteriemia/tratamiento farmacológico , Daptomicina/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Endocarditis Bacteriana/tratamiento farmacológico , Enterococcus faecium , Genes Bacterianos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Marcapaso Artificial/microbiología , Válvula Tricúspide/microbiología , Enterococos Resistentes a la Vancomicina/efectos de los fármacos
10.
PLoS Negl Trop Dis ; 15(11): e0009869, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34748586

RESUMEN

PURPOSE: Vancomycin-resistant enterococci infection is a worrying worldwide clinical problem. To evaluate the accuracy of GeneXpert vanA/vanB in the diagnosis of VRE, we conducted a systematic review in the study. METHODS: Experimental data were extracted from publications until May 03 2021 related to the diagnostic accuracy of GeneXpert vanA/vanB for VRE in PubMed, Embase, Web of Science and the Cochrane Library. The accuracy of GeneXpert vanA/vanB for VRE was evaluated using summary receiver to operate characteristic curve, pooled sensitivity, pooled specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. RESULTS: 8 publications were divided into 3 groups according to two golden standard references, vanA and vanB group, vanA group, vanB group, including 6 researches, 5 researches and 5 researches, respectively. The pooled sensitivity and specificity of group vanA and vanB were 0.96 (95% CI, 0.93-0.98) and 0.90 (95% CI, 0.88-0.91) respectively. The DOR was 440.77 (95% CI, 37.92-5123.55). The pooled sensitivity and specificity of group vanA were 0.86 (95% CI, 0.81-0.90) and 0.99 (95% CI, 0.99-0.99) respectively, and those of group vanB were 0.85 (95% CI, 0.63-0.97) and 0.82 (95% CI, 0.80-0.83) respectively. CONCLUSION: GeneXpert vanA/vanB can diagnose VRE with high-accuracy and shows greater accuracy in diagnosing vanA.


Asunto(s)
Proteínas Bacterianas/genética , Ligasas de Carbono-Oxígeno/genética , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Antibacterianos/farmacología , Proteínas Bacterianas/metabolismo , Ligasas de Carbono-Oxígeno/metabolismo , Humanos , Sensibilidad y Especificidad , Vancomicina/farmacología , Enterococos Resistentes a la Vancomicina/clasificación , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/genética
11.
Artículo en Inglés | MEDLINE | ID: mdl-34755816

RESUMEN

Surveillance strategies to detect colonization are an important tool to prevent and control the spread of microorganisms in hematopoietic stem cell transplant (HSCT) units. The aim of this study was to evaluate routine surveillance cultures for screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa), and vancomycin-resistant enterococci (VRE). Surveillance cultures were collected (1,323 samples) from 200 patients admitted to an HSCT unit over one year; swabs were taken on admission and then weekly. We compared the positivity of cultures for each site, agent, clinical and epidemiological data according to the colonization status. Infection due to multidrug-resistant organisms (MDROs) occurred in 52 (21.5%) patients, 45 (86.5%) due to blood stream infection; 12 (23%) patients had a positive surveillance culture before the infection. Cultures of 554 (41.8%) samples were performed for CRPa, 413 (31.2%) for VRE and 356 (27%) for CRE. Of these, 179 (13.5%) were positive. Colonization by any MDRO, CRE or CRPa was associated with increased risk of infection (P < 0.05), but not with death. Previous colonization by an MDRO was a significant risk for infection by these pathogens, specially by CRE. Overall, rectal swabs had the highest positivity rate compared with other sites, oropharynx swabs were an option for CRPa, and fecal cultures showed low positivity. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, routine VRE surveillance should be questioned with regard to patients undergoing auto-HSCT due to the additional cost and little impact on survival rates.


Asunto(s)
Infecciones por Enterobacteriaceae/epidemiología , Trasplante de Células Madre Hematopoyéticas , Infecciones por Pseudomonas/epidemiología , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Farmacorresistencia Bacteriana Múltiple , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Pseudomonas aeruginosa/aislamiento & purificación , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
12.
Int J Antimicrob Agents ; 58(6): 106452, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34648944

RESUMEN

OBJECTIVES: Patients having previous contact with healthcare systems abroad are routinely screened for resistant bacteria on admission to hospitals in Copenhagen. This study aimed to present carriage prevalence and geographical risk stratification, as well as phenotypic and genotypic characterisation of resistant isolates. METHODS: This study included screening samples analysed at one department of clinical microbiology in Copenhagen from 2016-2019. Patients who had previous contact with healthcare systems abroad within 6 months were screened at admission for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and carbapenemase-producing organisms (CPO). Isolates were characterised phenotypically and by whole-genome sequencing. The relative frequency of positive findings stratified by geographical regions correlated with relative frequency of Danish residents' travel destinations. RESULTS: Of 2849 screening sets included in the study, 103 (3.6%) were positive. A total of 120 resistant isolates were detected (36 MRSA, 31 VRE and 53 CPO). The carrier prevalence for MRSA was 1.3%, 1.1% for VRE and 1.5% for CPO. Southern and Western Asia were overrepresented travel destinations in positive screening sets (41%). For VRE, 40% were related to Southern Europe, which also represented 35% of travel destinations. Genotypic characterisation confirmed a heterogenous genomic background reflecting global distribution of resistant clones. CONCLUSIONS: Exposure targeted screening identified a substantial number of asymptomatic carriers of MRSA, VRE and CPO with heterogenous genetic backgrounds. Although some geographical regions were overrepresented, the complex epidemiology of the different pathogens did not allow a restriction of the screening strategy to certain geographical regions.


Asunto(s)
Antibacterianos/farmacología , Tamizaje Masivo/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Viaje/estadística & datos numéricos , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Proteínas Bacterianas/metabolismo , Atención a la Salud , Dinamarca , Farmacorresistencia Bacteriana Múltiple , Genoma Bacteriano/genética , Hospitalización , Hospitales , Humanos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/genética , Infecciones Estafilocócicas/diagnóstico , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/genética , Secuenciación Completa del Genoma , beta-Lactamasas/metabolismo
13.
Microbiol Spectr ; 9(2): e0035621, 2021 10 31.
Artículo en Inglés | MEDLINE | ID: mdl-34523992

RESUMEN

Vancomycin-resistant enterococci (VRE) are nosocomial pathogens with increasing prevalence worldwide. Extensive hygiene measures have been established to prevent infection transmission in hospitals. Here, we developed a predictive score system (the predictive vancomycin-resistant enterococci [PREVENT] score) to identify the clearance or persistence in patients with a history of VRE carrier status at readmission. Over a cumulative 3-year period, patients with a positive VRE carrier status were included. The study population was recruited in two successive time periods and separated into training data for predictive score development and validation data for evaluation of the predictive power. The risk factors for persistent VRE colonization were analyzed in a univariable analysis before development of a logistic regression model based on the potential risk factors. The score points were determined proportionally to the beta coefficients of the logistic regression model. The data from 448 (79%) patients were used as the training data, and those from 119 (21%) as the validation data. Multivariable analysis revealed the following variables as independent risk factors: age of ≥60 years, hemato-oncological disease, cumulative antibiotic treatment for >4 weeks, and a VRE infection. The resulting logistic regression model exhibited an acceptable area under the curve (AUC) of 0.81 (95% confidence interval [CI], 0.72 to 0.91). The predictive score system had a sensitivity of 82% (95% CI, 65 to 93%) and a specificity of 77% (95% CI, 66 to 85%). The developed predictive score system is a useful tool to assess the VRE carrier status of patients with a history of VRE colonization. On the basis of this risk assessment, more focused and cost-effective infection control measures can be implemented. IMPORTANCE Given the increasing relevance of VRE as nosocomial pathogens worldwide, infection prevention and control measures, including patient isolation and contact precautions, are indispensable to avoid their spread in the hospital setting. In this study, we developed and validated the PREVENT score, a tool for rapid risk assessment of VRE persistence in patients with a history of previous VRE colonization. The score is designed to be easily performed, employing clinical information available in a regular admission setting and immediately providing information to inform the decision of whether to adopt patient isolation and contact precautions during the hospital stay. After validation, the score was shown to accurately identify patients with persistent VRE colonization upon admission, representing a suitable option as (i) a complementary method yielding preliminary results significantly more quickly than culture-based VRE detection techniques and (ii) an alternative strategy for VRE detection in settings in which microbiological VRE screening is not routinely performed due to limited resources.


Asunto(s)
Infección Hospitalaria/prevención & control , Infecciones por Bacterias Grampositivas/epidemiología , Control de Infecciones/métodos , Prevención Primaria/métodos , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Infección Hospitalaria/microbiología , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Infección Persistente/diagnóstico , Infección Persistente/epidemiología , Infección Persistente/microbiología , Medición de Riesgo/métodos , Factores de Riesgo
14.
Medicine (Baltimore) ; 100(32): e26913, 2021 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-34397929

RESUMEN

ABSTRACT: To investigate the factors affecting the duration of vancomycin-resistant enterococci (VRE) colonization in stroke patients.A total of 52 stroke patients with VRE colonization were enrolled. We divided the groups into several factors and confirmed whether each factor affected VRE colonization. Independent t test, bivariate correlation analysis, and Cox proportional hazards model were used to confirm statistical significance.Among 52 patients, 28 were ischemic stroke and 24 were hemorrhagic stroke. The mean duration of the VRE colonization was 39.08 ±â€Š44.22 days. The mean duration of VRE colonization of the ischemic stroke patients was 25.57 ±â€Š30.23 days and the hemorrhagic stroke patients was 54.83 ±â€Š52.75 days. The mean intensive care unit (ICU) care period was 15.23 ±â€Š21.98 days. Independent sample t test showed the hemorrhagic stroke (P < .05), use of antibiotics (P < .01), oral feeding (P < .01) were associated with duration of VRE colonization. Bivariate correlation analysis showed duration of ICU care (P < .001) was associated with duration of VRE colonization. Cox proportional hazard model showed oral feeding (P = .001), use of antibiotics (P = .003), and duration of ICU care (P = .001) as independent factors of duration of VRE colonization.Careful attention should be given to oral feeding, duration of ICU care, and use of antibiotics in stroke patients, especially hemorrhagic stroke patients, for intensive rehabilitation at the appropriate time.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Unidades de Cuidados Intensivos , Accidente Cerebrovascular/complicaciones , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Anciano , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo
15.
BMC Infect Dis ; 21(1): 683, 2021 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-34261450

RESUMEN

BACKGROUND: Third-generation cephalosporin-resistant Gram-negatives (3GCR-GN) and vancomycin-resistant enterococci (VRE) are common causes of multi-drug resistant healthcare-associated infections, for which gut colonisation is considered a prerequisite. However, there remains a key knowledge gap about colonisation and infection dynamics in high-risk settings such as the intensive care unit (ICU), thus hampering infection prevention efforts. METHODS: We performed a three-month prospective genomic survey of infecting and gut-colonising 3GCR-GN and VRE among patients admitted to an Australian ICU. Bacteria were isolated from rectal swabs (n = 287 and n = 103 patients ≤2 and > 2 days from admission, respectively) and diagnostic clinical specimens between Dec 2013 and March 2014. Isolates were subjected to Illumina whole-genome sequencing (n = 127 3GCR-GN, n = 41 VRE). Multi-locus sequence types (STs) and antimicrobial resistance determinants were identified from de novo assemblies. Twenty-three isolates were selected for sequencing on the Oxford Nanopore MinION device to generate completed reference genomes (one for each ST isolated from ≥2 patients). Single nucleotide variants (SNVs) were identified by read mapping and variant calling against these references. RESULTS: Among 287 patients screened on admission, 17.4 and 8.4% were colonised by 3GCR-GN and VRE, respectively. Escherichia coli was the most common species (n = 36 episodes, 58.1%) and the most common cause of 3GCR-GN infection. Only two VRE infections were identified. The rate of infection among patients colonised with E. coli was low, but higher than those who were not colonised on admission (n = 2/33, 6% vs n = 4/254, 2%, respectively, p = 0.3). While few patients were colonised with 3GCR- Klebsiella pneumoniae or Pseudomonas aeruginosa on admission (n = 4), all such patients developed infections with the colonising strain. Genomic analyses revealed 10 putative nosocomial transmission clusters (≤20 SNVs for 3GCR-GN, ≤3 SNVs for VRE): four VRE, six 3GCR-GN, with epidemiologically linked clusters accounting for 21 and 6% of episodes, respectively (OR 4.3, p = 0.02). CONCLUSIONS: 3GCR-E. coli and VRE were the most common gut colonisers. E. coli was the most common cause of 3GCR-GN infection, but other 3GCR-GN species showed greater risk for infection in colonised patients. Larger studies are warranted to elucidate the relative risks of different colonisers and guide the use of screening in ICU infection control.


Asunto(s)
Infección Hospitalaria , Farmacorresistencia Bacteriana Múltiple/genética , Escherichia coli , Tracto Gastrointestinal/microbiología , Control de Infecciones , Unidades de Cuidados Intensivos , Enterococos Resistentes a la Vancomicina , Antibacterianos/farmacología , Australia/epidemiología , Resistencia a las Cefalosporinas/genética , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Escherichia coli/patogenicidad , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Unidades de Cuidados Intensivos/normas , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios Prospectivos , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
16.
Sci Rep ; 11(1): 14780, 2021 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-34285270

RESUMEN

The spread of vancomycin-resistant enterococci (VRE) is a major threat in nosocomial settings. A large-scale multiclonal VRE outbreak has rarely been reported in Japan due to low VRE prevalence. We evaluated the transmission of vancomycin resistance in a multiclonal VRE outbreak, conducted biological and genomic analyses of VRE isolates, and assessed the implemented infection control measures. In total, 149 patients harboring VanA-type VRE were identified from April 2017 to October 2019, with 153 vancomycin-resistant Enterococcus faecium isolated being grouped into 31 pulsotypes using pulsed-field gel electrophoresis, wherein six sequence types belonged to clonal complex 17. Epidemic clones varied throughout the outbreak; however, they all carried vanA-plasmids (pIHVA). pIHVA is a linear plasmid, carrying a unique structural Tn1546 containing vanA; it moves between different Enterococcus spp. by genetic rearrangements. VRE infection incidence among patients in the "hot spot" ward correlated with the local VRE colonization prevalence. Local prevalence also correlated with vancomycin usage in the ward. Transmission of a novel transferrable vanA-plasmid among Enterococcus spp. resulted in genomic diversity in VRE in a non-endemic setting. The prevalence of VRE colonization and vancomycin usage at the ward level may serve as VRE cross-transmission indicators in non-intensive care units for outbreak control.


Asunto(s)
Proteínas Bacterianas/genética , Ligasas de Carbono-Oxígeno/genética , Infección Hospitalaria/microbiología , Infecciones por Bacterias Grampositivas/transmisión , Enterococos Resistentes a la Vancomicina/clasificación , Anciano , Programas de Optimización del Uso de los Antimicrobianos , Estudios de Casos y Controles , Infección Hospitalaria/transmisión , Brotes de Enfermedades , Electroforesis en Gel de Campo Pulsado , Enfermedades Endémicas , Femenino , Humanos , Japón , Masculino , Filogenia , Plásmidos/genética , Vigilancia de la Población , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
17.
PLoS One ; 16(6): e0251727, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34166383

RESUMEN

BACKGROUND: The emergence of vancomycin resistant Enterococci (VRE) has alarmed the global community due to its tendency for colonization of the gastrointestinal tract. Human Immunodeficiency Virus (HIV) patients are colonized by vancomycin resistant Enterococci than other groups. The aim of this study was to determine the incidence of vancomycin resistant Enterococci and its associated factors among HIV infected patients on Anti-Retroviral Therapy (ART). METHODS: Institution based cross sectional study was conducted among HIV infected patients on ART at from June 1 to August 30, 2020. Socio-demographic and clinical data were collected by pre-tested structured questionnaire. Stool sample was collected and processed by standard microbiological techniques. Kirby Bauer Disc diffusion method was used to perform antimicrobial susceptibility testing. Data were entered by Epi data version 4.6.0.2 and analyzed by SPSS version 25. Bivariable and multivariable logistic regression model was used to analyze the association between dependent and independent variables. P-values in the multivariable analysis, adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to determine the strength of association. P-value ≤0.05 was considered as significant. RESULTS: Enterococci spp was isolated on 123/200 (61.50%) patients. Among these isolates, the incidence of vancomycin resistant Enterococci was 11.4% [95% CI: (6.0-17.0)]. Antimicrobial susceptibility patterns against Enterococci showed highest rate of resistance to ampicillin (69.9%). Multidrug resistances were observed in 49.59% of Enterococci isolates. Study participants who had prior antibioticexposurer more than two weeks [AOR = 7.35; 95% CI: (1.2144.64)] and hospitalization for the last six months [AOR = 5.68; 95% CI: (1.09 29.74)] were significantly associated with vancomycin resistant Enterococci. CONCLUSIONS: In our study high incidence of vancomycin resistant Enterococci was found. Previous exposure to antibiotics for more than two weeks and hospitalization for more than six months were significantly associated with vancomycin resistant Enterococci. The isolated Enterococci had variable degrees of resistance to commonly prescribed antibiotics. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics and implementing infection prevention protocols may reduce colonization by VRE.


Asunto(s)
Antirretrovirales/uso terapéutico , Tracto Gastrointestinal/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por VIH/complicaciones , VIH/aislamiento & purificación , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Vancomicina/farmacología , Adolescente , Adulto , Anciano , Antibacterianos/farmacología , Estudios Transversales , Etiopía/epidemiología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/microbiología , Infecciones por VIH/virología , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
18.
Infect Genet Evol ; 92: 104889, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33933632

RESUMEN

The spread of vancomycin-resistant Enterococci (VRE) in Algerian hospital settings is poorly reported. Since the first report in 2006, few data have been available on the molecular mechanism of this resistance across the country. In this study, we investigate the frequency and antibiotic resistance mechanisms of Enterococci strains isolated from hospitalised patients in the Tlemcen university hospital. 191 Enterococcus spp. strains were collected from various clinical samples and were identified using MALDI-TOF-MS. The presence of van genes was investigated by standard PCR and sequencing. Results revealed that E. faecium and E. faecalis strains are the main pathogens identified in the study. Antibiotic susceptibility testing revealed that the resistance rate was high for the majority of antibiotic classes, including glycopeptides, and only linezolid was effective on all strains. Molecular analysis revealed that 52.2% of strains from intensive care unit (ICU) were positive for the vanA gene, including 44.44% E. faecium, 5.55% E. faecalis and 2.22% E. avium. 25.5% of these isolates co-harboured both the vanA and vanC genes, including E. gallinarum (n = 16) and E. faecium (n = 6). In surgical wards (SW) 29.70% of strains harboured the van genes, including 4.90% of E. faecalis harbouring the vanB gene, and of the rest of strains, (24.80%) harboured the vanC genes. Indeed, 9.90% E. gallinarum and 4.90% E. faecalis were positive for vanC1 and 9.90% of E. casseliflavus were positive for the vanC2/C3 gene. The glycopeptide resistance rate was higher among strains from the ICU and was mainly composed by E. faecium strains compared with surgical wards where resistant E. faecalis strains were predominant.


Asunto(s)
Infecciones por Bacterias Grampositivas/epidemiología , Hospitales/estadística & datos numéricos , Resistencia a la Vancomicina , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Argelia/epidemiología , Antibacterianos/farmacología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Incidencia , Masculino , Microbiota , Persona de Mediana Edad , Prevalencia , Vancomicina/farmacología , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Adulto Joven
19.
PLoS One ; 16(4): e0249823, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33831089

RESUMEN

BACKGROUND: Vancomycin resistant enterococci (VRE) and vancomycin resistance coagulase negative staphylococci (VRCoNS) are common pathogens causing difficult to treat health care associated infections (HAI). Hence, the World Health Organization listed VRE as one of the high priority pathogens for new antibiotic discovery and antimicrobial resistance surveillance. Despite this, data on the prevalence of VRE and VRCoNS in Ethiopia is scarce. Thus, the present study determined prevalence of VRE and VRCoNS among patients attending Felege-Hiwot comprehensive specialized hospital, Ethiopia. METHODS: A hospital based cross-sectional study was conducted on 384 patients selected conveniently from February to March 2020. Data on demographic and clinical variables were collected using a structured questionnaire by face-to-face interview. Simultaneously urine, venous blood and wound swab were collected and processed following standard bacteriological technique. Antimicrobial susceptibility test was performed by minimum inhibitory concentration method using E-test for vancomycin and Kirby-Bauer disc diffusion method for other classes of antibiotics. Data was entered and analyzed using SPSS version 23. Logistic regression was performed to identify factors associated with VRE infection. P. value < 0.05 was considered as statistically significant. RESULTS: The prevalence of enterococci and CoNS were 6.8% and 12% respectively. The prevalence of VRE was 34.61% (9/26), while all CoNS (46 isolates) were susceptible to vancomycin. The majority (66.7%) of VRE was isolated from blood samples. Furthermore all VRE (100%), 58.8% of vancomycin susceptible enterococci and 45.7% of CoNS were multidrug resistant (MDR). Having educational level of secondary school and below (AOR = 12.80, CI = 1.149-142.5), previous exposure to catheterization (AOR = 56.0, CI = 4.331-724.0) and previous antibiotic use practice (AOR = 26.25, CI = 3.041-226.2) were a significant associated explanatory factor for VRE infection. CONCLUSIONS: The prevalence of vancomycin resistance enterococci, which is also multidrug resistant, was significantly high. Though no vancomycin resistance CoNS detected, the MDR level of CoNS was high. Thus to limit enterococci and CoNS infections and MDR development, focused infection prevention measures should be implemented.


Asunto(s)
Infecciones Estafilocócicas/microbiología , Staphylococcus/patogenicidad , Infecciones Urinarias/microbiología , Enterococos Resistentes a la Vancomicina/patogenicidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Coagulasa/deficiencia , Coagulasa/metabolismo , Farmacorresistencia Bacteriana Múltiple , Etiopía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Prevalencia , Infecciones Estafilocócicas/epidemiología , Staphylococcus/enzimología , Staphylococcus/aislamiento & purificación , Infecciones Urinarias/epidemiología , Enterococos Resistentes a la Vancomicina/aislamiento & purificación
20.
Ann Clin Microbiol Antimicrob ; 20(1): 18, 2021 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-33743726

RESUMEN

BACKGROUND: The screening for intestinal carriage of vancomycin-resistant Enterococcus spp. (VRE) among high risk patients in the Balkan region and molecular epidemiology of VRE is insufficiently investigated, yet it could be of key importance in infection control. The aim of this study was to provide baseline data on VRE intestinal carriage among high-risk patients in Serbian university hospitals, to determine the phenotypic/genotypic profiles of the isolated VRE, to obtain knowledge of local resistance patterns and bridge the gaps in current VRE surveillance. METHODS: The VRE reservoir was investigated using stool samples from 268 inpatients. Characterization of isolated VRE stains consisted of BD Phoenix system, genotypic identification, glycopeptide and quinupristin-dalfopristin (Q-D) resistance probing, virulence gene (esp, hyl, efaA, asa1, gelE, cpd) detection and MLVA. Biofilm formation was evaluated by the microtiter plate method. RESULTS: VRE carriage prevalence among at-risk patients was 28.7%. All VRE strains were vanA positive multidrug-resistant Enterococcus faecium (VRfm), harboring ermB-1 (38.9%), esp (84%), efaA (71.2%), hyl (54.5%), asa1 (23.4%), gelE and cpd (11.6%) each. Ability of biofilm production was detected in 20.8%. Genetic relatedness of the isolates revealed 13 clusters, heterogeneous picture and 25 unique MTs profiles. CONCLUSION: The obtained prevalence of VRE intestinal carriage among high-risk inpatients in Serbia is higher than the European average, with high percentage of multidrug resistance. The emergence of resistance to Q-D is of particular concern. Close monitoring of pattern of resistance and strict adherence to specific guidelines are urgently needed in Serbia.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Enterococcus/metabolismo , Hospitales Universitarios , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Vancomicina/farmacología , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Biopelículas/crecimiento & desarrollo , Farmacorresistencia Bacteriana Múltiple/genética , Enterococcus/genética , Enterococcus/aislamiento & purificación , Enterococcus faecium/aislamiento & purificación , Genotipo , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Serbia/epidemiología , Virulencia/efectos de los fármacos , Factores de Virulencia/genética
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