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Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

ABSTRACT: The aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case-control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of odd-ratio exceeding one (Pr) >85% or <15%. Thirteen cases and 52 controls were recruited. The description of this outbreak highlighted the importance to quickly detect patients at risk of GRE carriage in order to implement the isolation measures and to transfer to dedicated department if they are effectively carriers. Following multivariate analysis, antibiotics during hospitalisation (Pr = 0.968), number of hospitalisation days in the year (Pr = 0.964), antacids intake (Pr = 0.878) (with a risk increase), immunosuppression (Pr = 0.026) and isolation measures (Pr = 0.003) (both with protective effect) were associated with GRE acquisition. The use of Bayesian statistics was useful because of our study's small population size and prior information availability.

SUBMITTER: Deboscker S

PROVIDER: S-EPMC6518758 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

Deboscker S S Schneider P P Séverac F F Ménard C C Gaudart J J Lavigne T T Meyer N N

Epidemiology and infection 20190101

The aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case-control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of ...[more]

PMID: 31063114

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Project description:IntroductionAntimicrobial resistance (AMR) is a global health concern, occurring when bacteria evolve to render antimicrobials no longer effective. Antimicrobials have important roles in beef production; however, the potential to introduce AMR to people through beef products is a concern. This scoping review identifies factors associated with changes in the prevalence of antimicrobial-resistant Enterococcus spp. applicable to the Canadian farm-to-fork beef continuum.MethodsFive databases (MEDLINE, BIOSIS, Web of Science, Embase, and CAB Abstracts) were searched for articles published from January 1984 to March 2022, using a priori inclusion criteria. Peer-reviewed articles were included if they met all the following criteria: written in English, applicable to the Canadian beef production context, primary research, in vivo research, describing an intervention or exposure, and specific to Enterococcus spp.ResultsOut of 804 screened articles, 26 were selected for inclusion. The included articles discussed 37 factors potentially associated with AMR in enterococci, with multiple articles discussing at least two of the same factors. Factors discussed included antimicrobial administration (n = 16), raised without antimicrobials (n = 6), metal supplementation (n = 4), probiotics supplementation (n = 3), pen environment (n = 2), essential oil supplementation (n = 1), grass feeding (n = 1), therapeutic versus subtherapeutic antimicrobial use (n = 1), feeding wet distiller grains with solubles (n = 1), nutritional supplementation (n = 1) and processing plant type (n = 1). Results were included irrespective of their quality of evidence.DiscussionComparability issues arising throughout the review process were related to data aggregation, hierarchical structures, study design, and inconsistent data reporting. Findings from articles were often temporally specific in that resistance was associated with AMR outcomes at sampling times closer to exposure compared to studies that sampled at longer intervals after exposure. Resistance was often nuanced to unique gene and phenotypic resistance patterns that varied with species of enterococci. Intrinsic resistance and interpretation of minimum inhibitory concentration varied greatly among enterococcal species, highlighting the importance of caution when comparing articles and generalizing findings.Systematic review registration[http://hdl.handle.net/1880/113592].

Project description:Although existence of a probable association between glycopeptide and biocide resistance among enterococci has often been hypothesized, all studies conducted so far on this subject have been inconclusive.The aim of this study was to explore the possibility of the existence of an association between glycopeptide resistance and reduced susceptibility to biocides among Enterococcus spp.This was a pilot study conducted in a super-speciality hospital situated in New Delhi, India, between June and November, 2015.Fourteen isolates of Enterococcus spp. obtained from various clinical samples of inpatients were subjected to susceptibility testing by modified Kirby-Bauer disk diffusion method to the following antibiotics: ampicillin (30 μg), gentamicin (120 μg), linezolid (30 μg), teicoplanin (30 μg), and vancomycin (30 μg). Based on the preliminary glycopeptide susceptibility results, all the isolates were classified into glycopeptide-sensitive and glycopeptide-resistant groups, respectively. Isolates belonging to both of these groups were subjected to tube dilution method for determining minimum inhibitory concentration of three biocides, namely, sodium hypochlorite, povidone-iodine, and absolute ethanol, respectively. Minimum bactericidal concentration of these disinfectants was also determined as per standard guidelines.Not applicable.More number of glycopeptide-sensitive strains exhibited reduced susceptibility to sodium hypochlorite than glycopeptide-resistant strains of enterococci. However, more number of glycopeptide-resistant isolates exhibited lower susceptibility to povidone-iodine than glycopeptide-sensitive isolates of enterococci. Both glycopeptide-sensitive and glycopeptide-resistant enterococci were equally susceptible to absolute ethanol.It seems that biocide resistance is an important issue and may have links with antibiotic resistance. This study points towards a possible association between glycopeptide resistance and reduced susceptibility to povidone iodine among enterococci. More studies should be conducted in order to further explore this supposedly enigmatic issue.

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Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

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Factors associated with acquisition of glycopeptide-resistant enterococci during a single-strain outbreak.

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