Increase of Carbapenem-Resistant Acinetobacter baumannii Infection in Acute Care Hospitals in Taiwan: Association with Hospital Antimicrobial Usage

Su, Cheng-Tau; Wang, Jann-Tay; Hsiung, Chao A.; Chien, Li‐Jung; Chi, Cheng-Liang; Yu, Hui-Tzu; Chang, Feng–Yee; Chang, Shan-Chwen

doi:10.1371/journal.pone.0037788

Cited by 56 publications

(45 citation statements)

References 28 publications

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“…High MRSA in the present study partially may be due to less sample size as compared to the above study. The present study had no isolation of Vancomycin resistant Enterococci, Carbapenem resistant Acinetobacter or Clostridium difficile unlike a study by Morgan DJ et al [6] [7]. These students are potential sources for infection spread in health care settings which needs addressing specially by infection control committee.…”

Section: Discussioncontrasting

confidence: 50%

Evaluation of Contamination of Hands of the Medical Students in a Medical Teaching Tertiary Care Hospital

Chauhan¹,

Mullan²

2017

AiM

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Background: In the hospital, patients are often exposed to multiple procedures, invasive devices etc., increasing their chances of contracting such potential pathogens. Most of the time these potential pathogens exhibit multiple drug resistance. Aim: In view of the above factors, this study was undertaken to determine the rate of colonization of potential bacterial pathogens in the hands of final year MBBS undergraduate students. As per their clinical teaching curriculum, they visit the wards/ICU/OT, etc. on a daily basis. Method: Samples were collected from the hands of final year MBBS undergraduate students. The samples were collected by rubbing a saline wet swab stick onto the hands of the students and were inoculated onto nutrient agar plates for 18 -24 hours at 37˚C aerobically. Bacterial isolates were identified till species level by performing gram staining and biochemical reactions. Antibiotic susceptibility testing was done by Kirby-baur disc diffusion method as per CLSI guidelines 2016. Conclusion: 103 samples were collected from hands of final year undergraduate MBBS students by swab culture method. 38 showed growth and 65 showed no growth. Out of 38 isolates, 36 were Gram positive cocci and 2 were Gram positive bacilli. No Gram negative bacilli were isolated.Amongst 36 Gram positive cocci, 16 were coagulase positive Staphylococcus aureus and 20 were Coagulase negative Staphylococci (CoNS). 14 Staphylococcus aureus out of 16 were methicillin sensitive and 2 were methicillin resistant Staphylococcus aureus (MRSA). Out of 16 Staphylococcus aureus, 1 isolate showed Inducible Clindamycin Resistance (iMLS B phenotype) and 6 isolates showed complete resistance to erythromycin and clindamycin (constitutive MLS B phenotype). 1 Staphylococcus aureus which was Inducible Clindamycin Resistance (iMLS B phenotype) was also methicillin resistant.

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Section: Discussioncontrasting

confidence: 50%

Evaluation of Contamination of Hands of the Medical Students in a Medical Teaching Tertiary Care Hospital

Chauhan¹,

Mullan²

2017

AiM

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“…Previous studies used individual-level data to investigate the association between antibiotic exposure and acquisition of resistance, and few studies have investigated aggregated population-level data [12][13][14]. Aggregated population-level data may be more suitable for such investigations because they consider the exposure of an entire population [15,16]. This study was conducted in order to investigate antibacterial consumption levels and specific patterns using the standardized ATC/DDD methodology.…”

Section: Discussionmentioning

confidence: 99%

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Zou

Liu

et al. 2014

Eur J Clin Microbiol Infect Dis

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The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (β = -10.504, p < 0.01). The resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (β = 34.94, p < 0.001), as did the correlation of P. aeruginosa to meropenem with antipseudomonal third-generation cephalosporins usage (β = 32.76, p < 0.01) and K. pneumoniae to amikacin with aminoglycosides usage (β = 22.01, p < 0.001). The decreased antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

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“…A study showed that 11% of nosocomial isolates of A. baumannii were carbapenem-resistant; resulting in a morbidity and mortality rate of 52% as compared with a rate of 19% of patients infected with carbapenem-sensitive isolates (4,(11)(12)(13). Among the many carbapenem derivatives, imipenem initially was highly effective in the treatment of patients with A. baumannii infections; however, imipenem resistance has been confirmed in 53.7% of Acinetobacter nosocomial infections since the early 1990s (4,14,15). The most common pathways leading to carbapenem resistance are associated with the loss of outer membrane porins, overexpression of efflux pumps, and overproduction of Ambler class B metallo-␤-lactamases, class D oxacillinases, and AmpC cephalosporinase (16 -18).…”

mentioning

confidence: 99%

Comparative Phosphoproteomics Reveals the Role of AmpC β-lactamase Phosphorylation in the Clinical Imipenem-resistant Strain Acinetobacter baumannii SK17

Lai

Yang

Chern

et al. 2016

Molecular & Cellular Proteomics

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Nosocomial infectious outbreaks caused by multidrugresistant Acinetobacter baumannii have emerged as a serious threat to human health. Phosphoproteomics of pathogenic bacteria has been used to identify the mechanisms of bacterial virulence and antimicrobial resistance. In this study, we used a shotgun strategy combined with high-accuracy mass spectrometry to analyze the phosphoproteomics of the imipenem-susceptible strain SK17-S and -resistant strain SK17-R. We identified 410 phosphosites on 248 unique phosphoproteins in SK17-S and 285 phosphosites on 211 unique phosphoproteins in SK17-R. The distributions of the Ser/Thr/Tyr/Asp/His phosphosites in SK17-S and SK17-R were 47.0%/27.6%/ 12.4%/8.0%/4.9% versus 41.4%/29.5%/17.5%/6.7%/ 4.9%, respectively. The Ser-90 phosphosite, located on the catalytic motif S 88 VS 90 K of the AmpC ␤-lactamase, was first identified in SK17-S. Based on site-directed mutagenesis, the nonphosphorylatable mutant S90A was found to be more resistant to imipenem, whereas the phosphorylation-simulated mutant S90D was sensitive to imipenem. Additionally, the S90A mutant protein exhibited higher ␤-lactamase activity and conferred greater bacterial protection against imipenem in SK17-S compared with the wild-type. In sum, our results revealed that in A. baumannii, Ser-90 phosphorylation of AmpC negatively regulates both ␤-lactamase activity and the ability to counteract the antibiotic effects of imipenem. These findings highlight the impact of phosphorylation-mediated regulation in antibiotic-resistant bacteria on future drug design and new therapies.

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Increase of Carbapenem-Resistant Acinetobacter baumannii Infection in Acute Care Hospitals in Taiwan: Association with Hospital Antimicrobial Usage

Cited by 56 publications

References 28 publications

Evaluation of Contamination of Hands of the Medical Students in a Medical Teaching Tertiary Care Hospital

Evaluation of Contamination of Hands of the Medical Students in a Medical Teaching Tertiary Care Hospital

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Comparative Phosphoproteomics Reveals the Role of AmpC β-lactamase Phosphorylation in the Clinical Imipenem-resistant Strain Acinetobacter baumannii SK17

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