Molecular characterization of carbapenem- resistant <i>Enterobacteriaceae</i> yields increasing rates of NDM-1 carbapenemases and colistin resistance in an OXA-48- endemic area

Çizmeci, Zeynep; Aktaş, Elif; Otlu, Barış; Açıkgöz, Özlem; Ördekçi, Seyhan

doi:10.1080/1120009x.2017.1323149

Cited by 25 publications

(18 citation statements)

References 39 publications

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“…OXA-48-like producing Enterobacteriaceae were first identified in Turkey in 2001 [67] and have reached endemic levels in Turkey and in Malta based on assessments by national experts [14]. Recent studies from Turkey showed that 69–92% of carbapenemases were OXA-48 [68,69]. OXA-48-like-producing Enterobacteriaceae have spread to neighboring countries in Europe, with high levels of interregional spread in Belgium, France, Romania, and Spain [14].…”

Section: Mechanisms and Epidemiology Of Antibiotic Resistance In Cmentioning

confidence: 99%

Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria

2019

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Antibiotic resistance has increased markedly in gram-negative bacteria over the last two decades, and in many cases has been associated with increased mortality and healthcare costs. The adoption of genotyping and next generation whole genome sequencing of large sets of clinical bacterial isolates has greatly expanded our understanding of how antibiotic resistance develops and transmits among bacteria and between patients. Diverse mechanisms of resistance, including antibiotic degradation, antibiotic target modification, and modulation of permeability through the bacterial membrane have been demonstrated. These fundamental insights into the mechanisms of gram-negative antibiotic resistance have influenced the development of novel antibiotics and treatment practices in highly resistant infections. Here, we review the mechanisms and global epidemiology of antibiotic resistance in some of the most clinically important resistance phenotypes, including carbapenem resistant Enterobacteriaceae, extensively drug resistant (XDR) Pseudomonas aeruginosa, and XDR Acinetobacter baumannii. Understanding the resistance mechanisms and epidemiology of these pathogens is critical for the development of novel antibacterials and for individual treatment decisions, which often involve alternatives to β-lactam antibiotics.

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Section: Mechanisms and Epidemiology Of Antibiotic Resistance In Cmentioning

confidence: 99%

Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria

2019

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“…In Turkey, colistin resistance has raised great concern as it has been associated with poor prognosis (Yilmaz et al, 2016). A study done by Cizmeci et al (2017), found that six out of eight patients with K. pneumoniae that are resistant to both carbapenems and colistin ended up dying when all treatment options failed. Carbapenem resistant isolates positive for the NDM-1 gene have been found to have a higher rate of concomitant colistin resistance than isolates positive for the OXA-48 gene (Cizmeci et al, 2017).…”

Section: Distribution Of Multi-drug Resistant Organisms In Humansmentioning

confidence: 99%

“…A study done by Cizmeci et al (2017), found that six out of eight patients with K. pneumoniae that are resistant to both carbapenems and colistin ended up dying when all treatment options failed. Carbapenem resistant isolates positive for the NDM-1 gene have been found to have a higher rate of concomitant colistin resistance than isolates positive for the OXA-48 gene (Cizmeci et al, 2017). Furthermore, not only is the potential for colistin resistant infections to be fatal worrisome in Turkey, their potential to cause epidemics is also worrisome; the isolation of identical colistin resistant strains circulating in the country over short periods of time validate those concerns (Metan et al, 2017).…”

Section: Distribution Of Multi-drug Resistant Organisms In Humansmentioning

confidence: 99%

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

et al. 2019

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In the last decade, extended-spectrum cephalosporin and carbapenem resistant Gram-negative bacilli (GNB) have been extensively reported in the literature as being disseminated in humans but also in animals and the environment. These resistant organisms often cause treatment challenges due to their wide spectrum of antibiotic resistance. With the emergence of colistin resistance in animals and its subsequent detection in humans, the situation has worsened. Several studies reported the transmission of resistant organisms from animals to humans. Studies from the middle east highlight the spread of resistant organisms in hospitals and to a lesser extent in livestock and the environment. In view of the recent socio-economical conflicts that these countries are facing in addition to the constant population mobilization; we attempt in this review to highlight the gaps of the prevalence of resistance, antibiotic consumption reports, infection control measures and other risk factors contributing in particular to the spread of resistance in these countries. In hospitals, carbapenemases producers appear to be dominant. In contrast, extended spectrum beta lactamases (ESBL) and colistin resistance are becoming a serious problem in animals. This is mainly due to the continuous use of colistin in veterinary medicine even though it is now abandoned in the human sphere. In the environment, despite the small number of reports, ESBL and carbapenemases producers were both detected. This highlights the importance of the latter as a bridge between humans and animals in the transmission chain. In this review, we note that in the majority of the Middle Eastern area, little is known about the level of antibiotic consumption especially in the community and animal farms. Furthermore, some countries are currently facing issues with immigrants, poverty and poor living conditions which has been imposed by the civil war crisis. This all greatly facilitates the dissemination of resistance in all environments. In the one health concept, this work re-emphasizes the need to have global intervention measures to avoid dissemination of antibiotic resistance in humans, animals and the environment in Middle Eastern countries.

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“…The mechanisms of resistance of Enterobacteriaceae bacteria to carbapenems are very complex. However, the primary mechanisms include the following types: production of carbapenemases, mainly including KPC and OXA-48; combination of AmpC enzyme or Extended-Spectrum β-Lactamases (ESBLs) with porin loss or reduced expression, resulting in the decreased permeability of the outer membrane; changes in penicillin-binding proteins at the drug action site of carbapenem (Cizmeci et al, 2017). The first and second mechanisms are the main resistance mechanisms of drug-resistant strains in China (Wang et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiology and Risk Factors of Ventilator-Associated Pneumonia Infection Caused by Carbapenem-Resistant Enterobacteriaceae

Gao

Yang

et al. 2019

Front. Pharmacol.

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Ventilator-associated pneumonia (VAP) infection caused by carbapenem-resistant Enterobacteriaceae (CRE) is becoming more prevalent, thus seriously affecting patient outcomes. In this paper, we studied the drug resistance mechanism and epidemiological characteristics of CRE, and analyzed the infection and prognosis factors of VAP caused by CRE, to provide evidence for effective control of nosocomial infection in patients with VAP. A total of 58 non-repetitive CRE strains of VAP were collected from January 2016 to June 2018. To explore the risk factors of CRE infection, 1:2 group case control method was used to select non CRE infection patients at the same period as the control group. Among the 58 CRE strains, the most common isolates included Klebsiella pneumoniae and Escherichia coli . All strains were sensitive to polymyxin B, which features better sensitivity to other antibiotics such as minocycline, trimethoprim/sulfamethoxazole, and amikacin. Multiple drug resistance genes were detected at the same time in most strains. KPC-2 was the most common carbapenemase-resistant gene in Klebsiella pneumoniae , whereas NDM-1 was more common in Escherichia coli . The risk factors correlated with CRE infection included intensive care unit (ICU) occupancy time >7 days (OR = 2.793; 95% CI 1.439~5.421), antibiotic exposure during hospital stay including those to enzyme inhibitors (OR = 1.977; 95% CI 1.025~3.812), carbapenems (OR = 3.268; 95% CI 1.671~6.392), antibiotic combination therapy(OR = 1.951; 95% CI 1.020~3.732), and nerve damage (OR = 3.013; 95% CI 1.278~7.101). Multivariable analysis showed that ICU stay >7 days (OR = 1.867; 95% CI 1.609~20.026), beta-lactamase inhibitor antibiotics (OR = 7.750; 95% CI 2.219~27.071), and carbapenem (OR = 9.143; 95% CI 2.259~37.01) are independent risk factors for VAP carbapenem caused by Carbapenem-resistant Enterobacteriaceae. A high resistance rate of CRE isolated from VAP indicated that the infected patients featured higher mortality and longer hospital stay time than the control group. Multiple risk factors for CRE infection and their control can effectively prevent the spread of VAP.

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Molecular characterization of carbapenem- resistant Enterobacteriaceae yields increasing rates of NDM-1 carbapenemases and colistin resistance in an OXA-48- endemic area

Cited by 25 publications

References 39 publications

Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria

Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

Molecular Epidemiology and Risk Factors of Ventilator-Associated Pneumonia Infection Caused by Carbapenem-Resistant Enterobacteriaceae

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