Fecal Carriage and Epidemiology of Extended-Spectrum Beta-Lactamase/Carbapenemases Producing Enterobacterales Isolates in Bulgarian Hospitals

Markovska, Rumyana; Stankova, Petya; Stoeva, Temenuga; Ivanova, Dobrinka; Pencheva, Daniela; Kaneva, Radka; Boyanova, Lyudmila

doi:10.3390/antibiotics10060747

Cited by 8 publications

(11 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are in concordance with the high incidence of third-generation cephalosporin-resistant invasive E. coli and K. pneumoniae isolates (38.6% and 75.7%, respectively) in Bulgaria in 2019, which was the highest in Europe and showed a stable trend during the last 5 years (https://www.ecdc.europa.eu/sites/default/files/documents/Additional-tables-EUEEApopulation-weighted-mean-2019.pdf), last accessed on 10 August 2022. We also found increased nonsusceptibility rates in the tested ESBL fecal isolates to aminoglycosides (50-68%) and quinolones (63-68%) in comparison to the rates found in 2015 (21-57% for aminoglycosides and 15-27% for quinolones) [25]. A similar trend was detected for carbapenem resistance-7% during the period of 2017-2019 and 3% in 2015 [25].…”

Section: Discussionsupporting

confidence: 73%

“…This study reveals a moderate rate of fecal colonization with ESBL producers (28.8%) among Bulgarian patients during the period 2017-2019. The rate of third-generation cephalosporinresistant isolates (mostly due to production of ESBL/carbapenemase/plasmid AmpC) was high (35.3%), but lower than the rate observed in a pilot study on hospital fecal carriage in Varna city, Bulgaria in 2015 (42.5%) [25]. A possible reason could be the multicenter design of the present study.…”

Section: Discussioncontrasting

confidence: 66%

See 1 more Smart Citation

Dissemination of High-Risk Clones Enterobacterales among Bulgarian Fecal Carriage Isolates

et al. 2022

Self Cite

View full text Add to dashboard Cite

The gastrointestinal tract is an important reservoir of high-risk Enterobacteria clones and a driver of antimicrobial resistance in hospitals. In this study, patients from six hospitals in four major Bulgarian towns were included in this study. Overall, 205 cefotaxime-resistant isolates (35.3%) of Enterobacterales order were detected in fecal samples among 580 patients during the period of 2017–2019. ESBL/carbapenemase/plasmidic AmpC producer rates were 28.8%, 2.4%, and 1.2%, respectively. A wide variety of ESBLs: CTX-M-15 (41%), CTX-M-3 (24%), CTX-M-27 (11%), and CTX-M-14 (4%) was found. The carbapenemases identified in this study were New Delhi metalo-β-lactamase (NDM)-1 (5.4%) and Klebsiella carbapenemase (KPC)-2 (1.5%). Most NDM-1 isolates also produced CTX-M-15/-3 and CMY-4 β-lactamases. They belonged to ST11 Klebsiella pneumoniae clone. The epidemiology typing revealed three main high-risk K. pneumoniae clones (26%)—ST11, ST258, and ST15 and five main Escherichia coli clones—ST131 (41.7%), ST38, ST95, ST405, and ST69. Sixty-one percent of ST131 isolates were from the highly virulent epidemic clone O25b:H4-ST131. Phylotyping revealed that 69% of E. coli isolates belonged to the virulent B2 and D groups. Almost all (15/16) Enterobacter isolates were identified as E. hormaechei and the most common ST type was ST90. Among all of the isolates, a high ESBL/carbapenemases/plasmid AmpC (32.4%) prevalence was observed. A significant proportion of the isolates (37%) were members of high-risk clones including two pan-drug-resistant K. pneumoniae ST11 NDM-1 producing isolates. Due to extensive antibiotic usage during COVID-19, the situation may worsen, so routine screenings and strict infection control measures should be widely implemented.

show abstract

Section: Discussionsupporting

confidence: 73%

Section: Discussioncontrasting

confidence: 66%

Dissemination of High-Risk Clones Enterobacterales among Bulgarian Fecal Carriage Isolates

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…44 In the current coronavirus disease 2019 (COVID-19) era, overuse of antibiotics may increase selection pressures in hospitals and communities and may increase the incidence and transmission of CRE. 45 Our study had some limitations. First, the study was conducted in a single center, and the results may not be generalizable to other institutions.…”

Section: Dovepressmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Bloodstream Infections in Patients with Rectal Colonization by Carbapenem-Resistant Enterobacteriaceae: A Prospective Cohort Study

Chu¹,

Hang²,

Li³

et al. 2022

IDR

View full text Add to dashboard Cite

Purpose Carbapenem-resistant Enterobacteriaceae (CRE) infection has become a concerning threat, especially in hospital settings; however, its phenotypic characterization, association with rectal colonization and subsequent bloodstream infections (BSI) remain to be clarified. This study aimed to investigate the incidence and risk factors of CRE infection in rectal CRE carriers and to understand the clonality of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains and their association with subsequent BSI in these patients. Patients and Methods This was a prospectively designed cohort study. Hospitalized patients treated at our institution from April 2019 to October 2020 with intestinal CRE carriage were screened at admission and weekly thereafter until death or discharge from the hospital. Stool and blood samples were obtained for strain growth and mass spectrometry. The colonization and clinical infection isolates were analyzed by antimicrobial susceptibility testing to identify CRE. The clonality of the CRE strains and their corresponding clinical infection strains was studied by whole-genome sequencing to explore the mechanism of drug resistance and evaluate possible transmission. CRE-associated risk factors were analyzed in combination with epidemiological data. Results Of the 1203 patients, 85 were colonized by CRE and 21 developed CRE infection, of whom 13 developed CRE bloodstream infection (BSI). Ninety-one CRE strains were isolated from the rectal specimens of the 85 patients. Tracheotomy and chemotherapy in the past three months were independent risk factors for CRE infection in intestinal CRE carriers. ST11-KL64 (92.3%, 24/26) was the most dominant capsule and multilocus sequence typing (MLST) type among clonal CRKP isolates. Single-nucleotide polymorphism clustering showed homology of representative colonization and infection CRKP strain pairs (n=13) in the same patient. One group of leading clones was endemic in surgical intensive care units (ICUs). Twenty-four CRKP strains carried β-lactamase K. pneumonia carbapenemase 2, and 73.1% (19 strains) of CRKP carried mucoid phenotype regulator genes A2 and iucABCD. Conclusion In summary, intestinal CRE colonization was detectable at an elevated rate among hospitalized patients and prevalent in ICU patients, with potential rapid horizontal transmission, providing evidence that CRE BSI infection in hospitalized patients might be due to their colonized strains and indicates the correlation between intestinal colonization and BSI.

show abstract

“…ST17 CRKP has also been sporadically reported in nonneonatal patients [163,164], animals [165,166], and wastewater [167]. Non-carbapenem-resistant ST17 K. pneumoniae has been found to commonly carry genes encoding ESBLs [168][169][170][171][172][173]. The vast majority of neonatal ST17 CRKP strains also carry ESBL genes [30,128], and there were 48 neonatal ST17 CRKP strains with genome sequences available, among which ESBL gene bla CTX-M was found in 43 PLOS MEDICINE (89.6%; S7 Dataset).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

Yang

Feng

et al. 2023

PLoS Med

View full text Add to dashboard Cite

Background Klebsiella pneumoniae is the most common pathogen causing neonatal infections, leading to high mortality worldwide. Along with increasing antimicrobial use in neonates, carbapenem-resistant K. pneumoniae (CRKP) has emerged as a severe challenge for infection control and treatment. However, no comprehensive systematic review is available to describe the global epidemiology of neonatal CRKP infections. We therefore performed a systematic review of available data worldwide and combined a genome-based analysis to address the prevalence, clonal diversity, and carbapenem resistance genes of CRKP causing neonatal infections. Methods and findings We performed a systematic review of studies reporting population-based neonatal infections caused by CRKP in combination with a genome-based analysis of all publicly available CRKP genomes with neonatal origins. We searched multiple databases (PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane, bioRxiv, and medRxiv) to identify studies that have reported data of neonatal CRKP infections up to June 30, 2022. We included studies addressing the prevalence of CRKP infections and colonization in neonates but excluded studies lacking the numbers of neonates, the geographical location, or independent data on Klebsiella or CRKP isolates. We used narrative synthesis for pooling data with JMP statistical software. We identified 8,558 articles and excluding those that did not meet inclusion criteria. We included 128 studies, none of which were preprints, comprising 127,583 neonates in 30 countries including 21 low- and middle-income countries (LMICs) for analysis. We found that bloodstream infection is the most common infection type in reported data. We estimated that the pooled global prevalence of CRKP infections in hospitalized neonates was 0.3% (95% confidence interval [CI], 0.2% to 0.3%). Based on 21 studies reporting patient outcomes, we found that the pooled mortality of neonatal CRKP infections was 22.9% (95% CI, 13.0% to 32.9%). A total of 535 neonatal CRKP genomes were identified from GenBank including Sequence Read Archive, of which 204 were not linked to any publications. We incorporated the 204 genomes with a literature review for understanding the species distribution, clonal diversity, and carbapenemase types. We identified 146 sequence types (STs) for neonatal CRKP strains and found that ST17, ST11, and ST15 were the 3 most common lineages. In particular, ST17 CRKP has been seen in neonates in 8 countries across 4 continents. The vast majority (75.3%) of the 1,592 neonatal CRKP strains available for analyzing carbapenemase have genes encoding metallo-β-lactamases and NDM (New Delhi metallo-β-lactamase) appeared to be the most common carbapenemase (64.3%). The main limitation of this study is the absence or scarcity of data from North America, South America, and Oceania. Conclusions CRKP contributes to a considerable number of neonatal infections and leads to significant neonatal mortality. Neonatal CRKP strains are highly diverse, while ST17 is globally prevalent and merits early detection for treatment and prevention. The dominance of blaNDM carbapenemase genes imposes challenges on therapeutic options in neonates and supports the continued inhibitor-related drug discovery.

show abstract

Fecal Carriage and Epidemiology of Extended-Spectrum Beta-Lactamase/Carbapenemases Producing Enterobacterales Isolates in Bulgarian Hospitals

Cited by 8 publications

References 43 publications

Dissemination of High-Risk Clones Enterobacterales among Bulgarian Fecal Carriage Isolates

Dissemination of High-Risk Clones Enterobacterales among Bulgarian Fecal Carriage Isolates

Bloodstream Infections in Patients with Rectal Colonization by Carbapenem-Resistant Enterobacteriaceae: A Prospective Cohort Study

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

Contact Info

Product

Resources

About