Pub Date : 2025-01-16DOI: 10.1016/j.jgar.2025.01.003
Ying Fu , Faye C. Morris , Stephanie C. Pereira , Xenia Kostoulias , Yan Jiang , Callum Vidor , Galain Williams , Yogi Srikhanta , Nenad Macesic , Yunsong Yu , Dena Lyras , Anton Y. Peleg
Objective
The IMP-4 carbapenemase is an endemic cause of carbapenem resistance in the Asia-Pacific region. Our aim was to determine the dissemination mechanism of the blaIMP-4 gene.
Methods
Twelve representative Australian IMP-4 clinical isolates from The Alfred Hospital (Victoria, Australia) were characterised using antimicrobial susceptibility testing, with their genome and plasmid assemblies analysed. The conjugation efficiencies of different plasmids were investigated using filter mating with four recipient strains across two species.
Results
Selected IMP-4 isolates included six species and four genera (Enterobacter, Klebsiella, Serratia, and Acinetobacter), whereby isolates of the same species belonged to the same sequence type and were closely related. Four IMP-4 plasmid types were noted: IncHI2A types 1 and 2 (Klebsiella spp. and Enterobacter hormaechei, respectively), IncC (Serratia marcescens and Klebsiella pneumoniae), and a novel type in Acinetobacter pittii. Sequence homology was observed across all plasmids at the blaIMP-4 location, termed Region I, with IS26 on IncHI2A, and IS5075 and Tn3 resistance gene cassettes present on IncC plasmids. Genomic rearrangements mediated by IS26 or Tn3 and IS5075 were identified in Region I of plasmids from the same Inc type. The plasmids of each Inc type were capable of conjugative transfer with varying efficiency. IncH12A plasmids and K. pneumoniae IncC displayed higher transfer efficiencies than other plasmids examined in this study when using the recipient E. coli strain J53 (with conjugation efficiencies of 1.17×10−2 to 5.02×10−5, P < 0.001).
Conclusions
Clonal spread, Inc type, homologous region, and insertion sequences are important mobility factors in the dissemination and evolution of blaIMP-4 plasmids.
{"title":"Mechanisms of blaIMP-4 dissemination across diverse carbapenem-resistant clinical isolates","authors":"Ying Fu , Faye C. Morris , Stephanie C. Pereira , Xenia Kostoulias , Yan Jiang , Callum Vidor , Galain Williams , Yogi Srikhanta , Nenad Macesic , Yunsong Yu , Dena Lyras , Anton Y. Peleg","doi":"10.1016/j.jgar.2025.01.003","DOIUrl":"10.1016/j.jgar.2025.01.003","url":null,"abstract":"<div><h3>Objective</h3><div>The IMP-4 carbapenemase is an endemic cause of carbapenem resistance in the Asia-Pacific region. Our aim was to determine the dissemination mechanism of the <em>bla</em><sub>IMP-4</sub> gene.</div></div><div><h3>Methods</h3><div>Twelve representative Australian IMP-4 clinical isolates from The Alfred Hospital (Victoria, Australia) were characterised using antimicrobial susceptibility testing, with their genome and plasmid assemblies analysed. The conjugation efficiencies of different plasmids were investigated using filter mating with four recipient strains across two species.</div></div><div><h3>Results</h3><div>Selected IMP-4 isolates included six species and four genera (<em>Enterobacter, Klebsiella, Serratia</em>, and <em>Acinetobacter</em>), whereby isolates of the same species belonged to the same sequence type and were closely related. Four IMP-4 plasmid types were noted: IncHI2A types 1 and 2 (<em>Klebsiella</em> spp. and <em>Enterobacter hormaechei</em>, respectively), IncC (<em>Serratia marcescens</em> and <em>Klebsiella pneumoniae</em>), and a novel type in <em>Acinetobacter pittii</em>. Sequence homology was observed across all plasmids at the <em>bla</em><sub>IMP-4</sub> location, termed Region I, with IS<em>26</em> on IncHI2A, and IS<em>5075</em> and Tn<em>3</em> resistance gene cassettes present on IncC plasmids. Genomic rearrangements mediated by IS<em>26</em> or Tn<em>3</em> and IS<em>5075</em> were identified in Region I of plasmids from the same Inc type. The plasmids of each Inc type were capable of conjugative transfer with varying efficiency. IncH12A plasmids and <em>K. pneumoniae</em> IncC displayed higher transfer efficiencies than other plasmids examined in this study when using the recipient <em>E. coli</em> strain J53 (with conjugation efficiencies of 1.17×10<sup>−2</sup> to 5.02×10<sup>−5</sup>, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Clonal spread, Inc type, homologous region, and insertion sequences are important mobility factors in the dissemination and evolution of <em>bla</em><sub>IMP-4</sub> plasmids.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 189-194"},"PeriodicalIF":3.7,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.jgar.2025.01.002
Lirong Li , Yawen Zhang , Fang He , Ningjun wu
Objectives
Pandoraea apista is notable for its multidrug resistance and is frequently identified in patients with cystic fibrosis or other chronic lung diseases, where it contributes to persistent lung infections. In this study, we describe a strain of P. apista harboring the blaOXA-153, isolated from the bronchoalveolar lavage (BAL) fluid of an inpatient in China.
Methods
The genomic DNA of P. apista strain PA167 was sequenced using the Illumina NovaSeq 6000 system and assembled with SPAdes v.3.13.0. Antimicrobial resistance genes (ARGs) were identified using ResFinder v.3.2 within the ABRicate v.0.9.0. Phylogenetic analysis was performed using the Snippy v.4.6.0.
Results
The genome sequence of P. apista strain PA167 comprises 5,580,873 bp, with 4,926 protein-coding sequences, 4 ncRNAs, 59 tRNAs, and 3 rRNA operons. Only one ARG was identified: blaOXA-153. PA167 exhibited resistance to multiple antibiotics, including cephalosporins and carbapenems, and was susceptible only to sulfamethoxazole/trimethoprim. Twenty-four P. apista strains, including PA167, could be retrieved from the NCBI database, all carrying the blaOXA-153. Complete genomic sequencing of five strains confirmed the chromosomal presence of blaOXA-153. The isolation sources of these 24 strains were predominantly clinical samples, mainly respiratory specimens, with some strains isolated from environmental sources.
Conclusion
Here, we present the genome sequence of a P. apista strain carrying the blaOXA-153, marking the first isolation of this strain from a clinical setting in China. The potential for future epidemic spread highlights the necessity for targeted antimicrobial strategies.
{"title":"Genomic insights into a multidrug-resistant pandoraea apista clinical isolate carrying blaOXA-153 from China","authors":"Lirong Li , Yawen Zhang , Fang He , Ningjun wu","doi":"10.1016/j.jgar.2025.01.002","DOIUrl":"10.1016/j.jgar.2025.01.002","url":null,"abstract":"<div><h3>Objectives</h3><div><em>Pandoraea apista</em> is notable for its multidrug resistance and is frequently identified in patients with cystic fibrosis or other chronic lung diseases, where it contributes to persistent lung infections. In this study, we describe a strain of <em>P. apista</em> harboring the <em>bla</em><sub>OXA-153</sub>, isolated from the bronchoalveolar lavage (BAL) fluid of an inpatient in China.</div></div><div><h3>Methods</h3><div>The genomic DNA of <em>P. apista</em> strain PA167 was sequenced using the Illumina NovaSeq 6000 system and assembled with SPAdes v.3.13.0. Antimicrobial resistance genes (ARGs) were identified using ResFinder v.3.2 within the ABRicate v.0.9.0. Phylogenetic analysis was performed using the Snippy v.4.6.0.</div></div><div><h3>Results</h3><div>The genome sequence of <em>P. apista</em> strain PA167 comprises 5,580,873 bp, with 4,926 protein-coding sequences, 4 ncRNAs, 59 tRNAs, and 3 rRNA operons. Only one ARG was identified: <em>bla</em><sub>OXA-153</sub>. PA167 exhibited resistance to multiple antibiotics, including cephalosporins and carbapenems, and was susceptible only to sulfamethoxazole/trimethoprim. Twenty-four <em>P. apista</em> strains, including PA167, could be retrieved from the NCBI database, all carrying the <em>bla</em><sub>OXA-153</sub>. Complete genomic sequencing of five strains confirmed the chromosomal presence of <em>bla</em><sub>OXA-153</sub>. The isolation sources of these 24 strains were predominantly clinical samples, mainly respiratory specimens, with some strains isolated from environmental sources.</div></div><div><h3>Conclusion</h3><div>Here, we present the genome sequence of a <em>P. apista</em> strain carrying the <em>bla</em><sub>OXA-153</sub>, marking the first isolation of this strain from a clinical setting in China. The potential for future epidemic spread highlights the necessity for targeted antimicrobial strategies.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 159-161"},"PeriodicalIF":3.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.1016/j.jgar.2024.12.030
Maria Scaturro , Alessio Lanni , Fabiola Mancini , Antonietta Girolamo , Silvia Fillo , Andrea Ciammaruconi , Florigio Lista , Clementina Elvezia Cocuzza , Rosario Musumeci , Christophe Ginevra , Ghislaine Descours , Sophie Jarraud , Jessica Iera , Paolo Visca , Maria Luisa Ricci
Objectives
Although antimicrobial resistance has not yet emerged as an overarching problem for Legionella pneumophila (L. pneumophila) infection, the description of clinical and environmental strains resistant to fluoroquinolones and macrolides is a cause of concern. This study aimed to investigate the antimicrobial susceptibility of L. pneumophila human isolates in Italy.
Methods
A total of 204 L. pneumophila clinical isolates were tested for sensitivity to 9 antibiotics using the broth microdilution assay (BMD). All isolates were typed by sequence-based typing, and Legionella pneumophila serogroup 1 (Lp1) isolates by monoclonal antibody subgrouping. Minimum inhibitory concentration (MIC) data were correlated with the possible source of infection and geographical distribution. The presence of the lpeAB efflux pump genes was also investigated. The genome sequences of a subpopulation of isolates showing reduced susceptibility to azithromycin were also analysed.
Results
The L. pneumophila isolates did not show significant resistance to the tested antibiotics, although a trend toward reduced sensitivity to azithromycin was observed in a subpopulation of 46 strains, most of which belonged to sequence type 1 (ST1), the second most widespread ST in Italy. An amplicon of the expected size overlapping the lpeAB genes was obtained only in the 46-subpopulation above mentioned. In 4 of the 46 isolates, sequencing analysis showed the occurrence of amino-acid substitutions already described in other strains. No further mutation was found.
Pub Date : 2025-01-14DOI: 10.1016/j.jgar.2024.12.027
Masoud Mohammadi , Seyed Hassan Faghihi
{"title":"Drug-resistant tuberculosis is an important challenge in long COVID patients","authors":"Masoud Mohammadi , Seyed Hassan Faghihi","doi":"10.1016/j.jgar.2024.12.027","DOIUrl":"10.1016/j.jgar.2024.12.027","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Page 162"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In Pseudomonas aeruginosa isolates, emerging meropenem resistance beyond imipenem resistance has become a problem. In this study, we aimed to investigate the relationship between the in vivo acquisition of antimicrobial resistance in fluoroquinolone- and carbapenem-resistant P. aeruginosa clinical isolates, the underlying molecular mechanisms, and exposure to antimicrobial agents.
Methods
Pulsed-field gel electrophoreses were performed to study the molecular relatedness of nine clinical isolates from a Japanese hospital. The minimal inhibitory concentrations of clinically relevant antibiotics were determined. Quantitative PCR was performed to analyze oprD, mexB, mexC, mexE, and mexY expression. DNA sequencing was performed to identify mutations.
Results
Eight of nine strains were metallo-β-lactamase (MBL) negative, and one strain was MBL positive. All eight non-MBL-resistant strains harbored mutations in the quinoline-resistance-determining regions (QRDR) of gyrA, gyrB, or parC. Five of the eight non-MBL strains had T83I, two had D87N, and one had both T83I and D87N mutations in gyrA. Of these eight strains, three carrying gyrA mutations had another QRDR mutation in subunits, gyrB or parC, associated with mexY overexpression. Additionally, seven of eight dual fluoroquinolone and carbapenem-resistant isolates carried a premature termination codon within oprD, containing either F170L or L7 shortening.
Conclusions
In dual fluoroquinolone- and carbapenem-resistant P. aeruginosa, alterations in the OprD porin and the presence of an active EP are primary resistance mechanisms. Meropenem exposure within the past 59 days may have contributed to the selection of the oprD mutant overexpressing mexB, and meropenem exposure within the past 6 months may have contributed to meropenem resistance.
{"title":"Impact of meropenem exposure on fluoroquinolone and carbapenem resistance in Pseudomonas aeruginosa infection in inpatients in a Japanese university hospital: Insights into oprD mutations and efflux pump overexpression","authors":"Tadanori Yamochi , Kazuhisa Ugajin , Rintaro On , Sho Inoue , Hiromi Ikeda , Toshiko Yamochi , Masafumi Takimoto , Issei Tokimatsu","doi":"10.1016/j.jgar.2024.12.029","DOIUrl":"10.1016/j.jgar.2024.12.029","url":null,"abstract":"<div><h3>Objectives</h3><div>In <em>Pseudomonas aeruginosa</em> isolates, emerging meropenem resistance beyond imipenem resistance has become a problem. In this study, we aimed to investigate the relationship between the <em>in vivo</em> acquisition of antimicrobial resistance in fluoroquinolone- and carbapenem-resistant <em>P. aeruginosa</em> clinical isolates, the underlying molecular mechanisms, and exposure to antimicrobial agents.</div></div><div><h3>Methods</h3><div>Pulsed-field gel electrophoreses were performed to study the molecular relatedness of nine clinical isolates from a Japanese hospital. The minimal inhibitory concentrations of clinically relevant antibiotics were determined<em>.</em> Quantitative PCR was performed to analyze <em>oprD, mexB, mexC, mexE</em>, and <em>mexY</em> expression. DNA sequencing was performed to identify mutations.</div></div><div><h3>Results</h3><div>Eight of nine strains were metallo-β-lactamase (MBL) negative, and one strain was MBL positive. All eight non-MBL-resistant strains harbored mutations in the quinoline-resistance-determining regions (QRDR) of <em>gyrA, gyrB</em>, or p<em>arC</em>. Five of the eight non-MBL strains had T83I, two had D87N, and one had both T83I and D87N mutations in <em>gyrA</em>. Of these eight strains, three carrying <em>gyrA</em> mutations had another QRDR mutation in subunits, <em>gyrB</em> or <em>parC</em>, associated with <em>mexY</em> overexpression. Additionally, seven of eight dual fluoroquinolone and carbapenem-resistant isolates carried a premature termination codon within <em>oprD</em>, containing either F170L or L7 shortening.</div></div><div><h3>Conclusions</h3><div>In dual fluoroquinolone- and carbapenem-resistant <em>P. aeruginosa</em>, alterations in the OprD porin and the presence of an active EP are primary resistance mechanisms. Meropenem exposure within the past 59 days may have contributed to the selection of the <em>oprD</em> mutant overexpressing <em>mexB</em>, and meropenem exposure within the past 6 months may have contributed to meropenem resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 163-168"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.jgar.2024.12.028
Faruk Demirocak, Diana Langerak, Erlangga Yusuf
Objective
Piperacillin/tazobactam antimicrobial susceptibility testing (AST) against Enterobacterales can be challenging. The aim of this study was to assess the reproducibility of various automated (VITEK 2) and nonautomated AST methods (broth microdilution (BMD), minimum inhibitory concentration (MIC) test strip, and disk diffusion) for piperacillin/tazobactam in ‘challenging’ E. coli isolates.
Methods
We performed 20 repeated ASTs for seven clinical E. coli isolates: Two resistant to piperacillin/tazobactam but susceptible to amoxicillin/clavulanic acid, four isolates with various β-lactamase coding genes (two blaTEM-1, one blaOXA-1, and one with plasmidal blaampC), and one isolate where VITEK 2 initially could not produce MIC measurements for piperacillin/tazobactam (i.e. no results generated).
Results
Upon repetition, the same MIC as the mode value (i.e. the most frequent MIC value of each AST method) was found between 21% and 87% (BMD), 46% and 100% (VITEK 2), and 48% and 100% (gradient test) of the repetitions. The range of essential agreement percentage (i.e. ±1 doubling dilution from this mode value) was 53–100% (BMD), 63–100% (VITEK 2), and 100% (gradient test). Percent categorical agreement (same susceptible of resistant category using EUCAST breakpoint v. 14.0) was 71–100% (BMD), 85–92% (VITEK 2), 76–100% (gradient test) and 100% (disk diffusion).
Conclusions
: In conclusion, this study provides insight on the reliability of AST results for piperacillin/tazobactam in challenging E. coli isolates. While the results indicate that most methods are generally reproducible, certain isolates may present inconsistent MIC results.
{"title":"Reliability of various antimicrobial susceptibility testing methods for piperacillin/tazobactam in challenging Escherichia coli isolates","authors":"Faruk Demirocak, Diana Langerak, Erlangga Yusuf","doi":"10.1016/j.jgar.2024.12.028","DOIUrl":"10.1016/j.jgar.2024.12.028","url":null,"abstract":"<div><h3>Objective</h3><div>Piperacillin/tazobactam antimicrobial susceptibility testing (AST) against Enterobacterales can be challenging. The aim of this study was to assess the reproducibility of various automated (VITEK 2) and nonautomated AST methods (broth microdilution (BMD), minimum inhibitory concentration (MIC) test strip, and disk diffusion) for piperacillin/tazobactam in ‘challenging’ <em>E. coli</em> isolates.</div></div><div><h3>Methods</h3><div>We performed 20 repeated ASTs for seven clinical <em>E. coli</em> isolates: Two resistant to piperacillin/tazobactam but susceptible to amoxicillin/clavulanic acid, four isolates with various β-lactamase coding genes (two <em>bla</em><sub>TEM-1</sub>, one <em>bla</em><sub>OXA-1</sub>, and one with plasmidal <em>bla</em><sub>ampC</sub>), and one isolate where VITEK 2 initially could not produce MIC measurements for piperacillin/tazobactam (i.e. no results generated).</div></div><div><h3>Results</h3><div>Upon repetition, the same MIC as the mode value (i.e. the most frequent MIC value of each AST method) was found between 21% and 87% (BMD), 46% and 100% (VITEK 2), and 48% and 100% (gradient test) of the repetitions. The range of essential agreement percentage (i.e. ±1 doubling dilution from this mode value) was 53–100% (BMD), 63–100% (VITEK 2), and 100% (gradient test). Percent categorical agreement (same susceptible of resistant category using EUCAST breakpoint v. 14.0) was 71–100% (BMD), 85–92% (VITEK 2), 76–100% (gradient test) and 100% (disk diffusion).</div></div><div><h3>Conclusions</h3><div><em>:</em> In conclusion, this study provides insight on the reliability of AST results for piperacillin/tazobactam in challenging <em>E. coli</em> isolates. While the results indicate that most methods are generally reproducible, certain isolates may present inconsistent MIC results.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 211-215"},"PeriodicalIF":3.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by Klebsiella pneumoniae producing Klebsiella pneumoniae Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in a neurorehabilitation unit in Italy, analysed through whole-genome sequencing (WGS) for transmission routes reconstruction to improve management of KPC-Kp infections in rehabilitation units.
Methods
We investigated cases and KPC-Kp isolates collected from February to October 2022 from hospital surveillance. Carbapenem resistance was identified with disk diffusion and minimum inhibitory concentration tests, carbapenemase production through immunochromatographic lateral flow assays. All isolates were genotyped through WGS to highlight possible phylogenetic relationships. The most likely transmission networks of KPC-Kp were reconstructed with Bayesian discrete-time stochastic models.
Results
Nineteen patients were colonized by KPC-Kp. Two isolates belonged to sporadic sequence types (STs; ST348 and ST219) whereas 9 of 19 and 8 of 19 isolates belonged to ST307 and ST716, respectively. Among the ST307 isolates, we identified two genomically distinct clusters of five and two cases. All ST716 isolates were highly similar. Genotyping and the reconstruction of transmission networks of KPC-Kp based on genomic data identified seven independent introductions into the neurorehabilitation unit rather than a single outbreak as initially hypothesized before genomic investigation. Three of the seven introductions generated chains of secondary infections, whereas the remaining four remained single cases.
Pub Date : 2025-01-11DOI: 10.1016/j.jgar.2024.12.023
Valeria Cento , Sara Carloni , Riccardo Sarti , Linda Bussini , Zian Asif , Paola Morelli , Francesco De Fazio , Federica Maria Tordato , Maddalena Casana , Debora Mondatore , Antonio Desai , Elena Generali , Nicola Pugliese , Elena Costantini , Massimo Vanoni , Maurizio Cecconi , Stefano Aliberti , Giorgio Da Rin , Erminia Casari , Michele Bartoletti , Antonio Voza
Objective
This study aimed to investigate the microbiological and clinical heterogeneity of community-onset bloodstream infections (BSIs) and identify features to support targeted empirical antibiotic therapy in the Emergency Department (ED).
Methods
Clinical and microbiological data from 992 BSI cases (1,135 isolates) diagnosed within 24 h of ED admission at IRCCS Humanitas Research Hospital, Milan, Italy (January 2015–June 2022), were analysed. Drug resistance was interpreted using EUCAST-2023. Clinical features included age, sex, comorbidities (e.g., cancer, diabetes), infection source, presence of central venous catheters (CVC), ongoing therapies, and sepsis severity. Microbiological data included pathogen identification and antimicrobial susceptibility.
Results
Antibiotic-susceptible Escherichia coli (29.5%) was the most common isolate, including extended-spectrum beta-lactamase (ESBL)-producing strains (11.3%), followed by methicillin-susceptible Staphylococcus aureus (MSSA, 8.4%). BSIs due to E. coli were more frequent in patients >60 years (43.9% vs. 27.3%, P < 0.001) and associated with ESBL production (OR = 2.202, P = 0.031) and urosepsis (OR = 1.688, P = 0.006). Younger patients (≤60 years) had more S. aureus-associated BSIs (22.4% vs. 10.8%, P < 0.001) and methicillin resistance (7.9% vs. 3.6%, P = 0.021). Carbapenem-resistant Enterobacterales were rare (2.1%-2.8%), predominantly involving Klebsiella pneumoniae. Onco-hematological patients had a lower multidrug-resistance prevalence (9.5% vs. 21.1%, P < 0.001).
Conclusions
Community-onset BSIs demonstrated substantial prevalence of resistant pathogens, including ESBL and MRSA, emphasizing the need for robust surveillance systems. Age is a critical factor in guiding empirical antibiotic therapy in the ED.
目的：本研究旨在探讨社区发病血流感染（bsi）的微生物学和临床异质性，并确定特征，以支持急诊科（ED）的靶向经验性抗生素治疗。方法：分析2015年1月至2022年6月意大利米兰IRCCS人道研究医院急诊入院24小时内诊断的992例BSI患者（1135株）的临床和微生物学资料。使用EUCAST-2023分析耐药性。临床特征包括年龄、性别、合并症（如癌症、糖尿病）、感染来源、中心静脉导管（CVC）的存在、正在进行的治疗和脓毒症的严重程度。微生物学数据包括病原鉴定和抗菌药物敏感性。结果：最常见的是抗生素敏感的大肠杆菌（29.5%），其中产广谱β -内酰胺酶（ESBL）的菌株（11.3%），其次是甲氧西林敏感的金黄色葡萄球菌（MSSA）（8.4%）。大肠杆菌引起的bsi在60岁以下的患者中更为常见（43.9% vs. 27.3%）。结论：社区发病的bsi显示出耐药病原体的大量流行，包括ESBL和MRSA，强调了强大的监测系统的必要性。年龄是指导急诊经验性抗生素治疗的关键因素。
{"title":"Epidemiology and Resistance Profiles of Bacteria Isolated From Blood Samples in Septic Patients at Emergency Department Admission: A 6-Year Single Centre Retrospective Analysis From Northern Italy","authors":"Valeria Cento , Sara Carloni , Riccardo Sarti , Linda Bussini , Zian Asif , Paola Morelli , Francesco De Fazio , Federica Maria Tordato , Maddalena Casana , Debora Mondatore , Antonio Desai , Elena Generali , Nicola Pugliese , Elena Costantini , Massimo Vanoni , Maurizio Cecconi , Stefano Aliberti , Giorgio Da Rin , Erminia Casari , Michele Bartoletti , Antonio Voza","doi":"10.1016/j.jgar.2024.12.023","DOIUrl":"10.1016/j.jgar.2024.12.023","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the microbiological and clinical heterogeneity of community-onset bloodstream infections (BSIs) and identify features to support targeted empirical antibiotic therapy in the Emergency Department (ED).</div></div><div><h3>Methods</h3><div>Clinical and microbiological data from 992 BSI cases (1,135 isolates) diagnosed within 24 h of ED admission at IRCCS Humanitas Research Hospital, Milan, Italy (January 2015–June 2022), were analysed. Drug resistance was interpreted using EUCAST-2023. Clinical features included age, sex, comorbidities (e.g., cancer, diabetes), infection source, presence of central venous catheters (CVC), ongoing therapies, and sepsis severity. Microbiological data included pathogen identification and antimicrobial susceptibility.</div></div><div><h3>Results</h3><div>Antibiotic-susceptible <em>Escherichia coli</em> (29.5%) was the most common isolate, including extended-spectrum beta-lactamase (ESBL)-producing strains (11.3%), followed by methicillin-susceptible <em>Staphylococcus aureus</em> (MSSA, 8.4%). BSIs due to <em>E. coli</em> were more frequent in patients >60 years (43.9% vs. 27.3%, <em>P</em> < 0.001) and associated with ESBL production (OR = 2.202, <em>P</em> = 0.031) and urosepsis (OR = 1.688, <em>P</em> = 0.006). Younger patients (≤60 years) had more <em>S. aureus</em>-associated BSIs (22.4% vs. 10.8%, <em>P</em> < 0.001) and methicillin resistance (7.9% vs. 3.6%, <em>P</em> = 0.021). Carbapenem-resistant Enterobacterales were rare (2.1%-2.8%), predominantly involving <em>Klebsiella pneumoniae</em>. Onco-hematological patients had a lower multidrug-resistance prevalence (9.5% vs. 21.1%, <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Community-onset BSIs demonstrated substantial prevalence of resistant pathogens, including ESBL and MRSA, emphasizing the need for robust surveillance systems. Age is a critical factor in guiding empirical antibiotic therapy in the ED.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 202-210"},"PeriodicalIF":3.7,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-08DOI: 10.1016/j.jgar.2024.12.026
Phyu Win Ei , Mi Mi Htwe , Myat Htut Nyunt , Aye Su Mon , Zaw Myint , Wint Wint Nyunt , Su Mon Win , Sandar Aung , Wai Myat Thwe , Wah Wah Aung
Objective
Detecting rifampicin (RIF) resistance is crucial in selecting tuberculosis (TB) treatment. Recently, several studies reported that I491F and V170F rpoB mutations were found with a varying prevalence. This study aimed to find out RIF resistance missed by routine diagnostic assays using next generation genome sequencing tool.
Methods
Sputum specimens from first-line TB treatment failed patients attending Tuberculosis Centers in Yangon Region during 2022 were cultured in solid media. Phenotypic drug susceptibility testing was conducted using Mycobacterial Growth Indicator Tube method. Whole genome or Deeplex-targeted next-generation sequencing was performed using Illumina Miseq. Mutation analysis was done by PhyResSE and SAM-TB online platforms.
Results
A total of 32 culture-positive isolates with DNA qualified for genome sequencing were included in the study. Those were diagnosed as rifampicin-susceptible by routine GeneXpert and line probe assays. RIF resistance-conferring mutations were found in 17/32 (53.1%) Mycobacterium tuberculosis isolates; 14 (43.7%) had mutations outside the RIF resistance determining region (I491F and V170F), two (6.3%) were S450L, mutation within RIF resistance determining region, and one isolate (3.1%) with interim resistance mutations S428T and S441A.
Conclusion
This study highlighted the presence of rifampicin-resistant TB strains missed by current diagnostic strategies, and are circulating as treatment-failed patients. This demonstrates a gap in current World Health Organization-endorsed algorithms for capturing all multidrug-resistant-TB strains.
{"title":"Detection of I491F and V170F rpoB mutations associated with misdiagnosis of rifampicin resistance among patients with drug-susceptible tuberculosis treatment failure, Myanmar, 2022","authors":"Phyu Win Ei , Mi Mi Htwe , Myat Htut Nyunt , Aye Su Mon , Zaw Myint , Wint Wint Nyunt , Su Mon Win , Sandar Aung , Wai Myat Thwe , Wah Wah Aung","doi":"10.1016/j.jgar.2024.12.026","DOIUrl":"10.1016/j.jgar.2024.12.026","url":null,"abstract":"<div><h3>Objective</h3><div>Detecting rifampicin (RIF) resistance is crucial in selecting tuberculosis (TB) treatment. Recently, several studies reported that I491F and V170F <em>rpo</em>B mutations were found with a varying prevalence. This study aimed to find out RIF resistance missed by routine diagnostic assays using next generation genome sequencing tool.</div></div><div><h3>Methods</h3><div>Sputum specimens from first-line TB treatment failed patients attending Tuberculosis Centers in Yangon Region during 2022 were cultured in solid media. Phenotypic drug susceptibility testing was conducted using Mycobacterial Growth Indicator Tube method. Whole genome or Deeplex-targeted next-generation sequencing was performed using Illumina Miseq. Mutation analysis was done by PhyResSE and SAM-TB online platforms.</div></div><div><h3>Results</h3><div>A total of 32 culture-positive isolates with DNA qualified for genome sequencing were included in the study. Those were diagnosed as rifampicin-susceptible by routine GeneXpert and line probe assays. RIF resistance-conferring mutations were found in 17/32 (53.1%) <em>Mycobacterium tuberculosis</em> isolates; 14 (43.7%) had mutations outside the RIF resistance determining region (I491F and V170F), two (6.3%) were S450L, mutation within RIF resistance determining region, and one isolate (3.1%) with interim resistance mutations S428T and S441A.</div></div><div><h3>Conclusion</h3><div>This study highlighted the presence of rifampicin-resistant TB strains missed by current diagnostic strategies, and are circulating as treatment-failed patients. This demonstrates a gap in current World Health Organization-endorsed algorithms for capturing all multidrug-resistant-TB strains.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Pages 169-172"},"PeriodicalIF":3.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-08DOI: 10.1016/j.jgar.2024.12.009
Lorenzo Volpicelli , Sara Cairoli , Dania Al Ismail , Floriana Baisi , Federica Sacco , Bianca Maria Goffredo , Mario Venditti , Alessandra Oliva
{"title":"Corrigendum to “Simultaneous post-neurosurgical ventriculitis and bacteraemia by two different strains of KPC-producing K. pneumoniae successfully treated with meropenem/vaborbactam and high dose of Fosfomycin” [Journal of Global Antimicrobial Resistance 37 (2024) 86-90]","authors":"Lorenzo Volpicelli , Sara Cairoli , Dania Al Ismail , Floriana Baisi , Federica Sacco , Bianca Maria Goffredo , Mario Venditti , Alessandra Oliva","doi":"10.1016/j.jgar.2024.12.009","DOIUrl":"10.1016/j.jgar.2024.12.009","url":null,"abstract":"","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"41 ","pages":"Page 20"},"PeriodicalIF":3.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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