Extended-spectrum β-lactamase producing Escherichia coli: changing epidemiology and clinical impact

Oteo, Jesús; Pérez-Vázquez, Marı́a; Campos, José

doi:10.1097/qco.0b013e3283398dc1

Cited by 257 publications

(190 citation statements)

References 62 publications

(46 reference statements)

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“…ESBL in uropathogens isolated from the community is cause for concern due to the enormous potential for multidrug resistance from strains that produce these enzymes, which could lead to failure of empiricallyadministered therapies and development of complicated UTIs. [18][19]. The Infectious Diseases Society of America guidelines suggest that 10-20% resistance warrants a change in the recommended antibiotic used as the first-line therapy [7].…”

Section: Discussionmentioning

confidence: 99%

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

Villar¹,

Jugo²,

Macan³

et al. 2014

J Infect Dev Ctries

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Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. Methodology: Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. Results: Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%), and Klebsiella pneumoniae (11.9%). Gram-negative organisms represented 78.8% of urinary pathogens. The highest activities against Gramnegative bacteria were found with imipenem (99.0%), amikacin (98.1%), ertapenem (94.2%), fosfomycin (90.7%), and piperacillintazobactam (90.1%). The frequencies of ESBLs among E. coli, K. pneumoniae, and P. mirabilis were 15.2 %, 22.3%, and 8%, respectively. Fosfomycin, piperacillin-tazobactam, and nitrofurantoin were most effective against Gram-positive organisms. Conclusions: Fosfomycin may be an excellent option for cystitis treatment in patients without risk factors, whereas piperacillin-tazobactam is preferred for the treatment of parenchymatous UTIs, complicated UTIs, and UTIs associated with risk factors. To ensure the optimal selection of antibiotics, physicians should have access to up-to-date information about the local prevalence of antimicrobial resistance.

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Section: Discussionmentioning

confidence: 99%

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

Villar¹,

Jugo²,

Macan³

et al. 2014

J Infect Dev Ctries

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“…Bei drei der hier referierten Ausbrüche durch Klebsiella pneumoniae handelte es sich um ein CTX-M-15 bildendes Isolat [28][29][30]. Solche β-Laktamasen mit erweitertem Wirkspektrum werden in den letzten Jahren zunehmend bei Enterobacteriaceae, insbesondere auch bei E. coli im ambulanten Setting (Harnwegsinfektionen) gefunden [53,54].…”

Section: Ausbruchsuntersuchung Und Maßnahmen Zur Ausbruchskontrolleunclassified

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Kraus-Haas

Mielke

Simon

2015

Bundesgesundheitsbl.

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Häufungen von Infektionen mit einem (vermeintlich) einheitlichen Erreger in neonatologischen Intensivpflegestationen (NICUs) sind unerwünschte Ereignisse, durch die die Sicherheit der Patienten und ein günstiger Ausgang der Intensivtherapie gefährdet wird [1]. Mitunter sterben die Kinder an unmittelbaren Komplikationen bzw. langfristigen Folgen dieser "Late-onset"-Infektionen oder ihre psychomotorischen und mentalen Entwicklungsoptionen werden durch diese Ereignisse nachhaltig beeinträchtigt [2]. Ausbrüche bedingen zudem erhebliche Mehrbelastungen des Behandlungsteams (zu dem wir auch das Hygienefachpersonal zählen) [3] und können zur vorüber-gehenden oder dauerhaften Schließung einer Abteilung führen [4][5][6][7][8]. Aufgrund der besonderen Infektionsgefährdung der Patienten, der strukturell-organisatorischen Besonderheiten der Intensivtherapie in NICUs, des initial sehr uncharakteristischen klinischen Bildes und aufgrund des speziellen Erregerspektrums (z. B. Serratia marcescens) müssen Ausbrüche auf NICUs separat von anderen Ausbrüchen betrachtet werden [1].Die

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“…In some, fosfomycin resistance is encoded by a gene included in a transposon 124,125 or by gene cassettes included in integrons, [126][127][128] and we know that sometimes such resistance may be responsible for outbreaks of multidrug-resistant infections that are difficult to treat. 38,129 In a study describing the trends for fosfomycin resistance in strains of E. coli producing CTX-M-15 extended-spectrum β-lactamase, Oteo et al 128 in vitro susceptibility testing and interpretative standards Susceptibility testing for fosfomycin may be performed by the agar disk diffusion method, the gradient diffusion method (Etest ® , AB Biodisk, Solna, Sweden), the agar or broth dilution method, or by the break point dilution method. Unfortunately, for many reasons, fosfomycin susceptibility results were not reported in many of the publications dealing with multidrug-resistant bacteria.…”

Section: Mechanisms Of Resistancementioning

confidence: 99%

Fosfomycin and Its Application in the Treatment of Multidrug-Resistant Enterobacteriaceae Infections

2011

Clinical Medicine Reviews in Therapeutics

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Abstract:The use of fosfomycin has been limited in therapeutics in recent years. Because it has shown good antibacterial activity in vitro and clinical efficacy in some domains, it has been proposed as an alternative to current antimicrobial agents, which are subject to increasing resistance. This paper reviews the main properties of fosfomycin and the latest publications concerning multidrugresistant Enterobacteriaceae infections. In uncomplicated urinary tract infections, a single oral dose was found to be safe and effective. In complicated urinary tract infections, the same results were observed with several doses. In both cases, by using fosfomycin to treat infections, the use of carbapenems could be reduced, leading to lower costs and better microbial ecology. In severe infections, combinations with intravenous fosfomycin need to be explored further because its future activity may depend on choosing a good partner drug. Because of the fast evolution of microbial resistance, more studies are urgently needed.

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Extended-spectrum β-lactamase producing Escherichia coli: changing epidemiology and clinical impact

Abstract: The worldwide emergence of multiresistant ESBL-producing E. coli raises key therapeutic problems; interventions addressed to their quick detection and early appropriate antibiotic treatment and prevention are urgently needed.

Cited by 257 publications

References 62 publications

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

Literatur-Update zu Ausbrüchen auf neonatologischen Intensivpflegestationen – Serratia marcescens, Klebsiella pneumoniae, Acinetobacter baumannii und Pseudomonas aeruginosa

Fosfomycin and Its Application in the Treatment of Multidrug-Resistant Enterobacteriaceae Infections

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