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Project Title
NON-CARBAPENEMASE PRODUCING CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE: POPULATION STRUCTURE, MECHANISMS OF RESISTANCE AND THERAPY
Partner Organisations
Internal ID
1211947
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Start Date
2021

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Clinical outcomes and bacterial characteristics of carbapenem-resistant Klebsiella pneumoniae complex among patients from different global regions (CRACKLE-2): a prospective, multicentre, cohort study

2022 , Minggui Wang , Michelle Earley , Liang Chen , Blake M Hanson , Yunsong Yu , Zhengyin Liu , Soraya Salcedo , Eric Cober , Lanjuan Li , Souha S Kanj , Hainv Gao , MUNITA SEPULVEDA, JOSE MANUEL , Karen Ordoñez , Greg Weston , Michael J Satlin , Sandra L Valderrama-Beltrán , Kalisvar Marimuthu , Martin E Stryjewski , Lauren Komarow , Courtney Luterbach , Steve H Marshall , Susan D Rudin , Claudia Manca , David L Paterson , Jinnethe Reyes , Maria V Villegas , Scott Evans , Carol Hill , Rebekka Arias , Keri Baum , Bettina C Fries , Yohei Doi , Robin Patel , Barry N Kreiswirth , Robert A Bonomo , Henry F Chambers , Vance G Fowler , Cesar A Arias , David van Duin , Lilian M Abbo , Deverick J Anderson , Rebekka Arias , Cesar A Arias , Keri Baum , Robert A Bonomo , Henry F Chambers , Liang Chen , Kean Lee Chew , Eric Cober , Heather R Cross , Partha Pratim De , Samit Desai , Sorabh Dhar , Valentina Di Castelnuovo , Lorena Diaz , AN Q Dinh , Yohei Doi , Michelle Earley , Brandon Eilertson , Beth Evans , Scott Evans , Vance G Fowler Jr , Bettina C Fries , Hainv Gao , Julia Garcia-Diaz , Omai B Garner , Kerryl Greenwood-Quaintance , Blake Hanson , Erica Herc , Carol Hill , Jesse T Jacob , Jianping Jiang , Robert C Kalayjian , Souha S Kanj , Keith S Kaye , Angela Kim , Lauren Komarow , Barry N Kreiswirth , Courtney Lauterbach , Lanjuan Li , Zhengyin Liu , Claudia Manca , Kalisvar Marimuthu , Steven H Marshall , Todd McCarty , Oon Tek Ng , Jose Millan Oñate Gutierrez , Karen Ordoñez , Robin Patel , David L Paterson , Anton Peleg , Jinnethe Reyes , Susan D Rudin , Robert A Salata , Soraya Salcedo , Michael J Satlin , Suzannah Schmidt-Malan , Nares Smitasin , Maria Spencer , Martin Stryjewski , Jiachun Su , Paul Ananth Tambyah , Sandra Valderrama , David van Duin , Maria Virginia Villegas Botero , Minggui Wang , Mary Waters , Greg Weston , Darren Wong , Glenn Wortmann , Yang Yang , Yunsong Yu , Fujie Zhang

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Contemporary Clinical and Molecular Epidemiology of Vancomycin-Resistant Enterococcal Bacteremia: A Prospective Multicenter Cohort Study (VENOUS I)

2021 , German A Contreras , MUNITA SEPULVEDA, JOSE MANUEL , Shelby Simar , Courtney Luterbach , An Q Dinh , Kirsten Rydell , Pranoti V Sahasrabhojane , Rafael Rios , Lorena Diaz , Katherine Reyes , Marcus Zervos , Helina M Misikir , Gabriela Sanchez-Petitto , Catherine Liu , Yohei Doi , Lilian M Abbo , Luis Shimose , Harald Seifert , Carlota Gudiol , Fernanda Barberis , Claudia Pedroza , Samuel L Aitken , Samuel A Shelburne , David van Duin , Truc T Tran , Blake M Hanson , Cesar A Arias

Abstract Background Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSIs) are lacking. Methods The Vancomycin-Resistant Enterococcal BSI Outcomes Study (VENOUS I) is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or Enterococcus faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing. Results Forty-two of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (hazard ratio [HR], 3.13), microbiological failure (HR, 2.4), VRE BSI (HR, 2.13), use of urinary catheter (HR, 1.85), and Pitt BSI score ≥2 (HR, 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E faecium bacteremia (HR, 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. Enterococcus faecalis sequence type 6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E faecium was identified. Conclusions Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.

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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 , ACEVEDO ROMO, JOHANNA PATRICIA , Catalina Paredes , Maite González , RIVAS JIMENEZ, LINA MARIA , Maria Spencer-Sandino , Anne Peters , Ayesha Khan , Dino Sepulveda , Loreto Rojas Wettig , María Luisa Rioseco , Pedro Usedo , Pamela Rojas Soto , Laura Andrea Huidobro , Catterina Ferreccio , Benjamin J Park , Eduardo Undurraga , Erika M C D’Agata , Alejandro Jara , MUNITA SEPULVEDA, JOSE MANUEL

Abstract Background 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. Methods 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. Results 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. Conclusions 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.

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Dynamics of the MRSA Population in a Chilean Hospital: a Phylogenomic Analysis (2000–2016)

2023 , José R. W. Martínez , Paul J. Planet , Maria Spencer-Sandino , RIVAS JIMENEZ, LINA MARIA , Ahmed M. Moustafa , Lorena Díaz , Blake Hanson , RIQUELME NEIRA, ROBERTO ANDRES , ALCALDE RICO, MANUEL , Ana Quesille-Villalobos , Lina P. Carvajal , Sandra Rincón , Jinnethe Reyes , Marusella Lam , Patricia García , ARAOS BRALIC, RAFAEL IGNACIO , César A. Arias , Juan F. Calderon , MUNITA SEPULVEDA, JOSE MANUEL , Adriana E. Rosato

Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health pathogen that disseminates through the emergence of successful dominant clones in specific geographic regions. Knowledge of the dissemination and molecular epidemiology of MRSA in Latin America is scarce and is largely based on small studies or more limited typing techniques that lack the resolution to represent an accurate description of the genomic landscape.

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Multiple clonal transmissions of clinically relevant extended-spectrum beta-lactamase–producing Escherichia coli among livestock, dogs, and wildlife in Chile

2023 , Juliette Hayer , Marília Salgado-Caxito , Andrés Opazo-Capurro , Paulina González Muñoz , Javier Millán , Ana Piñeiro , MUNITA SEPULVEDA, JOSE MANUEL , RIVAS JIMENEZ, LINA MARIA , Julio A. Benavides

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Trends and socioeconomic, demographic, and environmental factors associated with antimicrobial resistance: a longitudinal analysis in 39 hospitals in Chile 2008–2017

2023 , Kasim Allel , Jaime Labarca , Camila Carvajal , Patricia Garcia , Marcela Cifuentes , Francisco Silva , MUNITA SEPULVEDA, JOSE MANUEL , Eduardo A. Undurraga

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Acquisition of resistance to ceftazidime-avibactam during infection treatment in Pseudomonas aeruginosa through D179Y mutation in one of two blaKPC-2 gene copies without losing carbapenem resistance

2022-09 , García, Patricia , Brito, Bárbara , ALCALDE RICO, MANUEL , MUNITA SEPULVEDA, JOSE MANUEL , Martínez, José R.W. , Olivares-Pacheco, Jorge , Quiroz, Valeria , Wozniak, Aniela

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