- Infection caused by Klebsiella pneumoniae ST11 in a patient after craniectomy.
Infection caused by Klebsiella pneumoniae ST11 in a patient after craniectomy.
Folia Microbiol (Praha). 2019 May 22;:
Authors: Ojdana D, Kochanowicz J, Sacha P, Sieńko A, Wieczorek P, Majewski P, Hauschild T, Mariak Z, Tryniszewska E
Klebsiella pneumoniae infections have always been an important problem in public health, but today, the increasing resistance of these bacteria to antibiotics due to β-lactamases production has renewed interest in K. pneumoniae infections. The aim of the study was to present a case of a neurosurgical patient with multidrug-resistant K. pneumoniae ST11 infection after craniectomy. Four K. pneumoniae isolates from various clinical materials of the patient undergone identification and susceptibility testing with the Vitek2 system. Tests for β-lactamases production were performed according to EUCAST guidelines. Strains were analyzed for bla genes responsible for β-lactamase production (blaTEM, blaSHV, blaCTX-M, blaVIM, blaIMP, blaNDM, blaKPC, blaOXA-48) using PCR. Moreover, the genetic relatedness of these isolates was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). All tested strain presented multidrug resistance. The highest susceptibility was observed for imipenem, meropenem, and ertapenem. The strain isolated from the nervous system was ESBL-positive with blaSHV-11, blaTEM-1, and blaCTX-M-15 genes. Additionally, the strain from urine was blaKPC-3-positive. Molecular typing revealed that all strains belonged to the same clone and identified two PFGE profiles. The analysis of MLST allelic profile showed that tested K. pneumoniae strains belonged to ST11. Identification of ST11 K. pneumoniae as etiological factor of infection unfavorably impacts on prognosis among neurosurgical patient after craniectomy.
PMID: 31119589 [PubMed - as supplied by publisher]
- Susceptibilities of Gram-negative bacilli from hospital- and community-acquired intra-abdominal and urinary tract infections: a 2016-2017 update of the Chinese SMART study.
Susceptibilities of Gram-negative bacilli from hospital- and community-acquired intra-abdominal and urinary tract infections: a 2016-2017 update of the Chinese SMART study.
Infect Drug Resist. 2019;12:905-914
Authors: Zhang H, Johnson A, Zhang G, Yang Y, Zhang J, Li D, Duan S, Yang Q, Xu Y
Objectives: To update the epidemiology and susceptibility of hospital-acquired (HA) and community-acquired (CA), as well as intensive care unit (ICU) vs non-ICU-derived intra-abdominal infection (IAI) and urinary tract infection (UTI) pathogens in Chinese hospitals. Methods: A total of 2,546 Gram-negative isolates from IAIs and 1,947 isolates from UTIs collected in 16 hospitals and 7 regions of China from 2016 to 2017 were analyzed. Results: E. coli and K. pneumoniae were the most common pathogens identiﬁed in HA (40.7%, 21.9%) and CA (49.2%, 21.3%) IAIs and in HA (59.0%, 17.3%) and CA (64.3%, 12.7%) UTIs, respectively. The overall rates of extended-spectrum β-lactamase (ESBL)-positive strains were 48.2% for E. coli and 26.4% for K. pneumoniae. The rates of ESBL-positive E. coli and K. pneumoniae strains were signiﬁcantly higher in HA than in CA IAIs (51.7% vs 42.4%, P=0.016 and 22.0% vs 20.6%, P<0.001). IAI E. coli ESBL-producing isolates were most susceptible to IPM (97.2%) and AMK (93.9%), and UTI-associated E. coli ESBL-producers were 94.74% susceptible to amikacin (AMK), 97.02% to imipenem (IPM), and 91.4% to ertapenem (ETP). IAI K. pneumoniae ESBL-producing isolates were most susceptible to AMK (84.43%) and IPM (82.79%), and UTI-associated K. pneumoniae ESBL-producers were 88.39% susceptible to AMK, 87.5% to IPM, and 82.14% to ETP. Overall, percentages of susceptible strains to ETP, IPM, AMK, and Piperacillin-Tazobactam (TZP) were in the range of 82.0% to 96.4%, to 5 cephalosporins in the range of 31.4%-69.6% and to 2 fluoroquinolones in the range of 37.8%-45.5% for E. coli and 65.5%-90.7%, 37.7%-75.3%, and 43.9%-73.2% for K. pneumoniae, respectively. Conclusion: E. coli and K. pneumoniae continued to be the main pathogens in Chinese UTIs and IAIs with high ESBL-positive rates between 2016 and 2017. Carbapenem- or amikacin-based therapies were the most effective to combat IAI and UTI pathogens.
PMID: 31118698 [PubMed]
- Ertapenem for osteoarticular infections in obese patients: a pharmacokinetic study of plasma and bone concentrations.
Ertapenem for osteoarticular infections in obese patients: a pharmacokinetic study of plasma and bone concentrations.
Eur J Clin Pharmacol. 2018 Dec 04;:
Authors: Chambers J, Page-Sharp M, Salman S, Dyer J, Davis TME, Batty KT, Manning L
PURPOSE: Ertapenem is used off-label to treat osteoarticular infections but there are few pharmacokinetic (PK) data to guide optimal dosing strategies in patients who may be obese with multiple co-morbidities including diabetes and peripheral vascular disease.
METHODS: Participants undergoing lower limb amputation or elective joint arthroplasty received a dose of intravenous ertapenem prior to surgery. Eight plasma samples were collected over 24 h, together with at least one bone sample per patient. Ertapenem concentrations in plasma and bone were measured using liquid-chromatography/mass-spectroscopy and analysed using non-linear mixed effects PK modelling.
RESULTS: Plasma and bone concentrations were obtained from 10 participants. The final population PK model showed that a fat free body mass was the most appropriate body size adjustment. Ertapenem diffused rapidly into bone but concentrations throughout the 24 h dosing period were on average 40-fold higher in plasma, corresponding to a bone to plasma ratio of 0.025, and highly variable between individuals. Simulations demonstrated a high probability of target attainment (PTA) for free plasma concentrations when the minimum inhibitory concentrations (MIC) were ≤ 0.25 mg/L. By contrast, at MICs of 0.5 mg/L and ≥ 1 mg/L, the fractions of patients attaining this target was ~ 80% and 40%, respectively. In bone, the PTA was ≤ 45% when the MIC was ≥ 0.25 mg/L.
CONCLUSION: Local bone and free plasma concentrations appear adequate for osteoarticular infections where Enterobacteriaceae are the main causative pathogens, but for Staphylococcus aureus and other bacteria, conventional dosing may lead to inadequate PTA.
PMID: 30511329 [PubMed - as supplied by publisher]