Bloodstream Infections by AmpC-Producing Enterobacterales: Risk Factors and Therapeutic Outcome

Overview

Journal Pathogens

Date 2023 Sep 28

PMID 37764933

Authors

Mladen Pospisil

Haris Car

Vesna Elvedi-Gasparovic

Natasa Beader

Zoran Herljevic

Branka Bedenic

Affiliations

Soon will be listed here.

Abstract

Bloodstream infections associated with AmpC-producing Enterobacterales are severe medical conditions which, without prompt and effective treatment, may have dire ramifications. This study aimed to assess whether certain comorbidities and previous surgical procedures coincide with resistance determinants of AmpC-producing Enterobacterales associated with bloodstream infections. Antibiotic resistance patterns and therapy outcome were also determined. The patients' data obtained revealed that the prevalence of recent surgical procedures, solid organ tumors, metabolic diseases, kidney and liver failure, and hematological malignancies do not differ between resistant and susceptible isolates of AmpC-producing Enterobacterales. Furthermore, no difference was reported in mortality rates. Regarding antibiotic resistance, 34.52% of isolates were confirmed to be resistant (AmpC hyperproduction, ESBL, or carbapenemase). More than one in five AmpC hyperproducers were reported amid spp., , , and strains. Carbapenemases were mostly noted in spp. followed by and strains. had the highest proportion of ESBLsof ESBLs. Resistance to expanded-spectrum cephalosporins of spp. and strains exceeded 50%, and resistance to meropenem over 10% was observed only in strains. Enterobacterales' ever-growing resistance to antibiotics is becoming quite a challenge for clinicians and new treatment options are required.

References

Santajit S, Indrawattana N . Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens. Biomed Res Int. 2016; 2016:2475067. PMC: 4871955. DOI: 10.1155/2016/2475067. View

Perez-Palacios P, Girlich D, Soraa N, Lamrani A, Maoulainine F, Bennaoui F . Multidrug-resistant Enterobacterales responsible for septicaemia in a neonatal intensive care unit in Morocco. J Glob Antimicrob Resist. 2023; 33:208-217. DOI: 10.1016/j.jgar.2023.02.011. View

Simsek M . Determination of the antibiotic resistance rates of isolates obtained from various clinical specimens. Niger J Clin Pract. 2019; 22(1):125-130. DOI: 10.4103/njcp.njcp_362_18. View

Bedenic B, Sardelic S, Luxner J, Bosnjak Z, Varda-Brkic D, Lukic-Grlic A . Molecular characterization of class b carbapenemases in advanced stage of dissemination and emergence of class d carbapenemases in Enterobacteriaceae from Croatia. Infect Genet Evol. 2016; 43:74-82. DOI: 10.1016/j.meegid.2016.05.011. View

Bedenic B, Firis N, Elvedi-Gasparovic V, Krilanovic M, Matanovic K, Stimac I . Emergence of multidrug-resistant Proteus mirabilis in a long-term care facility in Croatia. Wien Klin Wochenschr. 2016; 128(11-12):404-13. DOI: 10.1007/s00508-016-1005-x. View

Wesevich A, Sutton G, Ruffin F, Park L, Fouts D, Fowler Jr V . Newly Named Klebsiella aerogenes (formerly Enterobacter aerogenes) Is Associated with Poor Clinical Outcomes Relative to Other Species in Patients with Bloodstream Infection. J Clin Microbiol. 2020; 58(9). PMC: 7448666. DOI: 10.1128/JCM.00582-20. View

Jacoby G . AmpC beta-lactamases. Clin Microbiol Rev. 2009; 22(1):161-82, Table of Contents. PMC: 2620637. DOI: 10.1128/CMR.00036-08. View

Mashaly G, Mashaly M . Colistin-heteroresistance in carbapenemase-producing Enterobacter species causing hospital-acquired infections among Egyptian patients. J Glob Antimicrob Resist. 2020; 24:108-113. DOI: 10.1016/j.jgar.2020.11.019. View

Jelic M, Skrlin J, Bejuk D, Koscak I, Butic I, Guzvinec M . Characterization of Isolates Associated with Emergence of OXA-48-Producing Klebsiella pneumoniae in Croatia. Microb Drug Resist. 2017; 24(7):973-979. DOI: 10.1089/mdr.2017.0168. View

10.

Cheng L, Nelson B, Mehta M, Seval N, Park S, Giddins M . Piperacillin-Tazobactam versus Other Antibacterial Agents for Treatment of Bloodstream Infections Due to AmpC β-Lactamase-Producing Enterobacteriaceae. Antimicrob Agents Chemother. 2017; 61(6). PMC: 5444164. DOI: 10.1128/AAC.00276-17. View

11.

da Cunha Ferreira T, Martins I . Risk Factors of Death in Bloodstream Infections Caused by AmpC β-Lactamase-Producing in Patients with Neoplasia. Infect Drug Resist. 2021; 14:3083-3097. PMC: 8364842. DOI: 10.2147/IDR.S312920. View

12.

Chaubey V, Pitout J, Dalton B, Gregson D, Ross T, Laupland K . Clinical and microbiological characteristics of bloodstream infections due to AmpC β-lactamase producing Enterobacteriaceae: an active surveillance cohort in a large centralized Canadian region. BMC Infect Dis. 2014; 14:647. PMC: 4299784. DOI: 10.1186/s12879-014-0647-4. View

13.

Suto S, Bedenic B, Likic S, Kibel S, Anusic M, Ticic V . Diffusion of OXA-48 carbapenemase among urinary isolates of Klebsiella pneumoniae in non-hospitalized elderly patients. BMC Microbiol. 2022; 22(1):30. PMC: 8767700. DOI: 10.1186/s12866-022-02443-y. View

14.

Tot T, Kibel S, Sardelic S, Nemer K, Bencic A, Vranes J . Polyclonal spread of colistin resistant in Croatian hospitals and outpatient setting. Germs. 2021; 11(2):163-178. PMC: 8373405. DOI: 10.18683/germs.2021.1254. View

15.

MacDonald J, Chibabhai V . Evaluation of the RESIST-4 O.K.N.V immunochromatographic lateral flow assay for the rapid detection of OXA-48, KPC, NDM and VIM carbapenemases from cultured isolates. Access Microbiol. 2020; 1(5):e000031. PMC: 7470286. DOI: 10.1099/acmi.0.000031. View

16.

Intra J, Carcione D, Sala R, Siracusa C, Brambilla P, Leoni V . Antimicrobial Resistance Patterns of and Strains Isolated from Clinical Specimens: A Twenty-Year Surveillance Study. Antibiotics (Basel). 2023; 12(4). PMC: 10135309. DOI: 10.3390/antibiotics12040775. View

17.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

18.

Rodriguez-Bano J, Navarro M, Romero L, Muniain M, Cueto M, Rios M . Bacteremia due to extended-spectrum beta -lactamase-producing Escherichia coli in the CTX-M era: a new clinical challenge. Clin Infect Dis. 2006; 43(11):1407-14. DOI: 10.1086/508877. View

19.

Serefhanoglu K, Turan H, Timurkaynak F, Arslan H . Bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae: risk factors for multidrug-resistance. Braz J Infect Dis. 2010; 13(6):403-7. DOI: 10.1590/s1413-86702009000600003. View

20.

Liu J, Wang R, Fang M . Clinical and drug resistance characteristics of infections in 76 patients. J Int Med Res. 2020; 48(10):300060520962296. PMC: 7588764. DOI: 10.1177/0300060520962296. View