BACKGROUND & AIMS: :We examined the effect of applying the updated 2010 Clinical and Laboratory Standards Institute (CLSI) susceptibility breakpoints for extended-spectrum cephalosporins (ESCs) to detect extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In total, 202 ESBL-producing, plasmidic AmpC- and carbapenemase-negative isolates derived from separate patients were collected from three Greek hospitals during 2007-2011, including 150 Escherichia coli, 43 Klebsiella pneumoniae and 9 Enterobacter cloacae clinical isolates. ESBLs were detected using the ESBL CLSI confirmatory test and PCR assays. Sequencing analysis showed that 91 (45.0%) of the ESBL-producers carried the bla(CTX-M-3) gene, 66 (32.7%) carried the bla(CTX-M-15) gene and the remaining 45 (22.3%) carried the bla(SHV-5) gene. Minimum inhibitory concentrations for cefotaxime, ceftazidime and cefepime were determined by the agar dilution method. Based on the new CLSI breakpoints, 13 (6.4%) of the ESBL-producers were susceptible to cefotaxime, 90 (44.6%) to ceftazidime and 112 (55.4%) to cefepime; as many as 145 (71.8%) were susceptible to at least one ESC. Among the 150 E. coli, 12 (8.0%), 87 (58.0%) and 79 (52.7%) were susceptible to cefotaxime, ceftazidime and cefepime, respectively, whilst among the 43 K. pneumoniae, 1 (2.3%), 3 (7.0%) and 25 (58.1%) were susceptible to the above ESCs, respectively. None of the nine E. cloacae were susceptible to cefotaxime and ceftazidime, but all except one were susceptible to cefepime. By implementation of the new 2010 CLSI breakpoints, a considerable proportion of ESBL-possessing Enterobacteriaceae would be reported as susceptible, mostly to ceftazidime and cefepime, leading to possible infection control and therapeutic implications.

背景与目标： ：我们研究了应用更新的2010年临床和实验室标准协会（CLSI）敏感性点对超广谱头孢菌素（ESC）检测产生超广谱β-内酰胺酶（ESBL）的肠杆菌科的效果。在2007年至2011年期间，总共从三名希腊医院收集了202份来自不同患者的产ESBL的，质粒化的AmpC和碳青霉烯酶阴性的分离株，包括150株大肠杆菌，43株肺炎克雷伯菌和9株泄殖腔肠杆菌临床分离株。使用ESBL CLSI确证测试和PCR测定法检测ESBL。测序分析表明，有91个（45.0％）的ESBL生产者带有bla（CTX-M-3）基因，有66个（32.7％）带有bla（CTX-M-15）基因，其余45个（22.3％）携带bla（SHV-5）基因。用琼脂稀释法测定头孢噻肟，头孢他啶和头孢吡肟的最低抑菌浓度。根据新的CLSI断点，有13名（6.4％）的ESBL生产者易受头孢噻肟的影响，90名（44.6％）对头孢他啶易感，112名（55.4％）对头孢吡肟易感；多达145个（71.8％）易受至少一种ESC的影响。在150例大肠杆菌中，分别有12例（8.0％），87例（58.0％）和79例（52.7％）易受头孢噻肟，头孢他啶和头孢吡肟的影响，而43例肺炎克雷伯菌中有1例（2.3％），3例。 （7.0％）和25（58.1％）易受上述ESC影响。九种阴沟肠杆菌均不易受头孢噻肟和头孢他啶的影响，但除一个外，其余均易受头孢吡肟的影响。通过实施新的2010年CLSI断点，据报道，相当一部分拥有ESBL的肠杆菌科细菌很容易感染，其中大部分容易感染头孢他啶和头孢吡肟，从而可能导致感染控制和治疗意义。

BACKGROUND & AIMS: :We collected and analyzed the time to detection (TTD) of blood cultures in the BacT/Alert automated system from 2002 to 2007. Among the 10,893 monomicrobial isolates from a total of 133,735 blood culture sets, the recoveries of aerobic bottles were compared with those of anaerobic bottles in this study. Significantly more Gram-positive cocci (except Staphylococcus aureus and enterococci), glucose nonfermentative Gram-negative bacteria, and yeast were recovered from aerobic bottles than from anaerobic bottles. The average TTD was 19.0 hr and 20.1 hr for the aerobic and anaerobic bottles, respectively, and 96.8% of the microorganisms were detected within the first 72 hr. Of the 5,489 microorganisms recovered from both of the blood culture bottle pair, microbial growth was significantly more often detected first in the anaerobic bottles than the aerobic bottles for Enterobacteriaceae except Serratia marcescens, while S. aureus, coagulase-negative staphylococci and Pseudomonas aeruginosa were more often detected first in the aerobic bottles. According to these data, we conclude that the earlier positivity of anaerobic bottles is a useful marker for rapid presumptive identification of Enterobacteriaceae infection.

背景与目标： ：我们收集并分析了2002年至2007年BacT / Alert自动化系统中血液培养物的检测时间（TTD）。在总共133,735个血液培养物中的10,893株微生物分离物中，将有氧瓶的回收率与回收率进行了比较。在这项研究中的厌氧瓶。从需氧瓶中回收的革兰氏阳性球菌（金黄色葡萄球菌和肠球菌除外），葡萄糖非发酵性革兰氏阴性菌和酵母的数量要比厌氧瓶中的多。好氧瓶和厌氧瓶的平均TTD分别为19.0小时和20.1小时，在前72小时内检测到96.8％的微生物。从两个血培养瓶对中回收的5,489种微生物中，除粘质沙雷氏菌外，在厌氧瓶中首先检测到的细菌生长要比需氧菌瓶中的细菌增长要多得多，而金黄色葡萄球菌，凝固酶阴性葡萄球菌和铜绿假单胞菌则更多。通常首先在有氧瓶中检测到。根据这些数据，我们得出结论，厌氧瓶的早期阳性是快速推定肠杆菌科感染的有用标志物。

BACKGROUND & AIMS: :Tigecycline In-vitro Surveillance in Taiwan (TIST), initiated in 2006, is a nationwide surveillance programme designed to monitor longitudinally the in-vitro activity of tigecycline against commonly encountered resistant bacteria. This study compared the in-vitro activity of tigecycline against clinical isolates of resistant Gram-negative bacteria determined by the broth microdilution and Etest methods. A total of 622 isolates were collected from patients treated at 20 teaching hospitals. Tigecycline had excellent in-vitro activity against extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (N = 275) with MIC(90) 0.5 microg/mL and a 99.6% susceptibility rate, and also against ESBL-producing Klebsiella pneumoniae (N = 324) with MIC(90) 2 microg/mL and a 98.5% susceptibility rate. For ESBL-producing Proteus mirabilis (N = 15) the MIC(90) was 4 microg/mL with a 73.3% susceptibility rate. For ESBL-producing Klebsiella oxytoca (N = 8) the MIC(50) and MIC(90) were 0.5 and 1 microg/mL, respectively, with a 100% susceptibility rate. Limited agreement (<80%) was found between the broth microdilution and the Etest methods when determining the in-vitro activity of tigecycline against ESBL- producing K. pneumoniae and K. oxytoca.

背景与目标： 台湾的Tigecycline体外监测（TIST）于2006年启动，是一项全国性的监测计划，旨在纵向监测tigecycline对常见耐药菌的体外活性。这项研究比较了肉汤微稀释和Etest方法测定的替加环素对耐药革兰氏阴性菌临床分离株的体外活性。从20家教学医院接受治疗的患者中总共收集了622株分离株。 Tigecycline对产生超广谱β-内酰胺酶（ESBL）的大肠杆菌（N = 275）具有MIC（90）0.5 microg / mL和99.6％的敏感性，并且对产生ESBL的肺炎克雷伯菌具有优异的体外活性（N = 324）MIC（90）2 microg / mL，敏感性为98.5％。对于产生ESBL的变形杆菌（N = 15），MIC（90）为4 microg / mL，敏感性为73.3％。对于产ESBL的产酸克雷伯菌（N = 8），MIC（50）和MIC（90）分别为0.5和1 microg / mL，敏感性为100％。当确定替加环素对产生ESBL的肺炎克雷伯菌和产氧克雷伯氏菌的体外活性时，在肉汤微稀释法和Etest方法之间发现有限的一致性（<80％）。

BACKGROUND & AIMS: :The aim of this study was to describe the prevalence and characteristics of knee prosthetic joint infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. From 2000 to 2007, 132 infections out of 5,076 arthroplasties (2.6%) were registered. Seven out of 132 infections (5.3%) were due to ESBL-producing Enterobacteriaceae, Escherichia coli in six cases and Klebsiella pneumoniae in one. Open debridement and retention of the implant was the first surgical approach and all patients received intravenous carbapenems. Relapse was documented in four cases and remission in three. Therefore, debridement without prosthesis removal was associated with a high failure rate.

背景与目标： ：这项研究的目的是描述由于产生超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌引起的膝关节假体感染的患病率和特征。从2000年到2007年，共进行了5,076例关节置换术中的132例感染（占2.6％）。 132例感染中有7例（5.3％）是由于产生ESBL的肠杆菌科，6例大肠杆菌和1例肺炎克雷伯菌引起的。开放性清创术和保留植入物是第一种外科手术方法，所有患者均接受了静脉注射碳青霉烯类药物。记录有4例复发和3例缓解。因此，未清除假体的清创术与高失败率相关。

BACKGROUND & AIMS: :Extended-spectrum beta-lactamase (ESBLs) are defined as ß-lactamase able to hydrolyze all penicillins and cephalosporins with the exception of cephamycins (cefotixin, cefotetan), moxalactam and carbapenems and are encoded by mobile genes. The most frequently encountered ESBLs belong to the CTX-M, SHV, and TEM families. ESBLs were found first in Klebsiella pneumonia and then predominantly in E. coli. The incidence of patients with ESBLs E. coli increase since 2000 in Robert Debré Hospital in Paris. They were mainly implicated in urinary tract infections and less frequently in other infections such as materno-foetal infections or neonatal meningitis. An increase of consumption of carbapenems may lead to spread of carbapenem resistant organisms. Thus alternative to carbapenems for treatment of ESBL producers are needed.

背景与目标： ：广谱β-内酰胺酶（ESBLs）定义为ß-内酰胺酶，能够水解除头孢霉素（头孢替辛，头孢替坦），莫拉西坦和碳青霉烯外的所有青霉素和头孢菌素，并由流动基因编码。最常遇到的ESBL属于CTX-M，SHV和TEM系列。 ESBLs首先在肺炎克雷伯菌中发现，然后主要在大肠杆菌中发现。自2000年以来，巴黎罗伯特·德布雷医院的ESBLs大肠杆菌患者的发病率增加。它们主要与尿路感染有关，而与其他感染（例如，胎粪-胎儿感染或新生儿脑膜炎）相关的频率较低。碳青霉烯类的消费量增加可能导致对碳青霉烯类耐药生物的传播。因此，需要用碳青霉烯替代ESBL生产者。

BACKGROUND & AIMS: :Background: Urinary tract infections (UTIs) are common in women, and during pregnancy can cause significant morbidity. Growing and greatly varying antimicrobial resistance (AMR) of Enterobacteriaceae, responsible for most UTIs, necessitates regular local AMR surveillance. In obstetric population, where beta-lactams are the mainstay for treatment of severe UTIs, particular focus should be placed on beta-lactam resistance. This study aimed to evaluate AMR rates and frequency of extended spectrum beta-lactamase (ESBL) and carbapenemase genes in uropathogenic Enterobacteriaceae among reproductive-age women in St. Petersburg, Russia.Materials/methods: Urine samples were collected from consecutive reproductive-age women, who attended the D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology from October 2017 to November 2019, and cultured according to routine procedures. Susceptibility to antibiotics and ESBL production was determined using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. All urine samples and Enterobacteriaceae isolates were tested for ESBL and carbapenemase genes using real-time PCR.Results: Enterobacteriaceae were detected in 91 (56 pregnant and 35 non-pregnant) of 119 (76%) included women. The vast majority of Enterobacteriaceae strains were susceptible to nitrofurantoin, fosfomycin and meropenem (99-100%). The frequency of strains susceptible to penicillins and cephalosporins ranged from 59% to 82%; 78% of strains were susceptible to ciprofloxacin. ESBL production was phenotypically detected in 15 (16%) Enterobacteriaceae strains, with CTX-M genes revealed in all cases. In all corresponding urine samples, CTX-M genes were also detected. The remaining 104 urine samples were negative for CTX-M genes. In none of the isolates and urine samples, carbapenemase genes were present.Conclusions: The frequency of ESBL producing Enterobacteriaceae was relatively high (16%), with CTX-M genes detected in all cases in both urine and urine cultures. Rapid PCR detection of CTX-M genes directly in urine samples from women with pyelonephritis can be valuable for timely informing treatment choices.

背景与目标： 背景：泌尿系统感染（UTIs）在女性中很常见，在怀孕期间可能会导致严重的发病率。负责大多数UTI的肠杆菌科细菌耐药性（AMR）的增长和差异很大，因此需要定期进行局部AMR监测。对于以β-内酰胺类药物为主要治疗重度尿路感染的产科人群，应特别关注β-内酰胺类药物的耐药性。这项研究的目的是评估俄罗斯圣彼得堡育龄妇女泌尿系统致病性肠杆菌科细菌的AMR发生率和超广谱β-内酰胺酶（ESBL）和碳青霉烯酶基因的频率。材料/方法：从连续生育年龄的妇女中收集尿液样本，参加了DO奥特（Ott）妇产科与生殖研究所于2017年10月至2019年11月，并按常规程序进行培养。根据欧洲抗生素敏感性试验委员会（EUCAST）指南，使用圆盘扩散法确定对抗生素和ESBL的敏感性。结果：在包括119名女性在内的119名女性中，有91名（56名孕妇和35名非孕妇）检出了肠杆菌科。绝大多数肠杆菌科菌株对呋喃妥因，磷霉素和美罗培南敏感（99-100％）。对青霉素和头孢菌素敏感的菌株的频率范围为59％至82％。 78％的菌株对环丙沙星敏感。在15个（16％）肠杆菌科菌株中表型检测到ESBL产生，在所有情况下均显示CTX-M基因。在所有相应的尿液样本中，也检测到了CTX-M基因。其余104个尿液样本中CTX-M基因阴性。结论：产ESBL肠杆菌科细菌的频率相对较高（16％），在所有病例中尿液和尿液培养物中均检测到CTX-M基因。直接从肾盂肾炎妇女的尿液样本中快速检测CTX-M基因的PCR对及时告知治疗选择可能很有价值。

BACKGROUND & AIMS: BACKGROUND:In the middle of October 2011, the Hygiene Department of Caen University Hospital suspected an outbreak of surgical site infections (SSI) after open-heart operations with an unusually high proportion of microorganisms belonging to the Enterobacteriaceae family. The attack rate was 3.8%, significantly different (p = 0.035) from the attack rate of 1.2% in 2010 over the equivalent period. A case-control study was conducted to search specifically for risk factors for Enterobacteriaceae infections after median sternotomy in cardiac patients. METHODS:Case patients were defined retrospectively as patients with superficial or deep surgical site infection with Enterobacteriaceae within 30 days of median sternotomy. Four control patients were selected per case patient from patients matched for date of operation (± 15 days) and European System for Cardiac Operative Risk Evaluation (<5, [5-10], >10). RESULTS:Univariate analysis identified the following risk factors: inappropriate skin preparation on the morning of the intervention (p = 0.046), use of vancomycin (p = 0.030), and number of sternotomy dressings (p = 0.033). A multivariate logistic regression analysis found that vancomycin use was independently associated with an increased risk of postoperative SSI with Enterobacteriaceae (p = 0.019; odds ratio = 7.4). CONCLUSIONS:Although vancomycin is known to be effective for preventing infection with methicillin-sensitive organisms, our results suggest that it was associated with a risk for the development of SSI with gram-negative organisms after median sternotomy. This study led to a multidisciplinary meeting that defined new guidelines for prophylactic antibiotic therapy before open-heart operations.

背景与目标： 背景：2011年10月中旬，卡昂大学医院卫生部怀疑在进行开胸手术后爆发了手术部位感染（SSI），其中肠杆菌科的微生物比例异常高。攻击率为3.8％，与2010年同期的1.2％的攻击率有显着差异（p = 0.035）。进行了一项病例对照研究，以明确寻找心脏病患者中位胸骨切开术后肠杆菌科感染的危险因素。
方法：病例病例回顾性定义为在正中胸骨切开术后30天内患有肠杆菌科的浅表或深部手术部位感染的患者。每例患者从手术日期（±15天）和欧洲心脏手术风险评估系统（<5，[5-10]，> 10）匹配的患者中选择四名对照患者。
结果：单因素分析确定了以下危险因素：干预当天早上不适当的皮肤准备（p = 0.046），使用万古霉素（p = 0.030）和胸骨切开术敷料的数量（p = 0.033）。多元logistic回归分析发现，万古霉素的使用与肠杆菌科术后SSI风险增加独立相关（p = 0.019；优势比= 7.4）。
结论：尽管已知万古霉素可有效预防对甲氧西林敏感的生物体感染，但我们的结果表明，在正中胸骨切开术后，它与革兰氏阴性生物体发生SSI的风险有关。这项研究导致了一个多学科会议，该会议确定了在进行心脏直视手术之前进行预防性抗生素治疗的新指南。

BACKGROUND & AIMS: :We developed a PCR-RFLP assay to detect mutations in the quinolone-resistance determining regions of gyrA and parC associated with fluoroquinolone resistance in Enterobacteriaceae. The assay detected mutations associated with reduced susceptibility to fluoroquinolones and may therefore serve as a specific, rapid, inexpensive, and simple testing alternative.

背景与目标： ：我们开发了一种PCR-RFLP分析法，以检测与肠杆菌科细菌中的氟喹诺酮耐药性相关的gyrA和parC喹诺酮耐药性确定区域中的突变。该测定法检测到与降低对氟喹诺酮类药物敏感性相关的突变，因此可以用作特异性，快速，廉价且简单的测试替代方法。

BACKGROUND & AIMS: BACKGROUND:More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). METHODS:A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. RESULTS:Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. CONCLUSIONS:De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.

背景与目标： 摘要背景：在减少临床广泛使用抗生素的策略中，还需要更多有关特定临床情况下抗生素降级安全性的数据。这项研究的目的是调查降级的预测因素及其对肠杆菌科（BSI-E）引起的血液感染患者预后的影响。
方法：对先前接受厄他培南或抗假性β-内酰胺类药物治疗的BSI-E患者的前瞻性，多中心队列进行事后分析。使用Logistic回归分析与早期降级（EDE）和Cox回归相关的因素，以了解EDE和晚期降级（LDE）对30天全因死亡率的影响。计算了EDE的倾向得分（PS）与未降级（NDE）的差异。还分析了治疗结束时的失败和住院时间。
结果：总共纳入516例患者。 241例患者（46％）进行了EDE，95例（18％）进行了LDE，180例（35％）进行了NDE。与较低的EDE概率独立相关的变量是耐多药菌株（比值比[OR]，0.50 [95％置信区间{CI} ，. 30-.83]）和根据经验用亚胺培南或美罗培南治疗的医院感染（OR， 0.35 [95％CI，.14-.87]。在控制了混杂因素之后，EDE并没有增加死亡率。危险比（HR）（95％CI）如下：通用模型，0.58（.25-1.31）； PS为0.69（.29-1.65）的模型；和基于PS的匹配对，为0.98（.76-1.26）。 LDE与死亡率无关。降级与临床失败或住院时间无关。
结论：肠杆菌科细菌引起的单菌菌血症患者的病情恶化与对临床结局的有害影响无关。

BACKGROUND & AIMS: BACKGROUND:Carbapenem-resistant Enterobacteriaceae are an emerging global infection threat. However, there are few data describing their clinical importance in children. AIM:This retrospective study reviewed the prevalence and resistance mechanisms of carbapenem-resistant Enterobacteriaceae grown from clinical and surveillance samples in a large tertiary referral children's hospital in the UK. METHODS:Carbapenem-resistant Enterobacteriaceae were sought in specimens submitted for diagnostic and surveillance purposes at Alder Hey Children's NHS Foundation Trust, Liverpool, between September 2011 and August 2012. Mechanisms of resistance were identified using phenotypic and/or molecular methods. Variable number tandem repeat profiling was used to type carbapenemase-producing strains. FINDINGS:During the 12-month study period, carbapenem-resistant Enterobacteriaceae were recovered from 24 patients. Five isolates were from clinical diagnostic specimens whereas 19 of 421 patients had positive rectal surveillance swabs (4.5%). Of the 24 isolates, seven (all Klebsiella spp.) harboured carbapenemases: three had blaKPC and four blaNDM, whereas 17 had resistance due to combinations of AmpC or extended-spectrum β-lactamase activity plus impermeability. CONCLUSION:Carbapenem-resistant Enterobacteriaceae and, in particular, those with carbapenemases, are an emerging infection problem in a major paediatric hospital in the UK. Active surveillance is required to monitor and control their spread.

背景与目标： 背景：对碳青霉烯类耐药的肠杆菌科是新兴的全球感染威胁。但是，很少有数据描述它们在儿童中的临床重要性。
目的：这项回顾性研究回顾了英国一家大型三级转诊儿童医院的临床和监测样本中产生的对碳青霉烯类耐药的肠杆菌科细菌的流行和耐药机制。
方法：2011年9月至2012年8月间，在利物浦的Alder Hey儿童NHS基金会信托基金提交的用于诊断和监测目的的标本中寻找对碳青霉烯类耐药的肠杆菌科。使用表型和/或分子方法确定了耐药机制。可变数目的串联重复序列分析用于产生碳青霉烯酶的菌株的类型。
结果：在为期12个月的研究期间，从24例患者中恢复了对碳青霉烯类耐药的肠杆菌科。从临床诊断标本中分离出5株，而421例患者中有19例直肠监测拭子阳性（4.5％）。在这24个分离株中，有7个（所有克雷伯菌属）都带有碳青霉烯酶：3个具有blaKPC和4个blaNDM，而17个由于AmpC或广谱β-内酰胺酶活性加不可渗透性的结合而具有耐药性。
结论：对碳青霉烯类耐药的肠杆菌科，尤其是那些具有碳青霉烯酶的肠杆菌科，是英国一家大型儿科医院中正在出现的感染问题。需要主动监视以监视和控制其传播。

BACKGROUND & AIMS: :This study aimed to evaluate the prevalence and genetic characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in hospital sewage and river water in the Philippines, which has a typical tropical maritime climate. We collected 83 water samples from 7 hospital sewage and 10 river water sites. CPE were identified using CHROMagar mSuperCARBA, and Gram-negative strains were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) or 16S rRNA gene sequencing. Resistance genes in Enterobacteriaceae strains were identified using PCR and DNA sequencing, and transferability of carbapenemase genes from the CPE was investigated with conjugation experiments. Genotyping was performed using multilocus sequence typing (MLST) for Escherichia coli and Klebsiella pneumoniae Out of 124 Enterobacteriaceae isolates, we identified 51 strains as CPE and divided these into 7 species, 11 E. coli, 14 Klebsiella spp., 15 Enterobacter spp., and 11 others, including 4 additional species. Conjugation experiments via broth mating and using E. coli J53 revealed that 24 isolates can transfer carbapenemase-encoding plasmids. MLST analysis showed that 6 of 11 E. coli isolates belonged to clonal complex 10 (CC10). Of 11 K. pneumoniae strains, 9 unique sequence types (STs) were identified, including ST147. Five types of carbapenemase genes were identified, with the most prevalent being NDM (n = 39), which is epidemic in clinical settings in the Philippines. E. coli CC10 and K. pneumoniae ST147, which are often detected in clinical settings, were the dominant strains. In summary, our results indicate that hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.IMPORTANCE Carbapenemase-producing Enterobacteriaceae (CPE) cause severe health care-associated infections, and their increasing prevalence is a serious concern. Recently, natural ecosystems have been recognized as important reservoirs of antibiotic resistance genes. We investigated the prevalence and genetic characteristics of CPE isolated from the environment (hospital sewage and river water) in the Philippines and found several CPE, including Escherichia coli and other species, with different carbapenemases. The most prevalent carbapenemase gene type was NDM, which is endemic in clinical settings. This study revealed that isolates belonging to carbapenemase-producing E. coli CC10 and K. pneumoniae sequence type 147 (ST147), which are often detected in clinical settings, were dominant in the natural environment. Our work here provides a report on the presence and characteristics of CPE in the environment in the Philippines and demonstrates that both hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.

背景与目标： ：这项研究旨在评估菲律宾的医院污水和河水中产生碳青霉烯酶的肠杆菌科（CPE）的流行情况和遗传特征，菲律宾是典型的热带海洋性气候。我们从7个医院污水和10个河水站点收集了83个水样。使用CHROMagar mSuperCARBA鉴定CPE，并使用基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）或16S rRNA基因测序鉴定革兰氏阴性菌株。利用PCR和DNA测序鉴定肠杆菌科细菌的抗性基因，并通过缀合实验研究了来自CPE的碳青霉烯酶基因的可转移性。使用多基因座序列分型（MLST）对大肠杆菌和肺炎克雷伯菌进行基因分型，从124株肠杆菌科细菌中分离出51株CPE，并将其分为7种，分别为11种大肠杆菌，14种克雷伯菌，15种肠杆菌，其他11种，包括另外4种。通过肉汤交配和使用大肠杆菌J53进行的缀合实验表明，有24种分离株可以转移编码碳青霉烯酶的质粒。 MLST分析显示11株大肠杆菌中有6株属于克隆复合物10（CC10）。在11株肺炎克雷伯菌中，鉴定出9种独特的序列类型（ST），包括ST147。鉴定出五种碳青霉烯酶基因，其中最流行的是NDM（n = 39），这在菲律宾的临床环境中很流行。在临床环境中经常检测到的大肠杆菌CC10和肺炎克雷伯菌ST147是主要菌株。总而言之，我们的结果表明，医院污水和河水被属于临床上重要的克隆群体的CPE菌株污染。近来，自然生态系统已被认为是抗生素抗性基因的重要储存库。我们调查了菲律宾从环境（医院污水和河水）中分离出的CPE的流行情况和遗传特征，发现了几种CPE，包括大肠杆菌和其他物种，具有不同的碳青霉烯酶。最流行的碳青霉烯酶基因类型是NDM，在临床环境中很流行。这项研究表明，在临床环境中经常发现属于产碳青霉烯酶的大肠杆菌CC10和肺炎克雷伯氏菌序列类型147（ST147）的分离株。我们在这里的工作提供了有关菲律宾环境中CPE的存在和特征的报告，并证明了医院污水和河水均被临床上重要的克隆组的CPE菌株污染。

BACKGROUND & AIMS: OBJECTIVE:To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) carriage and acquisition among hospitalized patients in an area of CRE endemicity. DESIGN:Cohort study with a nested case-control study. SETTING:Two acute care, academic hospitals in New York City. PARTICIPANTS:All patients admitted to 7 study units, including intensive care, medical-surgical, and acute rehabilitation units. METHOD:Perianal samples were collected from patients at admission and weekly thereafter to detect asymptomatic gastrointestinal carriage of CRE. A nested case-control study was performed to identify factors associated with CRE acquisition. Case patients were those who acquired CRE during a single hospitalization. Control subjects had no microbiologic evidence of CRE and at least 1 negative surveillance sample. Clinical data were abstracted from the medical record. RESULTS:The prevalence of CRE in the study population was 5.4% (306 of 5,676 patients), and 104 patients met the case definition of acquisition during a single hospital stay. Mechanical ventilation (odds ratio [OR], 11.5), pulmonary disease (OR, 5.2), days of antibiotic therapy (OR, 1.04), and CRE colonization pressure (OR, 1.15) were independently associated with CRE acquisition. Pulsed-field gel electrophoresis analysis identified 87% of tested Klebsiella pneumoniae isolates as sharing related patterns (greater than 78% similarity), which suggests clonal transmission within and between the study hospitals. CONCLUSIONS:Critical illness and underlying medical conditions, CRE colonization pressure, and antimicrobial exposure are important risk factors for CRE acquisition. Adherence to infection control practices and antimicrobial stewardship appear to be critical components of a CRE control program.

背景与目标： 目的：描述在CRE流行地区住院的患者中对碳青霉烯类耐药的肠杆菌科（CRE）携带和获取的流行病学。
设计：队列研究与嵌套病例对照研究。
地点：纽约市的两家急诊学术医院。
参与者：所有患者均被纳入7个研究单位，包括重症监护室，内科手术室和急性康复室。
方法：入院时及其后每周收集患者的肛周样本，以检测CRE的无症状胃肠道运输。进行了巢式病例对照研究，以确定与CRE采集相关的因素。病例患者是指单次住院期间获得CRE的患者。对照组没有CRE的微生物学证据，并且至少有1例阴性监测样本。从病历中提取临床数据。
结果：在研究人群中，CRE的患病率为5.4％（5,676例患者中的306例），有104例患者在单次住院期间达到了获得性病例定义。机械通气（比值[OR]为11.5），肺部疾病（OR为5.2），抗生素治疗的天数（OR为1.04）和CRE定植压力（OR为1.15）与CRE的获得独立相关。脉冲场凝胶电泳分析确定了87％的肺炎克雷伯菌分离株具有共享的相关模式（相似性大于78％），这表明研究医院内部和医院之间存在克隆传播。
结论：重症疾病和潜在的医疗条件，CRE菌落压力和抗菌素暴露是获得CRE的重要危险因素。坚持感染控制措施和抗菌管理似乎是CRE控制计划的关键组成部分。

BACKGROUND & AIMS: BACKGROUND:Antibiotic prophylaxis that covers enteric pathogens is essential in preventing surgical site infections (SSIs) after colorectal surgery. Current prophylaxis regimens do not cover extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We aimed to determine whether the risk of SSI following colorectal surgery is higher in ESBL-PE carriers than in noncarriers. METHODS:We conducted a prospective cohort study of patients who underwent elective colorectal surgery in 3 hospitals in Israel, Switzerland, and Serbia between 2012 and 2017. We included patients who were aged ≥18 years, were screened for ESBL-PE carriage before surgery, received routine prophylaxis with a cephalosporin plus metronidazole, and did not have an infection at the time of surgery. The exposed group was composed of ESBL-PE-positive patients. The unexposed group was a random sample of ESBL-PE-negative patients. We collected data on patient and surgery characteristics and SSI outcomes. We fit logistic mixed effects models with study site as a random effect. RESULTS:A total of 3600 patients were screened for ESBL-PE; 13.8% were carriers SSIs occurred in 55/220 carriers (24.8%) and 49/440 noncarriers (11.1%, P < .001). In multivariable analysis, ESBL-PE carriage more than doubled the risk of SSI (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.50-3.71). Carriers had higher risk of deep SSI (OR, 2.25; 95% CI, 1.27-3.99). SSI caused by ESBL-PE occurred in 7.2% of carriers and 1.6% of noncarriers (OR, 4.23; 95% CI, 1.70-10.56). CONCLUSIONS:ESBL-PE carriers who receive cephalosporin-based prophylaxis are at increased risk of SSI following colorectal surgery.

背景与目标： 背景：涵盖肠道病原体的抗生素预防对于预防结直肠手术后的手术部位感染（SSI）至关重要。当前的预防方案并不涵盖产生广谱β-内酰胺酶的肠杆菌科（ESBL-PE）。我们旨在确定结直肠外科手术后SBL的风险是否在ESBL-PE携带者中比在非携带者中更高。
方法：我们对2012年至2017年之间在以色列，瑞士和塞尔维亚的3所医院接受了选择性结直肠手术的患者进行了一项前瞻性队列研究。我们纳入了年龄≥18岁的患者，这些患者在手术前接受了ESBL-PE支架筛查，接受了头孢菌素加甲硝唑的常规预防，并且在手术时没有感染。暴露组由ESBL-PE阳性患者组成。未暴露组是ESBL-PE阴性患者的随机样本。我们收集了有关患者和手术特征以及SSI结果的数据。我们将逻辑混合效应模型与研究地点拟合为随机效应。
结果：共筛查了3600名ESBL-PE患者。运营商SSI中有13.8％发生在55/220运营商中（24.8％）和49/440非运营商中（11.1％，P <.001）。在多变量分析中，ESBL-PE携带SSI的风险增加了一倍以上（几率[OR]为2.36； 95％置信区间[CI]为1.50-3.71）。承运商具有较高的深SSI风险（OR为2.25； 95％CI为1.27-3.99）。由ESBL-PE引起的SSI发生在7.2％的运营商和1.6％的非运营商中（OR为4.23； 95％CI为1.70-10.56）。
结论：接受基于头孢菌素的预防的ESBL-PE携带者在结直肠手术后罹患SSI的风险增加。

BACKGROUND & AIMS: :The in vitro antibacterial activity of two agents relatively resistant to beta-lactamases, BL-S786 and cefoxitin, was tested against 123 recent different clinical isolates of cephalothin-resistant Enterobacteriaceae. BL-S786 showed considerable activity against Escherichia coli and lesser activity against Klebsiella pneumoniae with, respectively, 68% and 41% inhibited at 32 microng/ml. Cefoxitin showed more activity in vitro against E. coli, K. pneumoniae, Serratia marcescens and Providencia stuartii. Cefoxitin appears to be a more promising agent for treating infections caused by cephalothin-resistant Enterobacteriaceae.

背景与目标： ：对β-内酰胺酶（BL-S786和头孢西丁）具有相对抗性的两种药物的体外抗菌活性已针对头孢菌素抗性肠杆菌科的123种近期不同临床分离株进行了测试。 BL-S786对大肠杆菌表现出相当大的活​​性，对肺炎克雷伯菌的活性较小，分别以32 microng / ml抑制了68％和41％。头孢西丁在体外显示出对大肠杆菌，肺炎克雷伯菌，粘质沙雷氏菌和斯氏普罗维登斯氏菌的更多活性。头孢西丁似乎是治疗由头孢菌素耐药性肠杆菌科细菌引起的感染的更有前途的药物。

BACKGROUND & AIMS: BACKGROUND:The prevalence of bacterial bloodstream infections (BSIs) in sub-Saharan Africa (sSA) is high and antimicrobial resistance is likely to increase mortality from these infections. Third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae are of particular concern, given the widespread reliance on ceftriaxone for management of sepsis in Africa. OBJECTIVES:Reviewing studies from sSA, we aimed to describe the prevalence of 3GC resistance in Escherichia coli, Klebsiella and Salmonella BSIs and the in-hospital mortality from 3GC-R BSIs. METHODS:We systematically reviewed studies reporting 3GC susceptibility testing of E. coli, Klebsiella and Salmonella BSI. We searched PubMed and Scopus from January 1990 to September 2019 for primary data reporting 3GC susceptibility testing of Enterobacteriaceae associated with BSI in sSA and studies reporting mortality from 3GC-R BSI. 3GC-R was defined as phenotypic resistance to ceftriaxone, cefotaxime or ceftazidime. Outcomes were reported as median prevalence of 3GC resistance for each pathogen. RESULTS:We identified 40 articles, including 7 reporting mortality. Median prevalence of 3GC resistance in E. coli was 18.4% (IQR 10.5 to 35.2) from 20 studies and in Klebsiella spp. was 54.4% (IQR 24.3 to 81.2) from 28 studies. Amongst non-typhoidal salmonellae, 3GC resistance was 1.9% (IQR 0 to 6.1) from 12 studies. A pooled mortality estimate was prohibited by heterogeneity. CONCLUSIONS:Levels of 3GC resistance amongst bloodstream Enterobacteriaceae in sSA are high, yet the mortality burden is unknown. The lack of clinical outcome data from drug-resistant infections in Africa represents a major knowledge gap and future work must link laboratory surveillance to clinical data.

背景与目标： 背景：撒哈拉以南非洲地区（sSA）的细菌血流感染（BSI）患病率很高，抗菌素耐药性可能会增加这些感染的死亡率。鉴于非洲广泛地依赖头孢曲松治疗败血症，第三代头孢菌素耐药性（3GC-R）肠杆菌科特别引起关注。
目的：回顾sSA的研究，我们旨在描述3GC-R BSI在大肠杆菌，克雷伯菌和沙门氏菌BSI中的3GC耐药率和住院死亡率。
方法：我们系统地审查了报告对大肠杆菌，克雷伯菌和沙门氏菌BSI进行3GC敏感性测试的研究。我们从1990年1月至2019年9月在PubMed和Scopus上搜索了报告sSA中与BSI相关的肠杆菌科细菌3GC敏感性的主要数据，并研究了报告3GC-R BSI死亡率的研究。 3GC-R被定义为对头孢曲松，头孢噻肟或头孢他啶的表型抗性。结果报告为每种病原体对3GC耐药的中位患病率。
结果：我们鉴定了40篇文章，其中7篇报告了死亡率。根据20项研究和克雷伯菌属（Klebsiella spp）的研究，大肠杆菌中3GC抵抗的中位患病率为18.4％（IQR 10.5至35.2）。 28项研究的结果为54.4％（IQR 24.3至81.2）。在非伤寒沙门氏菌中，来自12项研究的3GC耐药率为1.9％（IQR 0至6.1）。异质性禁止汇总死亡率估计。
结论：sSA患者血液中肠杆菌科细菌对3GC的抵抗力较高，但死亡率负担尚不明确。非洲缺乏耐药性感染的临床结果数据，这是一个主要的知识鸿沟，未来的工作必须将实验室监测与临床数据联系起来。