Dissemination of NDM-1 carbapenemase-producer Providencia stuartii strains in Romanian hospitals: a multicentre study

Molnár, Szabolcs; Flonta, Mirela; Almaș, Ariana; Buzea, Mariana; Licker, Monica; Rus, Maria; Főldes, Annamária; Székely, Edit

doi:10.1016/j.jhin.2019.04.015

Cited by 18 publications

(21 citation statements)

References 9 publications

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“…Regarding our PFGE findings, 10 KPC producing K. pneumoniae isolates belonging to the principal cluster A illustrated interhospital dissemination of a successful epidemic K. pneumoniae clone, and the rest of 2 strains affiliated to the cluster B indicated a possibile intrahospital spread. Our 2 bla NDM positive P. stuartii strains belonged to a successful P. stuartii clone which disseminated nationwide as reported recently by Molnar et al (18). Another Romanian study described a similar expansion of a K. pneumoniae OXA-48 positive clone (14).…”

Section: Discussionsupporting

confidence: 82%

“…Determination of colistin susceptibility is technically problematic, and the reference method for testing is broth microdilution (27,32). The highest level of antimicrobial drug resistance was observed in bla NDM positive P. stuartii and M. morganii isolates, as previously outlined by Molnar et al (18). To the best of our knowledge this is the first Romanian research attempting to investigate the notable risk factors, clinical data, outcomes, and treatment for CPE isolates.…”

Section: Discussionmentioning

confidence: 71%

“…In 2018 the European Centre for Disease Prevention and Control (ECDC) alerted about the emergence of resistance of CPE isolates to ceftazidime-avibactam, a newly authorized drug with activity especially against Klebsiella pneumoniae carbapenemase (KPC) producers (11). Some large Romanian medical institutions have confirmed the presence and dissemination of different types of carbapenemases (12)(13)(14)(15)(16)(17)(18)(19)(20)(21), but the involvement of risk factors, clinical impact of CPE pathogens, treatment, and patients' outcomes have not been sufficiently explored. Furthermore, a Romanian national centralized database of circulating carbapenemase types is not yet available.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Molecular epidemiology and the clinical impact of carbapenemase-producing Enterobacterales isolates among adult patients: aspects from a Romanian non-teaching hospital

Főldes

Molnár

Bilca

et al. 2020

Revista Romana De Medicina De Laborator

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Introduction: A dramatic increase of infections induced by carbapenemase-producing Enterobacterales (CPE) has been registered worldwide. The aim of this study was to evaluate the molecular epidemiology and the clinical impact of CPE strains isolated from adult inpatients.Material and methods: A one-year, single-center, retrospective observational study including 34 consecutive patients with 37 non-duplicate CPE strains recovered from clinical specimens was accomplished. The Vitek 2 Compact, M.I.C.Evaluator strips, the modified carbapenem inactivation method (mCIM), and the combination disks test (KPC, MBL, OXA-48 Confirm kit, Rosco Diagnostica) were applied as phenotypic tests. A multiplex polymerase chain reaction (PCR) assay was used for detection of blaKPC, blaNDM, and blaOXA-48-like genes. The clonality was assessed with pulsed-field gel electrophoresis (PFGE).Results: Klebsiella pneumoniae (n=25) was the most frequent CPE encountered. The carbapenemase types were NDM (n=13), KPC (n=12), and OXA-48-like (n=12). Two distinct clonal clusters were identified among the 12 KPC positive strains. All CPE isolates exhibited non-susceptibility to carbapenems, cephalosporins, ciprofloxacin. Respiratory tract infections (n=16) and hospitalization in the intensive care unit (ICU) (n=14) were dominant. The most common comorbidity was congestive heart failure (n=11). Monotherapy was the main strategy adopted (n=15). Death occurred in 18 patients.Conclusions: Our analysis underscores the scarcity of antibiotic solutions and high mortality. Monotherapy for urinary tract infections (UTIs) is beneficial. Inter- or intrahospital dissemination of successful epidemic clones is proved. The adequate CPE infections control programs and antimicrobial policies are essential..

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Molecular epidemiology and the clinical impact of carbapenemase-producing Enterobacterales isolates among adult patients: aspects from a Romanian non-teaching hospital

Főldes

Molnár

Bilca

et al. 2020

Revista Romana De Medicina De Laborator

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“…3,4,14 Such a situation has been reported in several Romanian hospitals over the last decade, where there has been an alarming increase in the incidence of carbapenem-resistant Proteeae (CRP) in samples from patients admitted to highrisk wards. [15][16][17] In this context, the present study aimed to provide a phenotypic and molecular characterisation of carbapenemases secreted by Proteeae strains isolated from patients admitted to high-risk wards in a university hospital in Western Romania and also to identify the associated factors involved in the acquisition of these strains.…”

Section: Introductionmentioning

confidence: 99%

Distribution of NDM1 Carbapenemase-Producing Proteeae Strains on High-Risk Hospital Wards

Rus¹,

Licker²,

Musuroi³

et al. 2020

IDR

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Background: Carbapenem-resistant Proteeae (CRP) is a group of multidrug-resistant (MDR) microorganisms that raise special treatment problems due to their intrinsic resistance to colistin. In this study, our aim is to provide a phenotypic and molecular characterization of the carbapenemases secreted by CRP strains isolated from inpatients from an intensive care unit (ICU) and surgical wards, as well as the identification of the risk factors involved in their acquisition. Methods: An observational, cross-sectional study was performed which included all Proteeae strains isolated in samples from inpatients on high-risk wards of the largest university hospital in Western Romania, from July 2017 to April 2019. Meropenemresistant strains (N=65) with MIC ≥16 µg/mL were subjected to a singleplex PCR assay for the detection of blaNDM, blaVIM and blaCTX-M genes. The analysis of risk factors was performed by logistic regression. Results: Out of 8317 samples that were processed, 400 Proteeae strains were isolated: 64% belonging to the genus Proteus, 26.75% to the genus Providencia and 9.25% to the genus Morganella. Most CRP strains (N=56) were of MBL type, and 55 had the blaNDM gene as the prevalent gene substrate. P. stuartii was the main species that provided the circulating MDR strains. Most CRP strains came from patients admitted to ICU, being isolated mainly from bronchial aspirates and blood cultures. Multivariate analysis revealed 3 independent risk factors -mechanical ventilation>96h ], p <0.001), tracheostomy (HR: 2.65 [1.14-6.17], p = 0.024) and prolonged antibiotic therapy (HR: 1.01 [1.00--1.02], p = 0.03). Conclusion:There is a significant increase in the incidence of CR P. stuartii strains, the MBL-blaNDM type being predominant. These strains presented various other resistance mechanisms, being often extremely difficult to treat and led to an excess of lethality of 27.16%.

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“…have been reported [2,3]. While it is considered uncommon, recent reports from various countries established the emergence of multiple drug resistant (MDR) isolates of Providencia species [4][5][6] and demonstrated their ability to disseminate amongst patients in hospital settings leading to nosocomial outbreaks with treatment challenges and complications [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Targeting Biofilm of MDR Providencia stuartii by Phages Using a Catheter Model

Rakov¹,

Ben-Porat²,

Alkalay-Oren³

et al. 2021

Preprint

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Providencia spp. are emerging pathogens mainly in nosocomial infections. Providencia stuartii in particular is involved in urinary tract infections and contributes significantly to the high incidence of biofilm-formation in catheterized patients. Furthermore, recent reports suggested a role for multiple drug resistant (MDR) P. stuartii in hospital-associated outbreaks which leads to excessive complications resulting in challenging treatments. Phage therapy is currently one of the most promising solutions to combat antibiotic-resistant infections. However, the number of available phages targeting Providencia spp. is extremely limited, restricting the use of phage therapy in such cases. In the present study, we describe the isolation and characterization of 17 lytic and lysogenic bacteriophages targeting clinical isolates of Providencia spp. as part of the Israeli Phage Bank (IPB). These phages, isolated from sewage samples, were evaluated for host range activity and effectively eradicated 95% of the tested bacterial strains isolated from different geographic locations and displaying a wide range of antibiotic resistance. Their lytic activity is demonstrated on agar plates, planktonic cultures, and biofilm formed in a catheter model. The results suggest that these bacteriophages can potentially be used for treatment of antibiotic-resistant Providencia spp infections in general and of urinary tract infections in particular.

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Dissemination of NDM-1 carbapenemase-producer Providencia stuartii strains in Romanian hospitals: a multicentre study

Cited by 18 publications

References 9 publications

Molecular epidemiology and the clinical impact of carbapenemase-producing Enterobacterales isolates among adult patients: aspects from a Romanian non-teaching hospital

Molecular epidemiology and the clinical impact of carbapenemase-producing Enterobacterales isolates among adult patients: aspects from a Romanian non-teaching hospital

Distribution of NDM1 Carbapenemase-Producing Proteeae Strains on High-Risk Hospital Wards

Targeting Biofilm of MDR Providencia stuartii by Phages Using a Catheter Model

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