Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital

Ryan, Louise; O’Mahony, E.; Wrenn, C.; Fitzgerald, Susan; Fox, U.; Boyle, Breida; Schaffer, Kirsten; Werner, Guido; Klare, Ingo

doi:10.1093/jac/dkv185

Cited by 34 publications

(27 citation statements)

References 29 publications

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“…We further observed that the use of antibiotics of all classes predisposed both ACHand ITCF-admitted patients to VRE colonization. This is consistent with previous reports suggesting that antibiotic pressure selected for vancomycin resistance in enterococci (32)(33)(34). This also highlights the importance of good antimicrobial stewardship not only in ACHs but also in ITCFs for the prevention of VRE.…”

Section: Discussionsupporting

confidence: 92%

Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Tan

Htun

Koh

et al. 2018

Antimicrob Agents Chemother

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Vancomycin-resistant enterococci (VRE) are an important cause of nosocomial infections in acute-care hospitals (ACHs), intermediate-care facilities (ITCFs), and long-term care facilities (LTCFs). This study contemporaneously compared the epidemiology and risk factors for VRE colonization in different care settings in a health care network. We conducted a serial cross-sectional study in a 1,700-bed ACH and its six closely affiliated ITCFs and LTCFs in June and July of 2014 to 2016. Rectal swab or stool specimens were cultured for VRE. Multivariable logistic regression was used to assess for independent risk factors associated with VRE colonization. Of 5,357 participants, 523 (9.8%) were VRE colonized. VRE prevalence was higher in ACHs (14.2%) than in ITCFs (7.6%) and LTCFs (0.8%). Common risk factors between ACHs and ITCFs included prior VRE carriage, a longer duration of antibiotic therapy, surgery in the preceding 90 days, and the presence of a skin ulcer. Independent risk factors specific to ACH-admitted patients were prior methicillin-resistant carriage, a higher number of beds per room, prior proton pump inhibitor use, and a length of stay of>14 days. For ITCFs, a length of stay of >14 days was inversely associated with VRE colonization. Similarities and differences in risk factors for VRE colonization were observed between health care settings. VRE prevention efforts should target the respective high-risk patients.

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Section: Discussionsupporting

confidence: 92%

Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Tan

Htun

Koh

et al. 2018

Antimicrob Agents Chemother

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“…52 Only a few VRE fm strains (sequence type (ST)17, ST18, ST78, and ST203) cause invasive infections in blood or sterile body fluids according to the studies in Taiwan 53 and Ireland. 54 The nature of the classification problem would be more simple when the number of labels is fewer.…”

Section: Discussionmentioning

confidence: 99%

Rapidly predicting vancomycin resistance ofEnterococcus faeciumthrough MALDI-TOF MS spectrum obtained in real-world clinical microbiology laboratory

Wang

Chung

et al. 2020

Preprint

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50Enterococcus faecium is one of the leading pathogens in the world. In this study, we proposed 51 a strategy to rapidly and accurately distinguish vancomycin-resistant Enterococcus faecium 52 (VREfm) and vancomycin-susceptible E. faecium (VSEfm) to help doctors correctly determine 53 the use of vancomycin by a machine learning (ML)-based algorithm. A predictive model was 54 developed and validated to distinguish VREfm and VSEfm by analyzing MALDI-TOF MS 55 spectra of unique E. faecium isolates from different specimen types. Firstly, 5717 mass spectra, 56 including 2795 VREfm and 2922 VSEfm, were used to develop the algorithm. And 2280 mass 57 spectra of isolates, namely 1222 VREfm and 1058 VSEfm, were used to externally validate the 58 algorithm. The random forest-based algorithm demonstrated good classification performances 59 for overall specimens, whose mean AUROC in 5-fold cross validation, time-wise validation, 60 and external validation was all greater than 0.84. For the detection of VREfm in blood, sterile 61 body fluid, urinary tract, and wound, the AUROC in external validation was also greater than 62 0.84. The predictions with algorithms were significantly more accurate than empirical 63 antibiotic use. The accuracy of antibiotics administration could be improved by 30%. And the 64 algorithm could provide rapid antibiotic susceptibility results at least 24 hours ahead of routine 65 laboratory tests. The turn-around-time of antibiotic susceptibility could be reduced by 50%. In 66 conclusion, a ML algorithm using MALDI-TOF MS spectra obtained in routine workflow 67 accurately differentiated VREfm from VSEfm, especially in blood and sterile body fluid, which 68 can be applied to facilitate the clinical testing process due to its accuracy, generalizability, and 69 rapidness. 70 71 3 Introduction 72 Enterococcus spp. is one of the leading pathogens in healthcare-associated infection. 1 73 Enterococcal infection could cause urinary tract infection, blood stream infection, and even 74 mortality. 2 Until recently, vancomycin was virtually the only drug that could be consistently 75 relied on for treating multidrug-resistant enterococcal infections 3,4 . Vancomycin-resistant 76 Enterococcus (VRE) has led to heavy burden on healthcare worldwide since its first-time 77 isolation. 5,6 Enterococcus faecalis and E. faecium are the 2 most commonly isolated 78 Enterococcus spp. in clinical practice. 1 VRE faecium (VREfm) has received considerably more 79 attention than VRE faecalis (VREfs) because most of the clinically isolated VRE is E. faecium 80 in the recent decades 4,7 and VREfm causes more severe infection than VREfs 8,9 . Early detection 81 of vancomycin resistance is essential for successfully treating VREfm infection. 10 Vancomycin 82 could be discontinued, and antimicrobial agents could be replaced with other antibiotics (eg, 83 linezolid and daptomycin) based on the laboratory results of vancomycin resistance 11,12 . 84 Patients' prognosis could be improved and further drug resistance development ...

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“…Respiratory infections could be the key source of XDR K. pneumoniae BSIs, which require a prolonged antibiotic therapy and are considered as an important factor for acquired resistance of pathogens (Ryan et al, 2015). The case-fatality rate attributed to BSIs caused by XDR K. pneumoniae here was 40% (14/35), the higher than the overall mortality rate (15–20%) associated with BSIs in previous studies (Russotto et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Extensively Drug-Resistant Klebsiella pneumoniae Causing Nosocomial Bloodstream Infections in China: Molecular Investigation of Antibiotic Resistance Determinants, Informing Therapy, and Clinical Outcomes

Liu

Dunstan

et al. 2017

Front. Microbiol.

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The rise in diversity of antimicrobial resistance phenotypes seen in Klebsiella pneumoniae is becoming a serious antibiotic management problem. We sought to investigate the molecular characteristics and clinical implications of extensively drug-resistant (XDR) K. pneumoniae isolated from different nosocomial bloodstream infections (BSIs) patients from July 2013 to November 2015. Even in combination treatment, meropenem did not protect against mortality of BSIs patients (P = 0.015). In contrast, tigecycline in combination with other antimicrobial agents significantly protected against mortality (P = 0.016). Antimicrobial susceptibility tests, molecular detection of antibiotic resistance determinants, conjugation experiments, multilocus sequence typing (MLST), S1-PFGE, Southern blot, SDS-PAGE, immunoblot analysis, and pulsed-field gel electrophoresis (PFGE) were used to characterize these isolates. These XDR K. pneumoniae strains were resistant to conventional antimicrobials except tigecycline and polymyxin B and co-harbored diverse resistance determinants. rmtB, blaKPC−2 as well as blaCTX−M−9 were located on a transferable plasmid of ~54.2 kb and the most predominant replicon type was IncF. 23 of the 35 isolates belonging the predominant clone were found to incorporate the globally-disseminated sequence type ST11, but others including a unique, previously undiscovered lineage ST2281 (allelic profile: 4-1-1-22-7-4-35) were also found and characterized. The porins OmpK35 and OmpK36 were deficient in two carbapenemase-negative carbapenem-resistant strains, suggesting decreased drug uptake as a mechanism for carbapenem resistance. This study highlights the importance of tracking hospital acquired infections, monitoring modes of antibiotic resistance to improve health outcomes of BSIs patients and to highlight the problems of XDR K. pneumoniae dissemination in healthcare settings.

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Epidemiology and molecular typing of VRE bloodstream isolates in an Irish tertiary care hospital

Cited by 34 publications

References 29 publications

Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Rapidly predicting vancomycin resistance ofEnterococcus faeciumthrough MALDI-TOF MS spectrum obtained in real-world clinical microbiology laboratory

Extensively Drug-Resistant Klebsiella pneumoniae Causing Nosocomial Bloodstream Infections in China: Molecular Investigation of Antibiotic Resistance Determinants, Informing Therapy, and Clinical Outcomes

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