Stewardship / Resistance Scan for Jun 14, 2017

Drug resistance in GI illness
MDR in neonatal sepsis

Egyptian study finds high rates of resistance in community-onset GI cases

A single-center study in Egypt found that nearly two thirds of the Enterobacteriaceae isolates collected from the feces of patients who had community-onset gastrointestinal complaints were extended-spectrum beta-lactamase (ESBL) producers, and 4.4% were carbapenemase-producing Enterobacteriaceae (CPE).

Writing in Antimicrobial Resistance & Infection Control, the authors said they recovered 113 Enterobacteriaceae isolates from 100 consecutive patients at El-Ahrar General Hospital in Zagazig in early 2013. The most common pathogens detected were Escherichia coli (72 of 113), Klebsiella pneumoniae (23), and Enterobacter cloacae (3). Seventy-three isolates (64.6%) were ESBL Enterobacteriaceae.

Of the 100 patients, 68 harbored ESBL Enterobacteriaceae, while 5 tested positive for CPE. Twenty-two (47.8%) of the ESBL-positive isolates were multidrug resistant. Three of the 5 CPE isolates harbored New Delhi metallo-beta-lactamase (NDM), a known resistance gene.

The researchers conclude, "These high colonization rates are worrying, therefore prudent antimicrobial use should be adopted in Egyptian community settings."
Jun 13 J Antimicrob Resist Infect Control study


Egyptian data show high MDR rate in neonatal sepsis

Another Egyptian study published yesterday in the same journal detailed a 38% rate of multidrug-resistant (MDR) bacteria in pathogens isolated from infants who had sepsis.

Of 953 neonates admitted to the neonatal intensive care unit of Cairo University Children's Hospital in a 12-month period, 314 were diagnosed as having sepsis: 123 with early-onset sepsis and 191 with late onset.

The investigators assessed antimicrobial sensitivity and resistance patterns for all 245 isolated bacteria isolated from the patient, with 166 from blood cultures and 79 endotracheal aspirate cultures. Of those 245 bacteria, 92 (37.6%) were MDR. And gram-negative bacteria accounted for 78 of those MDR pathogens, or 84.8%, and the rest were gram-positive.

Of the 314 patients, 67 (21.3%) harbored MDR bacteria. The rate was lower in the early-onset group (18/123, or 14.6%) than the late-onset group (49/191, or 25.7%).

Gram-negative bacteria were most resistant to ampicillins (100%), cephalosporins (93%-100%), and piperacillin-tazobactam (99%), with less resistance to aminoglycosides (36%-52%).
Jun 13 J Antimicrob Resist Infect Control study

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