BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that ...BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.CASE SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.CONCLUSION Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.展开更多
The improper use of antimicrobials against infectious diseases has allowed microorganisms to develop defense mechanisms that give them insensitivity to these agents. All bacteria are concerned by this phenomenon. This...The improper use of antimicrobials against infectious diseases has allowed microorganisms to develop defense mechanisms that give them insensitivity to these agents. All bacteria are concerned by this phenomenon. This work aimed to assess prevalence of beta-lactamase produced by enterobacterial isolates. Then, disc diffusion, double disc synergy test (DDST) and combined disc test (CDT) were respectively used for antimicrobial resistance, detection of Extended-Spectrum Beta-Lactamases (ESBL) and Metallo-Beta-Lactamases (MBL). bla genes were detected by PCR. A total of 132 enterobacterial strains were studied. Resistance to antibiotic families was observed with a greater frequency than 50%. Gentamicin was the least active beta-lactam antibiotic, with a resistance rate of 88%. 40.9% of strains show an ESBL phenotype and 16.6% were MBL. An overall prevalence of 74% (40/54) and respectively rates of 29.6%, 27.7% and 16.7% for blaSHV, blaCTX and blaTEM genes were observed. SHV, CTX, CTX/SHV/TEM, CTX/TEM, SHV/TEM and CTX/SHV were different ESBL genotypes observed. ESBL-producing enterobacteria isolation worried about the future of antimicrobial therapy in the Republic of Congo. This is a public health problem that requires careful monitoring and implementation of a policy of rational antibiotics use.展开更多
Background Antimicrobial resistance is an increasing challenge in low and middle-income countries as it is wide-spread in these countries and is linked to an increased mortality.Apart from human and environmental fact...Background Antimicrobial resistance is an increasing challenge in low and middle-income countries as it is wide-spread in these countries and is linked to an increased mortality.Apart from human and environmental factors,animal-related drivers of antimicrobial resistance in low-and middle-income countries have special features that differ from high-income countries.The aim of this narrative review is to address the zoonotic sources and the spread of antimicrobial resistance from the perspective of low-and middle-income countries.Main body Contamination with extended-spectrum beta-lactamase(ESBL)-producingEscherichia coli is highest in poultry(Africa:8.9–60%,Asia:53–93%)and there is a risk to import ESBL-producingE.coli through poultry meat in Africa.In aquacultures,the proportion of ESBL-producers amongE.coli can be high(27%)but the overall low quality of published studies limit the general conclusion on the impact of aquacultures on human health.ESBL-producingE.coli colonization of wildlife is 1–9%in bats or 2.5–63%birds.Since most of them are migratory animals,they can disperse antimicrobial resistant bacteria over large distances.So-called‘filth flies’are a relevant vector not only of enteric pathogens but also of antimicrobial resistant bacteria in settings where sanitary systems are poor.In Africa,up to 72.5%of‘filth flies’are colonized with ESBL-producingE.coli,mostly conferred by CTX-M(24.4–100%).While methicillin-resistantStaphylococcus aureus plays a minor role in livestock in Africa,it is frequently found in South America in poultry(27%)or pork(37.5–56.5%)but less common in Asia(poultry:3%,pork:1–16%).Conclusions Interventions to contain the spread of AMR should be tailored to the needs of low-and middle-income countries.These comprise capacity building of diagnostic facilities,surveillance,infection prevention and control in small-scale farming.展开更多
Objective:To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from patients in a certain hospital and provide a basis for the rational use of antibiotics in the clinical treatmen...Objective:To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from patients in a certain hospital and provide a basis for the rational use of antibiotics in the clinical treatment for the infection of Klebsiella pneumoniae.Methods:1,192 strains of Klebsiella pneumoniae isolated from clinical specimens from 2012 to 2016 were collected.The strains were identified by VITEK-2 Compact Microbiological Identification System,and the corresponding results of the antimicrobial susceptibility test were interpreted in accordance with the standards recommended by Clinical and Laboratory Standards Institute(CLSI).Results:1,192 strains of Klebsiella pneumoniae were mainly isolated from sputum(65.6%),and most of them were from Respiratory Medicine Department and Medical Intensive Care Unit of Respiratory Medicine Department(MICU),accounting for 41.4%.Out of 1,192 strains,448 strains were detected to produce extended-spectrum beta-lactamases(ESBLs),accounting for 37.6%.In addition,the detection rates of ESBL-producing Klebsiella pneumoniae for 5 consecutive years showed an increasing trend year by year,and they were higher than the national average values published by China Antimicrobial Resistance Surveillance System(CARSS)in the corresponding period.The drug resistance rate of ESBL-producing Klebsiella pneumoniae was significantly higher than that of non ESBL-producing strains.Conclusions:The infection caused by Klebsiella pneumoniae mainly occurs in the lower respiratory tract,and the drug resistance rates of Klebsiella pneumoniae to antibiotics in the drug susceptibility spectrum are maintained at a high level.Therefore,the rational selection of antibiotics for the clinical treatment of lower respiratory tract infection caused by Klebsiella pneumoniae must be based on the production of ESBLs and the results of antimicrobial susceptibility test.展开更多
文摘BACKGROUND Appendicitis, the inflammation of the appendix, is the most common abdominal surgical emergency requiring expedient surgical intervention. Extendedspectrum beta-lactamases(ESBLs) are bacterial enzymes that catalyse the degradation of the betalactam ring of penicillins and cephalosporins(but without carbapenemase activity), leading to resistance of these bacteria to beta-lactam antibiotics. Recent increases in incidence of ESBL-producing bacteria have caused alarm worldwide. Proportion estimates of ESBLEnterobacteriaceae hover around 46% in China, 42% in East Africa, 12% in Germany, and 8% in the United States.CASE SUMMARY The impact of ESBL-producing bacteria on appendiceal abscesses and consequent pelvic abscesses are yet to be examined in depth. A literature review using the search words "appendiceal abscesses" and "ESBL Escherichia coli(E. coli)" revealed very few cases involving ESBL E. coli in any capacity in the context of appendiceal abscesses. This report describes the clinical aspects of a patient with appendicitis whodeveloped a postoperative pelvic abscess infected with ESBL-producing E. coli. In this report, we discuss the risk factors for contracting ESBL E. coli infection in appendicitis and post-appendectomy pelvis abscesses. We also discuss our management approach for postappendectomy ESBL E. coli pelvic abscesses, including drainage, pathogen identification, and pathogen characterisation. When ESBL E. coli is confirmed, carbapenem antibiotics should be promptly administered, as was done efficaciously with this patient. Our report is the first one in a developed country involving ESBL E. coli related surgical complications in association with a routine laparoscopic appendectomy.CONCLUSION Our report is the first involving ESBL E. coli and appendiceal abscesses, and that too consequent to laparoscopic appendectomy.
文摘The improper use of antimicrobials against infectious diseases has allowed microorganisms to develop defense mechanisms that give them insensitivity to these agents. All bacteria are concerned by this phenomenon. This work aimed to assess prevalence of beta-lactamase produced by enterobacterial isolates. Then, disc diffusion, double disc synergy test (DDST) and combined disc test (CDT) were respectively used for antimicrobial resistance, detection of Extended-Spectrum Beta-Lactamases (ESBL) and Metallo-Beta-Lactamases (MBL). bla genes were detected by PCR. A total of 132 enterobacterial strains were studied. Resistance to antibiotic families was observed with a greater frequency than 50%. Gentamicin was the least active beta-lactam antibiotic, with a resistance rate of 88%. 40.9% of strains show an ESBL phenotype and 16.6% were MBL. An overall prevalence of 74% (40/54) and respectively rates of 29.6%, 27.7% and 16.7% for blaSHV, blaCTX and blaTEM genes were observed. SHV, CTX, CTX/SHV/TEM, CTX/TEM, SHV/TEM and CTX/SHV were different ESBL genotypes observed. ESBL-producing enterobacteria isolation worried about the future of antimicrobial therapy in the Republic of Congo. This is a public health problem that requires careful monitoring and implementation of a policy of rational antibiotics use.
基金We acknowledge the open access fund of the University of Münster.
文摘Background Antimicrobial resistance is an increasing challenge in low and middle-income countries as it is wide-spread in these countries and is linked to an increased mortality.Apart from human and environmental factors,animal-related drivers of antimicrobial resistance in low-and middle-income countries have special features that differ from high-income countries.The aim of this narrative review is to address the zoonotic sources and the spread of antimicrobial resistance from the perspective of low-and middle-income countries.Main body Contamination with extended-spectrum beta-lactamase(ESBL)-producingEscherichia coli is highest in poultry(Africa:8.9–60%,Asia:53–93%)and there is a risk to import ESBL-producingE.coli through poultry meat in Africa.In aquacultures,the proportion of ESBL-producers amongE.coli can be high(27%)but the overall low quality of published studies limit the general conclusion on the impact of aquacultures on human health.ESBL-producingE.coli colonization of wildlife is 1–9%in bats or 2.5–63%birds.Since most of them are migratory animals,they can disperse antimicrobial resistant bacteria over large distances.So-called‘filth flies’are a relevant vector not only of enteric pathogens but also of antimicrobial resistant bacteria in settings where sanitary systems are poor.In Africa,up to 72.5%of‘filth flies’are colonized with ESBL-producingE.coli,mostly conferred by CTX-M(24.4–100%).While methicillin-resistantStaphylococcus aureus plays a minor role in livestock in Africa,it is frequently found in South America in poultry(27%)or pork(37.5–56.5%)but less common in Asia(poultry:3%,pork:1–16%).Conclusions Interventions to contain the spread of AMR should be tailored to the needs of low-and middle-income countries.These comprise capacity building of diagnostic facilities,surveillance,infection prevention and control in small-scale farming.
文摘Objective:To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from patients in a certain hospital and provide a basis for the rational use of antibiotics in the clinical treatment for the infection of Klebsiella pneumoniae.Methods:1,192 strains of Klebsiella pneumoniae isolated from clinical specimens from 2012 to 2016 were collected.The strains were identified by VITEK-2 Compact Microbiological Identification System,and the corresponding results of the antimicrobial susceptibility test were interpreted in accordance with the standards recommended by Clinical and Laboratory Standards Institute(CLSI).Results:1,192 strains of Klebsiella pneumoniae were mainly isolated from sputum(65.6%),and most of them were from Respiratory Medicine Department and Medical Intensive Care Unit of Respiratory Medicine Department(MICU),accounting for 41.4%.Out of 1,192 strains,448 strains were detected to produce extended-spectrum beta-lactamases(ESBLs),accounting for 37.6%.In addition,the detection rates of ESBL-producing Klebsiella pneumoniae for 5 consecutive years showed an increasing trend year by year,and they were higher than the national average values published by China Antimicrobial Resistance Surveillance System(CARSS)in the corresponding period.The drug resistance rate of ESBL-producing Klebsiella pneumoniae was significantly higher than that of non ESBL-producing strains.Conclusions:The infection caused by Klebsiella pneumoniae mainly occurs in the lower respiratory tract,and the drug resistance rates of Klebsiella pneumoniae to antibiotics in the drug susceptibility spectrum are maintained at a high level.Therefore,the rational selection of antibiotics for the clinical treatment of lower respiratory tract infection caused by Klebsiella pneumoniae must be based on the production of ESBLs and the results of antimicrobial susceptibility test.
