Interim Recommendations for the Reporting of Extensively Drug Resistant and Pan Drug Resistant Isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp. And Stenotrophomonas maltophilia

German, Gregory; Gilmour, Matthew W.; Almohri, Huda; Bullard, James M.; Domingo, Marc-Christian; Fuller, Jeffrey; Girouard, Gabriel; Haldane, David; Hoang, Linda; Levett, Paul N.; Longtin, Jean; Melano, Roberto G.; Needle, Robert; Patel, Samir N.; Rebbapragada, Anu; Reyes, RC; Mulvey, Michael R.

doi:10.14745/ccdr.v42i04a04

Cited by 11 publications

(11 citation statements)

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“…One isolate, a K. pneumoniae ST512 bla KPC carbapenemase producer, was resistant to all classes of antimicrobials tested, including tigecycline and colistin. A recent publication describes the interim recommendation of reporting extensively drug-resistant (XDRO) and pan-drug-resistant (PDRO) Gram-negatives ( 21 ). According to these recommendations, we found 122 (46.7%) and 53 (20.3%) of CPE to be XDRO and PDRO, respectively.…”

Section: Resultsmentioning

confidence: 99%

Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae , 2010 to 2014

Mataseje

Abdesselam

Vachon

et al. 2016

Antimicrob Agents Chemother

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Carbapenemase-producing Enterobacteriaceae (CPE) are increasing globally; here we report on the investigation of CPE in Canada over a 5-year period. Participating acute care facilities across Canada submitted carbapenem-nonsusceptible Enterobacteriaceae from 1 January 2010 to 31 December 2014 to the National Microbiology Laboratory. All CPE were characterized by antimicrobial susceptibilities, pulsed-field gel electrophoresis, multilocus sequence typing, and plasmid restriction fragment length polymorphism analysis and had patient data collected using a standard questionnaire. The 5-year incidence rate of CPE was 0.09 per 10,000 patient days and 0.07 per 1,000 admissions. There were a total of 261 CPE isolated from 238 patients in 58 hospitals during the study period. blaKPC-3 (64.8%) and blaNDM-1 (17.6%) represented the highest proportion of carbapenemase genes detected in Canadian isolates. Patients who had a history of medical attention during international travel accounted for 21% of CPE cases. The hospital 30-day all-cause mortality rate for the 5-year surveillance period was 17.1 per 100 CPE cases. No significant increase in the occurrence of CPE was observed from 2010 to 2014. Nosocomial transmission of CPE, as well as international health care, is driving its persistence within Canada.

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Section: Resultsmentioning

confidence: 99%

Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae , 2010 to 2014

Mataseje

Abdesselam

Vachon

et al. 2016

Antimicrob Agents Chemother

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“…One isolate (8%) was multidrug-resistant (Table 3, Ontario isolate), as defined by the Canadian Public Health Laboratory Network Antimicrobial Resistance Working Group. 22 No colistin-resistant isolate was extensively drug-resistant or pan-drug-resistant. 22 Of the 12 colistin-resistant E. coli isolates, only 2 tested positive for the mcr-1 gene, and the mcr-2 gene was not detected in any of the isolates.…”

Section: Resultsmentioning

confidence: 99%

“…22 No colistin-resistant isolate was extensively drug-resistant or pan-drug-resistant. 22 Of the 12 colistin-resistant E. coli isolates, only 2 tested positive for the mcr-1 gene, and the mcr-2 gene was not detected in any of the isolates. The first mcr-1-positive isolate was obtained in 2010 from the bloodstream of a male patient assessed at an emergency department in Ontario.…”

Section: Resultsmentioning

confidence: 99%

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Frequency of MCR-1-mediated colistin resistance among Escherichia coli clinical isolates obtained from patients in Canadian hospitals (CANWARD 2008-2015)

et al. 2016

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Background: Colistin is often used as an antimicrobial of last resort for the treatment of infections caused by multidrug-resistant gram-negative bacilli. In 2015, plasmid-mediated colistin resistance in Escherichia coli due to MCR-1 was described. The purpose of this study was to evaluate the frequency of colistin resistance among E. coli clinical isolates obtained from patients in Canadian hospitals as part of the Canadian Ward Surveillance Study (CANWARD) and to determine how often the mcr-1 gene is detected among the colistin-resistant subset. Methods:From January 2008 to December 2015 (excluding 2011), 10 to 15 sentinel hospitals submitted consecutive clinical isolates (1 per patient per infection site) from blood (100-240), respiratory (100-150), urine (25-100) and wound (25-100) infections. We performed susceptibility testing using Clinical and Laboratory Standards Institute broth microdilution methods. Isolates that showed resistance to colistin as defined by European Committee on Antimicrobial Susceptibility Testing breakpoints (minimum inhibitory concentration ≥ 4 µg/mL) were evaluated for the mcr-1 gene by polymerase chain reaction. Results:In total, 5571 E. coli clinical isolates were obtained over the study years. Twelve isolates (0.2%) were resistant to colistin. The proportion of colistin-resistant isolates varied from 0.0% to 0.5% depending on the study year, and there was no clear trend toward increasing resistance over time. Typically the colistin-resistant isolates remained susceptible to antimicrobials from several other classes. Two colistin-resistant isolates (0.04%) were found to harbour the mcr-1 gene. Interpretation:The results suggest that colistin resistance among E. coli human clinical isolates, including resistance mediated by the mcr-1 gene, remains rare in Canada. AbstractResearch Research CMAJ OPEN E642CMAJ OPEN, 4(4)to MCR-1. MCR-1 (encoded for by the mcr-1 gene) is a member of the phosphoethanolamine transferase enzyme family. It confers resistance to colistin by the transfer of phosphoethanolamine to lipid A, thereby reducing the affinity of the target (by reducing the negative charge) for this polycationic antimicrobial. 7 E. coli isolates with the mcr-1 gene typically have colistin minimum inhibitory concentrations (MICs) in the range of 4 to 8 µg/mL. 7-11The location of the mcr-1 gene on a plasmid is concerning, as this raises the possibility that the resistance determinant may be transferred to multidrug-resistant gram-negative bacteria. Indeed, the mcr-1 gene has already been detected in multidrugresistant E. coli isolates that also contain an extended-spectrum β-lactamase or a carbapenemase enzyme.12-15 Plasmid-mediated colistin resistance attributed to a second mcr gene (mcr-2) has also recently been described. 16 Many clinical microbiology laboratories do not test colistin routinely against E. coli, so the frequency with which resistance occurs in Canada is difficult to estimate from local data. The purpose of this study was to evaluate the frequency of colistin res...

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“…Se han descrito tres categorías generales, denominadas multirresistencia (MDR, del inglés multidrug-resistance ), resistencia extendida (XDR, del inglés extensively drug-resistance ) y panresistencia (PDR, del inglés pandrug-resistance ), sin un acuerdo en cuanto a sus definiciones (8, 9). Los primeros intentos colaborativos en este sentido se plasmaron en dos publicaciones: una iniciativa conjunta de los Centros para la Prevención y Control de Enfermedades de la Unión Europea y de los Estados Unidos de América (10), y una iniciativa de la Red Canadiense de Laboratorios de Salud Pública (11, 12). En ambos consensos, el objetivo fue proveer definiciones normalizadas acerca de las formas más apropiadas de detectar y reportar un fenotipo adquirido de resistencia múltiple a antibióticos.…”

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Consenso latinoamericano para definir, categorizar y notificar patógenos multirresistentes, con resistencia extendida o panresistentes

Rosales¹,

Francesconi²,

Molina³

et al. 2019

Rev Panam Salud Publica

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RESUMEN Se presenta un consenso latinoamericano que permite estandarizar las definiciones de los diferentes niveles de resistencia a los antimicrobianos en bacterias de importancia en salud pública. Se describen los criterios de inclusión y exclusión para las metodologías a utilizar y para los antibióticos a incluir (por disponibilidad, relevancia y existencia de puntos de corte). Como propuesta piloto se eligieron tres microorganismos gramnegativos de gran impacto en el ambiente hospitalario ( Klebsiella pneumoniae , Pseudomonas aeruginosa y Acinetobacter spp.). La falta de puntos de corte para ciertos antibióticos (por ejemplo, tigeciclina, fosfomicina y colistina), claves para el tratamiento de infecciones causadas por estos patógenos que presentan multirresistencia o resistencia extendida, llevó a la necesidad de discutir y consensuar puntos de corte provisorios para la vigilancia de la resistencia a estos fármacos. Se abordó y consensuó también el uso de pruebas de sensibilidad alternativas a los métodos aprobados por las guías internacionales, de aplicación más sencilla como pruebas de rutina en los laboratorios de bacteriología clínica. El principal beneficio de este documento es proporcionar a los laboratorios latinoamericanos un marco estandarizado y consensuado para la identificación y la vigilancia constante y unificada de microorganismos resistentes. Las recomendaciones incluidas en este documento son el resultado consensuado por los representantes de los laboratorios nacionales de referencia de los países que integran la Red Latinoamericana de Vigilancia de la Resistencia a los Antibióticos coordinada por la Organización Panamericana de la Salud.

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Interim Recommendations for the Reporting of Extensively Drug Resistant and Pan Drug Resistant Isolates of Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter spp. And Stenotrophomonas maltophilia

Cited by 11 publications

References 5 publications

Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae , 2010 to 2014

Results from the Canadian Nosocomial Infection Surveillance Program on Carbapenemase-Producing Enterobacteriaceae , 2010 to 2014

Frequency of MCR-1-mediated colistin resistance among Escherichia coli clinical isolates obtained from patients in Canadian hospitals (CANWARD 2008-2015)

Consenso latinoamericano para definir, categorizar y notificar patógenos multirresistentes, con resistencia extendida o panresistentes

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