Stewardship / Resistance Scan for Nov 16, 2017

Ceftriaxone-resistant gonorrhea
;
E coli ST131 in China
;
Single-room ICU design

Canadian patient identified with rare ceftriaxone-resistant gonorrhea

Canadian researchers have identified a ceftriaxone-resistant Neisseria gonorrhea isolate in a Canadian patient, according to a new report in Emerging Infectious Diseases. It's one of only a handful of ceftriaxone-resistant N gonorrhea isolates reported worldwide.

The isolate was identified in a 23-year-old woman who tested positive for gonorrhea in January 2017. Antimicrobial susceptibility testing indicated that the isolate was non-susceptible to ceftriaxone and cefixime but susceptible to azithromycin. Tests of cure 14 days after initial treatment with azithromycin and cefixime came back negative, suggesting the azithromycin was effective in treating the infection.

Testing of two previous sexual partners for gonorrhea also came back negative, but one of the men reported unprotected sexual activity during a trip to China and Thailand in November 2016.

Whole genome sequencing showed that the isolate belonged to multilocus sequence type ST1903 and contained a mosaic penA allele (penA-60); these elements are identical to those found in a ceftriaxone- and multidrug-resistant N gonorrhea isolate reported in Japan in 2015. The authors of the study say the epidemiologic information suggests the international spread of a penA allele associated with high-level ceftriaxone resistance.

Rising resistance to the combination therapy of azithromycin and ceftriaxone or cefixime—the last remaining effective treatment for gonorrhea—has raised concerns about the global emergence of untreatable gonorrhea.
Nov 13 Emerg Infect Dis study

 

Chinese study shows prevalence, characteristics of E coli clone

More than 11% of Escherichia coli isolated from patients at a Chinese hospital belong to the extensively drug-resistant sequence type (ST) 131 clonal group, researchers reported yesterday in Antimicrobial Resistance and Infection Control.

For the study, researchers at a Chinese university hospital collected a total of 700 non-duplicate E coli isolates obtained from urine, blood, miscellaneous sources from August 2014 to August 2015. Isolates belonging to ST131 were identified by polymerase chain reaction testing and multilocus sequence typing and were also characterized for antibiotic resistance levels, resistance genes, and virulence factors.

Overall, 83 isolates (11.6%) were identified as belonging to the ST131 clonal group, which is similar to rates reported previously. The H30 lineage, an important ST131 subclone that has become the most dominant and extensively distributed multidrug-resistant lineage of E coli worldwide, accounted for 63.9% of the isolates. Results of O typing revealed that the ST131 isolates belonged to two types—O25b-B2-ST131 (66.3%) and O16-B2-ST131 (33.7%).

The researchers say that although O25b-B2-ST131 remains the predominant ST131 clone type in China, the high percentage of O16-B2-ST131 identified in the study indicates the subclone may be an important type of E coli ST131 in China and should be further investigated.
Nov 15 Antimicrob Resist Infect Control study

 

Dutch researchers find single-room ICU design reduced MDR pathogens

A study in the Netherlands indicates that transforming an intensive care unit (ICU) into single-occupancy rooms helped reduce transmission of multidrug-resistant (MDR) pathogens, Dutch researchers reported yesterday in Antimicrobial Resistance and Infection Control.

The single-center retrospective study looked at two periods at a Dutch ICU: A first period from January 2002 to April 2009 and second period from May 2009 to March 2013. In the first period, the patients were treated in an ICU with 21 beds located in five single rooms, two double rooms, and an open bay. This unit was closed on two occasions because of outbreaks of extended-spectrum beta lactamase-producing Klebsiella pneumoniae (ESBL-Kp) and MDR Acinetobacter baumannii. In May 2009, the patients were transferred to a newly built ICU with 9 single-occupancy rooms.

The two periods were compared with respect to the occurrence of representative MDR gram-negative (MDR-GN) bacteria. Routine microbiological screening was performed on all patients on admission to the ICU and then twice a week. To assure comparability, the two periods were approximately identical with respect to number of admissions, number of beds, and bed occupancy rate, per year and per month.

The results showed that despite infection prevention efforts—including improved hand hygiene, use of contact precautions, isolation of ESBL-Kp patients, and temporary ward closure on two occasions—high prevalence of MDR-GN bacteria continued to occur during the first period. After the move to the single-room ICU, a clear and sustained decrease in MDR-GN bacteria was observed.

"Our results provided strong evidence that the single room policy as an infection control strategy has contributed significantly to the control of cross transmission of resistant pathogens in the ICU," the authors write.
Nov 15 Antimicrob Resist Infect Control study

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