JAC-Antimicrobial Resistance最新文献

{"title":"Antimicrobial susceptibility testing data analysis over 3 years at the Yaoundé General Hospital, Cameroon.","authors":"Marie Paule Ngogang, Abel Fils Nkoth, Welysiane Ngaleu, Heroine Mfouapon, Priscille Ekoume, Yannick Nibeye, Christiane Medi Sike, Esther Voundi Voundi, Mohammed Moctar Mouliom Mouiche, Marie Christine Fonkoua, Michel Toukam, Francois-Xavier Mbopi-Keou","doi":"10.1093/jacamr/dlae043","DOIUrl":"https://doi.org/10.1093/jacamr/dlae043","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a major health concern with high rates in low-income countries. Bacteriology laboratories sustain the fight against AMR by providing antibiotic susceptibility testing (AST) results to ensure appropriate therapies. These laboratories generate a lot of data, which are usually used for prospective interventions. Our study conducted in a lower-middle-income hospital setting aimed to describe the profile of bacteria isolated from the specimens received over 3 years, assess their susceptibility profile and identify potential gaps or area of improvement from the analysis of our data.</p><p><strong>Methods: </strong>Monthly data were retrieved from registers for all specimens received between January 2020 until December 2022. Data were compiled and analysed using the R and WHONET software.</p><p><strong>Results: </strong>Out of 3582 specimens received, 797 were culture positive (22.3%). <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i> were frequently isolated (30.5% and 24.2%, respectively). AST results analysis showed high resistance of Gram-negative bacteria to penams and cephems, whereas low resistance was observed to carbapenems. Susceptibility to antibiotics based on the AWaRe antibiotic classification was variable. The bacteriological profile in the various types of specimen was established and rational information to design a therapeutic protocol adapted to our hospital setting was obtained.</p><p><strong>Conclusions: </strong>AST results may not only be used for prospective guidance for treatment, but rather cumulative data analysis can contribute to design effective antibiotic prescriptions and improve general practices at the laboratory. This is, however, dependent on a good record-keeping, standardization of practices and collaboration between clinicians and laboratory scientists.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11040207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel survey distribution methods: impact on antimicrobial resistance research outcomes.","authors":"Rasha Abdelsalam Elshenawy, Nkiruka Umaru, Zoe Aslanpour","doi":"10.1093/jacamr/dlae055","DOIUrl":"https://doi.org/10.1093/jacamr/dlae055","url":null,"abstract":"","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11037271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140863101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic prescribing practices of medical doctors in a resource-limited setting and the influence of individual perceptions and stewardship support: a survey in three tertiary hospitals in Vietnam.","authors":"Huong Thi Lan Vu, Thuy Thi Thanh Pham, Yen Hai Duong, Quan Anh Truong, Hong Khanh Nguyen, Tu Thi Cam Nguyen, Long Xuan Trinh, Ha Thi Hong Nguyen, Minh Quang Le, Vinh Hai Vu, Duc Minh Chau, Nguyet Thi Huynh, Em Thi Hoang Dung Vo, Hoa Nguyen Minh Le, Thach Ngoc Pham, Todd M Pollack, H Rogier Van Doorn","doi":"10.1093/jacamr/dlae064","DOIUrl":"https://doi.org/10.1093/jacamr/dlae064","url":null,"abstract":"<p><strong>Objectives: </strong>To understand antibiotic prescribing and influencing factors to inform antimicrobial stewardship (AMS) interventions to reduce unwanted consequences of antibiotic use in hospitals in Vietnam, a lower-middle-income country in Asia.</p><p><strong>Methods: </strong>We conducted a cross-sectional study of doctors at three tertiary hospitals using non-probability convenience sampling, through a paper-based (Hospitals 1 and 2) or electronic (Hospital 3) survey. Questions included items on perceptions regarding antibiotic resistance and AMS, prescribing practices, knowledge, demographics and training. We used principal components analysis and mixed-effects models to examine practices and identify influencing factors.</p><p><strong>Results: </strong>Among 314 surveyed participants, 61%, 57% and 59% in Hospitals 1, 2 and 3, respectively, felt certain about the appropriateness of their antibiotic prescriptions. In total, 9% reported sometimes prescribing antibiotics when not needed to meet patients' expectations, and 13% reported doing so to avoid perceived complications. Higher prescribing confidence was found among those with positive perceptions about AMS (<i>P</i> < 0.0001), whereas negative perceptions about colleagues' practices reduced this confidence (<i>P</i> < 0.0001). Individual preference for branded antibiotics was associated with more unnecessary prescribing whereas having higher prescribing confidence decreased the habits of prescribing when not needed.</p><p><strong>Conclusions: </strong>This study provides important implications for design of hospital interventions to address influencing factors on antibiotic prescribing in Vietnam and similar resource-limited settings. Specific interventions should target improving knowledge through education and training for doctors, enhancing the support from the AMS team, and promoting guidelines and policies for appropriate antibiotic use in hospital.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11022071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial stewardship markers and healthcare-associated pneumonia threshold criteria in UK hospitals: analysis of the MicroGuide^Tm application.","authors":"Luke S P Moore, Ioannis Baltas, James Amos, Mineli Cooray, Stephen Hughes, Rachel Freeman, Tom Ashfield","doi":"10.1093/jacamr/dlae058","DOIUrl":"https://doi.org/10.1093/jacamr/dlae058","url":null,"abstract":"<p><strong>Background: </strong>To address antimicrobial resistance, antimicrobial stewardship (AMS) principles must be implemented and adhered to. Clinical decision aids such as the MicroGuide^TM app are an important part of these efforts. We sought to evaluate the consistency of core AMS information and the diversity of classification thresholds for healthcare-associated pneumonia (HAP) in the MicroGuide app.</p><p><strong>Methods: </strong>Guidelines in the MicroGuide app were extracted and analysed for content related to AMS and HAP. Guidelines were characterized according to HAP naming classification; community-acquired pneumonia (CAP) classifications were analysed to serve as a comparator group.</p><p><strong>Results: </strong>In total, 115 trusts (119 hospitals) were included. Nearly all hospitals had developed MicroGuide sections on AMS (<i>n</i> = 112/119, 94%) and sepsis management (<i>n</i> = 117/119, 98%). Other AMS sections were outpatient parenteral antimicrobial therapy (47%), antifungal stewardship (70%), critical care (23%) and IV to oral switch therapy (83%). Only 9% of hospitals included guidance on the maximum six key AMS sections identified. HAP definitions varied widely across hospitals with some classifying by time to onset and some classifying by severity or complexity. The largest proportion of HAP guidelines based classification on severity/complexity (<i>n</i> = 69/119, 58%). By contrast, definitions in CAP guidelines were uniform.</p><p><strong>Conclusions: </strong>The high heterogeneity in HAP classification identified suggests inconsistency of practice in identifying thresholds for HAP in the UK. This complicates HAP management and AMS practices. To address HAP in alignment with AMS principles, a comprehensive strategy that prioritizes uniform clinical definitions and thresholds should be developed.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11022069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of proxy indicators estimating the appropriateness of antibiotic prescriptions in general practice: a national consensus procedure in France.","authors":"Maïa Simon, Aurélie Bocquier, Ouarda Pereira, Alexandre Charmillon, Damien Gonthier, Florence Lieutier Colas, Camille Vallance, Adeline Welter, Céline Pulcini, Nathalie Thilly","doi":"10.1093/jacamr/dlae059","DOIUrl":"https://doi.org/10.1093/jacamr/dlae059","url":null,"abstract":"<p><strong>Background: </strong>GPs are responsible for more than 70% of outpatient antibiotic prescriptions in France. Metrics are important antibiotic stewardship tools that can be used to set targets for improvement and to give feedback to professionals and stakeholders.</p><p><strong>Objectives: </strong>The primary objective of the present study was to select a set of proxy indicators (PIs) based on 10 previously developed PIs, to estimate the appropriateness of antibiotic prescriptions by GPs. The secondary objective was to evaluate the clinimetric properties of the selected PIs.</p><p><strong>Methods: </strong>A RAND-modified Delphi consensus procedure was conducted with a multidisciplinary panel of stakeholders. This procedure consisted of two successive online surveys with a consensus meeting in between. Clinimetric properties (measurability, applicability and potential room for improvement) were evaluated for the PIs selected through the consensus procedure, using 2022 Regional Health Insurance data.</p><p><strong>Results: </strong>Seventeen experts participated in the first-round survey and 14 in the second-round. A final set of 12 PIs was selected. Among the 10 initial PIs, 3 were selected without modification and 7 were modified and selected. Moreover, two newly suggested PIs were selected. Ten of the 12 PIs presented good clinimetric properties.</p><p><strong>Conclusions: </strong>The 12 selected PIs cover the main situations responsible for inappropriate and unnecessary use of antibiotics in general practice. These PIs, easily calculable using routinely collected health insurance reimbursement data, might be used to give feedback to prescribers and stakeholders and help improve antibiotic prescriptions in primary care.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11022070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of carbapenem MIC for NDM-producing Enterobacterales by different AST methods.","authors":"Alfred Lok Hang Lee, Eddie Chi Man Leung, Viola Chi Ying Chow","doi":"10.1093/jacamr/dlae028","DOIUrl":"https://doi.org/10.1093/jacamr/dlae028","url":null,"abstract":"<p><strong>Introduction: </strong>This study compared the performance of MIC test strip (ETEST), automated AST card (Vitek 2) and broth microdilution (BMD) in determining carbapenem susceptibility and MIC values of NDM-producing Enterobacterales.</p><p><strong>Methods: </strong>NDM-producing Enterobacterales recovered from clinical specimens were included. The presence of <i>bla</i>_NDM was confirmed by PCR. Identification of bacterial isolates was done by MALDI-TOF. Phenotypic susceptibility to three carbapenems (ertapenem, imipenem and meropenem) was tested by BMD, ETEST and Vitek 2. MIC values were interpreted in accordance with CLSI M100 (2022 edition). Using BMD as the reference standard, the essential agreement (EA), categorical agreement (CA), very major error (VME) and major error (ME) rates were evaluated.</p><p><strong>Results: </strong>Forty-seven NDM-producing Enterobacterales isolates were included, 44 of which were <i>Escherichia coli</i>. The EA of Vitek 2 was 97.9% for ertapenem, 25.5% for meropenem and 42.6% for imipenem. Using Vitek 2, there were 0% VMEs across all three carbapenems tested. The EA of ETEST was 53.2% for ertapenem, 55.3% for imipenem and 36.2% for meropenem. The rates of VMEs for ETEST were high too (ertapenem 8.5%, meropenem 36.2%, imipenem 26.1%). The MIC values obtained from Vitek 2 were consistently higher than those from BMD, while MICs from ETEST were consistently lower than those from BMD.</p><p><strong>Conclusions: </strong>The VME rate for ETEST was unacceptably high when BMD was used as the standard for comparison. Vitek 2 had acceptable EA and CA for ertapenem when BMD was used as the standard for comparison. For meropenem and imipenem, neither of the methods (ETEST, Vitek 2) showed acceptable EA and CA when compared with BMD.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11057202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the stability of ceftazidime/avibactam in elastomeric infusion devices used for outpatient parenteral antimicrobial therapy utilizing a national stability protocol framework.","authors":"Saiyuri Naicker, Jason A Roberts, Hayoung Won, Steven C Wallis, Sean Unwin, Conor Jamieson, Tim Hills, Mark Gilchrist, Mark Santillo, R Andrew Seaton, Felicity Drummond, Fekade B Sime","doi":"10.1093/jacamr/dlae056","DOIUrl":"https://doi.org/10.1093/jacamr/dlae056","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the stability of ceftazidime/avibactam in elastomeric infusers, utilizing the UK's Yellow Cover Document (YCD) stability testing framework, in conditions representative of OPAT practice.</p><p><strong>Methods: </strong>Ceftazidime/avibactam was reconstituted with sodium chloride 0.9% (w/v) in two elastomeric infusers at concentrations (dose) levels of 1500/375, 3000/750 and 6000 mg/1500 mg in 240 mL. The infusers were exposed to a fridge storage (2°C-8°C) for 14 days followed by 24 h in-use temperature (32°C).</p><p><strong>Results: </strong>After 14 days of fridge storage and subsequent 24 h exposure to 32°C, mean ± SD of ceftazidime percent remaining was 75.5% ± 1.8%, 79.9% ± 1.1%, 82.4% ± 0.6%, for Easypump, and 81.7% ± 1.2%, 82.5% ± 0.5%, 85.4% ± 1.1% for Dosi-Fuser devices at the high, intermediate and low doses tested, respectively. For avibactam, mean ± SD percent remaining was 83.2% ± 1.8%, 87.4% ± 2.0%, 93.1% ± 0.9% for Easypump, and 85.1% ± 2.0%, 86.7% ± 0.1%, 92.5% ± 0.1% for Dosi-Fuser devices. The cumulative amount of pyridine generated in the devices ranged from 10.4 mg at low dose to 76.9 mg at high dose. Regression-based simulation showed that the degradation of both ceftazidime and avibactam was <10% for at least 12 h of the running phase, if stored in a fridge for not more than 72 h prior to in-use temperature exposure.</p><p><strong>Conclusions: </strong>Whilst not meeting the strict UK YCD criteria for ≤5% degradation, ceftazidime/avibactam may be acceptable to administer as a continuous 12 hourly infusion in those territories where degradation of ≤10% is deemed acceptable.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10995722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence of ceftriaxone-resistant and XDR <i>Neisseria gonorrhoeae</i> in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP).","authors":"V Ouk, L Say Heng, M Virak, S Deng, M M Lahra, R Frankson, K Kreisel, R McDonald, M Escher, M Unemo, T Wi, I Maatouk","doi":"10.1093/jacamr/dlae053","DOIUrl":"10.1093/jacamr/dlae053","url":null,"abstract":"<p><strong>Objectives: </strong>Antimicrobial resistance (AMR) in <i>Neisseria gonorrhoeae</i> is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated <i>N. gonorrhoeae</i> AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia.</p><p><strong>Methods: </strong>Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire.</p><p><strong>Results: </strong>From 437 male patients, 306 had positive <i>N. gonorrhoeae</i> cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR <i>N. gonorrhoeae</i>. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment.</p><p><strong>Conclusions: </strong>A high prevalence of ceftriaxone-resistant, MDR and XDR <i>N. gonorrhoeae</i> in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded <i>N. gonorrhoeae</i> AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10993901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and institutional predisposing factors of MRSA surgical site infection and outcomes-a retrospective case-control-study in 14 European high-volume surgical centres.","authors":"Jule Rutz, Jan-Hendrik Naendrup, Caroline Bruns, Annika Y Classen, Jon Salmanton-García, Harald Seifert, Rosanne Sprute, Jannik Stemler, Sarah V Walker, Oliver A Cornely, Blasius J Liss, Sibylle C Mellinghoff","doi":"10.1093/jacamr/dlae046","DOIUrl":"https://doi.org/10.1093/jacamr/dlae046","url":null,"abstract":"<p><strong>Objectives: </strong>To assess incidence rates of surgical site infections (SSI) by MRSA and to determine related factors and clinical outcome compared to MSSA, including country-specific, institutional and patient determinants.</p><p><strong>Patients and methods: </strong>We performed a subgroup analysis of the Europe-wide SALT (NCT03353532) study population with MRSA SSI from 14 centres in France, Germany, Italy, Spain and the UK.</p><p><strong>Results: </strong>An overall MRSA SSI incidence of 0.06% (<i>n</i> = 104) was found in 178 903 patients undergoing invasive surgery in 2016. Frequently observed comorbidities were chronic cardiovascular disease, diabetes and solid tumours. Compared to the overall MRSA SSI incidence, incidence rates were significantly higher in Spain (58 of 67 934 cases) and lower in Germany (16 of 46 443 cases; both <i>P </i>< 0.05). Centres with antibiotic stewardship (ABS) and infectious disease (ID) consultation programmes (<i>n</i> = 3/14) had lower MRSA rates (17 of 43 556 cases versus 61 of 83 048 cases, <i>P </i>< 0.05). In bivariate analyses, MRSA SSI patients were significantly older, had higher BMI and more comorbidities compared to MSSA (<i>P </i>< 0.05 each). Surgery performed between 6:00 and 12:00 pm led to higher MRSA proportions among <i>S. aureus</i> SSI (17 of 104 cases versus 62 of 640 cases, <i>P </i>< 0.05).</p><p><strong>Conclusions: </strong>This study shows low overall and country-specific incidence rates of MRSA SSI in Europe. We could show significant differences between countries as well as between centres with established ABS and ID consultation programmes were observed. The number of those programmes seems too small against this background.</p>","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10993902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heteroresistance to piperacillin/tazobactam in Klebsiella pneumoniae is mediated by increased copy number of multiple β-lactamase genes","authors":"Ahmed Babiker, Sarah Lohsen, Julia Van Riel, Karin Hjort, David S. Weiss, Dan I. Andersson, Sarah W Satola","doi":"10.1093/jacamr/dlae057","DOIUrl":"https://doi.org/10.1093/jacamr/dlae057","url":null,"abstract":"Abstract Background Piperacillin/tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of activity that is often used as empirical and/or targeted therapy among hospitalized patients. Heteroresistance (HR) is a form of antibiotic resistance in which a minority population of resistant cells coexists with a majority susceptible population that has been found to be a cause of antibiotic treatment failure in murine models. Objectives To determine the prevalence of HR and mechanisms of HR to piperacillin/tazobactam among Klebsiella pneumoniae bloodstream infection (BSI) isolates. Materials From July 2018 to June 2021, K. pneumoniae piperacillin/tazobactam-susceptible BSI isolates were collected from two tertiary hospitals in Atlanta, GA, USA. Only first isolates from each patient per calendar year were included. Population analysis profiling (PAP) and WGS were performed to identify HR and its mechanisms. Results Among 423 K. pneumoniae BSI isolates collected during the study period, 6% (25/423) were found to be HR with a subpopulation surviving above the breakpoint. WGS of HR isolates grown in the presence of piperacillin/tazobactam at concentrations 8-fold that of the MIC revealed copy number changes of plasmid-located β-lactamase genes blaCTX-M-15, blaSHV33, blaOXA-1 and blaTEM-1 by tandem gene amplification or plasmid copy number increase. Conclusions Prevalence of HR to piperacillin/tazobactam among bloodstream isolates was substantial. The HR phenotype appears to be caused by tandem amplification of β-lactamase genes found on plasmids or plasmid copy number increase. This raises the possibility of dissemination of HR through horizontal gene transfer and requires further study.","PeriodicalId":14594,"journal":{"name":"JAC-Antimicrobial Resistance","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}