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      6Scopus© Citations 2
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    Catheter-associated bloodstream infection caused by Leifsonia aquatica in a haemodialysis patient: a case report
    (2012)
    Lorena Porte  
    ;
    Andrés Soto
    ;
    Daniela Andrighetti
    ;
    Jeannette Dabanch
    ;
    Stephanie Braun
    Scopus© Citations 16  3
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    High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
    (2023)
    ARAOS BRALIC, RAFAEL IGNACIO  
    ;
    Rachel M Smith
    ;
    Ashley Styczynski
    ;
    Felipe Sánchez
    ;
    Lea Maureira
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9–50.0), 41.2% (95% CI, 37.7–44.6), 14.5% (95% CI, 12.0–16.9), and 26.3% (95% CI, 23.2–29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4–44.6), 28.9% (95% CI, 24.2–33.6), 5.6% (95% CI, 3.2–8.0), and 4.8% (95% CI, 2.6–7.0), respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.</jats:p> </jats:sec>
    Scopus© Citations 10  2
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      5Scopus© Citations 22
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    Silicone Stent Versus Fully Covered Metallic Stent in Malignant Central Airway Stenosis
    (2021)
    Rosa Maria Ortiz-Comino
    ;
    Arturo Morales
    ;
    Rosa López-Lisbona
    ;
    Noelia Cubero
    ;
    Marta Diez-Ferrer
    Scopus© Citations 38  1
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    A multispecies outbreak of carbapenem-resistant bacteria harboring the blaKPC gene in a non-classical transposon element
    (2021)
    Aniela Wozniak
    ;
    Cristian Figueroa
    ;
    Francisco Moya-Flores
    ;
    Piero Guggiana
    ;
    Claudia Castillo
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p><jats:italic>Klebsiella pneumoniae</jats:italic> is the most frequent KPC-producing bacteria. The <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene is frequently embedded in Tn4401 transposon, and less frequently in non-Tn4401 elements (NTE<jats:sub>KPC</jats:sub>) variants I-III. The first case of KPC in the UC-CHRISTUS Clinical Hospital was detected in <jats:italic>Pseudomonas aeruginosa</jats:italic>. Soon after this event, KPC was detected in 2 additional <jats:italic>Pseudomonas aeruginosa</jats:italic>, 3 <jats:italic>Escherichia coli</jats:italic>, 3 <jats:italic>Enterobacter cloacae</jats:italic>, 3 <jats:italic>Klebsiella pneumoniae,</jats:italic> and 1 <jats:italic>Citrobacter freundii</jats:italic>, isolated from 6 different patients. We aimed to elucidate the possible mechanisms of genetic transfer and dissemination of the <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene among isolates of this multispecies outbreak. A molecular epidemiology analysis of the above mentioned clinical isolates (<jats:italic>n</jats:italic> = 13) through Multi-Locus Sequence Typing, plasmid analysis, Pulsed-Field Gel-Electrophoresis, and Whole-genome sequencing (WGS) was performed.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>High-risk sequence types were found: <jats:italic>K. pneumoniae</jats:italic> ST11, <jats:italic>P. aeruginosa</jats:italic> ST654, and <jats:italic>E. cloacae</jats:italic> ST114. All enterobacterial isolates were not clonal except for 3 <jats:italic>E. coli</jats:italic> isolated from the same patient. WGS analysis in 6 enterobacterial isolates showed that 4 of them had <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> embedded in a novel variant of NTE<jats:sub>KPC</jats:sub> designated NTE<jats:sub>KPC</jats:sub>-IIe. Upstream of <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene there was a 570 pb truncated <jats:italic>bla</jats:italic><jats:sub>TEM-1</jats:sub> gene followed by an insertion sequence that was 84% similar to ISEc63, a 4473 bp element of the Tn3 family. Downstream the <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene there was a truncated ISKpn6 gene, and the inverted repeat right sequence of Tn4401. The ISec63-like element together with the <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene plus Tn4401 remnants were inserted in the Tra operon involved in conjugative transfer of the plasmid. This NTE was carried in a broad host-range IncN plasmid. <jats:italic>P. aeruginosa</jats:italic> isolates carried <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> gene embedded in a typical Tn4401b transposon in a different plasmid, suggesting that there was no plasmid transfer between <jats:italic>Enterobacteriaceae</jats:italic> and <jats:italic>P. aeruginosa</jats:italic> as initially hypothesized.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Most enterobacterial isolates had <jats:italic>bla</jats:italic><jats:sub>KPC</jats:sub> embedded in the same NTE<jats:sub>KPC</jats:sub>-IIe element, suggesting that this multispecies KPC outbreak was due to horizontal gene transfer rather than clonal spread. This poses a greater challenge to infection control measures often directed against containment of clonal spread.</jats:p> </jats:sec>
    Scopus© Citations 21  3
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      15Scopus© Citations 39
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    Microbial Disruption Indices to Detect Colonization With Multidrug-Resistant Organisms
    (2017)
    Satish Munigala
    ;
    Kathleen M. McMullen
    ;
    Anthony J. Russo
    ;
    S. Reza Jafarzadeh
    ;
    Joan Hoppe-Bauer
    <jats:sec id="S0899823X17001908_abs1" sec-type="general"><jats:title>OBJECTIVE</jats:title><jats:p>To characterize the microbial disruption indices of hospitalized patients to predict colonization with multidrug-resistant organisms (MDROs).</jats:p></jats:sec><jats:sec id="S0899823X17001908_abs2" sec-type="general"><jats:title>DESIGN</jats:title><jats:p>A cross-sectional survey of the fecal microbiome was conducted in a tertiary referral, acute-care hospital in Boston, Massachusetts.</jats:p></jats:sec><jats:sec id="S0899823X17001908_abs3" sec-type="general"><jats:title>PARTICIPANTS</jats:title><jats:p>The study population consisted of adult patients hospitalized in general medical/surgical wards.</jats:p></jats:sec><jats:sec id="S0899823X17001908_abs4" sec-type="methods"><jats:title>METHODS</jats:title><jats:p>Rectal swabs were obtained from patients within 48 hours of hospital admission and screened for MDRO colonization using conventional culture techniques. The V4 region of the 16S rRNA gene was sequenced to assess the fecal microbiome. Microbial diversity and composition, as well as the functional potential of the microbial communities present in fecal samples, were compared between patients with and without MDRO colonization.</jats:p></jats:sec><jats:sec id="S0899823X17001908_abs5" sec-type="results"><jats:title>RESULTS</jats:title><jats:p>A total of 44 patients were included in the study, of whom 11 (25%) were colonized with at least 1 MDRO. Reduced microbial diversity and high abundance of metabolic pathways associated with multidrug-resistance mechanisms characterized the fecal microbiome of patients colonized with MDRO at hospital admission.</jats:p></jats:sec><jats:sec id="S0899823X17001908_abs6" sec-type="conclusions"><jats:title>CONCLUSIONS</jats:title><jats:p>Our data suggest that microbial disruption indices may be key to predicting MDRO colonization and could provide novel infection control approaches.</jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol</jats:italic> 2017;38:1312–1318</jats:p></jats:sec>
    Scopus© Citations 16  1
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    Scopus© Citations 47  2