Search

Background Recently, the spread of multidrug‐resistant bacteria has become a global problem. Extended‐spectrum beta‐lactamase (ESBL)‐producing Enterobacteriaceae (enterobacteria) is one example. The incidence of urinary tract infections caused by ESBL‐producing enterobacteria has been increasing in some Japanese community settings. Currently, there is insufficient evidence on the effectiveness of oral antibiotics used for the treatment of pyelonephritis caused by ESBL‐producing enterobacteria. We investigated the effectiveness of oral antibacterial agents against pyelonephritis caused by ESBL‐producing Enterobacteriaceae. Methods The records of patients who had been treated for pyelonephritis caused by ESBL‐producing enterobacteria with oral antibiotics between April 1, 2014, and March 31, 2019, were reviewed retrospectively to assess the effectiveness of oral antibiotic treatment. Results A total of seven cases were identified, including 1 patient with a positive blood culture and one patient with a Pitt bacteremia score of four points, indicating that the infections were severe. The antibiotics used to treat pyelonephritis were amoxicillin‐clavulanic acid (n = 3), minocycline (n = 1), levofloxacin (n = 3), and sulfamethoxazole‐trimethoprim with amoxicillin‐clavulanic acid (n = 1). None of the patients had recurrence of pyelonephritis in the 60 days following oral antibiotic treatment, and there were no deaths during the 60‐day follow‐up period. Conclusions These antibiotics should be considered for oral treatment of pyelonephritis caused by ESBL‐producing enterobacteria. However, as there is insufficient evidence available on the effectiveness of these antibiotics for the management of ESBL‐producing enterobacterial infections, further large‐scale prospective studies are needed.

The purpose of this study is to assess risk factors for the acquisition of extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) colonization and infection (AI) in ICUs with low ESBL-GNB prevalence rate. We conducted a retrospective observational study in three ICUs in Bretagne, France. All patients admitted from January 2016 to September 2017 with a length of stay of 2 days or more were included. Universal screening for ESBL-GNB colonization was performed in all participating ICUs. Of the 3250 included patients, 131 (4.0%) were colonized at admission, 59 acquired colonization while hospitalized (1.9%; 95% CI [1.5–2.5%]), and 15 (0.5%; 95% CI [0.3–0.8%]) acquired ESBL-GNB infections. In the case of infection, the specificity and the negative predictive values of preexistent colonization for the ESBL-GNB etiology were 93.2% [91.5–95.1%] and 95.2% [93.5–97.1%], respectively. Colonization was the main risk factor for ESBL-GNB AI (OR = 9.61; 95% CI [2.86–32.29]; p

Background. There is little information about the efficacy of active alternative drugs to carbapenems except beta-lactam/beta-lactamase inhibitors for the treatment of bloodstream infections (BSIs) due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). The objective of this study was to assess the outcomes of patients with BSI due to ESBL-E who received empiric therapy with such drugs (other active drugs [OADs]) or carbapenems. Methods. A multinational retrospective cohort study of patients with BSI due to ESBL-E who received empiric treatment with OADs or carbapenems was performed. Cox regression including a propensity score for receiving OADs was performed to analyze 30-day all-cause mortality as main outcome. Clinical failure and length of stay were also analyzed. Results. Overall, 335 patients were included; 249 received empiric carbapenems and 86 OADs. The most frequent OADs were aminoglycosides (43 patients) and fluoroquinolones (20 patients). Empiric therapy with OADs was not associated with mortality (hazard ratio [HR], 0.75; 95% confidence interval [CI],.38-1.48) in the Cox regression analysis. Propensity score-matched pairs, subgroups, and sensitivity analyses did not show different trends; specifically, the adjusted HR for aminoglycosides was 1.05 (95% CI,.51-2.16). OADs were neither associated with 14-day clinical failure (adjusted odds ratio, 0.62; 95% CI,.29-1.36) nor length of hospital stay. Conclusions. We were unable to show that empiric treatment with OAD was associated with a worse outcome compared with carbapenems. This information allows more options to be considered for empiric therapy, at least for some patients, depending on local susceptibility patterns of ESBL-E.

This study determined the presence of important antibiotic-resistant bacteria in selected environments in Thailand, including wastewater samples from 60 hospitals, washed fluid, leachate, flies, cockroaches, and rats collected from five open markets, washed fluid from garbage trucks, and stabilized leachate from a landfill facility. At least one type of antibiotic-resistant bacteria was isolated from all samples of influent fluid before treatment in hospitals, from wastewater treatment tank content in hospitals, and from 15% of effluent fluid samples after treatment with chlorine prior to draining it into a public water source. Antibiotic-resistant bacteria were recovered from 80% of washed market fluid samples, 60% of market leachate samples, all fly samples, 80% of cockroach samples, and all samples of intestinal content of rats collected from the open markets. Antibiotic-resistant bacteria were recovered from all samples from the landfill. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and/or Klebsiella pneumoniae were the most common antibiotic-resistant bacteria recovered from all types of samples, followed by carbapenem-resistant E. coli and/or K. pneumoniae. Colistin-resistant Enterobacteriaceae, carbapenem-resistant Psuedomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, colistin-resistant Enterobacteriaceae, vancomycin-resistant Enterococci, and methicillin-resistant S. aureus were less common. These findings suggest extensive contamination by antibiotic-resistant bacteria in hospital and community environment in Thailand.

Antimicrobial drug treatment of travelers' diarrhea is known to increase the risk for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae. Among 288 travelers with travelers' diarrhea, the colonization rate without medications was 21%. For treatment with loperamide only, the rate was 20%; with antimicrobial drugs alone, 40%; and with loperamide and antimicrobial drugs, 71%.